Is There a Bidirectional Relationship Between Maternal Well-Being and Child Behavior Problems in Autism Spectrum Disorders? Longitudinal Analysis of a Population-Defined Sample of Young Children Vasiliki Totsika, Richard P. Hastings, Eric Emerson, Gillian A. Lancaster, Damon M. Berridge, and Dimitrios Vagenas The aim of this study was to examine whether the relationship between maternal psychological well-being and behavior problems in children with an autism spectrum disorder (ASD) is bidirectional. Data were available at 9 months, 3 years, and 5 years old for 132 children with ASD, identified from a population-representative sample of UK children. Three-wave cross-lagged models examined reciprocal effects between child behavior and maternal well-being (psycho- logical distress, physical health functioning, and life satisfaction). Results indicated that the relationships between maternal well-being and child problem behaviors were not bidirectional. Specifically, findings suggested that while early behavior problems are not a risk factor for later maternal well-being, maternal psychological distress, physical health limitations, and lower life satisfaction are risk factors for later child behavior problems. Autism Res 2013, 6: 201–211. © 2013 International Society for Autism Research, Wiley Periodicals, Inc. Keywords: autism; behavior problems; maternal well-being; bidirectional; longitudinal; population-representative Introduction The high levels of problem behaviors present in children with an autism spectrum disorder (ASD) have consis- tently been associated with lower levels of maternal well- being, with research suggesting that these behaviors may be the main drivers of parental psychological difficulties, much more so than the severity of autism symptoms [Barker et al., 2011; Blacher & McIntyre, 2006; Hastings et al., 2005; Lounds, Seltzer, Greenberg, & Shattuck, 2007; Totsika, Hastings, Emerson, Lancaster, & Berridge, 2011b]. This strong association between child problem behavior and parental well-being is evident in numerous cross-sectional studies in ASD [Davis & Carter, 2008; Hastings et al., 2005; Totsika, Hastings, Emerson, Berridge, & Lancaster, 2011a], and there is an expectation that the association extends over time and is bidirectional in nature. The assumption of a longitudinal relationship between child behavior and parental well-being in ASD has a more limited evidence base compared with cross-sectional findings, possibly because of the difficulties of conduct- ing longitudinal research in a population with relatively low prevalence. Subsequently, there is a dearth of evi- dence on whether the relationship is bidirectional over time. The expectation that children affect their environ- ments, and environments affect children [Sameroff & Mackenzie, 2003] over time methodologically translates into identifying significant longitudinal reciprocal effects between child outcomes and environmental factors. Findings of reciprocal effects support the theoretical view of development as a process of continuous transaction between the child and his/her social environment [Sameroff, 2009, 2010]. In the field of ASD, in addition to the difficulties of conducting longitudinal studies with small N, few attempts are evident of explicitly modeling reciprocal effects, as the dominant approach is the examination of child-driven effects, with most studies looking at the negative outcomes of raising a child with ASD. While this has partly risen as a response to historical views of autism as the result of suboptimal parenting to some extent From the School of Psychology, Bangor University, Bangor, UK (V.T., R.P.H.,); Centre for Disability Research, Lancaster University, Lancaster, UK and University of Sydney, Sydney, New South Wales, Australia (E.E.,); Department of Mathematics and Statistics, Lancaster University, Lancaster, UK (G.A.L., D.M.B.,); Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia (D.V.) Received September 3, 2012; accepted for publication January 21, 2013 Address for correspondence and reprints: Vaso Totsika, North Wales Clinical Psychology Programme, School of Psychology, Bangor University, 43 College Road, Bangor, Gwynedd, Wales LL572DG, UK. E-mail: v.totsika@bangor.ac.uk Grant Sponsor: Economic and Social Research Council (ESRC), Grant Number: ESRC RES-000-22-3216. Conflict of Interest Declaration: The authors have no direct or indirect conflict of interest related to the work presented in this paper. Published online 21 February 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/aur.1279 © 2013 International Society for Autism Research, Wiley Periodicals, Inc. RESEARCH ARTICLE INSAR 201 Autism Research 6: 201–211, 2013