Intervention Affects the Families of Adolescents with Autism Spectrum Disorders: Group and Individual-Level Analyses of Parent Stress, Efficacy, and Family Disruption

Background:   The difficulties of children with Autism Spectrum Disorders (ASD) affect caregivers across a variety of domains, increasing stress and decreasing feelings of parenting efficacy.  The impact of having a child with ASD appears to reverberate throughout the entire family system.  Interventions for ASD do not necessarily ameliorate, and may even exacerbate, these family concerns.  Thus, comprehensive evaluation of interventions should include assessment of family domains.  The Program for the Education and Enrichment of Relationship Skills (PEERS; Laugeson & Frankel, 2009) is a manualized, evidence-based, social skills training intervention for adolescents with ASD. Parents participate in a concurrent, separate group designed to teach PEERS concepts to parents and generalize teen practice of skills outside of group.  Though several studies have suggested positive outcomes for adolescents following PEERS, studies have not yet evaluated parent and family outcomes.

Objectives:   The purpose of this study was to understand how participation in PEERS intervention affects parents and families of teenagers with ASD in terms of parenting efficacy, parenting stress, and family functioning.

Methods:   Fifty parent-adolescent dyads (mean adolescent age = 13.7 years) were randomly assigned to an “Experimental” (n = 23) or “Waitlist Control” (n= 27) group for PEERS intervention.  Parents in both groups completed the Parenting Sense of Competency (PSOC) scale, a measure of family disruption (CHAOS scale: Matheny et al., 1996), and the Stress Index for Parents of Adolescents (SIPA) prior to and immediately following the Experimental group’s participation in PEERS. Adolescents with ASD and their parents in the Experimental group then participated in 14 weeks of sessions focusing on initiating and maintaining friendships.   Group-level analyses included bivariate correlations, paired samples t-tests, and mixed between-within subjects Analysis of Variance (ANOVA); Individual-level analyses included reliable change measures (Jacobson & Truax, 1991) for the SIPA.

Results:   Bivariate correlations indicated a significant inverse relationship between parenting self-efficacy and total parenting stress, r = -.473, n = 50, p = .001, and family disruption, r = -.483, n = 50, p < .001, before PEERS. There was a significant increase in parenting self-efficacy from pre- to post-PEERS in the Experimental group, t (22) = -2.18, p = .04. There was a significant interaction between time and group for family disruption, F (1, 48) = 5.61, p= .02, indicating a decrease over time in family disruption for the Experimental group compared to the Waitlist Control group.  Finally, individual-level analyses indicated that 6 of 17 parents (who decreased in stress levels) demonstrated a reliable decrease in parenting stress.

 

Conclusions:  Taken in sum, these results suggest that significant and positive changes occur in parents and families of adolescents with ASD following involvement in PEERS.  Parents participating in PEERS experience decreased parenting stress and family disruption, and increased parenting efficacy, following the intervention, and are likely better able to help their adolescent as a result. In conjunction with previous literature on PEERS, this study highlights the overall efficacy of this intervention.