Research Article| Volume 66, e122-e129, September 2022

Self-esteem and family functioning mediates the association of symptom severity and parental affiliate stigma among families with children with ASD


      • Parents of children with ASD have higher parenting and psychological stress than parents of healthy children.
      • Public misconceptions and rejection of children with ASD leave parents feeling a sense of shame.
      • Parents of children with ASD in China have low self-esteem and family functioning and high affiliate stigma.
      • ASD symptom severity, parental self-esteem, and family functioning are predictors of parental affiliate stigma.
      • The relationship between ASD symptom severity and affiliate stigma was mediated by self-esteem and family functioning



      To investigate the level of affiliate stigma among parents of children with autism spectrum disorder and to explore the mediating role of self-esteem and family functioning.

      Design and methods

      A cross-sectional study was conducted in a large regional hospital and two childhood rehabilitation centers in Guangdong, China. Data related to demographics, parental self-esteem, family functioning, and affiliate stigma were collected from 180 parents of children diagnosed with ASD. We used t-tests, analysis of variance, and correlation analysis to explore the related factors of parental affiliate stigma. Path analysis was used to determine the mediating roles of self-esteem and family functioning in the relationship between symptom severity and affiliate stigma.


      Parents of children with autism spectrum disorder in China experienced low self-esteem, family functioning, and high affiliate stigma. Symptom severity was negatively correlated with self-esteem and family functioning. Self-esteem and family functioning were significantly negatively correlated with affiliate stigma. Symptom severity was positively correlated with affiliate stigma. Self-esteem and family functioning mediated the relationship between symptom severity and affiliate stigma.


      Symptom severity affects parental affiliate stigma among families with children with ASD. Self-esteem and family functioning are the two mediators in the relationship. We should take steps to improve self-esteem and family functioning in order to alleviate parental affiliate stigma.

      Practice implications

      This study emphasizes the importance of the influence of ASD severity and family functioning on affiliate stigma. In clinical practice, psychological support should be provided for parents of children with ASD to improve their mental health.


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