The Impact of Multisystemic Therapy on Youths with Autism Spectrum Disorder

Background: Parents of youths with Autism Spectrum Disorder (ASD) report a multitude of individual and family problems, including high levels of stress, maladaptive coping patterns, depressive symptoms, substance use, and frequent conflict. In addition, many youths with ASD engage in problematic behaviors (e.g., interpersonal aggression) that have been linked with negative outcomes for other family members. Multisystemic therapy (MST; Borduin & Henggeler, 1990) is an intensive, family- and community-based treatment that has been evaluated in multiple randomized clinical trials with youths exhibiting severe behavioral problems, including antisocial behavior. MST has demonstrated improved family functioning, improved caregiver and youth mental health, and reduced youth problem behaviors relative to comparison treatments and services (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). Furthermore, adaptations of the MST model have demonstrated promising results for other clinical populations (e.g., youths with type-1 diabetes, youths with HIV). We believe that MST may represent an effective treatment in reducing severe behavioral problems and improving family and peer relations in youths with ASD.

Objectives: The primary goal of this pilot study is to evaluate the effects of MST on youths diagnosed with ASD and their families. More specifically, we are examining the impact of MST on relevant individual (i.e., behavior problems, peer relations), parent (i.e., parenting stress, marital conflict), and family (i.e., conflict, warmth) variables.

Methods: Participants include youths (11-17 years of age; approximate N = 8) who have (a) a diagnosis of ASD that has been confirmed by the Autism Diagnostic Observation Schedule or the Autism Diagnostic Interview-Revised within the past 6 months and (b) severe behavior problems (e.g. physical aggression towards another person, property destruction) during the past 3 months. Youths and their families who consent to participate in MST complete a multiagent, multimethod assessment battery designed to assess functioning across individuals and systems using family (e.g., Family Adaptability and Cohesion Evaluation Scales-II), youth (e.g., Vineland-II), parent (e.g. Parenting Stress Index-Short Form), sibling (e.g. Child Behavior Checklist), and teacher (Teacher Report Form) measures at pre- and post-treatment assessments.

Results: Scores from self-report, other-report, and observational measures will be compared pre- and post- treatment with respect to the following variables: youth autism traits, youth peer relations, youth adaptive functioning (in home, school, and community settings), youth behavior problems, parent social support, parent symptoms, parent stress, parent marital satisfaction, and family relations.

Conclusions: The results of this ongoing pilot study will have implications for the continued adaptation and validation of the MST model for ASD youths who exhibit severe behavior problems. This study represents a step towards a more comprehensive approach to ASD treatment that is designed to improve both adolescent and family functioning and is intended to lead toward a larger randomized clinical trial in which we plan to examine treatment outcomes and mechanisms of change with this population.