J Autism Dev Disord (2011) 41:879–890
DOI 10.1007/s10803-010-1112-x
ORIGINAL PAPER
Stress and Personal Resource as Predictors of the Adjustment
of Parents to Autistic Children: A Multivariate Model
Ayelet Siman-Tov • Shlomo Kaniel
Published online: 25 September 2010
Ó Springer Science+Business Media, LLC 2010
Abstract The research validates a multivariate model that
predicts parental adjustment to coping successfully with an
autistic child. The model comprises four elements: parental
stress, parental resources, parental adjustment and the child’s
autism symptoms. 176 parents of children aged between 6 to
16 diagnosed with PDD answered several questionnaires
measuring parental stress, personal resources (sense of
coherence, locus of control, social support) adjustment
(mental health and marriage quality) and the child’s autism
symptoms. Path analysis showed that sense of coherence,
internal locus of control, social support and quality of mar-
riage increase the ability to cope with the stress of parenting
an autistic child. Directions for further research are suggested.
Keywords Stress
Adjustment
Resources
Autism

Parents
Coherence
Theoretical Background
Parenting a child with a developmental disability such as
autism is a complex situation of chronic stress for the
parents (for review see Shapiro and Accardo 2008). Such
The research reported here served as part of the first author’s
dissertation, supervised by the second author, submitted to the School
of Education Bar Ilan University Israel, in partial fulfillment of
requirements for the Ph.D.
A. Siman-Tov (&)
Department of Special Education, Kibbutzim College
of Education Technology and the Arts, Tel Aviv, Israel
e-mail: yosicpa@netvision.net.il
S. Kaniel
School of Education, Bar Ilan University, Ramat Gan, Israel
e-mail: kaniels@mail.biu.ac.il
long-term care not only impacts on parents’ various life
domains (e.g. marriage, career) and leads to caregiver
stress, but also affects service utilization and treatment
effectiveness for the children and their family as a whole,
which amount to significant societal costs. Thus, from both
the individual and societal perspectives, identifying and
understanding factors related to parenting stress are
important to the treatment of the child, the well-being of
the caregivers and the entire family, and the interests of the
community (Mak et al. 2007; Saloviita et al. 2003).
The suggested multivariate model relies on several
theories such as: the double ABCX model of family stress
(Pakenham et al. 2005; Saloviita et al. 2003), the appraisal
theory (Lazarus 2001) and resource-based theories (Anto-
novsky 1993; Vancouver et al. 2008). It is assumed that
these variables have a high probability of predicting
parental adjustment for successful coping with the autistic
child. The suggested model comprises four elements:
parental stress, parental resources, parental adjustment and
the child’s autism symptoms.
Parental Stress
Stressors refer to threats, demands, or structural constraints
which, when present, may call into question the operating
integrity of the organism (Wheaton 1997). There is little
question that raising a child with a developmental disability
constitutes a significant stressor for families. Parents of
children with autism reported higher levels of stress than
parents of children with Down’s syndrome, developmental
disabilities, or other psychiatric difficulties (Eisenhower
et al. 2005; Fisman et al. 2000; Hastings et al. 2005;
Oelofsen and Richardson 2006; Pisula 2007).
The parents’ perception of the stressors are the key
element for understanding the notion that the greater the
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severity of the disability, the more distress reported by
parents (Perry et al. 2005). Such perceptions are deter-
mined mainly by stressor appraisals (Folkman 1997).
Appraisal has been described as the cognitive interpretation
one has regarding a potential stressor. The degree of stress
and subsequent adjustment depend on the individual’s
appraisals of both the stressor and his or her coping ability
and support resources, and the types of coping strategies he
or she uses to manage the event. When the nature of the
stressor and its implications are clear, it is easier to cope
than when the situation is ambiguous. Autism is of unclear
etiology and children with autism often do not ‘‘look’’
disabled. Parents frequently report getting the ‘‘runaround’’
from friends, family and professionals who say their chil-
dren will grow out of it or imply that poor parenting is an
issue. Ambiguity may also lead to disagreements between
parents as to the nature and cause of the child’s problem,
which may reinforce parental feelings of uncertainty and
increase stress (Bristol et al. 1988).
Resources
Resources are those skills, objects, personal characteristics,
conditions, or energies that help people cope with stressors
(Hobfoll 2001). Resource-based theories of stress (Anto-
novsky 1993; Vancouver et al. 2008) complement apprai-
sal-based theories, because the latter are only one
component of the many resources. Among the wide range
of resources, we will focus on three that have been proven
as having the power to predict adjustment in parents and
children: sense of coherence, locus of control and social
support.
