Interventions to Improve Outcomes for Parents of Children with Autism Spectrum Disorder: A Meta-Analysis

Comparison of effects of interventions to promote the mental health of parents of children with autism: A systematic review and network meta-analysis

Individuals diagnosed with autism spectrum disorders often face persistent challenges in social interaction and engage in repetitive and stereotyped behaviors. Parenting a child with autism can profoundly affect parents both physically and psychologically, potentially leading to negative impacts on their mental health. This study employs a network meta-analysis methodology to evaluate the comparative effectiveness of mental health interventions specifically designed for parents of autistic children. A total of 69 empirical intervention studies involving 4213 parents of autistic children were included in the analysis. Employing the frequency framework model and utilizing Stata 16.0 software, we quantitatively analyzed the impact of various interventions on anxiety, depression, parenting stress, and parenting self-efficacy. Our findings indicate that mindfulness-based interventions demonstrate the highest efficacy in reducing parenting stress, while cognitive behavioral therapy is effective in alleviating anxiety and depression in parents of children with autism. Psychoeducational interventions have shown significant benefits in mitigating parental anxiety, depression, and parenting stress, and acceptance and commitment (ACT) displays promising outcomes in reducing depression. We also elaborate on the underlying mechanisms that contribute to the effectiveness of these interventions. This network meta-analysis presents valuable insights for the development of targeted interventions to provide support to parents of children with autism.

The physical and psychosocial benefits of a family judo program for parents of children with Autism Spectrum Disorder: A pilot study

BACKGROUND

Parents of children with Autism Spectrum Disorder (ASD) tend to have high levels of stress and poor health habits. There is a lack of interventions that focus on improving health outcomes in parents of children with ASD.

OBJECTIVE

To examine the physical and psychosocial effects of a family-based judo program on parents of children diagnosed with ASD.

METHODS

This study utilized a pre-post single group design. Eighteen parent-child dyads participated in a 14-week judo program for families of children with ASD. Judo sessions were held once a week for 45 min. Parents wore wrist accelerometers to assess physical activity/sleep quality, and completed surveys regarding self-reported stress levels pre- and post-judo. Parents also completed open-ended questions regarding their experience in the program. Paired sample t-tests were conducted to examine changes in stress, physical activity, and sleep quality from pre-to post-program.

RESULTS

Both a decrease in parental stress (47.77 vs. 41.61, p < 0.01) and an increase in minutes per day of physical activity (35.49 vs 45.94, p = 0.002) were observed from baseline to post-program. Fourteen of the 18 parents (78 %) reported at least one psychosocial benefit (e.g. increased self-confidence) or physical health benefit (e.g. increased physical activity) from participation in the program.

CONCLUSIONS

A family judo program may provide health benefits, such as reducing stress levels and increasing physical activity in parents of children with ASD. Further research involving larger sample sizes is necessary to better determine the effects of judo on both parents and their children with ASD.

An Exploratory Study on the Association between Atypical Behavioral Responses to Tickling and Autistic Traits in Japanese Children

Although play is an essential occupation for children, parents of children with autistic traits tend to struggle with play-based interpersonal interaction with them. Tickling play appears to be one of the most interpersonal forms of play because nobody can tickle themselves. However, atypical tactile processing (e.g. tactile sensitivity) has been reported in children with autistic traits, who may exhibit atypical behavioral responses during tickling play. Our aim was to investigate the association between autistic traits and behavioral responses during parent-child tickling play in Japanese young children. We recorded tickling interaction between children and their parents using behavior coding with six behavioral items. Autistic traits and tactile sensitivity were measured using parent-reported questionnaires. Results showed two behavioral responses were significantly associated with autistic traits in all children: "approach with positive emotional response" and "no response" were negatively and positively correlated with autistic traits, respectively. This exploratory study suggests that behavioral responses during tickling play may be associated with autistic traits.

