Evaluation of the effects of passive smoking and parental stress on challenging behaviors in autistic and neurodevelopmentally atypical children through urine cotinine levels

Aim This study aimed to determine the effects of passive smoking and parental stress on challenging behaviors of autistic and neurodevelopmentally atypical children.Materials and Methods This descriptive-analytical cross-sectional study was completed by collecting data from 60 parents of children with special needs in a provincial center in Turkiye between May and September 2024. Data were collected with the Child’s Challenging Behavior Scale (CCBS), the Parenting Stress Scale (PSS), Fagerstrom Test for Nicotine Dependence (FTND), and a sociodemographic information form. Cotinine and creatinine levels were measured in urine samples obtained from the children participating in the study and cotinine/creatinine ratios were calculated. Data were analyzed using number, percentage, mean, standard deviation, and regression analysis.Findings The ratio of autism spectrum disorder (ASD) was 29.7%; the ratio of mild intellectual disability was 68.3%. The mean PSS score of the mothers was 15.67 ± 11.33 and the mean CCBS score of the children was 18.77 ± 4.49, which were at low levels. When the nicotine dependence scores of the parents were analyzed, it was determined that mothers had very low dependency (0.58 ± 1.27) and fathers had low dependency (2.83 ± 3.42). Mother’s opinion on stress increasing a child’s challenging behavior was 46.7%.Conclusion The participants’ parenting stress levels, smoking status, addiction levels of parents, urinary cotinine levels and cotinine/creatine levels of children had no significant effect on children’s challenging behavior. Thus, qualitative and mixed-method studies are needed to better understand the mechanisms underlying these conclusions.Practice implications In future research, it is recommended to examine the challenging behaviors of children of parents who cannot protect their children from passive smoking and/or have nicotine addiction and/or high stress. These studies could include children with severe challenging behavior, and/or data could be collected during the winter season.