Sense of Coherence (SOC)
Sense of coherence (SOC) may be construed as a mecha-
nism that helps individuals select the best available
resources to cope with various stressors in their lives
(Antonovsky 1993). SOC is conceptualized as a global
orientation that expresses the extent to which one feels
confident that (a) the stimuli deriving from one’s internal
and external environments in the course of living are
structured, predictable, and explicable–comprehensibility;
(b) resources are available to meet the demands posed by
these stimuli–manageability; and (c) these demands are
challenges worthy of investment and engagement–mean-
ingfulness (Antonovsky 1993).
Even though there are three elements, SOC should be
regarded as a unitary construct that has been linked to
greater stress-resistance and better health. Conscious of
difficulties or frustrations, a person with a strong SOC does
not ignore them and is more confident that basic difficulties
can be resolved or dealt with. Unlike focusing on specific
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coping strategies and the appraisal process vis-à-vis a
particular stressor, a sense of coherence underscores a
global orientation in the perception of life events that
individuals may bring to different situations. It may act as a
general resilience to stress as well as a precursor in setting
other cognitive processes in motion that are specific to the
situation at hand (i.e. taking care of a child with autism).
Numerous studies have found SOC to be a potent stress
resource across various settings and populations. People
with a strong SOC were more likely to perceive their lives
as less stressful, to report fewer stressful events and to rate
life events as less stressful. SOC was also found to be
inversely correlated to depression, anxiety and physical
symptoms, psychological health and well-being (Chumbler
et al. 2004; Lindstrom and Eriksson 2005; Mak et al. 2007;
Sagy and Antonovsky 2000) and positively correlated with
academic competence and perceived wellbeing (Amirkhan
and Greaves 2003; Johnson 2004). Although ample
empirical support has been found on the positive effects of
SOC on physical and mental health, very little research has
been conducted on using SOC to understand the experience
of caregivers of children with autism and other develop-
mental disabilities (Al-Yagon and Margalit 2009; Olsson
and Hawang 2002).
Locus of Control
One more resource is locus of control, which determines
how individuals explain the situations they experience
(Rotter 1975). There are two different dimensions in locus
of control: internality and externality. Internals explain life
events as a result of their own behavior and actions which
are under their control. As such, internals actively seek
information and knowledge concerning their situation, are
more likely to assume their efforts will be successful, and
more likely to take initiative and responsibility.
Externals explain life events as under the control of
powerful others such as ‘fate’. Since they locate control
outside themselves, externals tend to feel they have less
control over their life, tend to be more stressed and more
prone to clinical depression (Konstantareas and Papageor-
giou 2006; Kormanik and Rocco 2009; Lefcourt 1991).
Parents with an internal locus of control and a belief that
they control their lives were characterized by family
cohesion, optimism and less stress. On the other hand,
parents of autistic children with an external locus of control
were characterized by less family cohesion pessimism and
depression (for review see Kormanik and Rocco 2009).
Social Support
Social support refers to the individual’s perception that he
or she can be helped or can attain the understanding,
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cooperation and assistance of close or significant persons.
This help can be instrumental (e.g., a parent’s need for a
ride) and/or social and emotional from a close person while
coping with stress. Social and community support also
emerges as a significant resource for families under stress
and as a protective factor that contributes to successful
adjustment of parents of children with developmental dis-
orders (Altiere and Kluge 2009; Armstrong et al. 2005;
Bromley et al. 2004; Dunst et al. 1997; Tehee et al. 2009;
White and Hastings 2004).
Parental Adjustment
Adjustment is characterized by a balance between the
demands of the stressors and the resources. Good adjust-
ment is characterized by a balance between the family
demands of the stressors and the ability to cope with these
demands. Poor adjustment is characterized by imbalance
between family demands of the stressors and the ability to
cope with them (Lavee and Olson 1991). Parental adjust-
ment involves two main variables: (a) mental health, (b)
quality of marriage. Although no definitive consensus has
emerged to distinguish the various types of adjustment or
coping activities, there is widespread acknowledgement of
the fact that the concept may refer to a variety of behaviors
designed to handle stressors. In this study we focus on two
important variables that emerged as high predictors: (a)
mental health, (b) quality of marriage.
Mental Health
The term ‘mental health’ has no single ‘‘official’’ defini-
tion, since it is used by many disciplines such as anthro-
pology, education, psychology, religion and sociology.
