Effects of Caregiver-Focused Programs on Psychosocial Outcomes in Caregivers of Individuals with ASD: A Meta-Analysis

Background: Caregivers of individuals with autism spectrum disorder (ASD) experience greater negative psychosocial outcomes than caregivers of individuals with other developmental disabilities. The majority of interventions for this population have focused exclusively on the offspring with ASD. Few studies have specifically targeted the caregivers of individuals with ASD, and the effectiveness of these interventions is not clear.

Objectives: To fill the gap, the current study used meta-analytic techniques to comprehensively review interventions that directly target psychosocial outcomes in caregivers of those with ASD and to explore potential moderators of effectiveness.

Methods: The initial literature search was conducted in September 2017 in multiple sources (e.g., ERIC, MEDLINE, PubMed). Backward and forward searches and e-alerts were conducted for additional relevant studies. Articles generated from e-alerts were screened for inclusion criteria until July 2018. The search encompassed published and unpublished empirical studies, systematic reviews, and conference proceedings. A random-effects model was used to calculate the mean effect size, Hedges’ g. The mean effect sizes from both pre-post intervention comparisons and group comparisons between treatment and control groups were calculated. Subgroup analyses and meta-regressions were conducted to examine potential moderators.

Results: A total of 41 unique studies met the inclusion criteria, targeting 1771 caregivers. Overall, the interventions had a small positive effect on improving psychosocial outcomes in caregivers of individuals with ASD (within-subjects: Hedges’ g = .44; between-subjects: Hedges’ g = .28). A variety of intervention approaches were identified: cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness-based intervention, psychoeducational intervention, social support, positive psychotherapy, written emotional disclosure, and multicomponent interventions. Intervention impact was associated with type of intervention. Specifically, CBT and ACT/mindfulness-based interventions were more consistently effective in improving caregivers’ overall psychosocial outcomes. The strongest pre- to post-treatment effect size impacts were noted for decreased perceived stress/distress (Hedges’ g = .56) and parenting stress (Hedges’ g = .55) and improved general well-being (Hedges’ g = .54). The largest between group caregiver effect sizes were for decreased parenting stress (Hedges’ g = .49), reduced depressive symptoms (Hedges’ g = .32) and anxiety level (Hedges’ g = .42), and improved general well-being (Hedges’ g = .65).

Conclusions: Overall, interventions were effective in improving caregivers’ psychosocial outcomes with a small, significant effect size. Most of the intervention approaches demonstrated some evidence of effectiveness although there was inconsistency in demonstrating significance for both within- and between-subjects analyses. The most consistent evidence was for ACT and mindfulness-based interventions which were moderately effective in improving caregiver psychosocial outcomes in both pre-post and group comparisons. The results indicate some evidence for the effectiveness of caregiver-focused interventions, however more studies with larger sample size, rigorous research design, and long-term follow-up assessments are needed.