Influences on Parent Perceptions of Autism Severity

Research in autism spectrum disorder (ASD) often relies on parent report for describing behavior and symptoms. Psychometric studies in assessment have supported the utility of parent report; however, cultural and external factors may influence ratings of severity. The purpose of this study was to investigate if parent characteristics influence the severity rating of ASD over and above child characteristics. Using the 2009-2010 National Survey of Children With Special Health Care Needs (NS-CSHCN), we examined 3,037 parents who answered questions about their child's ASD symptoms. We used hierarchical multiple regression to assess child-level variables (age, developmental delay, intellectual disability, and number of co-occurring emotional or behavioral conditions) and family-level variables (education, income, and language). We also performed mediation analyses to examine the relationship between language and severity ratings. Parents rated their child's ASD as mild (52.3%), moderate (36%), or severe (11.8%). Parent-level variables explained a significant amount of variance over and above child-level variables. Several different stressors and challenges for English Language Learner parents mediated the relationship between language and severe ASD ratings. When asking parents to evaluate a child's ASD symptoms, clinicians and researchers must consider the influence of sociocultural factors on ratings. In addition, because parent perception can drive help-seeking behaviors, professionals need to understand that there may be differences across sociocultural groups. Future research should investigate which sociocultural perceptions or expectations may be affecting parent ratings of ASD severity.