Cultural differences, subjective assessments, and compet-
ing professional theories all affect how mental health is
defined. The World Health Organization defines mental
health as ‘‘a state of wellbeing in which the individual
realizes his or her own abilities, can cope with the normal
stresses of life, can work productively and fruitfully, and is
able to make a contribution to his or her community’’. For
our purposes, we will characterize mental health by two
elements: (a) an absence of a major mental health condition
or psychological distress such as anxiety, depression and
loss of emotional or behavioral control, (b) psychological
wellbeing (Brown et al. 2003; Diener et al. 2008). Mental
health can be seen as a continuum along which an indi-
vidual’s mental health may have many different possible
values. Mental wellness is generally viewed as a positive
attribute, such that a person can reach enhanced levels of
mental health, even if they do not have any diagnosable
mental health condition. This definition of mental health
highlights emotional wellbeing, the capacity to live a full
881
and creative life, and the flexibility to deal with life’s
inevitable challenges.
Mothers of autistic children reported lower mental
health than mothers of children with other syndromes
(Abbeduto et al. 2004; Eisenhower et al. 2005). Other
researches found higher levels of depression and anxiety
among mothers of children with Asperger syndrome
(Pakenham et al. 2005) and PDD (Fisman et al. 2000).
Quality of Marriage
Quality of marriage relates to the spouses’ subjective
evaluation of the quality of their relationships in different
domains such as: communication, satisfaction, friendship,
assigning roles, recreation, sharing personal experiences
and mutual tolerance (Florian and Findler 2001; Lavee and
Olson 1991). Researches demonstrated how parenting an
autistic child can lower the quality of marriage and satis-
faction (e.g., Bristol et al. 1988; Risdal and Singer 2004;
Schulz et al. 2004; Stoneman and Gavidia-Payn 2006).
Coping with high levels of stress in domains external to the
relationship tends to tax parents’ cognitive resources,
leaving them fewer resources to effectively manage nega-
tive perceptions of their relationships (Baumeister 2002)
and navigate the ups and downs with their partners (Neff
and Karney 2009). Parents whose global satisfaction fluc-
tuates more severely report lower levels of commitment
and are more likely to be in relationships that ultimately
end in dissolution compared with those whose satisfaction
levels remain stable, even if those stable feelings are not
particularly positive. Spouses under stress often tend to
report more specific problems within the relationship such
as: withdrawal from their partners, reduced involvement at
home by engaging in fewer household tasks, showing less
affection to one another and spending less time together
(Neff and Karney 2009).
Child Autism Symptom Severity
According to DSM-IV (APA 2000) the diagnosis of an
autistic disorder is made on the basis of deficits in three
domains of criteria: (a) reciprocal social behavior; (b)
language development; and (c) repetitive/stereotypic
behaviors. A child’s autism symptoms will be demon-
strated in the level of the severity of autism based on the
above criteria. In a comprehensive study, Constantino et al.
(2004) found a singular underlying factor of major effect
across the three domains of criteria for autistic disorders.
Moreover, differences within the autistic syndrome are not
recognized by an item endorsement profile, but by the
degree of impairment that existed (mild, moderate or
severe) across all three DSM-IV criterion domains for
autistic disorders.
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The Main Hypothesis
The process of selecting research variables had two stages.
First, the integrative theory imposed the choice of the
broad variables: resources and adjustment to stress. Sec-
ond, within each broad variable we were free to choose the
variables defined as resources and stress variables. A
review of the literature on resources led us to choose the
variables of: sense of coherence, locus of control and social
support. The sense of coherence is a very common variable
in psychology literature. Coherence—a global worldview
on stress situations comprised of comprehensibility,
meaningfulness and manageability—is a very important
variable for interpreting stress situations. Locus of control
adds to the world view of coherence the personal percep-
tion in that it examines to what extent a person believes in
his or her ability to control every day life. Social support
expands on the variable of resources and adds the parents’
perspective of their immediate environment.
Selecting the variables of adjustment to stress: mental
health and the quality of marriage, are in accordance with
the family stress approach and the theories of stress relating
to the individual (Folkman and Lazarus 1985; Lazarus
1993; Lazarus and Folkman 1984; McCubbin and Patterson
1983; McCubbin and Thompson 1987). These approaches
stress the mental health of the individual and the quality of
the marriage as key variables for parental adjustment.
All of these briefly reviewed variables have never pre-
viously been put together in one multidimensional model.
Our main hypothesis is that the resources (sense of
coherence, locus of control and social support), will be
negatively correlated with parental stress. The more social
support parents have and the greater their sense of coher-
ence and internal locus of control, the less stress they will
report in parenting their autistic child. The intensity of the
stress will be also negatively correlated with parental
adjustment (mental health and quality of marriage).
