Reduced Levels of Anxiety, Depression, and Stress in Parents of Children with ASD Following Participation in Pivotal Response Treatment

Background: Parents of children with autism spectrum disorder (ASD) are more susceptible to psychological stress, depression, and anxiety than parents of typically developing children and parents of children with other disabilities (Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001; Miodrag & Hodapp, 2010; Taylor & Warren, 2012). Past research found 33%-59% of mothers of children with autism report depressive symptoms warranting psychiatric evaluation and nearly 40% express clinically significant levels of parenting stress (Feinberg et al., 2014). The prevalence of mental health challenges facing parents of children with autism highlights the importance of evaluating how treatment interventions for children could impact parental mental health.

Objectives: We investigated levels of anxiety, depression, and stress in parents of children with ASD. Then, we evaluated the changes in parents’ symptom severity after their children participated in a 16-week trial of Pivotal Response Treatment (PRT).

Methods: Thirty-seven parents, twenty-two mothers, participated in a study of PRT for children with ASD aged 4-8. PRT is a naturalistic behavioral treatment focused on improving children’s social communication skills. Treatment included 7 hours of weekly individual work with the child and parent training over 16 weeks. Both at the beginning and end of the 16-week treatment, parents completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Parental Stress Index (PSI). Scores greater than 21 indicate moderate anxiety on the BAI. On the BDI, scores above 13 indicate mild depression, and scores of 14-19 indicate moderate depression. Total scores greater than 109 on the PSI indicate high or critically high stress levels.

Results: At baseline, 2.7% of parents showed moderate-level anxiety as measured by the BAI. On the BDI, 16.7% of parents showed mild depression and 13.9% showed moderate depression. The PSI showed 2.7% of parents had stress in the high range and 8.1% had stress in the critically high range. Mothers showed significantly higher symptoms of depression at baseline than fathers (mothers mean=12.00, fathers mean=4.07, p<.05), but did not differ significantly on any other scale at baseline.

Conclusions: These findings indicate that parental anxiety, depression, and stress were significantly reduced following a 16-week trial of PRT. Additionally, with the exception of depression, mothers’ and fathers’ symptoms did not differ significantly at baseline. These results are promising in that although parents did not receive direct treatment, their wellbeing was improved following the trial. The parent-training component likely provided parents a sense of empowerment, and their symptoms also may have been reduced as a result of their child’s improvements in skills and behaviors.