The Efficacy of a Novel Emotion Regulation Group Intervention in Parents of Children with ASD
Children with Autism Spectrum Disorder (ASD) have impairment in reading socio-emotional information such as affect, social cues, and facial expressions and often experience less reward in social interaction. These characteristics limits children’s capacity to understand their own mental state, that is, to mentalize. From the parent’s perspective the child’s “mindblindedness” makes him a most challenging social partner who brings only few rewards into the relationship. A child with ASD needs a supportive relationship to survive, but even more than most children he needs his parents to be stable regulators of his experiences and emotions. Thus, parents need to make sense of what seems incomprehensible and unrewarding to their child with ASD.
The goal of this pilot study was to examine the effectiveness of a novel Regulative Parenting Workshop in teaching mentalization, reflective functioning, and emotion regulation skills in parents of children with ASD.
The study involved a non-randomized controlled 4-week trial. Parents were assigned to treatment or control groups. Measures included Parental Developmental Interview (PDI) that assesses the parent’s mentalization level. Children’s internalizing and externalizing behavior, and total problems were assessed with the Child Behavior Checklist. Measures from the treatment group were taken at baseline before the workshop and at 4 weeks after completing the workshop. Measures from the control group were taken twice with an interval of 3-4 weeks between the two assessments.
Twenty-three parents in the treatment group and 24 parents in the control group completed assessments at all time points and were included in the analysis. There were no differences at baseline between the groups on any demographic variable. Parents age ranged from 31-64 years. Eighty percent were female, and 19.6% were male. A large majority of participants were married (95.6%), 2.2% were single, and 2.2% were in a committed relationship. The majority of participants had completed masters degree or graduate degree (51.2%), 18.6% had a bachelors degree, and 20.9% completed college.
Results: Preliminary analyses from this pilot investigation revealed that parents receiving the intervention showed significant increase in total mentalization level based on the PDI (F(1,45)=4.5, p=.04). Moreover, parents in the intervention group increased in mentalization on all PDI subscales except of one. Children’s total problems (F(1,41)= 11.18, p=.002), internalizing behavior (F(1,41)=6.62, p=.014), and externalizing behavior (F(1,41)=2.85, p=0.05) decreased in the treatment group, but not in the control group.
Conclusions: Parents of children with ASD were able to improve their mentalization capacity towards their children after four group sessions focused on constructive strategies to regulate emotions. It seems that the parent’s capacity to mentalize the child by itself has a strong regulative effect. Parents reported after the workshop that the children’s symptoms decreased. It may be possible that the parents’ perception about the child’s symptoms changed and not necessarily the symptoms. However, changing the perception about the children’s symptoms may be an important goal by itself. Future studies are needed to replicate these observations in a randomized controlled investigation of a larger sample of participants.