Family-Centric Applied Behavior Analysis Promotes Sustained Treatment Utilization and Attainment of Patient Goals

BACKGROUND/OBJECTIVES

 Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication difficulties and restricted repetitive behaviors or interests. Applied behavior analysis (ABA) has been shown to significantly improve outcomes for individuals on the autism spectrum. However, challenges regarding access, cost, and provider shortages remain obstacles to treatment delivery. To this end, parents were trained as parent behavior technicians (pBTs), improving access to ABA, and empowering parents to provide ABA treatment in their own homes. We hypothesized that patients diagnosed with severe ASD would achieve the largest gains in overall success rates toward skill acquisition in comparison to patients diagnosed with mild or moderate ASD. Our secondary hypothesis was that patients with comprehensive treatment plans (>25-40 hours/week) would show greater gains in skill acquisition than those with focused treatment plans (less than or equal to 25 hours/week).  Methods: This longitudinal, retrospective chart review evaluated data from 243 patients aged two to 18 years who received at least three months of ABA within our pBT treatment delivery model. Patients were stratified by utilization of prescribed ABA treatment, age, ASD severity (per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and treatment plan type (comprehensive vs. focused). Patient outcomes were assessed by examining success rates in acquiring skills, both overall and in specific focus areas (communication, emotional regulation, executive functioning, and social skills).

RESULTS

Patients receiving treatment within the pBT model demonstrated significant progress in skill acquisition both overall and within specific focus areas, regardless of cohort stratification. Patients with severe ASD showed greater overall skill acquisition gains than those with mild or moderate ASD. In addition, patients with comprehensive treatment plans showed significantly greater gains than those with focused treatment plans.

CONCLUSION

The pBT model achieved both sustained levels of high treatment utilization and progress toward patient goals. Patients showed significant gains in success rates of skill acquisition both overall and in specific focus areas, regardless of their level of treatment utilization. This study reveals that our pBT model of ABA treatment delivery leads to consistent improvements in communication, emotional regulation, executive functioning, and social skills across patients on the autism spectrum, particularly for those with more severe symptoms and those following comprehensive treatment plans.

Correlates of Impairment and Growth in Families of Young Autistic Children

The purpose of this project was to investigate potential correlates of family life impairment in families of young autistic children. This project incorporated measures of specific child and parent challenges in addition to a commonly used unidimensional measure of autism characteristics. In this way, we could assess whether such challenges explain variance in family life impairment, and whether their inclusion diminish associations between autism characteristics and family life impairment. Cross-sectional data were collected from 564 parents of autistic children aged 2 to 5 years who participated in a larger online study. Participants completed measures on child characteristics (autism characteristics, emotion dysregulation, speaking ability, flexibility, and sleep problems), parent depression, and family life impairment, using the Family Life Impairment Scale (FLIS). Multiple linear regression models were generated to examine whether any of the independent variables were associated with the four domains of the FLIS. Models controlled for child age and sex, parent education, and single-parent homes. All independent variables were associated with impairment in one or more FLIS domains. None of the primary independent variables were significantly associated with positive growth. More overt characteristics and behaviors (e.g., autism characteristics, reactivity, speaking ability, and flexibility) were associated with impairment in domains that reflected a family's ability to navigate the community. However, sleep challenges and parent and child emotional difficulties were most strongly associated with parent impairment. Findings suggests that families may have different needs across contexts and provide new avenues through which they might be better supported.

Health, Wellbeing and Empowerment E-workshops for Mothers of Children with Disabilities: A Non-randomised Comparison Study

Mothers of children with disabilities can experience compromised health. Targeted interventions require investigation to determine effectiveness. Healthy Mothers Healthy Families (HMHF) is a health, wellbeing and empowerment program that addresses mothers need to protect, and or, recover their own health due to caregiving impacts. This study compared the effectiveness of HMHF e-workshops online compared to no intervention. The HMHF e-workshops were delivered to 290 mothers across the 2020-2022 Covid-19 pandemic and 172 participated in research. The HMHF e-workshops included 3 online 2- hour workshops facilitated by credentialled peer-facilitators, closed online group chat, e-workbook and online learning package. Participants in both groups completed surveys pre and post the workshops (or control) over 8-10 weeks. Mothers who participated in HMHF significantly increased health help seeking behaviours (p < .001), and improved mental health and health behaviors over time: health behavior (p < .001), positive wellbeing (p < .004) and depression (p < .001) and stress symptoms (p = .005). Compared to controls, HMHF e-workshop participants significantly improved health behaviours (p < .001) and self-reported symptoms of depression (p = .002) and stress (p = .005) over 8-10 weeks. E-workshops were accessible and effective for mothers of children with high care needs and family responsibilities across the COVID-19 pandemic. Compared to no intervention, the HMHF intervention was more effective for improving healthy behaviours and mental health.

