Development and Pilot of the Caregiver Strategies Inventory: Measuring Parents' Everyday Responses to Children's Sensory Features

Background:  Sensory features (i.e., hyperresponsiveness, hyporesponsiveness, sensory seeking, and enhanced perception) are prevalent in 40-90% of individuals with autism spectrum disorder (ASD) (Baranek et al., in press). These features were recently added to the diagnostic classification of ASD in the DSM-5 (APA, 2013) and are understood to impact participation in everyday activities for children with ASD and their families (Bagby et al., 2012). Research suggests caregivers use many different strategies in attempt to manage their children’s sensory features in the course of their daily routines (Schaaf et al., 2011). However, the frequency with which they use particular strategies may differentially impact child outcomes in previously unexplored ways.

Objectives:  To design and pilot a questionnaire to quantify caregiver responses to sensory features within three conceptually-distinct categories: cognitive-behavioral strategies, sensory-perceptual strategies, and avoidance strategies.

Methods: Designed as a companion tool to the Sensory Experiences Questionnaire (SEQ; Baranek, 2009), the Caregiver Strategies Inventory (CSI) measures strategies parents of children with ASD use to manage their children’s sensory features in everyday activities. On the CSI, caregivers rate the frequency (6-point scale, 0=‘not at all’ to 5=‘every time’) with which they implement each of five different strategy types (2 sensory-perceptual, 2 cognitive-behavioral, and 1 avoidance) during 22 different sensory situations. Situations were chosen based on SEQ items with factor loadings ≥0.4 from a confirmatory factor model (Ausderau et al., in press) and/or ≥70% parent strategy endorsement (Little et al., 2011). Strategy options were based on conceptually-grouped caregiver responses to open-ended questions collected over a decade (N=1056). Three researchers expert in ASD, cognitive-behavioral theories, and/or sensory features reviewed the questionnaire and subsequent adjustments were made. The CSI was piloted as an online survey through Qualtrics with a national sample of 187 families of children with ASD (ages 4-14 years) to determine internal consistency, explore preliminary associations, and collect parent feedback.

Results:  Internal consistency values for conceptual strategies were strong: cognitive-behavioral, α= .95; sensory-perceptual, α=.95; avoidance, α= .85. Overall, parents reported cognitive-behavioral strategy use most often (M=2.24, SD=0.71), followed by sensory-perceptual (M=1.91, SD=0.71), and avoidance strategies (M=1.22, SD=0.61). Preliminary regression analyses (significant at p<0.05) suggest that sensory-perceptual strategy use was partially driven by younger chronological age and lower intellectual functioning, cognitive-behavioral strategy use by younger chronological age, and avoidance strategy use by lower intellectual functioning. The overwhelming majority of participants agreed that scenarios were easy to understand (96%) and relevant to their child (87%), that strategies were easy to understand (100%) and reflected strategies they use (88%), and that they would be willing to take this questionnaire again in future studies (100%).

Conclusions:  Based on pilot data, the CSI has utility for measuring caregiver strategies and, importantly, received positive feedback from parents.  Preliminary analyses suggest parents’ strategy choices may differ as a function of chronological age and intellectual functioning. The CSI can be used in future work to explore differential impacts of caregiver strategies on child outcomes longitudinally.  This knowledge will ultimately inform parent training on best practices for addressing sensory features during everyday activities.