Educational Social Skills and Parental Mental Health in COVID-19: Relationships with Child Behavior in ASDAbstract:
This study aimed to evaluate changes in the treatment of children with Autism Spectrum Disorder (ASD) during the COVID-19 pandemic, assess and correlate educational social skills (ESS), the mental health of parents/caregivers, children’s social skills (SS) and behavioral problems (BP), and compare ESS between parents with and without mental health indicators. Reports from 69 participants were analyzed using the IHSE-parents, DASS-21 and SSRS version-parents instruments. Results indicated a decrease in consultation frequency. While ESS values were average, the children’s repertoire was deficient. There was a positive correlation between ESS and SS and internalizing BP, as well as between parental mental health and SS. A negative correlation was observed between parental mental health and BP. Parents with anxiety and depression displayed a worse ESS repertoire. These findings underscore the importance of parental mental health and ESS in supporting ASD development.
Keywords:
parent-child relations; social skills; COVID-19; children; Autism Spectrum Disorder
Resumo:
Por meio dos relatos de 69 pais/cuidadores de crianças com Transtorno do Espectro Autista (TEA), este estudo teve como objetivo avaliar mudanças nos tratamentos, avaliar e correlacionar as habilidades sociais educativas (HSE), a saúde mental dos pais, as habilidades sociais (HS) e problemas de comportamento (PC) dos filhos e comparar pais com e sem indicadores de saúde mental em relação a HSE durante a pandemia de COVID-19. Foram utilizados os instrumentos IHSE-pais, DASS-21 e SSRS versão-pais. Os resultados apontaram diminuição na frequência das consultas. As HSE eram medianas e o repertório das crianças era deficiente. Houve correlação positiva entre HSE e HS e PC internalizantes e entre saúde mental parental e HS e correlação negativa com PC. Grupos de pais com ansiedade e depressão apresentaram pior repertório de HSE. A saúde mental e a HSE parental mostraram relevância para o desenvolvimento do TEA.
Palavras-chave:
relações pais-filho; habilidades sociais; COVID-19; crianças; Transtorno do Espectro Autista
Resumen:
A partir de los relatos de 69 padres/cuidadores de niños con Transtorno del Espectro Autista (TEA), este estudio tuvo como objetivo evaluar cambios en los tratamientos, valorar y correlacionar las habilidades sociales educativas (HSE), la salud mental de los padres, las habilidades sociales (HS) y problemas de conducta (PC) de los hijos y comparar padres con y sin indicadores de salud mental respecto la HSE durante la pandemia del covid-19. Se utilizaron los instrumentos IHSE-padres, DASS-21 y SSRS versión-padres. Los resultados mostraron una disminución en la frecuencia de consultas. Las HSE fueron medias; y el repertorio infantil deficiente. Hubo correlación positiva entre HSE y HS y PC internalizantes. entre la salud mental de los padres y la HS. y correlación negativa con la PC. Los grupos de padres con ansiedad y depresión tenían un peor repertorio de HSE. La salud mental y las HSE de los padres demostraron relevancia para el desarrollo de TEA.
Palabras clave:
relaciones padres-niños; habilidades sociales; COVID-19; niños; Transtorno del Espectro Autista
The COVID-19 pandemic was a period of significant challenges for both children with Autism Spectrum Disorder (ASD) and their parents/caregivers. Social distancing measures required adaptation to new routines, leading to a significant loss of learning opportunities (Mutluer et al., 2020 ) and reduced access to healthcare treatments for children (Fortes et al., 2021 ; Siracusano et al., 2021 ). Studies conducted during this period reported an increase in behavioral problems (Colizzi et al., 2020 ; Mutluer et al., 2020 ) and impairments in the social repertoire of children with ASD (Siracusano et al., 2021 ), as well as considerable declines in quality of life and intensified parental psychological distress (Fortes et al., 2021 ; Wang et al., 2021 ; Yılmaz et al., 2021 ).
