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Journal of Intellectual Disability Research
1
Psychometric properties of the Parenting Stress Index
with parents of children with autistic disorder
L. A. Dardas1 & M. M. Ahmad2
1 Community Health Nursing Department, The University of Jordan/The Faculty of Nursing, Amman, Jordan
2 Clinical Nursing Department, The University of Jordan/The Faculty of Nursing, Amman, Jordan
Abstract
Purpose The purpose of this study was to examine
the psychometric properties and the theoretical
structure of the Parenting Stress Index-short form
(PSI-SF) with Jordanian parents of children with
autistic disorder.
Methods Using a cross-sectional design for data
collection, the convenience sample of the study was
composed of 184 Jordanian parents of children with
autistic disorder. The factor structure for the
PSI-SF was examined using confirmatory and
exploratory factor analyses.
Results We found that the modified three-factor
model (30 items) fits the data significantly better
than the 36-item model. The results showed that
the 12 items of the Parental Distress sub-scale
support the original scale structure. However, items
in the Parent–Child Dysfunctional Interaction and
Difficult Child sub-scales did not show stability in
their structure. The results in this study showed
that the PSI-SF in its 30-item model has endorsed
the necessary validity of the scale with parents of
children with autistic disorder. The study provides
information on the effects of Arab culture on the
validity of PSI-SF.
Correspondence: Ms Latefa Ali Dardas, Community Health
Nursing Department, The University of Jordan, Amman 11942,
Jordan (e-mail: l.dardas@ju.edu.jo).
© 2013 John Wiley & Sons Ltd, MENCAP & IASSID
doi: 10.1111/jir.12053
Conclusion It is recommended to use the new
factors structure of the PSI-SF with the 30 items in
the studies that intend to examine the stress among
parents with children with autistic disorder in the
Arab world.
Keywords Arabs, autistic disorder, confirmatory
factor analysis, Parenting Stress Index,
psychometrics
Introduction
Stress is an inevitable aspect of human life that
affects people differently (Lazarus & Folkman
1984). Parenting stress can be defined as an ‘aver-
sive psychological reaction to the demands of being
a parent’ (Deater-Deckard 1998, p. 315). According
to Abidin (1995), parenting stress stems from a
complex combination that has three sets of factors
related to the child, the parent, and the child–parent
interactions. Although some parenting stress is con-
sidered normal and functional for all parents (Crnic
& Greenberg 1990; Deater-Deckard & Scarr 1996),
research indicates that parents of children with
chronic disabilities are at increased risk of experi-
encing elevated levels of stress. Indeed, it has been
found that raising a child with chronic developmen-
tal disability is one of the most significant stressors
for the parents (Weiss 1991; Koegel et al. 1992;
 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF
Ericzon et al. 2005). Autistic disorder represents not
only one of the most severe and pervasive chronic
childhood disorders but also, the most complex in
its developmental pattern [American Psychiatric
Association (APA) 2000]. The disorder affects brain
functions, specifically those areas that control social
behaviours and communication skills. Thus,
affected individuals are characterised by marked
impairments in social interaction, delayed and/or
stereotyped communication, and restricted or
repetitive behaviours and interests (APA).
Raising a child with autistic disorder has many
inter-mutual influences on parents and their chil-
dren. It has been found that the complexity and
chronicity of autistic disorder can drain the parents’
energy and leave them exhausted, in despair and at
risk for many psychosocial problems including
elevated levels of stress (Sivberg 2002; Abbeduto
et al. 2004; Seltzer et al. 2004). On the other hand,
high levels of parental stress can adversely affect the
children’s cognitive, language, behavioural and
social development (McGlone et al. 2002; Anthony
et al. 2005; Farver et al. 2006; Hart & Kelley 2006;
Pesonen et al. 2008).
