Effectiveness of Parent Training for Disruptive Behavior of Children with Autism Spectrum Disorder in a Clinic Setting

Background: The Research Units on Pediatric Psychopharmacology (RUPP) Autism Network developed a parent training (PT) manual for children with autism spectrum disorder (ASD) and disruptive behavior. Randomized clinical trials suggest that manualized PT is an efficacious treatment for disruptive behavior in children with ASD (Johnson et al., 2007; Aman et al., 2009; Handen et al., 2015; Bearss et al., 2015). However, little is known about the effectiveness of this intervention when conducted in clinical settings, and in general results of studies evaluating the external validity of manualized psychotherapy treatments in community settings are inconclusive (Weisz, Donenberg, Han, and Weiss, 1995; Shadish, Matt, Navarro, and Phillips, 2000). We implemented an adaptation of the RUPP manual in a clinic setting. Administration differed from previous RCTs in that clinicians were encouraged to administer the treatment manual flexibly, with the primary goal of the clinic being to meet the unique needs of each patient.

Objectives: (1) Evaluate differences between implementation of the PT manual in a clinic setting to implementation in a previous RCT (Bearss et al., 2015); and (2) Compare the effects of the intervention conducted in a clinic setting to the previous RCT.

Methods: Participants included were children whose caregivers completed the parent training program and pre- and post- treatment questionnaires in the current outpatient behavioral health clinic (N=50). We analyzed data on child characteristics (age, gender, race, ethnicity, and diagnoses) and intervention characteristics (length of treatment, number of sessions attended, session content covered). We also conducted paired sample T-tests and calculated effect sizes for pre- and post-treatment questionnaires: the Home Situations Questionnaire, Autism Spectrum Disorder (HSQ-ASD; Chowdhury et al., 2015), Brief Assessment of Mealtime Behavior in Children (BAMBI; Lukens and Linscheid, 2008), and Children’s Sleep Habits Questionnaire (CHSQ; Owens, Spirito and McGuinn, 2000). Data from the current clinical sample was compared to data reported in Bearss et al. (2015).

Results: Child Characteristics: Children in the current sample tended to be older (M=6.3) and less likely to have a diagnosis of ASD (48 percent) compared to the prior RCT. Intervention Characteristics: On average, caregivers attended treatment for 12.48 sessions over 15.33 weeks. Session topics covered in treatment differed some from the previous RCT. Outcome Measures: We saw a 40 percent reduction in HSQ-ASD Total Mean Severity Scores from pre- to post- treatment, yielding a large effect size, comparable to reductions exhibited on pre-treatment and 12-week follow up in the prior RCT. Small effects were observed on the BAMBI and CSHQ.

Conclusions: Overall, we found some differences in the children who were served and the sessions that were administered in our current clinical sample. Despite differences, decreases in disruptive behavior (assessed by the HSQ-ASD) were comparable to the previous RCT.Many individuals who participated in our parent training program were not included in the current analysis, due to missing/incomplete questionnaires. Therefore, the current sample may be biased. However, the current investigation provides preliminary support for PT for children with developmental disabilities and disruptive behavior in a clinical setting.