Children with ASD commonly present impaired social skills and behavioral problems (Agostini & Freitas, 2023 ), which may contribute negatively to parental mental health (Li et al., 2022 ; Osborne et al., 2008 ; Rahman & Jermadi, 2021 ; Rodriguez et al., 2019 ). These factors may also interfere with behavioral aspects of parenting, such as modifying positive and negative educational practices and/or parental communication styles (Boonen et al., 2014 ; Maljaars et al., 2014 ; Rahman & Jermadi, 2021 ). Similarly, studies have indicated the influence of parental mental health and behaviors on the occurrence of behavioral problems (Boonen et al., 2014 ; Maljaars et al., 2014 ; McRae et al., 2018 ; Rodriguez et al., 2019 ) and on the social repertoire of children with ASD (Agostini & Freitas, 2023 ). Although these studies remain inconclusive on the direction of such associations, they highlight the importance of these variables in the quality of the parent-child relationship, child development, and parental mental health. However, the relation between these variables during the pandemic requires further empirical investigation, given the social changes resulting from isolation/distancing measures and their subsequent effects.
Social skills (SS) are a set of behaviors that act as protective factors during child development both by reinforcing consequences for children as well as by contributing to their social competence (Del Prette & Del Prette, 2017 ). They include verbal and nonverbal skills in the expression of affection, social poise, self-control, civility, assertiveness, among others (Del Prette & Del Prette, 2017 ). Deficits in SS are central to ASD diagnosis and may have been exacerbated by social isolation and the interruptions/changes in healthcare services during the pandemic, as noted by Siracusano et al. ( 2021 ). These deficits impact socioemotional reciprocity and nonverbal communication, compromising self-control, assertion, and cooperation skills, as well as leading to communication deficits and affecting the types of behavioral problems children present (Boonen et al., 2014 ; Rahman & Jermadi, 2021 ).
Children with ASD typically present higher rates of behavioral problems (BP) when compared to their peers with typical development (McRae et al., 2018 ). Both externalizing disorders (aggression, hyperactivity, opposition, coerciveness, among others) and internalizing disorders (anxiety, depression, social withdrawal) can compose BP, and it tends to compete with as well as interfere in the development of SS (Gresham & Elliott, 2016 ). Furthermore, the combination of both types of problems can be an aggravating factor for deficits in SS (Gresham & Elliott, 2016 ).
Studies evaluating the behavioral dimensions of parenting in the context of ASD are scarce (Agostini & Freitas, 2023 ; Boonen et al., 2014 ; Maljaars et al., 2014 ; Osborne et al., 2008 ; Shawler & Sullivan, 2015 ), as are those linking them to SS (Agostini & Freitas, 2023 ) and children’s behavioral problems (Boonen et al., 2014 ; Maljaars et al., 2014 ; Osborne et al., 2008 ; Shawler & Sullivan, 2015 ). The studies found report that parents of children with and without ASD differ in their behaviors (Boonen et al., 2014 ; Maljaars et al., 2014 ). Parents of children with ASD tend to use more positive parenting behaviors, environmental stimulation, and adaptation (ASD-adapted dimensions of parenting) as well as fewer rules and limits (Maljaars et al., 2014 ). Moreover, studies have identified that positive parenting behaviors may promote SS development (Agostini & Freitas, 2023 ) and that certain parenting dimensions directly or indirectly impact children’s behavioral problems (Boonen et al., 2014 ; Maljaars et al., 2014 ; Osborne et al., 2008 ; Shawler & Sullivan, 2015 ).
Educational social skills (ESS) are observable verbal and nonverbal parental behaviors, which include organizing educational conditions, establishing limits and rules, demonstrating attention and affection, and engaging in conversation (Del Prette & Del Prette, 2008 ). Agostini and Freitas ( 2023 ) identified a positive association between parents’ ESS and the SS of children with ASD. Additionally, the study found that the specific category of conversation/dialogue was a significant predictor of SS.