What is known about the adverse impacts of
autistic disorder on parental stress affirms the need
to intervene early and consistently to provide
support for those parents. In order to have confi-
dence in the interventions proposed based on the
parents’ level of stress, it is necessary to have a well-
established, reliable and valid measure for parenting
stress. One of the most commonly used measures is
the Parenting Stress Index-Short Form (PSI-SF;
Abidin 1995). The measure has three sub-scales,
Parental Distress (PD); Parent–Child Dysfunctional
Interaction (PCDI); and Difficult Child (DC)
(Abidin).
The PSI-SF is considered a valid and reliable
measure when used with parents of typically devel-
oping children. Indeed, several studies have investi-
gated the psychometric properties of the PSI-SF
with parents of typically developing children. While
some of these studies have revealed reasonably
distinct factor structure for the measures with
very good to excellent internal consistencies (e.g.
Reitman et al. 2002), other studies failed to support
the three-factor structure of the scale (e.g.
Whiteside-Mansell et al. 2007; McKelvey et al.
2009). According to Farmer & Peterson (2012),
© 2013 John Wiley & Sons Ltd, MENCAP & IASSID
these mixed results could be attributed to the
sample characteristics recruited for each study. In
particular, they found the differences in the chil-
dren’s ages as having a potential influence on paren-
tal stress ratings.
Surprisingly, the PSI-SF scale has been used in
many publications that targeted parents of children
with autistic disorder. However, psychometric work
on this measure has been conducted primarily with
samples of healthy children. To date, only one study
examined the psychometric properties of the
PSI-SF in samples of parents of children with
autistic disorder (Zaidman-Zait et al. 2010). In that
study, several items in the PCDI and DC sub-scales
showed poor functioning. The authors recom-
mended additional research work to examine the
factor structure of the PSI-SF in samples of parents
of children with autistic disorder. Further, no inves-
tigations were made in the Arab world yet. Thus,
two main reasons warrant conducting this study:
First, two of the PSI-SF sub-scales (PCDI and DC)
address the characteristics of children that may be
stressful to their parents. However, the characteris-
tics of children diagnosed with autistic disorder
differ substantially from those with typical develop-
ment. Consequently, assuming that the PSI-SF
(which was assessed with normative samples) is
valid across populations including those with perva-
sive chronic disabilities may lead to inappropriate
explanations. The second reason for conducting this
study relies in its population which was in part from
the Arab world (Jordanian parents of children with
autistic disorder).
Arabs are united in a shared culture that is con-
sidered substantially different from their western
counterparts (Retso 2002). The term culture can be
defined as a shared set of traditions, belief systems,
and behaviours shaped by history, religion, ethnic
identity, language, and nationality (Griffith et al.
2003). Among Arabs, it is an extremely important
responsibility to bring children up so that they will
reflect well on the family. Arabs tend to give parents
much of the credit for their children’s successes and
much of the blame for their failures (Nydell 2005).
In his review for the recent literature regarding the
impact of Arab culture on mental illness and mental
health, Fakhr El-Islam (2008) found that Arab cul-
tural beliefs and practices have many influences in
shaping the definition, perception, diagnosis, and
 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF
management of psychiatric disorders. Recognition
of such diversities among cultures is necessary in
order to design and conduct valid and reliable
research, as well as accurate cross-cultural pro-
grams. No investigations regarding the psychometric
properties of the PSI-SF have been made in the
Arab world in samples of parents of children with
developmental disabilities in general and autistic
disorder in particular. The purpose of this study
