Parental Misattribution of Environmental Stress Reaction Symptoms to Autism

Randall Phelps, Amanda Van Scoyoc, Melissa Marquardt

Research output: Contribution to journalArticlepeer-review


Objective: This research aims to characterize parental misattribution to autism of challenging child behaviors related to environmental stress. Methods: To identify differences between parental concern about behavioral challenges and child diagnoses, researchers reviewed records of children assessed at a child development clinic (N 5 50, mean age 5 4.38), genetics clinic (N 5 26, mean age 5 4.59), and therapeutic preschool (N 5 30, mean age 5 3.75), comparing referral information with child diagnoses postassessment. Surveys of parental and teacher concerns regarding children at therapeutic preschool who were not referred for consultation (N 5 49) were reviewed and compared with the referral population to assess for referral bias. Results: A high rate of parental concern about autism/neurodevelopmental disabilities was found in therapeutic preschool referrals (63%) and the child development clinic (74%), with fewer concerns in the genetics clinic (19%), in contrast with substantially lower numbers ultimately diagnosed with autism spectrum disorder (13%, 32%, and 8%, respectively). Across clinics, parents demonstrated greater concern about autism than environmental stress. In all clinics, more children had symptoms related to environmental stress than referrals suggested. Seventy-seven percent of children in the therapeutic preschool, 30% in the child development clinic, and 47% in the genetics clinic were diagnosed with trauma and stressor-related disorders. The results from children not referred for consultation suggest that referral bias plays a role in this phenomenon because parents of these children express similar levels of concern about their child’s development (32%) and challenges related to environmental stressors (29%). Conclusion: The results suggest a tendency for parents seeking consultation to attribute to autism behavioral symptoms related to environmental stress.

Original languageEnglish (US)
Pages (from-to)264-271
Number of pages8
JournalJournal of Developmental and Behavioral Pediatrics
Issue number4
StatePublished - May 1 2021


  • Autism
  • Differential diagnosis
  • Parental concern
  • Trauma
  • Trauma and stressor-related disorders

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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