Regarding the behavioral problems of children with ASD, Boonen et al. ( 2014 ) found a positive association between both positive and negative dimensions of parenting and externalizing problems. Boonen et al. ( 2014 ) and Maljaars et al. ( 2014 ), in turn, reported a positive association between stimulation and adaptation and the occurrence of internalizing problems. While investigating the role of parenting dimensions in the relationship between parental mental health and children’s behavioral problems, Osborne et al. ( 2008 ) and Shawler and Sullivan ( 2015 ) identified the establishment of limits and discipline strategies as mediators of the relationship between parental stress and children’s behavioral problems, respectively.
Despite the interrelations noted between parental mental health, parenting behaviors, and child development in ASD, few studies have evaluated these variables concurrently, either before or during the pandemic. Moreover, although studies indicate an intensification of pre-existing characteristics in the population of children with ASD following the pandemic (Fortes et al., 2021 ; Mutluer et al., 2020 ; Siracusano et al., 2021 ; Wang et al., 2021 ), there are few studies on the Brazilian context that specifically investigates the association between the variables considered here.
This study sought to evaluate changes in treatments, verify and correlate parents’ ESS, parental mental health, children’s SS and BP, and compare parents with and without mental health indicators regarding ESS during the COVID-19 pandemic. The specific objectives were: (1) to assess changes in the treatments of children with ASD during the pandemic; (2) to evaluate ESS and mental health indicators (anxiety, depression, and stress) in parents of children with ASD; (3) to evaluate children’s SS and BP; (4) to analyze the relationship between parents’ ESS and children’s SS and BP; (5) to analyze the relationship between parents’ mental health indicators and children’s SS and BP; (6) to analyze the relationship between parents’ mental health indicators and their educational social skills; and (7) to compare groups of parents with and without symptoms of anxiety, depression, and stress regarding their ESS.
Method
Participants
A total of 95 parents/caregivers of children with ASD who are users of the Specialized Rehabilitation Services for Intellectual Disability and/or Autism (SERDI) in five cities in the Zona da Mata region of Minas Gerais (MG) were invited to participate in the study. Inclusion criteria required that the child (a) was aged two to 13 years and (b) had a medical diagnosis of ASD. The exclusion criterion was whether the ASD diagnosis was still under investigation by a physician or healthcare team. As shown in Figure 1 , the final sample consisted of 69 parents/caregivers.
Instruments
Educational Social Skills Inventory - IHSE-Del-Pette (Del Prette & Del Prette, 2013 ). This inventory assesses the ESS of parents of children aged two to 17 years. It is a 60-item self-report questionnaire describing social behaviors parents display in their interactions with their children. Response options range from never or rarely (0) to always or almost always (4). The scale has five factors: F1 = Setting limits, correcting, controlling; F2 = Demonstrating affection and attention; F3 = Conversing/dialoguing; F4 = Inducing discipline; and F5 = Organizing educational conditions. This instrument was provided for use by its authors and has demonstrated satisfactory construct validity and internal consistency. Additionally, internal consistency analyses were conducted on the ESS scale (α = 0.955) as well as correlations between total scores and ESS factors ( r = 0.366 to 0.966) in this study sample.
Social Skills Rating System - SSRS (Gresham & Elliott, 1990 ), Brazilian version (Gresham & Elliott, 2016 ) This inventory assesses children aged three to 18 years, with the Brazilian version adapted for children aged six to 13. It evaluates the repertoire of SS, BP, and academic competence, with informants including children, parents, and teachers. Response options are: (0) = never , (1) = sometimes , or (2) = very often . The SSRS has extensive evidence of validity and reliability in Brazilian samples (Gresham & Elliott, 2016 ). The SS and BP scales for parents were used. The SS scale has 25 items and five factors: F1 = Responsibility, F2 = Self-control, F3 = Affection/cooperation, F4 = Social confidence, and F5 = Civility. The BP scale has 15 items and two factors: F1 = Externalizing BP and F2 = Internalizing BP.
