A Systematic Review of the Role of Parent Characteristics in Parent-Mediated Interventions for Children with Autism Spectrum Disorder

Background: Parent-mediated interventions (PMI) are increasingly being employed to improve outcomes for individuals with Autism Spectrum Disorder (ASD). Although the benefits of PMI are well documented (Oono et al., 2013), it is unclear whether parents’ characteristics affect their children’s outcomes. The lacuna is notable given long-standing literature suggesting that parents’ characteristics – including stress, mental health concerns, education, demographics, and certain cognitive profiles – may affect parents’ participation in treatment (Burrell & Borrego, 2012; de Veld et al., 2017; Karst & Van Hecke, 2012; Kazdin & Weisz, 2003). Better knowledge of how these characteristics, which are observed in parents of children with ASD, bear on PMI may enhance treatment procedures and outcomes.

Objectives: We reviewed the PMI literature and identified articles that explored the relationship between parent characteristics and children’s treatment outcomes.

Methods: We conducted multiple searches across PubMed, PubMed Central, and Web of Science databases, and screened, selected, and included articles in accordance with PRISMA guidelines (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009). We included articles that (a) were published in a peer-reviewed journal from 1987 to September 2018; (b) were written in English; (c) included at least one participant with a diagnosis of a Pervasive Developmental Disorder based on the DSM-III-R (American Psychiatric Association, 1987) or ASD in later DSM versions or the ICD classification systems; (d) included an intervention that explicitly employed a parent-mediated approach; (e) reported outcomes that focused on children’s behavior; (f) and employed an experimental design. Two authors then extracted and recoded key information about each study that met those criteria and was available in full text.

Results: We identified 511 unique articles that satisfied our selection criteria; of them, 115 met criteria for full-text review and 11 (~10%) examined the relationship between parent characteristics and children’s treatment outcomes. Their results indicated that stress, socioeconomic status, and the broad autism phenotype may be related to children’s outcomes in PMI, with the direction of the effects varying based on the specific treatment and outcome examined.

Conclusions: Existing literature suggests that treatment response may vary as a result of the individual characteristics of the child and/or parent in PMI. In recent years, researchers have strived to understand how the characteristics of the child affect treatment response. But, as shown by the limited number of studies available to date, we know far less about how the characteristics of the parent bear on children’s outcomes. Further research on that front is essential to understanding which families are best suited for particular interventions and how treatment procedures can be modified to improve intervention efficacy.