Method
Participants
The participants were 176 fathers and mothers (88 married
couples) of children who had been diagnosed with PDD
(Pervasive Developmental Disorders) by clinical psychol-
ogists or medical doctors. The parents were 22–50 years of
age (mean = 35.39, SD = 6.22) and most of them had a
college education (70.7%). Based on their education and
income, the parents belong to the middle and upper class.
Most of the research subjects (79.3%) live in towns and
the rest (20.7%) live in non-urban settlements. The number
of children in the family ranges from 2 (46%) to three
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(43.7%). Some 3.4% have only one child and 6.9% have
four or more children. The economic status of most of the
research subjects is above average (66.7%), 28.7% reported
an average economic situation and a minority (4.6%)
declared their economic situation was low. About two-
thirds (67.4%) of the families are members of one of the
associations for children with developmental disabilities
and about one-third (32.6%) reported that they do not
belong to any such association.
The PDD participants were mostly male (86%) and aged
between 6 and 16 years (mean = 10.3, SD = 3.1).
All the children are the parents’ biological offspring.
Regarding the characteristics of the disability, this research
did not include children with Rett’s Disorder, Childhood
Disintegrative Disorder or Asperger’s Disorder. The most
common diagnosis among the children was PDD: most of
the children (81%) were diagnosed as suffering from PDD
and the rest (19%) as suffering from PDDNOS (Pervasive
Developmental Disorder Not Otherwise Specified). Most of
the children in the research are boys (86%). Over half of
the children in the research are first-born (56.3%).
Most of the children were treated with integrative ther-
apeutic approach (65.1%) and the rest (34.9%) with a spe-
cific therapeutic approach. Most of them (49.4%) had a
moderate level of functioning, about one-third (31%)
functioned at a low level and the rest (19.5%) at a high level.
One-third of the children in the sample need supervision for
most of the day, 30% need supervision for a reasonable
number of hours a day, 24% need supervision 24 h a day
and 12.6% only need a few hours of supervision a day.
Measurements
There is an arsenal of valid and reliable measurements for
the variables suggested in the model. For example, in a
review, Lefcourt (1991) described 18 different measures
designed to assess control beliefs among different groups
and for different goals and situations. Consequently, we
preferred those measurements that were translated and used
successfully in Hebrew and were reported in scientific lit-
erature with high satisfactory Cronbach alphas.
Level of Stress in Raising an Autistic Child
The Questionnaire of Resources and Stress (QRS-F) scale
was translated to Hebrew (Raif and Rimmerman 1993) and
adapted for the purposes of this research. The scale consists
of 51 statements describing the negative and positive
impact of the autistic child on the family (e.g., I worry what
might happen to my child in the future when I cannot take
care of him). The questionnaire used 5-point Likert-like
scales (ranging from 1 = strongly disagree to 5 = strongly
agree). The level of stress was determined from an average
J Autism Dev Disord (2011) 41:879–890
score of items. The version in the present study obtained
high internal consistency (Cronbach alpha = 0.94).
Antonovsky (1993) Sense of Coherence Scale (SOC):
The SOC scale consists of 29 items organized in three
categories: (a) Comprehensibility: ‘‘When you talk to
people, do you have the feeling that they don’t understand
you?’’; (b) Manageability: ‘‘When you have a difficult
problem, the choice of a solution is always confusing and
hard to find?’’; and (c) Meaningfulness: ‘‘Do you anticipate
that your personal life in the future will be totally without
meaning, or full of meaning and purpose?’’ The question-
naire used a 7-point Likert scale, from never (1) to always
(7). A higher score indicates a higher sense of coherence.
Criteria validity for the SOC was established by Anto-
novsky (1993) by presenting significant correlations
between the SOC and measures of stress, health and well-
being, attitudes and behavior. The version in the present
study for SOC obtained high internal consistency (Cron-
bach alpha = 0.90).
Locus of Control
The locus of control scale (Rotter 1975) consists of 14 items
on which individuals express their explanations about
events in their lives on a 5-point Likert scale, from never (1)
to always (5). Factor analysis showed that there are two
factors: internals (e.g. my child’s progress depends on my
efforts) and externals (e.g. No one can change the fate of
my child). The version in the present study for both internal
and external locus of control obtained high internal con-
sistency respectively (Cronbach alpha = 0.74 and = 0.80).
Social Support
Social support scale (Dunst et al. 1997) consists of 20 items
on which each parent registered the amount of support they
felt they had from family, friends and different institutions
(e.g., How much help did you receive from your friends?