Internal consistency analyses were conducted for the SS (α = 0.799) and BP scales (α = 0.821), along with correlations between total scores and SS factors ( r = 0.637 to 0.884) and BP factors ( r = 0.643 to 0.917) in our sample. Additionally, significant score differentiation was observed by age (children under and over six years) for SS ( p < .001) and BP ( p < .017), 95% CI, with results aligning with the relevant literature (Bailey et al., 2019 ).
Brazilian Economic Classification Criterion Questionnaire - CCEB (ABEP, 2021). This questionnaire assesses the socioeconomic classes of the Brazilian population (A, B, C, and D/E), based on family possession of durable goods.
Sociodemographic and Service Utilization Questionnaire . This questionnaire was designed specifically for this research and includes questions about the age and sex of parents and children, as well as the frequency and type of healthcare services children attended during the pandemic.
Depression, Anxiety and Stress Scale - DASS-21 (Lovibond & Lovibond, 1995 ), adapted and validated for the Brazilian population (Vignola & Tucci, 2014 ). This 21-item self-report instrument evaluates the frequency and intensity of negative emotional states experienced during the past week. It is divided into three subscales (depression, anxiety, and stress). Responses are rated on a Likert scale: 0 = did not apply to me , 1 = applied to me some of the time , 2 = applied to me a considerable amount of time , and 3 = applied to me most of the time . Each subscale contains seven items. Symptoms are classified for each subscale separately into five categories: normal, mild, moderate, severe, and very severe. The instrument has satisfactory evidence of criterion and construct validity, as well as reliability (Vignola & Tucci, 2014 ).
Procedure
Data collection The recruitment and scheduling of interviews were conducted by phone calls or via WhatsApp from September 2021 to March 2022, a period during the pandemic when in-person activities were allowed in the cities, although some preventive measures were still in place. Contact lists provided by the SERDIs were used. Parents who agreed to participate in the interview received the informed consent forms electronically, and participants could then choose to complete the questionnaires at health institutions ( n = 34) or via an online form (Google Forms) ( n = 35).
Data analysis Descriptive and inferential analyses were conducted. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 23.0. The Kolmogorov-Smirnov test was used to assess normality and determine the choice of parametric or nonparametric tests.
To characterize the parents’ repertoire of educational social skills (ESS) and the children’s repertoire of social skills (SS) and behavioral problems (BP), descriptive analyses were performed, calculating frequencies, percentages, means, and standard deviations based on the scores obtained on the global and subscales of the instruments. Percentile parameters of the normative data for the IHSE (Del Prette & Del Prette, 2013 ) and for the SSRS (Gresham & Elliott, 2016 ) were considered. For the SSRS, only data from children older than six years were used for normative data comparison. The characterization of parents’ mental health indicators was conducted according to the DASS-21 manual.
Descriptive statistical analyses of the sample’s sociodemographic characteristics were conducted, with calculations of means, percentages, and standard deviations. Bivariate analyses were performed to examine relationships between global and factor scores of the IHSE and SSRS instruments, as well as between these scores and the factor scores of the DASS-21. Pearson’s chi-squared test was used for parametric correlations and Spearman’s test for non-parametric ones.
For comparisons between groups of parents with and without mental health indicators regarding their ESS, parametric analyses were conducted using Student’s t -test for independent samples, and non-parametric analyses were conducted using the Mann-Whitney U test. In all analyses, a p -value of at least .05 was considered significant.
Ethical Considerations
This study is part of a broader research project approved by the Research Ethics Committee of the Universidade Federal de São João Del Rei, under CAAE No. 48451421.0.0000.5151, Approval No. 4.891.293, and by the health services’ coordination boards where the study was conducted.
Results
Sample Characterization
The study included 69 caregivers of children with ASD, aged from 20 to 62 years ( M = 35.1, SD = 7.31). Most caregivers were females (89.9%). Regarding social class, 68.1% belonged to socioeconomic class C, 17.4% to class B, 11.6% to classes D and E, and only 2.9% to class A. The children age ranged from two to 13 years ( M = 7.1, SD = 2.81), with 43.5% under the age of six and 53.5% between seven and 13 years. Most children were male (84.1%). Table 1 presents the sociodemographic and clinical characterization of the sample.
