Does Adding Mindfulness Based Stress Reduction to Early Intervention Improve Caregiver Functioning?: A Randomized Controlled Trial

Background: Systems of care increasingly emphasize parent-delivered early intervention for young children with autism spectrum disorder (ASD). Multiple studies have documented high levels of psychological distress within parents of children on the autism spectrum. However, few studies have examined how to support caregiver wellbeing directly as part of early behavioral intervention.

Objectives: This randomized controlled trial compared caregivers who completed 12 sessions of the Parent-implemented Early Start Denver Model (P-ESDM; n = 31) to caregivers who completed P-ESDM in addition to six concurrent individual sessions of Mindfulness Based Stress Reduction (MBSR; n = 30).

Methods: Caregivers (53 mothers, 8 fathers) and their child with ASD (mean age = 2.37 years, sd = .46; mean ADOS-2 Calibrated Severity Score = 8.11, sd = 1.63) participated in 12 weekly P-ESDM sessions. Half of caregivers were randomized to also receive six individual MBSR sessions. Caregivers completed the Beck Depression Inventory, Beck Anxiety Inventory, Parenting Stress Index, and Five Facet Mindfulness Questionnaire at baseline, 6 weeks, 12 weeks (treatment end) and 1-, 3-, and 6-months post treatment. Groups were similar at baseline on all outcome variables and demographic characteristics (caregiver sex, annual income, caregiver educational level, racial/ethnic background). Attrition was similar across groups and caregiver demographics.

Results: Multilevel models with discontinuous slopes (active treatment slope, change in slope post-treatment) were used to test for group differences in change in outcomes over time. When considering the whole sample, resulting coefficients [standard errors] revealed significant (p < .001) average improvement during active treatment in all sub-domains of parent stress: parental distress (-1.32 [.28]), parent-child dysfunctional interaction (-1.18 [.26]), and difficult child (-.90 [.23]). These scores all significantly increased again post-treatment (ps < .01). During treatment, overall scores also decreased for depression (-.65 [.23]; p < .05) and anxiety (-.81 [.30]; p < .05). Depression scores significantly increased again post-treatment (.76 [.26]; p <.01), but improvements in anxiety were maintained (no significant change). Whole group analyses did not reveal changes in mindfulness. Considering groups separately, caregivers who received MBSR had greater improvements in parental distress (-1.69 [.47]; p < .01) and parent-child dysfunctional interactions (-1.12 [.45]; p < .05). Parental distress increased again post-treatment (1.46 [.69]; p < .05). Caregivers who received MBSR also improved in mindfulness (2.83 [1.36]; p < .05), whereas caregivers in only P-ESDM reported lower mindfulness scores over time. Treatment group did not significantly predict slopes (during active treatment or post-treatment) for depression or anxiety. Differential response trajectories emerged for male caregivers and caregivers of younger children, but no significant effects were found for child autism severity nor caregiver educational attainment.

Conclusions: Providing MBSR training as part of parent-mediated early behavioral intervention for very young, newly diagnosed children resulted in greater improvements in caregiver-reported levels of parenting stress relative to behavioral intervention alone. Results suggest that systems of care can offer caregivers manualized, low intensity training in stress reduction strategies that may have long-term impacts on how they interact with their children.