Parent Education for Young Children With Autism and Disruptive Behavior: Response to Active Control Treatment

Abstract

This study examines parent and child characteristics in young children with autism spectrum disorder and disruptive behavior who showed a positive response to a parent education program in a randomized clinical trial of parent training. Children with autism spectrum disorder (N = 180) were randomized to parent training (PT) or parent education program (PEP) for 6 months. Using the Clinical Global Impression-Improvement scale, masked independent evaluators rated positive response in 68.5% of children in PT compared to 39.6% in PEP. We compared baseline characteristics and change in parental stress, strain, competence, and mental health for participants who showed a positive response to PEP (PEP-R) to those who did not (PEP-NR). We also compared change in child and parent measures for PEP-R participants to those who showed a positive response to PT (PT-R). At baseline, PEP-R and PEP-NR participants did not differ on any demographic or clinical characteristics. Parents in PEP-R reported significant reductions on the Parenting Stress Index, Caregiver Strain Questionnaire, and Parent Health Questionnaire, and increases on the Parenting Sense of Competence scale. Improvements in child disruptive behavior and parental stress, strain, competence, and mental health for PEP-R participants were similar to PT-R participants. Vineland Daily Living Skills improved only for children in PT-R. PEP was an active control treatment with nearly 40% of participants showing a positive response. Change in child disruptive behavior and parental stress, strain, competence, and mental health were remarkably similar for participants independently rated with a positive response to PEP and PT.

The effectiveness of parent training for children with autism spectrum disorder: a systematic review and meta-analyses

“…Parents in both groups reported significant decrease in stress (PT: β = − 0.38, p = .009; PE: β = − 0.39, p = .006) and strain (PT: β = − 0.50, p < .001; PEP: β = − 0.45, p < .001) from week 12 to week 24. Bradshaw and colleagues [ 37 ] showed that parents in PEP-R (Parent Education Programme-Responders) reported significant reductions on the Parenting Stress Index [ 51 ], Caregiver Strain Questionnaire [ 52 ], and Parent Health Questionnaire [ 54 ], and increases on the Parenting Sense of Competence+ Scale score [ 53 ].…”

“…Sample size The number of children included in each study, varies from 12 in each group in two studies [31,33]; and 91 in Parent Training and 89 in the parent education control group in one study that produced three papers [35][36][37]. Rogers and colleagues [22] included 118 children at baseline and 80 at the last follow up.…”

“…Three papers from one study [35][36][37], found using an IQ measure that three fourth of the children in both intervention and control group did not have an intellectual disability. Jocelyn and colleagues [29] used Leiter Scale to determine IQ.…”

Evidence-Base Update for Parenting Stress Measures in Clinical Samples

“…Fortunately, parenting stress scores on multiple measures were highly responsive to interventions, even when the interventions were not directly targeting parenting stress. Results showed that there is a strong evidence base for the treatment sensitivity of parenting stress measures in relation to parent training, parent-child interaction therapy, and social skills training interventions, primarily for parents of youth with ADHD, ASD, and disruptive behavior problems (e.g., Bradshaw et al, 2018;Gonring et al, 2017;Harwood & Eyberg, 2006;Niec, Barnett, Prewett, & Shanley Chatham, 2016). A smaller but growing evidence base exists for the treatment sensitivity of parenting stress measures with respect to other interventions including mindfulness-based stress reduction programs for children with developmental delays, multiple family group intervention for juvenile first offenders, and motivational interviewing for adolescents with ADHD (Les Caldwell et al, 2007;Neece, 2014;Sibley et al, 2016).…”

The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism

“…Many systems used for tracking treatment outcomes are based on parent report via interviews or questionnaires or expert clinical assessment. However, recent research has highlighted the presence of a striking placebo effect in ASD populations: even when outcome evaluators are masked to treatment condition, significant improvements are still reported in a surprisingly substantial number of participants assigned to control conditions [Bradshaw et al, ; Jones, Carberry, Hamo, & Lord, ; Masi, Lampit, Glozier, Hickie, & Guastella, ]. This, in addition to the cost of training and maintaining fidelity on clinically based measures, leads us to believe that neither questionnaires nor clinical phenotyping are optimal outcome measures.…”