Description of the sociodemographic and clinical data of participants, in relative (%) and absolute frequency (F), means (M), and standard deviations (SD)
Normality analysis
Normal distribution was found for the overall score of SS ( KS = .082, p = .20) and behavioral problems (BP) ( KS = .086, p = .20), as well as for the factors F4 ( KS = .106, p = .05) of the IHSE instrument and F1 ( KS = .100, p = .09) of BP. The global scores of the IHSE ( KS = .109, p = .042) and the DASS-21 ( KS = .121, p = .014) did not show normal distribution, nor did the other factors: F1 ( KS = .138, p = .002), F2 ( KS = .240, p < .001), F3 ( KS = .120, p = .015), F5 ( KS = .116, p = .022) of the IHSE; F1 ( KS = .179, p < .001), F2 ( KS = .141, p = .002), F3 ( K S = .107, p = .049) of the DASS-21; F1 ( KS = .155, p = .000), F2 ( K S = .152, p < .001), F3 ( KS = .113, p = .028), F4 ( K S = .120, p = .016), F5 (KS = .142, p = .002) of SS; and F2 ( KS = .157, p < .001) of BP.
Descriptive Analyses
Changes in Children’s Treatments
Regarding changes in children’s treatments, most caregivers (63.1%) reported that in-person services had been resumed at the time of completion of the questionnaire, while 23.2% stated that they were not receiving services at that moment, 10.1% reported having both in-person and remote services, 1.4% were attending remote appointments, and 1.4% did not respond. Concerning the frequency of appointments, 76.5% indicated that the frequency had decreased during the pandemic. For 21.7%, the frequency remained the same, while for 1.4% of the sample, the frequency increased, and 1.4% of the participants did not respond.
Symptoms of Anxiety, Depression, and Stress in Caregivers
As indicated in Table 2 , the results from the DASS-21 indicated that approximately half of the sample did not show changes in mental health indicators. However, the other half of the respondents were classified as having symptoms of anxiety (49.3%), depression (50.6%), and stress (52.1%). Among these caregivers, at least 20% scored in the severe or very severe range for each of the indicators.
Repertoire of Educational Social Skills of Caregivers
As described in Table 2 , for the overall score, most caregivers (59.4%) presented a repertoire classified as average to elaborate. Results were similar at a factor level, as caregivers demonstrated a repertoire classified as average to elaborate (65.1%–79.7%) in almost all scales, except in F3 – Conversing/dialoguing, with only 41.8% in that range. The best performance was in the subscale F2 - Demonstrating affection/attention.
Repertoire of Children’s Social Skills
According to Table 2 , in the overall score of social skills of children over the age of six, most children (57.7%) presented a subpar repertoire. At a factor level, most children showed an average to elaborate repertoire in all subscales, with the best performance in subscale F1 - Responsibility and the poorest performances in subscales F2 – Self-Control and F5 - Civility, with at least 40% of children having a subpar repertoire.
Repertoire of Childhood Behavior Problems
As described in Table 2 , for the overall score of behavior problems, 46.6% of children (ages 6–13) exhibited very low to medium frequency, while most had a classification above the upper average. Regarding the factors, in F1 – Externalizing Problems, 53.3% of children were classified with very low to medium frequency. In F2 – Internalizing Problems, 48.8% were classified with very low to medium frequency. For both factors, approximately half of the sample showed behavioral problems above the upper average.
Relations Between Caregivers’ Educational Social Skills and Children’s Social Skills
Table 3 describes the different correlations between the study variables. Significant positive correlations, ranging from weak to moderate, were found between the overall score of the IHSE and the overall score of the SSRS ( r = .655, p < .001) as well as with all other factors of the SSRS. The global score of the SSRS showed weak, moderate, and strong correlations with the factors of the IHSE, except for F5 - Organizing educational conditions ( r = .050, p = .68). The strongest correlation between the overall scores of the IHSE and the SSRS occurred with F3 of the SSRS - Conversing/Dialoguing ( r = .725, p < .001).
