Reduced Levels of Parental Anxiety, Depression and Stress Following Pivotal Response Treatment
Parents of children with intellectual and developmental disorders are more susceptible to physical health problems, psychological stress, depressive and anxiety disorders (Miodrag & Hodapp, 2010; Taylor & Warren, 2012). Meta-analysis of past studies done by Singer in 2006, estimated that 30-35% mothers of children with developmental disabilities are likely to have elevated levels of depressive symptoms (Singer, 2006).
We characterized the severity of anxiety, depression and stress in parents of children with Autism Spectrum Disorders (ASD) and the change of these symptoms in those who took part in Pivotal Response Treatment (PRT).
We measured anxiety, depression and stress in 116 parents of children with ASD using the Beck Anxiety Inventory (BAI), Beck Depression Inventory, Second Edition (BDI-II) and Parental Stress Index, Forth Edition (PSI-4), respectively.
Then, we investigated the reduction of these symptoms in 25 of the parents (15 mothers and 10 fathers) after they participated in a 16-week trial of PRT. PRT is a naturalistic behavioral treatment that aims to improve a child’s social communication skill. PRT is a 16-week trial that includes 7 hours/week of individual work with a school-age child with autism and parent training. To measure the change in social functioning of the children who participated in PRT, parents completed Social Responsiveness Scale, Second Edition (SRS-2) before and after the intervention.
Out of 116 parents of children with ASD, 22% reported mild to moderate levels of depression (total BDI score >14), 3% reported moderate to high levels of anxiety (total BAI score >22) and 22% exhibited high levels of stress (total PSI-4 raw score >110).
Of the families who participated in the PRT trial, parents reported a significant decrease in their anxiety (BAI Total Score: pre-PRT M= 5.44, SD= 6.72; post-PRT M= 4.28, SD= 6.07, p<0.05) and stress (PSI-4 Total Score: pre-PRT M= 95.67, SD= 18.24; post-PRT M= 82.71, SD= 18.26, p<0.001). Individual PSI-4 subdomains, Parental Distress Score (p< 0.01), Child Dysfunctional Interaction Score (p<0.001) and Difficult Child Score (p<0.01) decreased significantly as well. A trend toward decreasing levels of depression was observed (BDI Total Score: pre-PRT M= 8.36, SD= 7.26; post-PRT M= 6.68, SD= 6.62, p=0.065).
The improvement in social functioning of children who participated in PRT, as measured by SRS-2, was correlated with the reduction in parental depression (r=-0.523, p<0.001) and stress (r=-0.489, p<0.01).
Our results show that rates of depressive symptoms and stress are high in parents of children with ASD and their symptoms are reduced after participating in PRT. The parent training component of PRT provides parents with the support and training to effectively implement PRT. Being actively engaged in PRT and witnessing the positive improvements in their children due to the intervention relieves the stress and anxiety parents have about their children and their disorder. It also provides them with a sense of hope for the future of their children.