Revista Enfermería Herediana

ORIGINAL ARTICLE

DOI: https://doi.org/10.20453/renh.v18i2.7123

2025, July-December | Volume 18, Issue 2, e7123

Intervention for the management of stress manifestations in parents of children with autism spectrum disorder

Esther Ellumi Irene Portales Marquez¹ , Diana Carolina Ortiz Quispe¹ , Nancy Laura Salinas Escobar^{1, 2}

¹ Universidad Peruana Cayetano Heredia, School of Nursing. Lima, Peru.

² Hospital Nacional Arzobispo Loayza. Lima, Peru.

Scientific contribution

Caring for children with autism generates significant physical and psychological stress in parents. Given the scarcity of programs for caregivers—most of which are primarily child-centered—this study evaluates the effectiveness of an educational intervention aimed at managing parental stress.

ABSTRACT

Objective: Objective: To determine the effectiveness of an educational intervention in managing stress manifestations in parents of children with autism spectrum disorder (ASD). Materials and methods: Pre-experimental study conducted in Lima, Peru. The sample included 50 parents of children with ASD at a Special Basic Education Center. The validated instrument “Questionnaire on manifestations of stress in parents of children with autism” was used. Data analysis was performed using the statistical program Stata v.18.0, employing frequency distributions and the paired Student's t test. Results: The average stress score decreased from 38.88 before the intervention to 23.62 after the intervention. In the behavioral/physical manifestations dimension, the predominant indicators prior to the intervention were muscle tension (32.0%) and fatigue (30.0%); subsequently, appetite disturbances (8.0%) and muscle tension (6.0%) stood out. In the psychological manifestations dimension, fear and worry decreased from 72.0% and 56.0% (pre-test) to 28.0% and 18.0% (post-test), respectively. Conclusions: The educational intervention proved to be effective in managing manifestations of stress in parents of children with ASD.

Keywords: autism spectrum disorder; stress; parents; effectiveness of interventions.

INTRODUCTION

It is estimated that approximately 300,000 children diagnosed with autism spectrum disorder (ASD) live in Latin America. This condition affects 1 in 94 boys and 1 in 150 girls (1). Children with this disorder often exhibit behavioral, communication, social interaction, and emotional development impairments, as well as restrictive or repetitive interests (2).

At home, families require preparation and adaptation, as receiving this type of diagnosis in a child represents a significant life change that generates uncertainty and stress (3). This situation impacts the family environment, dynamics, and financial stability. Furthermore, it may indirectly affect parents’ personality traits and behavioral responses, with negative consequences for their physical health and emotional well-being (4).

The demand for care increases or causes stress due to physical, emotional, and family overload on the father, who becomes the primary caregiver. Therefore, parental stress is defined as the discomfort derived from the demands associated with performing this role, an aspect that is accentuated in parents of children with ASD (1).

To protect and promote health, nursing professionals provide holistic care to these patients and their families. To enhance both physical and psychological well-being, communication-based strategies and relaxation techniques that promote positive change are used (5).

The nursing professional seeks to deliver the care required by parents through psychosocial support, guidance, health education, accompaniment, and counseling. The objective is to enable them to perform their caregiving role effectively, maintaining physical and mental balance while fostering assertive family interactions. By equipping parents with appropriate coping tools, they may better regulate their behaviors and manage stress manifestations as they arise (6).

In that sense, educational interventions are defined as motivational, pedagogical, methodological, and evaluative actions and activities implemented over a defined period. Their purpose is to educate specific individuals or groups to achieve predetermined objectives (7).

Several studies have implemented interventions among parents of children with ASD. In Saudi Arabia, after an intervention, appropriate caregiving practices increased from 35.0% to 75.0% (8). In Egypt, after a counseling intervention, moderate stress reported by parents decreased from 57.5% to 26.0%, while the expression of intense emotional responses declined from 80% to 32.5% (9).

Similarly, in Chile, with the implementation of a program, the mean score for parents’ knowledge of ASD increased from 57.71 to 88.76 points (10). In the same way, a study conducted in Peru showed that before the intervention, 54.0% of parents reported experiencing stress manifestations “almost always” and “always”; afterwards, 84.0% reported experiencing them “almost never” and “never” (11).

This highlights the importance of interventions by healthcare professionals, given the high levels of stress experienced by parents in this situation (12). However, research and public policies focused on the well-being of parents of children with autism remain limited. Within the national context, the issue lies in the scarcity of nursing-led educational interventions targeting the mental health of this population. Accordingly, the present study was conducted to determine the effectiveness of an intervention designed to manage stress manifestations in parents of children with ASD attending a Special Basic Education Center.

MATERIALS AND METHODS

This study employed a quantitative approach with a pre-experimental design. It was conducted at a Special Basic Education Center located in the district of Puente Piedra, Lima, Peru.

The study population consisted of 135 parents of children diagnosed with ASD. After the sample calculation, a result of 48 participants was obtained; however, to account for potential missing data, the sample was increased by 3.0%, resulting in a final total of 50 participants. Participants were selected using simple non-probability random sampling.

Data collection was carried out using the “Questionnaire on Manifestations of Stress in Parents of Children with Autism”, developed by Chayan et al. (11) in Peru. The instrument was validated by ten experts; the binomial test yielded a significance level of 0.0087 (p < 0.05). Reliability was determined through a pilot test involving 17 parents, resulting in a Cronbach’s alpha value of 0.878.

The questionnaire consisted of 20 indicators distributed across two subscales: behavioral/physical manifestations (fatigue or exhaustion, headaches, sleep-onset difficulties, nervous tics, overeating, decreased appetite, muscle tension, medication use, and impulsivity) and psychological manifestations (anxiety, concern regarding the child’s behavior, fear about potential harm to the child, depression, difficulty making decisions related to the child’s health, difficulty concentrating on other daily activities, irritability or bad mood, difficulty relaxing, concern about parental responsibility, exaltation, and loss of self-confidence. The assessment was carried out using a Likert scale from 0 to 4 points, structured as follows: 0 (never), 1 (almost never), 2 (sometimes), 3 (almost always), and 4 (always). The educational intervention, entitled “Learning to Manage Stress,” was supervised by a mental health professional and consisted of two in-person sessions lasting approximately 50 minutes each, with a frequency of once a week. The first session was conducted on the same day as the pre-test administration.

For pedagogical purposes, the sample was divided into two groups of 25 parents; both groups received the same intervention and information. Each session was structured into two approximately 25-minute segments: a theoretical component and a practical component, supported by didactic and supplementary educational materials.

Each session began with an introductory activity. The first session addressed the definition of stress, its physical manifestations, physical well-being, problem-solving strategies, and relaxation techniques. The second session focused on psychological manifestations, their classification, mental well-being, and relaxation techniques. At the end of each session, a feedback segment was conducted to address participants’ questions. An informational brochure was handed out, and upon completion of the program, attendees received a healthy snack kit.

The post-test was administered seven business days after the final session under the same conditions and facilities as the pre-test. This interval was considered appropriate to identify information assimilation and retention among participants.

Data analysis was performed using STATA version 18. After analyzing normality, a paired Student’s t-test was selected. A statistical significance level of 0.05 (p < 0.05) was considered.

The study adhered to established bioethical principles, even obtaining informed consent. These principles were observed, monitored, and approved by the Research Ethics Committee of Universidad Peruana Cayetano Heredia.

RESULTS

Table 1 presents the sociodemographic data of the study sample. 96.0% of participants were women, and the mean age was 39.

Table 1. Sociodemographic data of parents of children with autism spectrum disorder (ASD) attending a Special Basic Education Center.