Relations Between Caregivers’ Educational Social Skills and Childhood Behavioral Problems
There was no significant correlation between the overall score of the IHSE and the overall score of the behavioral problems scale, as well as F1 - Externalizing Problems. However, there was a significant, positive, moderate correlation between the overall score of the IHSE and F2 - Internalizing Problems ( r = .461, p < .001). Regarding the factors of the IHSE and the global score of behavior problems, there was a significant, positive, weak correlation between F1 - Establishing Limits, Correcting, and Controlling ( r = .275, p = .02) and F4 - Inducing Discipline ( r = .241, p = .04). Regarding the factors of the IHSE and the factors of behavior problems, the test indicated significant positive correlations, ranging from weak to moderate, between F1 - Establishing Limits, Correcting, and Controlling ( r = .482, p < .001), F3 - Conversing/Dialoguing ( r = .440, p < .001), and F4 - Inducing Discipline ( r = .358, p < .001), specifically in relation to Factor 2 - Internalizing Problems.
Relationships Between Children’s Social Skills and Parental Anxiety, Depression, and Stress
Regarding the factors of the DASS 21 and the general SS score, significant, negative, and weak correlations were found for F1 – Anxiety ( r = -.271, p = .02), F2 – Depression ( r = -.255, p = .04), and F3 – Stress ( r = -.287, p = .02). For the factors in general, there was a significant, negative, and weak correlation between F1 - Responsibility and F1 - Anxiety ( r = -.258, p = .03) and F3 - Stress ( r = -.239, p = .05); between F3 - Affectivity/Cooperation and F3 - Stress ( r = -.285, p = .02); and between F5 – Civility and F1 - Anxiety ( r = -.271, p = .02), F2 – Depression ( r = -.280, p = .02), and F3 – Stress ( r = -.303, p = .01).
Relationships Between Children’s Behavioral Problems and Parental Anxiety, Depression, and Stress
Regarding the general score of behavioral problems, a significant, positive, and moderate correlation was found with F1 - Anxiety ( r = .503, p < .001) and F3 - Stress ( r = .439, p < .001), and a weak correlation with F2 - Depression ( r = .382, p = .001) from the DASS-21. Significant positive correlations were identified between F1 - Externalizing Problems, showing a moderate correlation with F1 - Anxiety ( r = .501, p < .001) and a weak correlation with F3 - Stress ( r = .464, p < .001). Significant, positive, and weak correlations were found between F2 - Internalizing Problems and F1 - Anxiety ( r = .255, p = .034), F2 - Depression ( r = .345, p = .004), and F3 - Stress ( r = .240, p = .047).
Relationships Between Parental Anxiety, Depression, and Stress and Caregivers’ Educational Social Skills
Significant, negative, and weak correlations were found between F3 - Stress and F2 - Demonstrating affection/attention ( r = -.239, p = .05) and F5 - Organizing educational conditions ( r = -.273, p = .02) from the IHSE.
Comparison of Caregiver Groups with and without Mental Health Indicators Regarding the IHSE
The comparison between groups with anxiety ( M = 168.3) and without anxiety ( M = 187.2) conducted using the Mann-Whitney test indicated that the mean scores between the groups were statistically different ( Z = −2.035, p = .04, r = .24), with the group without anxiety showing a higher mean score in social skills. The comparison of groups with depression ( M = 167.94) and without depression ( M = 188.17) was also performed using the Mann-Whitney test, which indicated that the mean scores between the groups differed statistically ( Z = −2.231, p = .02, r = .03). The group without depression had a higher mean score in educational social skills. The comparison of groups with stress ( M = 172.47) and without stress ( M = 183.84) through Student’s t -test showed that the mean scores between the groups did not differ statistically ( Z = .009, t = 1.261, p = .21, Cohen’s d = .30).
