Effects of an attachment-based parent intervention on mothers of children with autism spectrum disorder: preliminary findings from a non-randomized controlled trial

Abstract

Background Caregivers of children with autism spectrum disorders (ASD) often experience difficulties in responding appropriately to the needs of those children, who typically express attachment in distinct and nonconventional ways. This highlights the need for an attachment-based approach targeted at caregivers of children with ASD. Circle of Security Parenting (COSP), an attachment-based parenting program, is designed to increase caregivers’ sensitivity to children’s attachment needs. The aim of this study was to provide verification of the effectiveness of COSP in mothers of children with ASD. Methods This study was a non-randomized controlled trial. Sixty mothers of children with ASD aged 4–12 were recruited. Twenty mothers received the COSP intervention, while 40 did not. The characteristics of children in the control group were matched with those of the intervention group. To evaluate the outcomes of the intervention, changes in parental self-efficacy and mental health were assessed using the Tool to Measure Parenting Self-Efficacy (TOPSE) and the General Health Questionnaire-30 (GHQ-30). The children’s improvement in emotional and behavioral problems was assessed from the mothers’ perspective using the Child Behavior Checklist (CBCL). Both groups completed the assessments in parallel. Evaluations were compared between baseline (T1) and 6-month follow-up (T2). Results Scores for self-efficacy and mental health of mothers and behavior of children were significantly improved from T1 to T2 in the intervention group, but not in the control group. Participants’ mental health was markedly worsened in the control group. Conclusion This study demonstrated that the COSP program for mothers of children with ASD improved their parental self-efficacy and mental health, and reduced their subjective sense of difficulties related to their children’s behaviors. Our findings support the effectiveness of the attachment-based program for mothers of children with ASD, providing the groundwork for further studies of the attachment-based intervention for children with ASD and their families. Future studies with larger samples and randomization are also needed for direct evaluation of the improvement of children's attachment security, and for exploration of the synergistic relationship between various family support strategies and COSP. Trial Registration This trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (No. UMIN000039574)

Dyadic Work in Conjunction With Electroconvulsive Therapy in a 12-Year-Old Female With Autism Spectrum Disorder and Catatonia

“…18 As demonstrated by Circle of Security-Parenting, parents who participated in a parent support component (protected time for the parent to express concerns and elicit support related to parental stress) to augment their participation in behavioral-based intervention work demonstrated reduced stress levels and greater child behavior change compared to parents who did not participate in parent-only sessions. 17 Parental overaccommodation and enmeshment can exacerbate and reinforce functional symptoms that often worsen health outcomes and hinder progress. 20 Parental attention and avoidance of limit setting due to parental distress may be secondary gains from inadvertent reinforcement of functional behavior.…”

“…In 2021, Kubo et al completed a randomized controlled trial measuring the effectiveness of Circle of Security–Parenting, an attachment-based parenting program, that showed improved parental self-efficacy and mental health (with the largest improvement in the categories of empathy and understanding) and decreased parental reports of emotional and behavioral problems in their children with ASD. 17 Of all the aforementioned studies, the sample sizes were small and treatment measures were often subjective. Additionally, the studies were time-limited and patient populations were not followed longitudinally.…”

Japanese infants’ attachment insecurity and externalizing/internalizing problems: Using strange situation and attachment Q‐sort methods

“…Externalizing and internalizing problems were assessed concurrently by the mother, and 6 months later by both mother and another adult who knew the infant well to increase psychometric reliability. This study is particularly important because attachment‐based interventions for Japanese children have recently begun to be implemented (Kitagawa et al., 2021; Kubo et al., 2021), although non‐Western evidence of infant attachment is still insufficient.…”

Effectiveness of Cognitive Behavioral Therapy (CBT) on Psychological Distress among Mothers of Children with Autism Spectrum Disorder: The Role of Problem-Solving Appraisal

“…The role of community mental health nurses in this context is crucial [18]. They are often the first line of support for mothers of children with ASD, providing guidance, training, and emotional support [50,51]. These professionals can play an essential role in the implementation of CBT and in the teaching of problem-solving techniques [52].…”

“…These professionals can play an essential role in the implementation of CBT and in the teaching of problem-solving techniques [52]. However, there is a lack of structured programs and research that focuses on the training provided by these nurses in the Arab world, further highlighting the research gap this study aims to address [50][51][52][53][54][55][56]. Given the above considerations, this study aims to evaluate the effectiveness of a customized CBT program, emphasizing problem-solving techniques, to improve the psychological well-being of mothers of children with ASD in the Arab world.…”