The Associations Between Internalizing and Externalizing Behaviors in Children with Autism and Parenting Stress: A Systematic Review

The Associations Between Internalizing and Externalizing Behaviors in Children with Autism and Parenting Stress: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Associations Between Internalizing and Externalizing Behaviors in Children with Autism and Parenting Stress: A Systematic Review Madyson Messiaen, Michel Sfeir, Justine Gaugue, Sarah Galdiolo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8346730/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Children with autism often exhibit behavioral problems, which can significantly affect family’s well-being by increasing parenting stress. A thorough understanding of the interactions between child behavioral problems and parenting stress is critical for developing effective support strategies. This systematic review synthesized findings from 88 studies investigating the associations between internalizing and externalizing behaviors and parenting stress in families of children with autism. The review specifically examined age-related changes in children’s behavioral patterns, identified behavioral subtypes most strongly linked to parenting stress, compared mothers’ and fathers’ experiences, and explored the evolution of these relationships over time. Studies assessing interventions designed to reduce behavioral problems and/or alleviate parenting stress were also included to evaluate their effectiveness. Across studies, higher levels of child behavioral problems were consistently linked to increased parenting stress. However, findings regarding the influence of the child’s age on the severity of behavioral problems, as well as the differences between mothers’ and fathers’ parenting stress levels, remained inconsistent. Longitudinal evidence supports transactional and bidirectional interactions that may intensify over time. Intervention programs demonstrated beneficial effects on both child behaviors and parenting stress, with effect sizes varying according to intervention type (parent-focused, child-focused, or parent–child interaction-centered). This review underscores the bidirectional relationship between child behavioral problems and parenting stress, highlighting the importance of interventions tailored to children’s developmental stage and family context. autism spectrum disorder child internalizing behaviors child externalizing behaviors parenting stress transactional relationships Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8346730","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618372153,"identity":"f2523bdb-3ce7-4b33-88af-85cab2641694","order_by":0,"name":"Madyson Messiaen","email":"data:image/png;base64,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","orcid":"","institution":"University of Mons","correspondingAuthor":true,"prefix":"","firstName":"Madyson","middleName":"","lastName":"Messiaen","suffix":""},{"id":618372156,"identity":"fb1720d3-df00-4ae4-aabb-99c8628c8096","order_by":1,"name":"Michel Sfeir","email":"","orcid":"","institution":"University of Mons","correspondingAuthor":false,"prefix":"","firstName":"Michel","middleName":"","lastName":"Sfeir","suffix":""},{"id":618372160,"identity":"895e489c-8d80-4dc1-8e6d-643c1ba94a7a","order_by":2,"name":"Justine Gaugue","email":"","orcid":"","institution":"University of Mons","correspondingAuthor":false,"prefix":"","firstName":"Justine","middleName":"","lastName":"Gaugue","suffix":""},{"id":618372165,"identity":"8fb9dd02-cd72-41fb-8d17-f805b63bec16","order_by":3,"name":"Sarah Galdiolo","email":"","orcid":"","institution":"University of Mons","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Galdiolo","suffix":""}],"badges":[],"createdAt":"2025-12-12 14:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8346730/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8346730/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106728056,"identity":"66223184-50f3-488f-82e8-0aebe3030dd6","added_by":"auto","created_at":"2026-04-12 18:41:38","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":965816,"visible":true,"origin":"","legend":"","description":"","filename":"BlindedManuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8346730/v1_covered_82136079-4150-41c1-9b5b-3430f473111c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Associations Between Internalizing and Externalizing Behaviors in Children with Autism and Parenting Stress: A Systematic Review","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"autism spectrum disorder, child internalizing behaviors, child externalizing behaviors, parenting stress, transactional relationships","lastPublishedDoi":"10.21203/rs.3.rs-8346730/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8346730/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChildren with autism often exhibit behavioral problems, which can significantly affect family\u0026rsquo;s well-being by increasing parenting stress. A thorough understanding of the interactions between child behavioral problems and parenting stress is critical for developing effective support strategies. This systematic review synthesized findings from 88 studies investigating the associations between internalizing and externalizing behaviors and parenting stress in families of children with autism. The review specifically examined age-related changes in children\u0026rsquo;s behavioral patterns, identified behavioral subtypes most strongly linked to parenting stress, compared mothers\u0026rsquo; and fathers\u0026rsquo; experiences, and explored the evolution of these relationships over time. Studies assessing interventions designed to reduce behavioral problems and/or alleviate parenting stress were also included to evaluate their effectiveness. Across studies, higher levels of child behavioral problems were consistently linked to increased parenting stress. 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