Spring is not yet here: raising a child with ASD in rural southwest China

PURPOSE

This study aims to reveal the parenting experiences of parents of children with autism spectrum disorder (ASD) in rural southwest China under the framework of ecological systems theory.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 21 parents of children with ASD from rural southwest China and the interview data were analyzed using the three coding steps of the grounded theory method, namely open, axial, and selective coding.

RESULTS

The results showed four themes: challenges from within the family; relationships between parents, the school, and the community; scarcity and low accessibility of available resources and services; the culture of discriminating against people with disabilities and the loss of eligibility for welfare. The mismatch between the needs of families of children with ASD and the resources available in social-environmental systems is the major issue faced by parents.

CONCLUSIONS

Raising a child with ASD in rural southwest China is affected by the interactions between the families and the internal structures in different environmental systems. The culture of discriminating against people with disabilities formed in the macrosystem could be the essential factor that affects the smoothness of the parenting process of children with ASD.

Effect of counselling intervention on stress and expressed emotions among family caregivers of children with autism

Parenting a child with autism represents an extraordinary challenge for families, resulting in prominent levels of stress and burden that subsequently affect their expressed emotions. This study aimed to evaluate the effect of counseling intervention on stress and expressed emotions among family caregivers of children with autism. The research used a pre-post interventional design, to evaluate 40 family caregivers of children with autism. The interviewing questionnaire assessed socio-demographic data, expressed emotions, and parenting stress, revealing that 57.5% of the evaluated family caregivers had severe stress pre-counseling, compared to 25% post-counseling intervention. Additionally, 80% of them had elevated levels of expressed emotions pre-counseling, compared to 32.5% during the post-counseling intervention. Most family caregivers of children with autism experienced significant levels of expressed emotions, and over half of them had severe levels of stress. However, these levels decreased following the implementation of the counseling interventions. Furthermore, there were highly statistically significant correlations between the total levels of expressed emotions and total stress levels among family caregivers before and after the implementation of the counseling intervention.

Brief Report: Telehealth Music-Enhanced Reciprocal Imitation Training in Autism: A Single-Subject Feasibility Study of a Virtual Parent Coaching Intervention

PURPOSE

Telehealth delivery increases accessibility of parent-mediated interventions that teach parents skills and support autistic children's social communication. Reciprocal Imitation Training (RIT), an evidence-based Naturalistic Developmental Behavioral Intervention (NDBI) focused on imitation skills, a common difficulty in autism, holds promise for telehealth-based parent training. Imitation is also a core component of musical play during childhood and the affordances of musical play/song naturally shape parent-child interactions. We evaluate the feasibility of a music-based, telehealth adaptation of RIT-music-enhanced RIT (tele-meRIT)-as a novel format for coaching parents in NDBI strategies.

METHODS

This single-subject, multiple baseline design study included 4 autistic children (32-53 months old) and their mothers. Parent-child dyads were recorded during 10-min free play probes at baseline, weekly tele-meRIT sessions, and one-week and one-month follow-up. Probes were coded for parents' RIT implementation fidelity, parent vocal musicality, and children's rate of spontaneous imitation.

RESULTS

No parent demonstrated implementation fidelity during baseline. All parents increased their use of RIT strategies, met fidelity by the end of treatment, and maintained fidelity at follow-up. Parent vocal musicality also increased from baseline. Intervention did not consistently increase children's imitation skills. A post-intervention evaluation survey indicated high parent satisfaction with tele-meRIT and perceived benefits to their children's social and play skills more broadly.

CONCLUSION

Implementing tele-meRIT is feasible. Although tele-meRIT additionally involved coaching in incorporating rhythmicity and song into play interactions, parents achieved fidelity in the RIT principles, suggesting one avenue by which music can be integrated within evidence-based parent-mediated NDBIs.