Discussion
The assessment of changes in the services and types of care provided to children with ASD at the SERDIs highlighted a significant decrease in the services offered during the pandemic. Although most services at the time of data collection were predominantly in-person, some children still remained without care, indicating potential challenges in resuming pre-pandemic routines. This context may have contributed to the results observed in this study concerning the main evaluated variables.
Regarding the ESS of caregivers of children with ASD, most caregivers (59.4%) displayed an average to elaborate repertoire. The skills classes showing the best and worst performance among caregivers were, respectively, demonstrating affection/attention and conversing/dialoguing . The former involves the ability of parents to recognize their children’s feelings and to express, value, and reciprocate their affection (Del Prette & Del Prette, 2013 ). This skill was shown to be related to the children’s social skills but not to behavioral problems. This finding contradicts evidence suggesting that such parental repertoire would contribute to reducing inappropriate behaviors (McRae et al., 2018 ). The second skill encompasses approaching and dialoguing with children (Del Prette & Del Prette, 2013 ). This piece of repertoire may have been less frequent due to the specific deficits of children with ASD and the potential difficulties parents face in communicating with their children. It is worth noting that the normative sample of the IHSE included parents in general, thus indicating a more advanced repertoire in this skill class.
The mental health indicators of caregivers were found to be significantly elevated, aligning with studies conducted both prior to and during the COVID-19 pandemic (Li et al., 2022 ; Fortes et al., 2021 ; Wang et al., 2021 ; Yılmaz et al., 2021 ), underscoring the vulnerability of this specific group of parents. The SS of children with ASD also showed significant deficits, consistent with the characteristics of the diagnosis and Brazilian studies using the same instrument (Agostini & Freitas, 2023 ). Notably, the reduction in the frequency of services offered at SERDIs and the interruption of interventions during the pandemic may have significantly influenced these results.
Almost half of the sample of children with ASD had BP that were above the normative mean compared to the SSRS sample, with poorer results for externalizing problems. These findings converge with studies demonstrating the co-occurrence of behavioral problems and ASD (Maljaars et al., 2014 ; McRae et al., 2018 ; Rahman & Jermadi, 2021 ). However, it is important to consider that these behaviors may have intensified during this period, as noted in studies by Colizzi et al. ( 2020 ), Mutluer et al. ( 2020 ), and Yılmaz et al. ( 2021 ), along with the reported reduction in treatments by caregivers.
The association between caregivers’ ESS and the SS of children with ASD reinforces the evidence found by Agostini and Freitas ( 2023 ) and, to some extent, by Rahman and Jermadi ( 2021 ). The class of organizing potential educational conditions , which was not associated with children’s social skills, encompasses behaviors that may have been influenced by COVID-19 containment measures, such as creating situations that foster social interaction and selecting educational content for teaching social skills.
The absence of an association between the overall repertoire of caregivers’ HSE and children’s behavioral problems (both overall score and externalizing problems) may be indirectly related to negative parenting practices and authoritarian parenting styles, which, unlike positive practices, have a negative impact on behavioral problems (Clauser et al., 2021 ; Rahman & Jermadi, 2021 ; Shawler & Sullivan, 2015 ). Overall, these findings highlight the importance of providing support and resources for caregivers to enhance their social skills and improve the outcomes for children with ASD, particularly in the context of ongoing challenges stemming from the pandemic. These classes involve, respectively, parental behaviors aimed at encouraging children to reflect on socially desired behaviors and values, as well as restricting the occurrence of undesired behaviors (Del Prette & Del Prette, 2013 ). The results partially confirm the findings by Boonen et al. ( 2014 ) and Maljaars et al. ( 2014 ), which positively associated the dimensions of environmental adaptation and stimulation for development with internalizing problems. The analysis of the items from the different instruments used indicated correspondences between the assessed factors. It is presumed that this relationship was found due to the pronounced deficits in the SS of the children in the sample. In this context, the demand for children to conform to certain socially accepted and expected behavior standards for their age could increase the frequency of negative emotional responses as a result of their lack of social repertoire to deal with such situations. On the other hand, some symptoms of anxiety may be mistaken for deficits in social communication in ASD (Davis et al., 2011 ), suggesting that parents might misinterpret these deficits.