was to validate the PSI-SF with Jordanian parents
of children with autistic disorder using exploratory
factor analysis (EFA) and confirmatory factor analy-
sis (CFA) techniques.
Methods
Participants
The convenience sample of the study was com-
posed of 184 parents of children with autistic disor-
der. Parents were included in the study if (1) they
had a child under the age of 12 with a clinical diag-
nosis of autistic disorder made by board-certificated
child psychiatrists using the Diagnostic and Statisti-
cal Manual of Mental Disorders DSM-IV-TR
(fourth edition, text revision), and (2) they were
able to read and write in Arabic. Parents were con-
tacted through special education centres licensed to
provide educational services for children with autis-
tic disorder. The collection of the data was con-
ducted by the first author over a period of 5 months
(March to August 2012).
Among the 184 participants, 62% (n = 114) were
females (mothers). The mean age for the sample
was 37 years (SD ⫾ 7.6) ranging from 21 to 69
years. About 97% (n = 178) of the participants were
married. The mean income for the participants’
family was 498 Jordanian Dinar (1 JD = 1.4 US
Dollar) ranging from 150 to 1500 JD. In relation to
the number of children the participants had, 3.8%
(n = 7) had one child, 24.5% (n = 45) had two chil-
dren, 28.8% (n = 53) had three children, 21.2%
(n = 39) had four children, 13.6% (n = 25) had five
children, and 8.2% (n = 15) had 6–10 children. All
of the participants had only one child diagnosed
with autistic disorder.
All of the children were clinically diagnosed with
autistic disorder from board-certificated child psy-
chiatrists using the DSM-IV criteria (American
© 2013 John Wiley & Sons Ltd, MENCAP & IASSID
Psychiatric Association 2000). Only one centre
adopted the multi-disciplinary diagnostic approach
using two assessment tools, the DSM-IV and the
Childhood Autism Rating Scale (CARS; Schopler
et al. 1988). The criteria of the DSM-IV were
used across the regions from which children were
recruited as it is considered a standardised diagnos-
tic procedure for autistic disorder in the country.
About 84% (n = 155) of the children were males.
The mean age for them was 6.3 years (⫾3) ranging
from 2 to 12 years. The mean age for the children
at which symptoms firstly appeared was 2 years
(SD ⫾ 1) ranging from 6 months to 5 years. The
mean age at which the children were medically
diagnosed with autistic disorder was 3 years
(SD ⫾ 1) ranging from 9 months to 6 years.
This study has followed Nunnally & Bernstein’s
(1994) guideline to determine the sample size when
using factor analysis; a minimum of five cases per
item are needed. The total number of items in the
original PSI is 36, thus, the sample size should be at
least 180.
Measures
The PSI-SF is a 36-item self-reported questionnaire
designed to measure stress associated with parenting
among parents of children younger than 12 years of
age (Abidin 1995). The measure has three sub-
scales, each consisting of 12 items: PD; PCDI; and
DC (Abidin). The PD sub-scale measures parents’
perceptions of their own behaviour including per-
ceived competence, marital conflict, views of social
support, and life restrictions because of the parent-
ing demands, (e.g. ‘I feel trapped by my responsi-
bilities as a parent’). The PCDI sub-scale measures
the parents’ view of expectations and interactions
with their child, (e.g. ‘My child rarely does things
for me that make me feel good’). The DC sub-scale
measures the parents’ perceptions of their child’s
temperament, demandingness, and compliance,
(e.g. ‘My child makes more demands on me than
most children’) (Abidin).
The PSI-SF also has a reliability scale (Defen-
sive Responding) consisting of seven items from
the PD scale. Respondents scoring less than a raw
score of 10 is thought to signify either that parents
are minimising parenting stress, that they are more
competent than the average parent and unusually
 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF
sanguine, or that they do not care enough about
the child to feel stressed by the difficult behaviour
(Abidin). In this study, the mean score for the
