Psychological interventions targeting mental health and the mother–child relationship in autism: Systematic review and meta‐analysis

Abstract

Aim: To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship.Method: Electronic databases were searched from inception to December 2021.Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/ or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences.Results: Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence).Interpretation: Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.

Identifying major predictors for parenting stress in a caregiver of autism spectrum disorder using machine learning models

“…Indeed, the current interventions of mainstream generally aimed at maximizing ASD patients' functioning by improving their core symptoms or specific behavioral problems (Lai et al, 2014). Psychological interventions targeting parenting stress were also suggested, of which the efficacy was confirmed by a metaanalysis of 16 randomized controlled trials with moderate certainty of evidence (standardized mean difference −0.33, 95% CI −0.46 to −0.19) (Kulasinghe et al, 2022). However, none of the meta-analyzed trials have included caregivers' psychopathology as a treatment target.…”

Child behavioral problems and parental adjustment: Family, interparental, and parent–child processes as simultaneous mediators.

“…Importantly, negative parent-child relationships may be reciprocally linked to higher depression, anxiety, and stress among parents of children with SEN (Lai et al, 2015). Based on a meta-analytic review of seven studies, Kulasinghe et al (2023) showed that interventions improving parent-child relationships may decrease the stress of parents of children with SEN. Therefore, we hypothesized that child behavioral symptoms would be linked to parent-child conflict, which in turn would be linked to parental maladjustment.…”

Trends in Autism Spectrum-Related Motherhood Research: A Bibliometric Study

“…Another systematic review, by Ilias et al [19], highlighted that social support, severity of ASD symptoms, financial difficulty, parents' perception and understanding of ASD, parental anxiety, and concerns about their children's future constitute a constellation of variables that Zhang [20] predict stress in mothers of children with ASD. A recent meta-analysis by Kulasinghe et al [21] was able to demonstrate that interventions that seek to promote appropriate and timely parenting styles to respond to the cognitive, emotional, and volitional demands of children with ASD had a positive effect on the mother-child relationship and a moderate impact in general stress of mothers. However, no bibliometric analysis specifically focused on ASD-related motherhood has been conducted to our knowledge.…”