How effective are group-based psychoeducation programs for parents of children with ASD in Turkey? A systematic review and meta-analysis

Recent research shows that group-based psychoeducation programs designed for parents of children with ASD have grown in popularity over time. The international evidence for the effectiveness of psychoeducation programs designed for parents of children with ASD in developed societies emphasizes the importance of providing a synthesis of the effectiveness of programs in developing societies. This study's primary aim is to assess the efficacy of group-based psychoeducation programs in Turkey for parents of children with ASD. The second aim is to investigate how the programs are influenced by the potential moderators (type of involvement, research design, number of sessions, duration of sessions, and number of participants). For these purposes, a database search was conducted that included group-based psychoeducation programs for parents of children with ASD implemented in Turkey. Twelve group-based psychoeducation programs that met the inclusion criteria were included in the study. The results showed that group-based psychoeducation programs for parents of children with ASD had "medium" effects on psychological symptoms [ES(SE) = 0.65 (.08), 95%CI (0.48-0.81)], "low" effects on social skills [ES(SE) = 0.32 (.16), 95%CI (0.02-0.62)], and "high" effects on well-being [ES(SE) = 1.05 (.19), 95%CI (0.66-1.43)]. According to moderator analyses, the type of involvement and the number of sessions were statistically significant moderators of psychological symptoms, but not the research design, duration of sessions, or number of participants.

Quality of Life of Mothers and Fathers of Children with Autism Spectrum Disorder in Jordan

Background

Parenting children with autism spectrum disorder (ASD) is widely identified to be associated with life-long impairment in parents' quality of life (QoL). However, there has been little information on the QoL of parents of children with ASD in the Jordanian context.

Objective

This study aimed to assess the QoL among mothers and fathers who have children with ASD in Jordan and to identify factors associated with it.

Methods

In this cross-sectional study, respondents were mothers and fathers of children with ASD attending autism rehabilitation centers in Amman. Data were collected from 206 participants using a validated questionnaire. Descriptive statistics, T-test, ANOVA and logistic regression, were applied.

Results

Overall quality of life was low (mean= 2.32). The physical dimension scored the highest (mean =2.79), and the environmental dimension scored the lowest (mean= 2.06). Results indicated that fathers and parents with low education reported significantly lower QoL scores (p = .024 and 0.001, respectively).

Conclusion

Among parents of children with ASD, parents at risk for low QoL were recognized. Our results can be utilized to design interventions to support mothers and fathers at risk in Jordan to enhance their QoL.

Perceived Support Needs of School-Aged Young People on the Autism Spectrum and Their Caregivers

With increasing demands for health, disability and education services, innovative approaches can help distribute limited resources according to need. Despite an increased focus on support needs within the clinical pathway and policy landscape, the body of research knowledge on this topic is at a relatively early stage. However, there appears to be a sense of unmet support needs and dissatisfaction with the provision of required support following an autism diagnosis amongst caregivers of young people on the spectrum. The primary aim of this study was to explore the perceived support needs of Australian school-aged young people on the spectrum and their caregiver(s). This was achieved using a phenomenographic Support Needs Interview conducted by occupational therapists during home-visits with caregivers of 68 young people on the spectrum (5-17 years). Qualitative data analysis resulted in two hierarchical outcome spaces, one each for young people and their caregivers, indicating interacting levels of support need areas that could be addressed through a combination of suggested supports. These support needs and suggested supports align with almost all chapters within the Body Functions, Activities and Participation and Environmental Factors domains of the International Classification of Functioning, Disability and Health. The overall goals of meeting these complex and interacting support needs were for the young people to optimize their functioning to reach their potential and for caregivers to ensure the sustainability of their caregiving capacity. A series of recommendations for support services, researchers and policy makers have been made to position support needs as central during the assessment, support and evaluation phases.

Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review

LAY ABSTRACT

Families from underrepresented ethnic or racial groups and those with limited financial resources could experience more difficulty in accessing support services for their autistic child due to certain types of barriers. We searched academic journals, websites, and other sources for studies which looked at what barriers might be present for such families and what might help families access support services for their autistic child. The search found 18 studies. Results from each study were examined and coded into themes. Parents reported that accessibility, diversity of support services, and stigma influenced their experiences with support services. We discuss what these findings might mean for future research and for service delivery.