defensive responding reliability scale was 23 (⫾5.7)
indicating valid results for subsequent analysis.
The items of the scale range from 1 (strongly
disagree) to 5 (strongly agree) and has a 5th grade
reading level. The expected time to complete the
questionnaire was between 10 and 15 min. Raw
scores above 33 on the PD and DC sub-scales and
above 27 on the PCDI sub-scale are considered
clinically elevated. Raw total scores above 90 indi-
cates clinically significant high level of stress scores
(Abidin 1995). Test–retest reliability coefficients of
the total stress score have been reported to be 0.84,
for the PD sub-scale 0.85, for the PCDI sub-scale
0.68 and for the DC 0.78. For the internal consist-
ency of the PSI-SF, reports for total stress have
been 0.91, for PD 0.87, for PCDI 0.80 and for the
DC sub-scale 0.85 (Abidin 1995).
Ethical considerations
Ethical approval was granted by the academic
research committee at the deanship of the academic
research in the University of Jordan. The purpose,
methods, risks, and benefits of the study were
explained to the participants before they decided to
participate. The participants were assured that their
participation is completely voluntary. Confidentiality
of the data obtained were assured by assigning an
identification number (ID) to the participants,
attaching the ID number rather than other identifi-
ers to the actual data, and restricting access to iden-
tifying information.
Factor analysis
Researchers used EFA to summarise data by
grouping together variables that are intercorre-
lated. Whereas CFA necessitates the estimation
and specification of one or more hypothesised
models of factors structure, each of which pro-
poses a set of latent variables (factors) to account
for covariance among a set of observed variables.
Moreover, there is a principal difference between
EFA and CFA; in EFA there is no priori restric-
tions placed on the pattern of relationships
between the observed measures and the latent
© 2013 John Wiley & Sons Ltd, MENCAP & IASSID
variables; while in CFA, the researcher must
specify in advance a number of key aspects of the
factor model such as the number of factors and
factor loadings (Brown 2006).
In this study, CFA was used to evaluate the
validity of the PSI among parents of children with
autistic disorder by assigning the items to their
respective factors according to theoretical expecta-
tions (Arbuckle 2012). However, CFA may follow
an EFA and both techniques are considered com-
plementary to each other (Munro 2005).
Results
Regarding the total scores among the three stress
sub-scales, the highest score was for PD sub-scale
(40.29 out of 60); whereas the lowest score was for
PCDI (37.70). The highest score among the 36
items was ‘ My child makes more demands on me
than most children’ (4.41 out of 5) under the DC
sub-scale. Table 1 presents the participants score
means and standard deviations for each item in the
36-item scale. The EFA was performed using the
Statistical Package for Social Sciences (IBM
Corporation 2012).
A principal components analysis with Varimax
rotation for the parents of children with autistic
disorder was performed with the 36 items in the
original PSI scale and with the modified 30 items.
Determining the number of factors to be extracted
depends on how strongly and cleanly the variables
load on the factors (Munro 2005). The variable
loads strongly on a particular factor if loading
ⱖ0.40, and is considered clean if the absolute dif-
ference between the loading is more than 0.20
(Nunnally & Bernstein 1994). Accordingly, non-
clean and or low loading items were deleted from
the model (PCDI: 19, 22, 24; DC: 31, 32, 33), and
two items (PCDI: 18, 21) were re-allocated to DC
sub-scale to fit the theoretical meaning and loading
criteria. The modified model ended with 30 items.
Table 2 shows the loading of the 30 items on the
three factors and the accounted cumulative variance
with entire sample was 50.36%. Yet, the accounted
cumulative variance with the 36 items was only
41.71%.
The Kaiser–Meyer–Oklin (KMO) is a measure
that provides an approach to comparing the
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF

