In all its colours and complexity. A conceptual and methodological study on parenting young children in the context of (emerging) autism

Parenting can be viewed as a relationship in which parent and child influence each other over an extended period of time, creating a spiral of intertwined reciprocal influences. In the context of autism, the hypothesis was formulated that genetic factors associated with autism, present at birth, may alter a child’s interaction with its social environment (including parenting), and that this gene-environment interaction may amplify early susceptibilities and contribute to a later autism phenotype. The development of parenting and autism can be investigated with prospective longitudinal follow-up studies. To date, these mainly included (parents of) younger siblings of autistic children (“siblings”), although very and extremely prematurely born infants (“preterms”) are also at elevated likelihood (EL) of autism. As siblings and preterms share an increased likelihood of autism but differ in other aspects, an exploration of their similarities and differences could help us better understand heterogeneity in autism.

In five chapters, this doctoral dissertation painted a picture of parenting among (mothers of) infants, toddlers, and pre-schoolers with or at EL of autism. We conceptualised parenting as an interplay between action-oriented (i.e., parent and child behaviours) and meaning-oriented (i.e., parenting stress, maternal well-being) components, that are influenced by child characteristics. Both observational measures and questionnaires were used in this doctoral project, as they are two complementary methods for the assessment of parenting.

The first two chapters focused on the conceptualisation of parenting behaviours. Our systematic review indicated that large heterogeneity exists in parenting constructs used in observational research in the autism field, and that descriptions of parenting constructs lack uniformity (Chapter 1). However, it was possible to create seven overarching categories of parenting behaviours, suggesting that some common core concepts exist. Partly based on these findings, we developed a coding scheme (CoPIT) to explore parenting behaviours in more detail, by assessing multiple specific behaviours in a neutral way (Chapter 2). By examining correlations within the CoPIT and between the CoPIT and a second coding scheme (PInTCI), we found evidence for an overarching ‘warmth/support’ parenting dimension, but not for a ‘control/directivity’ dimension. In the three subsequent chapters, we studied group differences in action- and meaning-oriented parenting components and the role of child characteristics. Overall, we observed more similarities than differences between (mothers of) siblings and preterms and between (mothers of) autistic and non-autistic pre-schoolers. In the first year of life, we found changes in child temperament, but temperament was not associated with mother-child interactions (Chapter 3). Preterms received higher Surgency scores, providing some preliminary evidence for the value of temperament as transdiagnostic construct. During the second year of life, we found more stability than change in reported parenting behaviours (Chapter 4). However, mothers from both EL groups reported an increase in disciplinary behaviours, in line with findings from the general population. Mothers of preterms also reported an increase in warm and supportive behaviours, while mothers of siblings reported no change. Exploration of the well-being trajectories indicated no group differences in initial well-being or change over time. Contrary to our hypotheses, maternal well-being was not associated with any of the parenting behaviours. Finally, we investigated whether parenting stress and externalising behaviour problems were similarly associated to observed and reported parenting behaviours among mothers of autistic and non-autistic pre-schoolers (Chapter 5). We found that mothers of autistic pre-schoolers demonstrated fewer sensitive and more negative behaviours during interaction with their child, and that they reported more parenting stress than mothers of non-autistic pre-schoolers. These differences could be explained by additional externalising behaviour problems, suggesting that this transdiagnostic factor may provide more insight in the dynamics between mother and child than autism characteristics or an autism diagnosis alone.

This doctoral dissertation shows us how colourful parenting in the context of (emerging) autism is, but also how complex the study of parenting can be. We provided insights in the mother-child relationship by comparing individual trajectories of children with or at EL of autism at the group level. Future research could focus on qualitative research and the application of a person-centred analytical approach. Our work will impact clinical practice as well as future scientific research.