Parent-Mediated Training for Behavior Problems in Children with ASD: We Have Miles to Go
Estimates suggest more than 90% of children and youth with ASD experience challenging and disruptive behaviors some time during their life (Matson, Wilkins, & Macken, 2009). Children with ASD display more challenging behaviors compared to children with other disabilities and those behaviors are associated with a variety of negative outcomes. Caregivers of children with ASD report higher stress compared to parents of neuro-typical children and parents of children from other disability groups (Baker-Ericzen, Brookman-Frazee, & Stahmer, 2005; Hayes & Watson, 2013). Family-centered care, specifically parent support and training, is imperative for these families. Numerous studies demonstrate the positive impact of parent training for improving developmental skills such as social communication in children with ASD, however, few have specifically addressed problem behaviors and even fewer have examined parental factors, such as stress or competency. Objectives: The current analysis represents part of a comprehensive meta-analysis concerning parent mediated interventions specifically targeting parents of children with Autism Spectrum Disorder and behavioral challenges. Conference participants should expect to gain knowledge of the current research base concerning parent-mediated interventions for problem behaviors in children with Autism Spectrum Disorder, specifically highlighting the large gaps in this research to date. The current research base, as well as its effectiveness in addressing parent concerns and characteristics will be discussed. Methods: Computer-based database and ancestry searches, and manual searches of peer-reviewed articles and dissertations were used to identify studies meeting inclusion criteria. To be included studies had to: (1) use a group design to evaluate the outcomes of a parent training or intervention for parents/caregivers of children with ASD, (2) report original data, (3) be published in English, (4) include five or more participants in their experimental groups, and (5) specifically be designed to address problem behaviors.
Review of the literature only produced seven group design studies that included parents as the key implementers of interventions designed to decrease disruptive behavior of their child with ASD. Of those studies, only three measured parent variables. Although effect sizes for children’s behavior based outcomes were positive, ranging from -0.73 to 2.02, direct comparison of outcomes was not possible because only 3 studies used the same outcome measures for child problem behavior. Overall, sample sizes were modest (range = 16 to 64) and dropout rates ranged from 5.1 to 48.5%. Neither implementation variables nor mechanisms of change variables were considered or mentioned in any of the seven studies.
The current analysis clearly highlights a need for parent-mediated interventions to address the needs of families of children with Autism Spectrum Disorder, specifically for problem behaviors. While discussion of a “need” persists, the current analysis would suggest we are much further behind in actually “doing” something to address that need. This review highlights both the dearth of studies and research investigating parent-based problem behavior intervention for ASD, as well as the large gaps in our knowledge about these interventions. Recommendations and directions for future research will be discussed.