The Relationship between Challenging Behaviors in Children with Developmental Disabilities and Maternal Depression: Serial Mediation Effects of Maternal Fatigue and Dysfunctional Coping in South Korea

Background and Purpose

Mothers of children with developmental disabilities (DD), including intellectual disability and autism spectrum disorder, are frequently exposed to their children’s challenging behaviors. These behaviors, often unpredictable and socially stigmatized, impose substantial physical and emotional burdens on mothers and are strongly associated with elevated levels of maternal depression. The ongoing need to manage, prevent, and respond to these behaviors fosters a heightened sense of parental responsibility, placing mothers under chronic stress and resulting in persistent fatigue. Sustained fatigue can impair mothers’ capacity to effectively cope with the demands of caregiving, increasing their reliance on maladaptive coping strategies such as irritability and inconsistent discipline. These dysfunctional responses have been linked to heightened depressive symptoms. However, limited empirical attention has been given to the mediating mechanisms through which challenging behaviors contribute to maternal depression. Addressing this gap, the present study positions maternal fatigue as a central construct and examines its serial mediating role—alongside dysfunctional coping—in the relationship between children’s challenging behaviors and maternal depression.

Methods
Data were collected in April 2018 from 400 mothers of children with DD in Seoul, Gyeonggi, and Incheon, South Korea, through convenience sampling from welfare organizations. Four validated instruments were employed: (1) Functional Assessment for Challenging/Problem Behaviors (Kim et al., 2017), (2) Patient Health Questionnaire-9 (Kroenke et al., 2001), (3) Fatigue Assessment Scale (Michielsen et al., 2003), and (4) Dysfunctional Coping Scale from the Brief COPE (Carver, 1997). Statistical analyses were conducted using SPSS 27.0 for two-way ANOVA and PROCESS macro v4.3 (Model 6) for mediation analysis.

Results
The results revealed that children’s challenging behaviors had a significant direct effect on maternal depression. Maternal fatigue was found to be a significant mediator in this relationship: higher levels of challenging behaviors increased fatigue, which in turn heightened depressive symptoms. While dysfunctional coping alone did not mediate the relationship, a significant serial mediation effect was observed—fatigue predicted increased use of dysfunctional coping strategies, which ultimately contributed to greater maternal depression. These findings underscore fatigue not only as a direct mediator but also as a critical precursor to maladaptive coping responses.

Conclusions and Implications
The study identifies maternal fatigue as a central psychological mechanism linking children’s challenging behaviors to maternal depression. These findings point to the need for targeted interventions that alleviate caregiver fatigue. Strategies such as respite care, accessible mental health support, and tele-coaching may help reduce caregiver burden and improve maternal well-being. Importantly, fatigue management should be prioritized in service planning, as it could foster more adaptive coping and lead to more sustainable caregiving. These results advocate for the development of comprehensive, family-centered policies that recognize and directly address the cumulative impact of fatigue among mothers of children with developmental disabilities.