From social workers?) The participants scored their
answers on 5-point Likert-type scales (ranging from
1 = strongly disagree to 5 = strongly agree). The version
for the family support scale in the present study obtained
high internal consistency (Cronbach alpha = 0.86).
Mental Health
The mental health scale (Veit and Ware 1983) consists of
38 items on which each parent scored a global feeling of
distress and physical health (Do you feel lonely?). The
participants registered their answers on 5-point Likert-type
scales (ranging from 1 = strongly disagree to 5 = strongly
883
agree). The version for the mental health scale in the
present study obtained high internal consistency (Cronbach
alpha = 0.96).
Quality of Marriage
The quality of marriage scale (Olson et al. 1987) consists
of 95 items on which each parent registered the quality of
the marriage in 9 dimensions: (a) personality traits, (b)
communication between the couple, (c) conflict resolution,
(d) financial management, (e) spending leisure time, (f)
sexual contact and affection, (g) parenting and child care,
(h) relationships with extended family members and (i) role
equality. The participants scored their answers on 5-point
Likert-type scales (ranging from 1 = strongly disagree to
5 = strongly agree). The version for the quality of mar-
riage scale in the present study obtained high internal
consistency (Cronbach alpha = 0.92).
Child Autism Symptom Severity
Each child’s autism symptoms were assessed by the parents
and by caregivers who have accompanied the child for at
least 2 years. Caregivers included preschool teachers,
special education teachers, paramedical professionals,
clinical communications therapists, occupational therapists
and educational psychologists.
Each parent and caregiver reported the child autism
symptoms on the ABC scale (Autism Behavior Checklist)
developed by Krug and Arick (2003). The scale consists of
57 items on 5 dimensions: (a) using senses, (b) social
connections, (c) using objects and body, (d) language, (e)
help seeking. The Cronbach alpha for the autism behavior
checklist scale is 0.95.
In the questionnaire, the measurement scale was expan-
ded from ‘‘correct’’–‘‘incorrect’’ (a dichotomous scale) into a
5-point scale where 1 denotes ‘‘not at all correct’’ and 5
denotes ‘‘correct to a very great extent’’. From the ques-
tionnaire, one measure was generated according to the
average of the subject’s assessments for the 57 items. The
higher the score, the higher the severity of the symptoms.
Demographics
The following demographic data were elicited from the
parents: Residence, age, education, family income and
their children’s age, gender, school, diagnosis of autism
and treatment history.
Procedures
Parents were approached through parents’ associations or
community treatment centers. In the first stage, several
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formal permissions were received to ensure that there were
no ethical problems. The parents were informed of the
nature and purpose of the study and were invited to par-
ticipate. In the second stage, a pilot study with 10 parents
was conducted. All the measurements were tested and
changes were made accordingly. In the final stage, all the
participants received the questionnaires in random order
and answered them at home.
Results
An analysis of the results was based on each parent sepa-
rately since the integrative theory underpinning this
research (resources and stress) is based on the subjective
perception of the individual regarding his or her resources
and stress. (Folkman and Lazarus 1985; Lazarus 1993,
2001; Lazarus and Folkman 1984;). Consequently, each
parent completed a self-reporting questionnaire that mea-
sures his or her resources or perceptions of stress and
personal coping with caring for the child. Accordingly, we
performed separate SEM path analyses for mothers and
fathers for simultaneous estimation of the relationships
among the variables. Although the number of subjects was
relatively small (88 subjects), it still complies with the
rules of the SEM test (Tabachnick and Fidell 2007). The
results of the analysis for fathers and mothers separately
were lower than the results of the model in which the
parents were entered as individuals. As such we will
present the path model and path coefficients for the vari-
ables when parents are analyzed as individuals.
The path analysis was performed using the structural
equation modeling program within the AMOS 5 procedure
(Arbuckle 2003). For simplicity and ease of explanation,
Social
support
-.24***
.24***
Sense of
coherence
Internal -.37***
locus of
control
-.19**
.25***
External
locus of
control
Fig. 1 Path model and path coefficients for fathers and mothers
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J Autism Dev Disord (2011) 41:879–890
the results reported here include only the path analysis and
not all the coefficients matrix and regression that support
such analysis. Path coefficients were calculated on the basis
of within-report Pearson rs converted to r.s. The fit of this
model was good, NFI = .99, CFI = .99, RMCEA = .01,
X2 = 4.23, p = .52.
