Importance of Parenthood and a look into Crucial Behavioral Strategies for children with ASD
It is difficult to understate the importance of parenthood in children’s well-being and personal growth. The relationship between the parent and the child are bidirectional, meaning that both the child and parent can impact each other by giving feedback in response to each other’s behavior. For parents of children with autism spectrum disorder (ASD), appropriate specialized care needs to be learned and implemented in order to foster a positive relationship, which can also affect the quality of care children with ASD receive both in and outside the house. There are parents who may not fully understand the child’s behavior, and behaviors that are common in children with ASD such as tantrums, aggression, and self injury can contribute to parental stress, which can then reduce a parent’s ability to handle disruptive behavior with appropriate care. It is important to note that ASD is on a spectrum so the quality of the bidirectional relationship can be affected by factors like the timing of diagnosis, age of child, and symptom severity. This study examines the efficacy of certain interventions, such as Parent Teaching (PT) and Psychoeducation program (PEP), which were used to teach parents skills that address particular skills in order to decrease disruptive behavior in children with ASD.
In this study, researchers conducted a series of studies centered around a structured PT manual that had integrated behavior change strategies, which were tested in single subject studies, for 180 children (aged 3-7) with ASD and disruptive behavior in a 24 week randomized control trial (RCT). One parent from each household was enrolled in PT or Psychoeducation program (PEP). PT consisted of 11 sessions of 60-90 minutes of direct instruction between the therapist and the parent, who received assignments to practice strategies, such as planned ignoring and positive reinforcement that were learned in the session. PEP involved 12 direct sessions that simply covered topics surrounding ASD, such as etiology of ASD and educational planning for the parents. Self reports of the parents in both groups suggest that there are larger improvements when administering PT (though both groups improved), which further suggests that addressing child behavior is an effective component of intervention.
One strength of this study was that researchers took great care into randomization of their study, which was performed within site and further stratified by educational intensity so that the groups had an equal number of therapist participants in high intensity school and therapeutic programming. Furthermore, they made sure to require a measure of eligibility for the subjects other than an ASD diagnosis. The subjects had to score greater than or equal to 15 on the Irritability subscale of the Aberrant Behavior Checklist and had to have a CGI severity (CGI-S) score of greater than or equal to 4. The controls in this particular experiment were monitored, and those with past or current treatment with PT for disruptive behavior had to be excluded.
One drawback of this study was that they were not able to control for parent variables that could moderate the effect of PT on disruptive behavior in children with ASD or parental stress. This study consisted of mostly white, middle and upper middle class families who were well educated, which is an important limitation to this study since stressors for those in minorities or under-resourced parents are different. Furthermore, primary outcomes on child behavior and parent outcomes were based on parent report, which could be biased since they did not measure objectively, such as by using physiological markers of parental stress. Importantly, parents were not blind to group assignment, which could also contribute to the bias in reports.
The results of this study draw attention to the importance of providing parents with specific tools to help reduce disruptive behavior, which can in turn reduce parental stress and improve parental competence. Measures of PT studies need to be improved further as the limitations reduces the reliability of the results. In all, this study directs researchers, parents, healthcare professionals, and therapists alike to start addressing the need for structured interventions like PT on reducing child disruptive behavior while increasing child’s adaptive behavior, all while decreasing parental stress and improving a parental sense of competence.
Article Reviewed: Teaching parents behavioral strategies for autism spectrum disorder (ASD): Effects on stress, strain and competence. Iadarola S, Levato L, Harrison B, Smith T, Lecavalier L, Johnson C, Swiezy N, Bearss K, Scahill L. J Autism Dev Disord. 2018 Apr;48(4):1031-1040.