Table 1 Means and standard deviations (SDs) for the 36 items of the Parenting Stress Index

Item # Item label Mean SD

pd1 I often have the feeling that I cannot handle things very well 3.53 1.08
pd2 I find myself giving up more of my life to meet my child’s needs than I ever expected 4.11 1.03
pd3 I feel trapped by my responsibilities as a parent. 3.65 1.23
pd4 Since having my child I have been unable to try new and different things 3.34 1.31
pd5 Since having my child I feel that I am almost never able to do things that I like to do 3.38 1.25
pd6 I am unhappy with the last purchase of clothing I made for myself 3.25 1.34
pd7 There are quite a few things that bother me about my life 3.66 1.13
pd8 Having a child has caused more problems than I expected in my relationship with my spouse 2.63 1.43
pd9 I feel alone and without friends 2.42 1.25
pd10 When I go to a party I usually expect not to enjoy myself 3.47 1.28
pd11 I am not as interested in people as I used to be 3.34 1.31
pd12 I don’t enjoy things as I used to. 3.51 1.26
Total score for Parental Distress sub-scale 40.29 10.47
pcdi13 My child rarely does things for me that make me feel good 3.36 1.18
pcdi14 Most times I feel that my child likes me and wants to be close to me 1.87 1.12
pcdi15 My child smiles at me much less than I expected
pcdi16 When I do things for my child, I get the feeling that my efforts are not appreciated very much 3.14 1.20
pcdi17 When playing, my child doesn’t often giggle or laugh. 2.82 1.20
pcdi18 My child doesn’t seem to learn as much as most children 4.23 1.01
pcdi19 My child is not able to do as much as I expected. 3.86 0.99
pcdi20 My child doesn’t seem to smile as much as most children. 3.47 1.32
pcdi21 It takes a long time and it is really hard for my child to get used to new things 3.40 1.22
pcdi22 I feel that I am: (being a parent) 2.25 1.03
pcdi23 I expected to have closer and warmer feelings for my child than I do and this bothers me 3.02 1.30
pcdi24 Sometimes my child does things that bother me just to be mean 3.35 1.25
Total score for Parent–Child Dysfunctional Interaction sub-scale 37.70 8.73
dc25 There are some things my child does that really bother me a lot. 4.23 0.78
dc26 My child generally wakes up in a bad mood 2.74 1.27
dc27 I feel that my child is very moody and easily upset 3.58 1.14
dc28 My child does a few things that bother me a great deal 3.88 1.00
dc29 My child reacts very strongly when something happens that my child doesn’t like 3.87 1.02
dc30 My child gets upset easily over the smallest thing 3.16 1.19
dc31 My child’s sleeping and eating schedule was much harder to establish than I expected. 3.04 1.36
dc32 I have found that getting my child to do something is: 2.08 0.90
dc33 Think carefully and count the number of things which your child does that bothers you. 2.22 1.30
dc34 My child turned out to be more of a problem than I expected. 3.16 1.29
dc35 My child makes more demands on me than most children. 4.41 0.80
dc36 My child seems to cry more often than most children 3.59 1.22
Total score for Difficult Child sub-scale 39.95 7.58

zero-order correlations to the partial correlations
between pairs of variables (Munro 2005). The
KMO in EFA in the study model is 0.89; Kaiser
(1974) stated that if KMO is greater than 0.50 it is
acceptable. The closer the KMO to one, the better
the correlations between pairs of variables that can
be explained by the other variables (Norusis 1998).
Bartlett’s Test of Sphericity evaluates all factors
together and each factor separately against a
hypothesis stating that there are no factors
(Tabachnick & Fidell 2001). The Bartlett’s Test in
this study is significant (P < 0.001), indicating that
enough shared variance is present. The modified
structural model for the PSI scale in this study is
identified by three interrelated constructs. The
Cronbach’s alphas for the 30-item three-factors
model of PSI in the current study were equal or
higher than the 36-item (Table 3).

