Parenting stress and interactive engagement behaviors in children with developmental delay

Background: In clinical practice, the importance of interactive engagement behaviors is overlooked in children with developmental problems other than autism spectrum disorder (ASD). Parenting stress affects children's development but lacks attention from clinicians. Purpose: This study aimed to identify the characteristics of interactive engagement behaviors and parenting stress among non-ASD children with developmental delays (DDs). We also analyzed whether engagement behaviors affect parenting stress. Methods: At Gyeongsang National University Hospital, between May 2021 and October 2021, we retrospectively enrolled 51 consecutive patients diagnosed with DDs in language or cognition (but not ASD) in the delayed group and 24 typically developing children in the control group. The Korean version of the Parenting Stress Index-4 and Child Interactive Behavior Test were used to assess the participants. Results: The median age of the delayed group was 31.0 months (interquartile range, 25.0-35.5 months); this group included 42 boys (82.4%). There were no intergroup differences in child age, child sex, parental age, parental educational background, mother's employment status, or marital status. Higher parenting stress (P<0.001) and fewer interactive engagement behaviors (P<0.001) were observed in the delayed group. Low parental acceptance and competence had the largest effects on total parenting stress in the delayed group. A mediation analysis revealed that DDs did not directly affect total parenting stress (beta=3.49, P=0.440). Instead, DDs contributed to total parenting stress, which was mediated by children's overall interactive engagement behaviors (beta=57.30, P<0.001). Conclusion: Interactive engagement behaviors were significantly reduced in non-ASD children with DDs and significantly mediated parenting stress. The importance of parenting stress and interactive behaviors in children with DDs should be further examined in clinical practice.