Maternal Anxiety Symptoms, Sensory Processing, and Play Performance in Children Aged 4-6 Years with Autism Spectrum...

Background: Children with autism spectrum disorder (ASD) often show atypical sensory processing and reduced play participation, and their mothers frequently report elevated anxiety. However, maternal anxiety symptoms, sensory processing, and children's play performance and playfulness have rarely been examined together, and the factors independently associated with maternal anxiety symptoms have not yet been clarified. Objective: This study examined relationships between maternal anxiety symptoms and children's sensory processing, play performance, and playfulness in children with ASD aged 4-6 years, and identified factors independently associated with maternal anxiety symptoms. Method: In this cross-sectional study, 58 mother-child dyads were recruited from a special education center in Istanbul, Türkiye. Maternal anxiety was assessed with the Beck Anxiety Inventory, sensory processing with the Dunn Sensory Profile, and play with the Revised Knox Preschool Play Scale and Test of Playfulness. Results: Maternal anxiety was negatively correlated with play performance (ρ = -0.564, p < 0.001) and playfulness (ρ = -0.492, p < 0.001), and positively correlated with low registration and sensation-seeking raw scores (ρ = 0.474, p < 0.001 and ρ = 0.343, p = 0.008, respectively; higher raw scores indicate more typical, less atypical processing). Children with comorbid ADHD had mothers with higher anxiety and lower play scores. In a multivariable model (R² = 0.516), play performance (β = -0.411, p = 0.002) and, preliminarily, comorbid ADHD (β = 0.274, p = 0.027; only 10 children with ADHD) were independently associated with maternal anxiety; maternal education, employment, and school type were not. Conclusions: In young children with ASD, maternal anxiety symptoms were most strongly associated with the child's play performance, while a preliminary association with co-occurring ADHD requires confirmation in larger samples; these findings support considering maternal wellbeing in family-centered occupational therapy assessment.