Interventions to Improve Outcomes for Parents of Individuals with Autism Spectrum Disorder: A Meta-Analysis

Background: Parents of children with autism spectrum disorders (ASD) tend to experience greater psychological and emotional distress than parents of typically developing children. Interventions directed toward parents and caregivers have traditionally consisted of skills training and/or knowledge building interventions designed to ultimately improve child outcomes. More recently, researchers have begun to recognize the needs of parents and the importance of developing interventions to support them directly in addition to their children. However, the extent to which parent outcomes are improved by existing parent interventions is unknown.

Objectives: The purpose of this study was to conduct a meta-analytic review of existing interventions for parents of children with ASD in an effort to examine the degree to which they improve parental outcomes.

Methods: A total of 24 peer-reviewed, empirical studies containing 81 effect sizes published between January 1946 and November 2018 were identified from literature searches in relevant databases. Included studies were randomized controlled trials of interventions for parents of children with ASD in which one or more parental psychological outcomes were quantified. Studies were standardized to a common effect size (Cohen’s d) and then subjected to a random-effects multilevel meta-analysis using inverse variance weighting. Meta-regression was conducted to examine potential study-level moderators of intervention efficacy.

Results: Analyses revealed that participation in parent interventions led to small but significant improvements in parent outcomes (d = .26 [95% CI = .08 - .43], p = .004). There was significant heterogeneity in effect sizes, suggesting wide variability in efficacy between studies, Q = 294.53, p < .001. When analyzed by outcome type, the overall effect was driven primarily by improvements in parenting confidence (d = .57, p = .000) and mental health symptoms (d = .30, p = .018). There were no significant effects of parent interventions on stress, caregiving burden, family adjustment, or physical health. When analyzed by intervention type, both parent implementation interventions (d = .20, p = .007) and parent support interventions (d = .29, p = .033) had significant effects on parental outcomes. Moderator analysis indicated that the efficacy of parent interventions was not significantly moderated by child age, parent age, intervention format (i.e. group/individual), or treatment duration.

Conclusions: The impact of existing parent interventions on the psychological and emotional outcomes of parents caring for individuals with ASD was modest and heterogeneous. Existing interventions had the greatest impact on caregiver confidence and mental health symptoms, yet had no consistent effect on stress, caregiving burden, family adjustment, or physical health. Both parent implementation and parent support interventions led to small but significant improvements in parental outcomes. While these results suggest promise in assisting parents, more work is needed to develop interventions that have a greater impact on parental outcomes.