© 2013 John Wiley & Sons Ltd, MENCAP & IASSID

 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF

Table 2 Exploratory factor analysis of the Parenting Stress Index The multivariate normality of the data was exam-
Scale with the total sample (n = 184) ined by conducting normality checks by using
Analysis of Moment Structure (AMOS, version
Principal components with 21.0) software (Arbuckle 2012). Normality assess-
varimax rotation ment is usually rejected if the ratio of skewness is
higher than ⫾1 and/or, kurtosis is higher than ⫾2
Parent–Child (Nunnally & Bernstein 1994). The 30 items distri-
Parental Difficult Dysfunctional bution in this study is accepted because none of
Item # Distress Child Interaction
them departs from normality.
Following the guideline of AMOS analysis
pd4 0.80 * 0.11
(Arbuckle 2012), items (observed indicators) are
pd12 0.79 0.21 0.13
pd5 0.78 0.16 * enclosed in rectangles. Factors (latent variables) are
pd6 0.77 * 0.23 enclosed in circles, whereas measurement errors are
pd11 0.75 0.14 * enclosed in ellipses. The structural model is identi-
pd9 0.70 * 0.10 fied by three interrelated constructs (PD, PCDI,
pd10 0.67 0.28 *
DC) connected to each other with double-headed
pd3 0.66 0.24 *
pd7 0.61 0.25 0.21 arrows representing a pattern of intercorrelations
pd2 0.53 0.23 * (Fig. 1). The single-headed arrows leading from the
pd1 0.47 0.30 0.24 circles to the rectangles are regression paths repre-
pd8 0.46 * 0.28 senting the link between the factors and their
dc27 0.15 0.69 0.22
respective set of observed variables; these coeffi-
dc28 0.22 0.68 0.12
dc36 0.23 0.67 * cients represent factor loadings. Moreover, the
dc30 0.17 0.65 0.25 single-headed arrows from ellipses to rectangles rep-
dc25 0.35 0.64 * resent measurement error associated with observed
dc18 * 0.62 0.31 variables.
dc21 * 0.58 0.21
Confirmatory factor analysis performed using the
dc34 0.37 0.57 0.10
dc29 0.27 0.56 * estimation method of the Maximum Likelihood
dc26 * 0.54 0.32 over the variance-covariance matrix for the three-
dc35 0.14 0.53 0.19 factor model through the AMOS 21.0 statistical
pcdi15 * 0.13 0.83 package (Arbuckle 2012). To achieve model identifi-
pcdi23 0.16 0.16 0.76
cation, regression coefficients of the error terms
pcdi20 * 0.23 0.73
pcdi16 0.15 0.27 0.71 over the endogenous variables were fixed to 1. The
pcdi17 0.13 0.15 0.66 CFA was performed in order to determine whether
pcdi14 0.15 * 0.65 the hypothesised statistical model fits the actual
pcdi13 0.31 0.27 0.45 data set. A number of ‘goodness-of-fit’ statistics
% variance† 20.57 16.25 13.55
were used on the three factor models derived by
Cumulative variance 20.57 36.81 50.36
means of EFA.
* Item loading of <0.10.
It is recommended to consider a variety of fit
†
Percentage of the variance accounted for each factor. indices so that the weakness of a particular index is
Bolded numbers mean that items have adequate loading.

Table 3 Cronbach’s Alpha, the reliability for the 3 sub-scales in 30 items and the 36 items

Parental Parent–Child Dysfunctional Difficult Total

Model Distress Interaction Child scale

36 items 12 items: 0.91 12 items: 0.85 12 items: 0.82 0.91

30 items 12 items: 0.91 7 items: 0.86 11 items: 0.87 0.92

© 2013 John Wiley & Sons Ltd, MENCAP & IASSID

 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF

Figure 1 Standardised estimates for the Parental Stress Index Model with 184 parents. PD, Parental Distress; PCDI, Parent–Child
Dysfunctional Interaction; DC, Difficult Child.

