Tailoring an Evidence-Based Practice to Parents Raising Preschoolers with Autism: Strengths, Challenges, and Future Research Directions

Background:  Parent strain and burden are high in families raising children with Autism Spectrum Disorder (ASD). Parents of preschool children with ASD in particular are particularly vulnerable to stress and depression. Poor parent mental health is associated with several negative outcomes, including child social difficulties, strained parent-child attachment, and marital unhappiness. Yet, few interventions address the direct needs of this growing population of parents.

Objectives:  The current study evaluated the outcomes of an existing evidence-based parenting program, The Incredible Years, adapted to caregivers of young children with ASD. The program focuses on improving child-parent communication, problem solving, stress management, and school readiness, as well as to reduce challenging child behaviors and poor family dynamics.

Methods:  Seven groups of parents in two sites participated in a pilot trial with no comparison group of the 12-week intervention. Participants were recruited from a community convenience sample. Pre/post changes in parenting stress using the Parenting Stress Index, caregiver coping using Ways of Coping Questionnaire, and child behavior using the Aberrant Behavior Checklist were examined, as well as acceptability and fidelity measures available in the Incredible Years manual. Data were analyzed with two-tailed, paired t-tests (p<.05) and basic descriptive statistical procedures using SPSS.

Results:  Of the 46 parents who completed baseline measures, 37 completed the program (80.4%). Most participants were mothers and married. The majority of caregivers identified as White (67%) or Latino/a (30%). Approximately two-thirds of the participants had a college degree or more. Participants reported a range of household income levels, with nearly a quarter of respondents noting a household income of less than $25,000. A minority of caregivers had mental health issues (15%).

Fidelity to the manualized intervention was maintained throughout the program period. Child-related parenting stress significantly declined at posttest, with a mean percentile decrease of 6 points (95% CI: .83, 11.02). Child irritability and agitation significantly decreased by 3 points (95% CI: .42, 6.17), and child lethargy and social withdrawal by 2 points (95% CI: .39, 4.20). While improvements in caregiver coping skills and child hyperactivity and non-compliance trended in the expected directions, the changes were not statistically significant. Acceptability was high among graduates of the program, particularly regarding the play-based approach of the program with specific skills in improving parent and child emotion regulation, as well as opportunities for social support and peer learning. Participants’ most common recommendation for improvement was to extend the program’s duration.

Conclusions:  The Incredible Years is a promising practice for parents raising preschoolers with ASD. A randomized controlled trial is needed to rigorously test the intervention. Specifically, more research is necessary to investigate further intervention modifications to improve outcomes for young children with ASD and their parents.