Examining Changes in Parental Distress, Self-Efficacy, and Children's Problem Behaviors from Admission to 2-Month Follow-up within the Autism Inpatient Collection (AIC) Sample

Background:  Parents of children with Autism Spectrum Disorder (ASD) have reported increased stress, which is associated with lower parental self-efficacy and child behavior problems.  There is a lack of research examining changes in parental distress, self-efficacy and children’s problem behavior over time, and whether differences in outcome occur based upon children’s verbal ability.   

Objectives:  To analyze preliminary data from the Autism Inpatient Collection (AIC) examining changes in parental distress, parental self-efficacy, and parent’s reports of children’s problem behaviors from admission, discharge, and 2-month follow-up.  Further, to explore potential differences in problem behavior between children with limited verbal ability and fluent speech. 

Methods:  Children and adolescents aged 4-20 years, with an Autism Diagnostic Observation Schedule-2 (ADOS-2) supported autism diagnosis and admitted to specialized inpatient psychiatry units were prospectively enrolled in a six-site study examining patient phenotypes and behavioral outcomes.  Parent measures, including the Parental Stress Index (PSI-SF 4) Parental Distress (PD) subscale, Difficult Behavior Self-efficacy Scale (DBSS), and the Aberrant Behavior Checklist - Irritability subscale (ABC-I), were collected at admission, discharge, and 2-month follow-up.  ADOS-2 Modules 1&2 were administered to patients with limited verbal ability, while Modules 3&4 were administered to patients with fluent speech.  Repeated measures analysis of variance (RMANOVA) was conducted to examine for changes in scores over time. 

Results:  Mean age of the first 108 enrolled children was 12.70 years (SD=3.50), 24% female, 77.8% Caucasian and 91.4% Non-Hispanic/Non-Latino.  Average length of stay across the six-sites was 25.35 days (SD=23.21, Median=19.0, Range=4-130).  Approximately half the sample (56%) was administered ADOS-2 Modules 1&2.  Preliminary results are based on complete data from forty-four parents with data from all three time points.  The majority of parent report measures came from patients’ biological mothers (70.7%), followed by biological father (9.8%), step/foster/adoptive mother (9.8%) or father (2.4%), and grandparent (7.3%).  Average age of parent respondents was 44.56 years (SD=10.30), 52% married, with an average annual household income <$35,000.  Parents reported a significant decrease in their child’s problem behavior between admission, discharge and 2-month follow-up, F=12.75, p<0.001, though this difference did not significantly vary between patients with limited verbal ability and fluent speech, F=0.23, p=0.79 (see Figure 1).  Parents also reported a significant decrease in parental distress between admission, discharge and 2-month follow-up, F=6.94, p=0.002.  There was no significant difference in parents’ report of their confidence in their ability to parent a difficult child (self-efficacy) between admission, discharge and-2 month follow-up, F=0.27, p=0.61.  Cronbach’s Alpha was >0.70 for all scales at all three time points indicating good scale reliability.

Conclusions: Preliminary data suggests that parents with children in specialized psychiatric inpatient units reported a significant reduction in their own distress and their child’s problem behavior from admission to 2-months post-discharge, regardless of the child’s verbal ability.  There was no change in parents’ report of their self-efficacy in managing problem behavior over time. Future research should examine how parent self-efficacy and mindfulness based stress reduction techniques may mediate parental distress and behavioral outcomes in children with autism.