© 2013 John Wiley & Sons Ltd, MENCAP & IASSID

 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF
Table 4 Goodness-of-Fit Indices for two models
Model c2* d.f.* P* c2/d.f.*
30 item 745.8 402 <0.01 1.86
36 item 1184.7 591 <0.01 1.94
* c2/d.f.: relative chi-square.
GFI, Goodness of fit index; AGFI, Adjusted GFI; CFI, Comparative fit index; IFI, Increment fit index; RMSEA, root mean square error of
approximation.
counteracted by the strength of another (March
et al. 1996). The commonly used fit statistics
include the comparative fit index (CFI), goodness
of fit index (GFI), and incremental fit index (IFI),
all with a range 0–1 and with values greater than
0.90 indicating a good fit (Wang et al. 1996). The
root mean square error of approximation (RMSEA)
of 0.05 or less indicates a ‘close fit’, while values of
more than 0.1 justify rejecting the model (Browne &
Cudeck 1989). The goodness-of-fit indices of the
30-item model are exceeding the 36-item model in
most of the indices (Table 4).
Discussion
The need for more cross-cultural studies of the
impact of parenting a child with developmental
disabilities and the need for more consistent use of
measures in family research have been highlighted
in recent years (IASSID 2012). The findings
reported in this study could help to address each of
these issues, more specifically among Jordanian
Parents of Children with Autistic Disorder and sets
out to assess the applicability of the PSI to this
group of parents.
The PSI-SF is commonly used for measuring
stress in parents of children with autistic disorder.
However, and up to our best knowledge, this is the
first study that has examined the psychometric
properties of the PSI-SF in a sample of parents of
children with autistic disorder in the Arab world.
The purpose of this study was to validate the
PSI-SF scale for Jordanian parents of children with
autistic disorder using EFA and CFA.
The PSI-SF is composed from three sub-scales:
PD; PCDI; and DC (Abidin 1995). The result of
this study showed that the items in the PD sub-
© 2013 John Wiley & Sons Ltd, MENCAP & IASSID
GFI* AGFI* CFI* IFI* RMSEA*
0.92 0.88 0.86 0.87 0.07
0.88 0.84 0.80 0.81 0.07
scale appear to be useful for assessing the severity of
distress among parents of young children with autis-
tic disorder. However, items in the PCDI and DC
sub-scales did not show stability in their structure.
The factor analyses results support the 12 items
of the PD sub-scale as it is presented in the original
PSI-SF scale. It should be also noted that all the
items on the PD sub-scale had high factor loadings
ranging from 0.46 to 0.80, which again supports the
unidimensionality of this sub-scale. Our findings
resulted also into deleting three items from the
PCDI sub-scale (19, 22, 24) and three items from
the DC sub-scale (31, 32, 33). All the deleted items
did not load sufficiently with their corresponding
factor or any other factors (sub-scales). Further, two
items (PCDI: 18, 21) were re-allocated to DC sub-
scale to fit the theoretical meaning and loading cri-
teria. Both items (‘My child doesn’t seem to learn
as much as most children’; and ‘It takes a long time
and it is really hard for my child to get used to new
things’) are more consistent with the notion of DC
sub-scale rather than PCDI sub-scale. The results
of this study support the content validity of the new
factors structure of the PSI-SF.
Psychometric work on the original PSI-SF has
been conducted with samples of healthy children.
However, the characteristics of children with autistic
disorder were found to be a significant source of
stress on parents because of the ambiguity of diag-
nosis, the severity and chronocity of the disorder,
and the problems they have with their child’s lack of
social skills and stereotypic and compulsive behav-
iours that appear peculiar and interfere with the
child functioning and learning (Bristol 1984). Thus,
the perceptions of the items that relate to the chil-
dren’s characteristics and the interaction between
the parents and their children may be greatly
different.
 Journal of Intellectual Disability Research
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L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF
Furthermore, the sample of this study was part
from the Arab world. Arabs differ significantly from
westerner in their perceptions to life stressors. Arabs
usually believe that God is the direct and ultimate
control of all that happens. Further, Arabs are more
likely to allow subjective perceptions to determine
what is real and to direct decisions (Nydell 2005).
According to Fakhr El-Islam (2008), many educa-
tional, economic and cultural factors affect mental
health perceptions and practices in the Arab world.
For example, although the extended family system
in the traditional Arab cultures was found to signifi-
cantly help individuals deal with their life stressors
(Fakhr El-Islam 2008; Kandel et al. 2004), studies
that targeted social support among parents of chil-
dren with chronic disabilities in the Arab cultures
found similar levels of social support as those in
Western cultures (Azar et al. 2006; 2010; McConkey
et al. 2008). The results were explained through
referring to the stigma associated with caring for a
child with chronic disability which deters mothers
from seeking informal support from family and
friends and leads parents to isolate themselves and
reduce their recreational and leisure activities
