The Affect of Delays to Treatment Outcome on How Caregivers of Children with ASDs Value Treatments

Background:  

Many autism treatments appear in the literature (Green et al., 2005).  Some have empirical support, but many caregivers utilize those that are not (Zane, Davis, & Rosswurm, 2008).  Most empirically supported treatments require significant time before benefits are achieved (Allen & Warzak, 2000).  These delays to treatment outcome may influence how caregivers of individuals with autism value empirically supported treatments.

Delay discounting refers to the degree to which individuals devalue outcomes as a result of the delay those outcomes (Madden & Johnson, 2010). Discounting is evaluated by presenting individuals with choices between hypothetical immediate and delayed rewards of varying magnitudes. A robust literature has shown that it is possible to quantify the degree to which individual’s choice making is susceptible to the influence of delays (Madden et al., 2010).  However, to date, no literature exists examining whether delay discounting influences how caregivers of individuals with autism value treatments outcomes. Additionally, there may be differences between caregivers discounting of delayed treatment outcomes based on type of treatment goal (i.e., reduction of problem behavior vs. skill acquisition).

Objectives:  

The objective of this study was to extend the existing literature on delay discounting to caregivers of individuals with autism and the choices they make regarding treatments for their child’s autism spectrum disorder.

Methods:  

Caregivers of children with autism who were receiving treatment for problem behavior or skill deficits participated in this study.  Each participant provided a definition of their treatment goals for their child. Participants then completed a delay discounting procedure (Mazur, ??) in which they were asked to make choices between hypothetical treatment outcomes that would be available immediately or after a various delays. The treatment outcomes presented to participants varied with respect to the percentage of their treatments goals achieved and the latency to achieving that outcome. For example, one choice trial consisted of “Would you prefer a treatment that will achieve 60% of your treatment goals immediately, or a treatment that will achieve 100% of your treatment goals 6 months now?” A titrating procedure was used in which the percentage of treatment goals achieved by the immediate treatment increased from 0% until the participant switched from the delayed to the immediate treatment.    

Results:  

Switch points were plotted for each delay assessed creating a monotonic decelerating curve Mazur, 1987), with area under the curve serving as measure of sensitivity to delays (Myerson, Green & Warusawitharana, 2001). Caregivers of children receiving treatment for skill deficits or problem behavior showed 0.84 and 0.80 AUC respectively. 

Conclusions:  

Both groups of participants demonstrated significant discounting of the delayed treatment outcomes, suggesting that their choices of treatment were highly influenced by delays to treatment outcomes.  Furthermore, caregivers who prioritized reductions in problem behavior showed greater sensitivity to delayed improvements in problem behavior than did caregivers who prioritized acquisition of skills by their child.  This result highlights the need for those who deliver or develop treatments for those with autism to continually refine their interventions to make them increasingly efficient.