Examining Parental Stress and Autism in the Early Days of the Pandemic: A Mixed-Methods Study

Round 1

Reviewer 1 Report

This is an interesting and valuable paper. I have no major criticisms except that the review of previous studies that investigated parental stress, anxiety and depression was too brief.  Section 1.2 would be stronger by including more of the reports of studies that have examined parental resilience in families with autistic children.

For example,    Bitsika, V., Elmose, M., Mertika, A., Sharpley, C.F., Ladopoulou, K., Kampakos, C., & Syriopoulou-Delli, C.K. (2023). Occurrence and correlates of anxiety and depression in carers of autistic children across three nations. International Journal of Developmental Disabilities. 69, 362-370.

There are other papers that should be included to offer the reader a more detailed account of the previous work that has been done on resilience in these parents.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

"Parental Stress Among Caregivers of Young Children with Autism During the Stay-at-Home Mandate: A Convergent Mixed-Methods Study"

1. The paper provides a comprehensive exploration of parental stress among caregivers of young children with autism during the stay-at-home mandate. The conceptual framework is well-structured and relevant. The study delves into the interconnected relations between various factors, including PSI-4-SF scores, caregiver questionnaires, and semi-structured interviews, contributing to a nuanced understanding of parental stress.

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3. The identification of key variables such as Total Stress (TS) scores, child autonomy and safety concerns, Difficult Child (DC) subscale scores, and the impact of service hours lost during the stay-at-home mandate is commendable. These variables contribute to a robust examination of stress factors.

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5. The paper effectively integrates existing literature on autism, caregiver stress, and the impact of the COVID-19 pandemic. The discussion of risk-taking behavior, injury prevalence, and the bidirectional relation between caregiver stress and challenging behavior is insightful.

1. The mixed-methods design enhances the study's richness. However, the small purposive sample of 16 participants from a specific state (Illinois) raises concerns about the generalizability of findings. Further justification for the sample size and selection criteria is needed.

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3. The use of PSI-4-SF, caregiver questionnaires, and semi-structured interviews adds depth to the study. However, the potential bias in self-report tools and interviews, especially considering the sensitive nature of stress reporting, should be acknowledged. The reliance on participant self-reports could introduce response bias.

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5. The identification of TS scores as a central node and the exploration of factors influencing stress levels are well-executed. However, the lack of significance in TS scores for caregivers whose children lost more than 20 hours of service per week needs further investigation. A more detailed exploration of potential confounding variables or factors influencing this result is crucial.

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7. The study's eight-week duration during the early stages of the stay-at-home mandate might limit the ability to capture evolving perspectives over time. The potential impact of this temporal limitation on the findings should be discussed.

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9. The acknowledgment of limitations related to social factors, such as ethnicity, influencing response depth is a positive aspect. However, more explicit discussion of how these factors may impact the study's outcomes is warranted.

The overall quality is satisfactory except for some minor editing requirements. 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Journal: Disabilities

Title: Examining parental stress and autism in the early days of the pandemic: A mixed-methods study

Overall, the paper was well-written and comprehensive. The topic of addressing the parental stress of children with autism during the pandemic is timely, and the authors generated good strategies that will be beneficial to parents and caregivers in the future if another global crisis emerges. The authors aimed to gather information about the significant impact of the abrupt lack of services and support to families with children diagnosed with autism spectrum disorder during the COVID-19 pandemic. Particularly the relation between parental stress and the challenging behaviors and learning challenges of their children. The introduction and the literature review were comprehensive and well cited. More specifically, the authors laid out their rationale for the research by explaining the over challenges of the stay-at-home mandates due to the pandemic and then focused on the families with children with ASD. While researching the stress of parents with disabilities, particularly autism is not a new phenomenon, asking the question about their well-being and support during a global pandemic is relevant and adds to the literature in the field.

The mixed method was appropriate for this study and the qualitative data enhanced the quantitative data. The authors have done an excellent job connecting the method to the research questions and purpose. The Parenting Stress Index was appropriate in addition to the demographic questionnaire. The qualitative method of using semi-structured interviews followed the questionnaires nicely. Figure 1, illustrating the Triangulation Design: Convergence Model was clear and concise. The authors described the participants and measures well.

My only concern is the small number of participants and the statistical power of the correlation and regression analysis. In typical correlation and regression analysis, there would be 50 or more participants, but in mixed methods, there may be justification or a smaller sample site. The authors may want to give some citations that this number is sufficient.

In terms of results, the authors were thorough in their descriptions for each measure and the tables and figures were easy to follow. I particularly liked the analysis of the qualitative data that was aligned with the areas identified earlier in literature review such as needs for social support, inadequate telehealth practices, and coping strategies. The quality of the data was appropriate and followed the research purpose and questions.

In the discussion, the authors nicely brought back their initial questions and purpose of the study and summarized their findings. Their interpretation was reasonable and relevant to the field of parent and caregiver stress as related to their children with disabilities. Lastly, the authors provided strategies that would be supportive of families should another crisis arise. I appreciated the section of limitations and implications where the authors acknowledged the small sample sizes and the challenges that go along with a mixed methods model.

There was an abundance of citations in APA format, and they were relevant to the topic.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The revisions made by the authors satisfy my concerns.