outside home. Therefore, the new structure of the
DC and PCDI sub-scales as resulted in this study
can fit the content validity better than the original
structure.
Further, the instability in the structure of the DC
and PCDI sub-scales can be supported through
referring to the previous psychometric works on
these scales. Many of the studies that examined the
factor structure of the scales in different cultures
failed to support its original structure because of
the variation in the sample characteristics that were
recruited for each study (Whiteside-Mansell et al.
2007; McKelvey et al. 2009; Farmer & Peterson
2012). However, the PD sub-scale held stable. Items
in the PD sub-scale measure parents’ perception of
their own behaviour including perceived compe-
tence, marital conflict, views of social support, and
life restrictions because of the parenting demands.
All these aspects are generic enough to suit the
perceptions of parents of children with autistic
disorder.
To date, only one study (Zaidman-Zait et al.
2010) has examined the psychometric properties of
the PSI-SF among parents of children with autistic
disorder. In that study, analysis showed that the PD
© 2013 John Wiley & Sons Ltd, MENCAP & IASSID
sub-scale was useful for assessing the stress among
parents of children with autistic disorder. Mean-
while, several items in the PCDI and DC sub-scales
showed poor functioning. The authors recom-
mended additional research work to examine the
factor structure of the PSI-SF in samples of parents
of children with autistic disorder. While drawing
attention to the work of Zaidman-Zait et al. (2010),
some limitations of their work were noticed. First,
91.4% of the participants were mothers. Many
studies revealed that mothers and fathers experience
different aspects of their child’s behaviour as espe-
cially stressful (Krauss 1993; Keller & Honig 2004).
Whereas mothers’ stress was related both to child
problem behaviours and fathers’ mental health,
fathers’ stress ratings were not significantly associ-
ated with either (Hastings et al. 2005). Moreover,
several studies revealed that mothers of children
with autistic disorder report higher levels of stress
than fathers (Moes et al. 1992; Allik et al. 2006;
Dale et al. 2006). Thus, appropriate presentation for
fathers when assessing parental stress provides
better understanding for the parental stress dynam-
ics (Davis & Carter 2008). In our study, more
balance between fathers and mothers was achieved,
(62%) were mothers. A second limitation of
Zaidman-Zait et al. (2010) study is that the mean
age of children was 46.6 months (range = 20.5–72.0
months). However, greater parental stress has been
found when the child with autistic disorder grows
older, possibly because of difficult transitional
periods the parents encounter, like finding an
appropriate school (Blacher et al. 2010). Thus, the
perceived levels of stress and sources of stress may
be significantly changed with samples of parents of
children who are older in age. In our study, the
mean age of children was 6.3 year ranging from 2 to
12 years. This study overcomes the limitations of
the work of Zaidman-Zait et al. (2010). Neverthe-
less, our results were consistent with their work in
terms of the stability of the PD sub-scale.
Conclusion, limitations and recommendations
In conclusion, the instrument structure indicated
that the 30-item scale is valid and reliable in meas-
uring the parental stress for parents of children with
autistic disorder. The goodness-of-fit indices
support the stability of the factor structure of the
 Journal of Intellectual Disability Research
10
L. A. Dardas & M. M. Ahmad • Psychometric properties of PSI-SF
PSI 30-item model. In the Principal Components
Analysis with Varimax rotation, the 30-item models
accounted for satisfactory variances (50.36%) higher
than the 36-item model variance (41.71%). The
three-factor model was found to be parsimonious,
valid, reliable, and empirically supported. The
results in this study showed that the PSI in its
30-item model has endorsed the necessary validity
of the scale with parents of children with autistic
disorder.
AMOS was used in this study because it is
quickly emerging in nursing research as a powerful
approach to measure unobserved variables using the
Structural Equation Modeling (SEM). Tradition-
ally, exploratory techniques have been used to
provide preliminary scales and assess measurement
properties; nevertheless, the EFA alone remains
exploratory in nature and can be unreliable.
However, SEM is not necessarily a replacement for
EFA; therefore both techniques were used in this
study to compare the best factor structure of the
models.
Although Jordanian people share cultural features
with Arabs in other countries, the generalisability of
the findings to all Arabs should be carried with
caution. Further, as this is the first study in the
Arab world which examined the psychometric prop-
erties and the theoretical structure of the PSI-SF
with Jordanian parents of children with autistic dis-
order, it was difficult to compare the results with
other findings in similar culture. It is recommended
to use the new factors structure of the PSI-SF to
examine the stress among parents of children with
autistic disorder in the Arab world.
Acknowledgement
The authors acknowledge the partial funding for
this study provided by The University of Jordan.
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