Autism & Developmental

The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning.

Rao et al. (2009) · Behavior modification 2009
★ The Verdict

High-functioning autism still brings high parent stress, so treat the family too, not just the child.

✓ Read this if BCBAs running home or clinic programs for school-age clients with HFA.
✗ Skip if Practitioners who only see infants or adults.

01Research in Context

01

What this study did

The team compared parents of kids with high-functioning autism to parents of typically developing kids.

They wanted to know if child IQ shields parents from stress.

The study used surveys and interviews with both groups.

02

What they found

Parents of children with HFA felt much more stress than the control parents.

Child IQ made no dent in this stress level.

Even bright kids with autism still wore their parents down.

03

How this fits with other research

Fahmie et al. (2013) pooled many studies and found the same big stress gap, so our 2009 result still stands.

Shepherd et al. (2018) later showed that fighting for services, not child IQ, is the real stress engine.

Dai et al. (2025) gave families hospital-plus-home DTT and finally cut that stress, proving the 2009 cry for help was real.

04

Why it matters

You can stop assuming that “high-functioning” means low parent stress. Build stress checks into every HFA treatment plan. Offer parent training, advocacy coaching, or brief mindfulness groups right away. When you ease parent stress, you free up energy for the child’s program to work.

Free CEUs

Want CEUs on This Topic?

The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.

Join Free →
→ Action — try this Monday

Add a five-question parent stress rating to your intake packet and review it each month.

02At a glance

Intervention
not applicable
Design
quasi experimental
Sample size
30
Population
autism spectrum disorder
Finding
negative

03Original abstract

The article discusses a study conducted to investigate the impact of children with high-functioning autism (HFA) on parental stress, sibling adjustment, and family functioning; the study involves a sample of parents of 15 children with HFA and parents of 15 matched control children who completed questionnaires measuring the dependent variables. The results indicate parents of children with HFA experience significantly more parenting stress than parents of children with no psychological disorder, which was found to be directly related to characteristics of the children. The study further shows that the higher intellectual functioning in children with HFA does not compensate for the stress associated with parenting children with autism spectrum disorders. Because the intervention efforts directed at children with HFA will not eliminate the child's primary symptoms, treatment programs may need to address parental stress, which in turn will help optimize treatment outcome for the child and the family.

Behavior modification, 2009 · doi:10.1177/0145445509336427