Figure 1 shows that the path coefficients of the resources
(the exogenous variable) of social support (b = -0.24;
p \ .001) and internal locus of control (b = -0.37; p \
.001) and external locus of control (b = 0.25; p \ .001)) to
stress are high and significant. However, sense of coherence
is not correlated with stress but with both variables of
parental adjustment, mental health (b = 0.21; p \ .001) and
marriage quality (b = 0.24; p \ .001). Parental mental
health has no path coefficient to child symptom severity but
quality of marriage has a negative path coefficient to child
symptom severity (b = -0.23; p \ .001). The intensity of
parental stress is positively correlated with child symptom
severity (b = 0.49; p \ .001).
Internal locus of control is negatively correlated to
quality of marriage (b = -0.21; p \ .001) and to mental
health (b = -0.19; p \ .01). Parental stress is negatively
correlated to quality of marriage (b = -0.35; p \ .001)
and to mental health (b = -0.53; p \ .001).
Separate path analysis for fathers (Fig. 2) and mothers
(Fig. 3) were calculated. The fit of the model for fathers
was good, (NFI = .96, CFI = .99, RMCEA = .07,
X2 = 7.07, p = .22) as well for the mothers (NFI = .97,
CFI = .99, RMCEA = .01, X2 = 4.88, p = .43). It seems
that there are only two minor differences between the two
models. The first difference relates to internal locus of
control and quality of marriage. In the fathers’ model there
is no relationship between internal locus of control and
quality of marriage, while in the mothers’ model there is a
Quality of
marriage
-.23***
-.35***
-.21***
Parental Child autism
.49***
stress symptom severity
.21***
-.53***
Parental mental
health
*P<.05 **P<.01 ***P<.001
J Autism Dev Disord (2011) 41:879–890 885

Social
support
Quality of
-.29***
.33*** marriage

Sense of -.24**
-.21*
coherence

Parental Child autism

.51***
stress symptom severity
Internal -.38***
locus of .53***
control -.33***

.25**
Parental mental
External health
locus of
control
*P<.05 **P<.01 ***P<.001

Fig. 2 Path model and path coefficients for the fathers

Social
support
Quality of
-.17*
marriage
.44***
Sense of -.19*
-.31***
coherence -.23**
-.30***
Parental Child autism
.47***
stress symptom severity
Internal -.41***
locus of .34***
control -.48***

.21*
Parental mental
External health
locus of
control
*P<.05 **P<.01 ***P<.001

Fig. 3 Path model and path coefficients for mothers

negative path coefficient (b = -0.23; p \ .01) between
internal locus of control and quality of marriage. The
second difference relates to sense of coherence and
parental stress. In the fathers’ model there is no relation-
ship between sense of coherence and parental stress while
in the mothers’ model there is a negative path coefficient
(b = -0.30; p \ .001) between sense of coherence and
parental stress.
Discussion
The present data provided support for the multivariate
model that predicts relationships among parental resources
to parental stress and the severity of their autistic children
symptoms. After presenting the general picture we can now
focus on each variable.
Sense of Coherence (Soc)
The results show positive pathway coefficients between
SOC and mental health (0.21) and quality of marriage
(0.24) but not a straight path to stress. The connection of
SOC to stress is through mental health (-0.53) and quality
of marriage (-0.35). These results support other researches
that showed positive correlations between SOC and mental
health, wellbeing and adjustment and a negative correlation
with distress (Antonovsky 1993; Chumbler et al. 2004).
The three elements of sense of coherence constitute
a general view towards explaining the world as

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comprehensible, manageable and meaningful. Parents with
a high SOC, feel generally confident about being able to
cope with general stressors (Johnson 2004; Sagy and
Antonovsky 2000). However, this general view is not
correlated to the specific elements of the stressors in
parenting an autistic child but rather with a general view
about mental health and quality of marriage. As asserted by
Antonovsky (1987), SOC lowers stress and promotes
health by facilitating the application of various resources
within the individual to cope with stressors. Thus, parents’
confidence in their parenting role and their acceptance of
their child’s behaviors and feelings may be more proximal
cognitive factors that mediate the relationship between
SOC and perceived stress (Mak et al. 2007).
Locus of Control
Internal locus of control has a straight pathways negative
coefficients with parental stress (-0.37), with quality of
marriage (-0.21) and with mental health (-0.19). External
locus of control has straight pathways positive coefficient
with stress (0.25). These results are compatible with other
research that showed that internal locus of control is one of
the main predictors of stress in parenting children with
severe problems (Jones and Passey 2005). The parents with
a high internal locus of control believe that their outcomes
and experiences are at least partially shaped by their own
actions. Consequently, they actively deal with stressors in
the hope of overcoming them. A more external locus of
control suggests less activity, and a conformity more ready
to capitulate when confronting stressful life events. As
such, the results show a positive correlation between
external locus of control and stress. Namely, the more
external the locus of control, the more stress parents have.
