15475
Early Intervention for Autism and Parental Stress As an Outcome Measure: Insights from Treatment As Usual
Few studies have deeply examined the question of whether parents’ stress levels affect their children’s progress in intervention. If by one side the research underlines the negative impact of the parent stress on outcome of children, another bulk of evidence pleads in favour of a different trend in parental stress with high parental stress at baseline evaluation linked to a better treatment outcome.
Objectives:
The aim was to examine the parental stress, as an outcome measure, after 6 months of treatment as usual (TAU).
Methods:
The sample consisted of 68 children (mean age: 2,94; sd: 0,79). At T0, 48 received a DSM-IV-TR diagnosis of Autism and 20 of PDD-NOS. At T0, 56 received an ADOS-G diagnostic classification of Autism and 12 of Spectrum. The ADOS-Calibrated Severity Score (CSS) of 68 children was 7,4 (± 0,83). The Griffiths Performance Development Quotient was of 73,5 (sd: 14,54). All children were at their first diagnosis of ASD and all parents filled out Parenting Stress Index (PSI) for two times (T0 and T1).
Results:
After 6 months of TAU, PSI mean scores showed a significant betterment. At T1, CSS improved in 37 of 68 children (Positive Outcome) while it was the same or worsed in 31 of 68 (No Positive Outcome).
At T0, PO and NPO groups did not differ significantly from each other on age (P = .432) and CSS (P = .073).
Regarding PSI at T0, analyses revealed significant higher mean scores for the PO group than the NPO on the scales Parent Domain (P= .046), Depression (P=.038), Health (P=.005) and Life Stress (P=.004).
At T1, no significant differences between PO versus NPO in terms of weekly hours of TAUs were found (P = .654). However, a significant difference between groups on time of TAUs ‘with the direct involving of parents’ was found (P = .048). No significant differences, between PO and NPO, were showed at T1 in all PSI scales.
The PSI Total scores obtained at T0 were correlated with the CSS change (T1-T0) separately in both the PO and NPO groups. The CSS change (Δ T1-T0) correlated at a highly significant level in the PO group (r = -,389; P = .017). In other words, the more stressed the family the greater was the improvement in CSS. In contrast, there was a non-significant negative correlation of PSI Total with CSS change in the NPO (r = -,275; P = .134).
Conclusions:
Results showed a global improvement in parental stress after an early TAU. The study showed that PO are characterized by higher parental stress levels at T0 than NPO. However, PO showed significant lower parental stress levels at T1 than NPO. In the PO, the higher parental stress levels could be given by their awareness about the presence of a developmental problem in own children and probably this awareness could help the parents in the search of a better treatment solution (for example parents of PO were significantly involved in the treatment than parents of NPO).