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

This systematic review synthesizes findings from 76 studies examining the associations between internalizing behaviors (IBs), externalizing behaviors (EBs), and parenting stress (PS) in families of children with autism. The objectives were to: (1) identify IBs and EBs subtypes most linked to PS; (2) compare PS levels between mothers and fathers; (3) assess the influence of child age on behavior severity; and (4) analyze transactional associations between PS and child behaviors. Positive correlations were observed between behavioral problems and PS. However, findings regarding the impact of child age on behavior severity and gender differences in PS levels were mixed. Most longitudinal studies supported transactional associations between PS and child behaviors, and intervention programs showed promise in reducing PS and behavioral issues. Keywords: autism spectrum disorder, child internalizing behaviors, child externalizing behaviors, parenting stress