These results demonstrate the utility of locus of control as a
predictor of how parents cope with stress.
Social Support
Social support has only one negative path coefficient to
stress (-0.24). Social support indirectly affects parental
adjustment and the child’s severity of symptoms through
stress. It seems that parents who perceive that they are
helped and can attain the understanding, cooperation,
assistance, and appraisal of close or significant persons feel
less stress. Social support is a resource provided by others
and may be instrumental, tangible, informational, or emo-
tional. Receiving support decreases stress by increasing the
feeling of control and gives meaning to individuals’ lives
by virtue of motivating them to give in return, to feel
obligated, and to be attached to their ties (Bromley et al.
2004; Hobfoll 2001).
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J Autism Dev Disord (2011) 41:879–890
Stress, Mental Health and Marriage Quality
The negative path coefficient among stress and mental
health (-0.53) and quality of marriage (-0.35) is sup-
ported also by other researches (Abbeduto et al. 2004;
Eisenhower et al. 2005; Fisman et al. 2000; Pakenham
et al. 2005; White and Hastings 2004). While talking with
the participants after they answered the questionnaires we
could visualize the stressors: giving up vacations and per-
sonal dreams, conflicts about the appropriate treatment for
the child, medical crises, the complex management of
multiple caregivers and a great deal of concern about the
child’s future independent capabilities. These stressors
create endless fluctuations between hope and despair, fear
and courage, optimism and pessimism and between help-
lessness and control.
The capacity to distinguish global judgments of the
relationship from daily experiences of specific relationship
events requires cognitive effort. Stress may magnify the
importance of these daily experiences for the individuals’
global judgments of their relationships. In contrast, parents
who are less stressed may find it easier to dismiss the
significance of these daily experiences, which allows them
to maintain stable levels of global satisfaction even though
their daily experiences fluctuate over time. In this way,
stress may act as a double-edged sword, increasing the
parents’ likelihood of experiencing negative relationship
events while simultaneously hindering their capacity to
process specific relationship information adaptively.
Maintaining a relationship requires that parents success-
fully navigate the ups and downs of daily relationship
experiences. Greater levels of external stress may deplete
parents of the resources necessary for positive relationship
functioning (Baumeister 2002).
Child Autism Symptom Severity
A child’s severity of symptoms is predicted directly only
by quality of marriage (-0.23) and parental stress (0.49). It
is important to note that the significant correlation between
quality of marriage and child symptoms supports many
findings in the literature. For example, parents to autistic
children reported on lower levels of satisfactions from
marriage than other parents (Higgins et al. 2005). It seems
that extreme conflicts and very bad quality of marriage may
increase the number of actual stressors that parents expe-
rience. In other words, the experience of a very bad mar-
riage—unhappy parents–perceive more external events as
negative (e.g., Bodenmann and Shantinath 2004) and this
reduces their resources to cope with the child’s needs.
Although there is no path coefficient between mental
health and the severity of a child’s symptoms, the corre-
lation is quite satisfactory and significant (-0.23). It seems
J Autism Dev Disord (2011) 41:879–890
that the very high path coefficient between stress and the
severity of child’s symptoms (0.49) is contaminating the
variance in mental health variable. The Amos technique is
like a very big telescope that has problems to detect minor
relationships.
In general, the findings of this study are contrary to
some other findings that report positive changes in parents
of children with developmental disorders (e.g., Brown et al.
2003; Summers et al. 2005). These positive changes as a
result of stressors are often referred to as ‘‘stress-related
growth’’ sometimes called post-traumatic growth (Park and
Fenster 2004). In this study, the processes involved in
confronting the stressors did not promote broadened per-
spectives, new coping skills, and the development of per-
sonal and social resources (Armeli et al. 2001; Park and
Fenster 2004; Tedeschi and Calhoun 1995). Partial results
that had not entered the path analysis indicate the possi-
bility that the parents’ appraisals of the stress was not
positive–a worthy challenge, but as a threat to be
overcome.
