Predictors of Successful Parent Training in Pivotal Response Treatment during the Jumpstart Program: Parent Mental Health and Self-Efficacy

Background: Many behavioral treatment models for autism spectrum disorder (ASD) include a parent training component. Theoretically, this allows the caregiver to implement intervention consistently and in multiple environments without the presence of a professional behavioral interventionist (Steiner et al., 2012). Many parents are able to successfully implement pivotal response treatment (PRT), a naturalistic therapy based on the principles of applied behavior analysis, with fidelity; however, there is considerable variability in parent fidelity of implementation (FOI) and the amount of time necessary for parents to learn how to implement PRT with acceptable FOI (Coolican et al., 2010). Little is known about parent characteristics associated with successful parent implementation of PRT. Parent mental health and parenting self-efficacy (SE) have been identified as potential correlates (Guimond et al., 2008; Steiner et al., 2012). JumpStart is a 20-hour education and empowerment program for parents of children recently diagnosed with ASD. JumpStart meets twice a week for four weeks, and parents receive 11.25 hours of PRT training (didactic, observation, and in-vivo coaching).  

Objectives: To examine: (1) changes in depression, parenting SE, parent FOI, and child responsivity among families who completed the JumpStart program, and (2) whether initial levels of depression and parenting SE predict changes in parent FOI and child responsivity. 

Methods: Participants were 65 parents (46 mothers; age M = 35.15 years, SD = 5.84) of 49 children (42 males; age M = 40.25 months, SD= 11.73) with a clinical diagnosis of ASD or an at-risk classification. Families were predominantly Caucasian and middle- to upper-middle class. Parents completed the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977) and the Early Intervention Parenting Self-Efficacy Scales (EIPSES; Guimond et al., 2008) pre- and post- JumpStart participation. Videotaped 10-minute probes pre- and post-JumpStart were coded for overall parent FOI and child responsivity.

Results: There were significant decreases in depression symptoms (F(1, 46) = 9.74, p = .003, h² = .18) and increases in parenting SE (F (1, 49) = 20.73, p < .001, h² = .30), FOI (F (1, 46) = 77.90, p < .001, h² = .63), and child responsivity (F (1, 46) = 36.38, p < .001, h² = .44) pre- to post- JumpStart participation. These effects did not differ between mothers and fathers. Time 1 depression levels were not associated with pre-post changes in FOI (ρ = -.20, p= .19) or child responsivity (ρ = -.03, p = .87); nor were parent age, level of education, or household income. Time 1 parenting SE was positively associated with pre-post change in FOI and child responsivity (Table 1). 

Conclusions: Findings indicate that participation in JumpStart reduces depression symptoms and increases parenting SE. From a family systems perspective, improvements in these domains may translate to improved outcomes and quality of life for children with ASD.  Initial parenting SE predicted positive change in parent FOI and child responsivity. Thus, it may be useful to implement interventions targeting parenting SE prior to parent training in PRT in order to maximize parent FOI and improve child outcomes.