Date Presented 04/22/2023

Stress, sleep, and sensory processing heavily influence a person’s occupational performance and occupational roles. OTs should understand the influence of resilience on these factors in order to offer appropriate caregiver support for parents of children with autism spectrum disorder (ASD). OT support will benefit parents, their children, families, and communities because they can cope better with everyday stressors.

Primary Author and Speaker: Megan C. Chang

Additional Authors and Speakers: Elana Candiotti-Pacheco, Kate Hatch, Chiana Hosseini, Carley Kruger, Mercedes Mansfield

INTRODUCTION: Current literature indicates high levels of stress (Pastor-Cerezuela et al., 2021) and poor sleep quality (Abdullah et al., 2021; Roberts et al., 2017) for parents of children with autism spectrum disorder (ASD). Resilience has a buffering effect on stress (Bitsika et al., 2013) and is vital for parents of children with ASD due the increased levels of stress and demands associated with ASD (Seltzer et al., 2000). Sensory processing is a significant factor that influences sleep quality and perceived stress (Engel-Yeger & Schochat, 2012), but there is limited research on the relationship between sensory processing patterns and resilience. The purpose of this study is to understand how resilience influences perceived stress, sleep quality, and sensory processing in parents of children with ASD while considering the mediating effects of children’s strengths and difficulties.

METHODOLOGY: This study is a cross-sectional, quantitative survey study conducted on Qualtrics. Along with a brief demographic questionnaire, five standardized assessments were included: (a) Connor-Davidson Resilience Scale (CD-RISC-25; Connor & Davidson, 2003), (b) Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989), (c) Adult Sensory Processing Scale (ASPS; Blanche et al., 2014), (d) Strength and Difficulties Questionnaire (SDQ; Goodman, 1997) and (e) The Perceived Stress Scale (PSS; Cohen et al., 1983). Descriptive, correlational, and inferential statistics were used for data analysis.

RESULTS: Of 65 started the survey, 22 parents of children with ASD participated in this study, with 81.8% being mothers. The average sleep hours were 7 hours and 45 minutes per night. Seventeen participants (77.2%) had a global score of 5 or higher on the PSQI. Results showed significant lower resilience levels (p < .001) and higher perceived stress (p < .001) when the sample data was compared to the norms. Regarding sensory processing patterns, compared to the population mean, there were significant higher scores in over-responsiveness to auditory input (p < .003), general under-responsiveness (p < .005), and under-responsiveness to proprioceptive-vestibular input affecting postural-motor abilities (p < .001). Low resilience was associated with sleep difficulties (r = -.46, p = .03) while higher resilience was associated with lower stress (r = -.81, p = .00). Additionally, significant positive correlational relationships were found between sleep difficulties and SDQ (r = .49, p = .02) as well as sleep difficulties and perceived stress (r = .59, p = .00).

DISCUSSION: Results indicated that these parents experienced significant sleep disturbances and stress, which may influence their resilience. Further, sleep disturbances may be impacted by sensory processing preferences and their child’s behavioral concerns. Thus, results suggest that parental resilience and associated factors of sleep, stress, and sensory processing patterns may need to be included in the evaluation when providing treatment to their children to develop a holistic and family-centered approach. Providing support to parents will ultimately help the child and support factors that influence occupational engagement and overall well-being. Occupational therapists can offer support for the parents’ unique sensory and sleep hygiene needs and educate them on the influence of resilience while they face their daily life stressors.


Pastor-Cerezuela, G., Fernandez-Andres, M. I., & Tijeras-Iborra, A. (2021). Parental stress and resilience in autism spectrum disorder and down syndrome. Journal of Family Issues, 42(1), 3–26.

Roberts, C. A., Hunter, J., & Cheng, A. L. (2017). Resilience in families of children with autism and sleep problems using mixed methods. Journal of Pediatric Nursing, 37, e2–e9.