Comparing Online and in-Person Parent Trainings to Support Executive Function and Self-Regulation: Feasibility, Acceptability, and Outcomes

Background: Unstuck and On Target (UOT; Cannon et al., 2011; 2018) is a school- and home-based cognitive behavioral intervention. It has been shown effective in two RCTs at improving executive functions (EF) and classroom behavior in children on the spectrum (Kenworthy, et al. 2014; Anthony, et al., in prep). In-person parent trainings were provided in the RCTs, but in-person trainings are not practical outside of research for the trainers and many families, who encounter disparities in access related to cost, geography, and free-time. To address these barriers, we developed an on-line parent training platform (e-Unstuck)that leverages the cognitive theory of multimedia learning (Mayer, 2009) for providing parents with interactive practice with EF concepts, opportunities to individualize materials/training for their child’s specific needs, and videos demonstrating: the lived experience of autism through interviews with an autistic self-advocate; the use of the Unstuck strategies with children; and the experience of other parents with Unstuck.

Objectives: Determine whether e-Unstuck is an effective alternative to in-person parent trainings and viable as a standalone treatment.

Methods: 85 parents of ASD children (mean age=10.3 years; mean IQ=104) were randomized to receive e-Unstuck (n=41) or two in-person trainings (n=44). Study outcome assessments were completed online both pre- and post-treatment. Two types of outcome assessments were given: 1) parent strain, empowerment, and competence, and 2) child EF (BRIEF-II and top 3 EF problems). Training use was also evaluated via usage metrics (online group), attendance logs (in-person group), and parent diary (both groups). Acceptability was elicited through both survey feedback (both groups) and focus groups (e-Unstuck).

Results: Acceptability and feasibility were rated positively in both groups, with no significant differences between the groups. ANCOVAs assessing change while controlling for pre-training baseline scores, child IQ, and parent education, revealed no group differences in outcomes (all p’s>0.27). Significant improvement in all parent self-ratings, as well as parent ratings of their child’s EF, indicated that parents (and their children) in both groups benefitted from the training they received (all p’s<0.01). Cohen’sdwas computed to further explore the impact of the training on parent self-ratings of strain, empowerment, and competence (Cohen’s d range=0.28-0.53), as well as parent ratings of their child’s EF problems (BRIEF ERI and BRIEF GEC, Cohen’s ds=0.26 and 0.28, respectively), indicated small to medium effect sizes. For the three most frequently nominated EF difficulties (flexibility, inhibition, and emotion control), parents reported significant improvement, as measured by rank, for flexibility (p=.027).Qualitative data is currently being analyzed and will be presented in an intramethod joint display (with the quantitative findings) to further explore parents’ reports of the aspects of the trainings and outcomes that were most important to them.

Conclusions: The results of this study indicate that e-Unstuckis equivalent to in-person training as led by an UOT author. e-Unstuckwill enable advanced training on this curriculum to be accessible to a significantly broader audience of parents than would be able to attend in-person trainings by the authors of UOT, which are only provided sporadically and in limited geographical settings.