Limitations and Further Research
The main strength of this research is the successful vali-
dation of a multivariate model with an exceptionally large
sample (176). Despite this strength, there are several lim-
itations to the current study. First, the participants were not
a representative sample due to the constraints of accepting
only those who agreed to participate. Consequently, there
is no way to ensure the sample is truly representative and
thus the reader must be more cautious in generalizing the
results (external validity). Second, the differences between
fathers (Fig. 2) and mothers (Fig. 3) are minor and we can
deduce that the relationships among the variables are quite
similar. There are contrary result about the differences
between fathers and mothers relating coping with raising
handicapped children. Few researches found differences
between mothers and fathers (e.g., Bristol et al. 1988;
Rimmerman et al. 2003). Other researches did not find such
differences (e.g., Altiere and Kluge 2009; Keller and Honig
2004). It is quite difficult to integrate the researches and to
find a clear answer about the differences between fathers
and mothers. This is due to the fact the each research is
focusing on different variables, different measures and
wide range of handicapped participants. Moreover, we
couldn’t find a research with similar variables and multi-
variate model with path analysis method. It seems that
further research has to be done in a multivariate designs
regarding the differences between fathers and mothers.
Regarding the socio-economic variable, one can see that
most of the research subjects were above average. The
reason for this is that it was not possible to obligate parents
to participate in the study as such the sample was
887
compound from volunteers. The parents who volunteered
for the research are naturally from a high socioeconomic
level and we couldn’t have a normal distribution on the
socioeconomic variable. As a result, the external validity of
the research is limited.
Control Beliefs and Self Regulation as Main Variables
for Further Research
It seems that the explanations of the results of this research
emphasize the concept of control. Sense of coherence does
not directly measure the ‘‘control’’ concept. Moreover,
even locus of control which has been proven a good pre-
dictor is also narrow and limited in scope. A strong sense of
control may facilitate use of active coping and support-
seeking methods, encourage persistence and promote
domain-specific satisfaction and affect (Lent 2004).
Research shows that control could not be a superordinate
variable that organizes self beliefs. Factor structures basi-
cally confirm that the component beliefs are distinct from
one another, with each typically forming its own factorial
dimension. As with many popular variables, control has
become a multivariate multidimensional construct that is
both complex and vague (Shell and Husman 2008).
Out of this complexity and vagueness of the concept of
control, we suggest adding three main variables that are
strongly relate to it: Self efficacy (Bandura 2006), causal
attributions (Weiner 2006) and self regulation (Kaplan
2008). Together with sense of coherence and locus of
control, these five variables embody the concept of control
and will have a stronger predictive validity for stress
and adjustment. Such validity should be located in a well
structured theory that would validate the terms used,
the relationships between them, and the choice of
measurements.
It is important to mention that these five variables are
also problematic (Hall et al. 2003; Schmeichel and Bau-
meister 2004; Shell and Husman 2008) and their definitions
and measurements have certain overlapping elements. For
example, careful distinctions should be made between
locus of control linked with expectancies about the future,
and attributional style which is linked with explanations for
past outcomes. A thorough analysis is needed to formulate
valid and reliable measurements. Moreover, specific
attention must be paid so that each of the variables is
measured both in the specific domain (raising an autistic
child) and the general domain (for review see Kaniel
2010).
Focusing on Processes
Another important recommendation is to focus on pro-
cesses. All of the data reported in this research are
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correlational and different processes (appraisal, control) are
suggested to explain the path coefficients. It is like ‘‘putting
the players on the court’’ and drawing some inferences
about the game. The main challenge for further research is
to identify the processes among the variables. This can be
done by using a different paradigm of methodology
because in the usual experimental designs, however
important universal principles are, they sometimes obscure
how real people actually function. By attempting to
describe only the average, one runs the risk of describing
nobody in particular. Process frameworks emphasize reci-
procal relations between variables. As such, they should be
validated by combining quantitative and qualitative meth-
odologies (stressful incidents in parenting), ‘thinking
aloud’ protocols (Ericsson 2003), narrative and case study
design. Namely, studying processes as they unfold natu-
rally in the course of daily life and people’s naive, or
‘‘lay,’’ theories (Molden and Dweck 2006). Each parent
should be treated as a system and characterized by a set of
interconnected variables that affect each other over the
course of time (Hollenstein 2007). Thus, in addition to the
controlled experimental (in vitro) laboratory studies, we
also saw merit in the naturalistic (in vivo) view (Dunbar
and Blanchette 2001).
Another aspect of combining approaches is to perform a
longitudinal study of parents coping with autism over a
period of approximately a decade. Researches show that
parents of children with autism have changed over time
(Gray 2006). Such methodology will have much more
power to establish causal linkage between personal and
external resources, stress experience, parental adjustment
and child symptom severity. These suggested studies may
not only enhance our understanding of the mechanisms
behind effective coping and mental health, but also con-
tribute to the enhancement of psycho-social services for
children and caregivers and the development of effective
service models that could benefit both the families and their
communities.
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