The negative associations found between parental mental health indicators and children’s social skills highlight the importance of evaluating general stress as a factor related to parenting in ASD, as noted by Rodriguez et al. ( 2019 ). Longitudinal studies tend to identify social deficits as predictors of poorer parental mental health indicators (Li et al., 2022 ). Specifically, the classes of responsibility and affectivity/cooperation in the children’s repertoire were negatively associated with caregiver stress, and in the first case, also with anxiety. These results suggest that deficits in specific social skills in children may increase parental anxiety and stress, or vice versa.
The positive association between anxiety, depression, and/or stress in caregivers and BP aligns with various studies in the field (Clauser et al., 2021 ; Osborne et al., 2008 ; Piro-Gambetti et al., 2022 ; Rahman & Jermadi, 2021 ). However, the associations between parental mental health indicators and SS identified only stress as a relevant factor for certain specific behavioral dimensions, such as demonstrating affection/attention and organizing potentially educational contexts . These dimensions were not significantly associated with the BP in the sample, indicating that these ESS may not mediate the relationship between general parental stress and BP in children with ASD.
The comparison of caregivers’ ESS based on the presence or absence of abnormal levels of anxiety, depression, and stress suggests that clinical levels of anxiety and depression may impact ESS. Although the effect size of these analyses was small, the results corroborate the findings of Bolsoni-Silva and Loureiro ( 2019 ) regarding depression, albeit in a sample of mothers of children without an ASD diagnosis. Regarding stress, there was no significant differentiation between the groups. It is assumed that the presence of clinical stress in the sample may be attributed to other factors unrelated to parenting or even to the pandemic, given that the measured stress was general and not specifically parental.
The findings of this study reveal an association between ESS, parental mental health, children’s social skills, and BP in children with ASD within the context of changes in service modalities offered during the COVID-19 pandemic. The evidence for the specific association between parents’ ESS and children’s social skills with ASD, as well as between ESS and internalizing problems, was also reinforced. Furthermore, the study contributes to the accumulation of evidence regarding the relationship between parental mental health and the social repertoire of children with ASD, underscoring the importance of assessing these conditions for both clinical practice and empirical research contexts. Finally, general parental stress was identified as an important variable in parenting in ASD and should be included in studies and interventions with parents.
Despite the potential contributions of the findings for evaluation and intervention processes within the investigated population, the study presented some methodological limitations. The instruments used were originally validated for parents and children in general, which may not fully capture some specific characteristics of ASD. Additionally, only one informant was used for the assessment of children’s repertoire. Future studies could enhance reliability and the breadth of results by expanding the number of informants.
Furthermore, it is suggested that future research specifically assess the severity of ASD symptoms, as this can influence both types of BP (Clauser et al., 2021 ) and the overall and specific development of language and communication in children. The importance of conducting longitudinal studies that track changes and the mutual influences between the considered variables throughout child development is also emphasized. Comparative studies between parents of children with and without ASD regarding parenting behaviors could contribute to a better understanding of the specificities of parenting in ASD.
References
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How to cite this article:
Agostini, J. M. G., & Freitas, L. C. (2024). Educational social skills and parental mental health in COVID-19: Relationships with child behavior in ASD. Paidéia (Ribeirão Preto), 34, e3439. doi: https://doi.org/10.1590/1982-4327e3439
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This study derives from the doctoral research of the first author under Advisory of the second author, at the Psychology Graduation Program of the Universidade Federal de São João del-Rei. Support: this study was supported by the Coordination for the Improvement of Higher Education Personnel - Brasil (CAPES) - Funding Code 1396/2024.
Edited by
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Associate editor:
Luciana Carla dos Santos Elias
