Leveraging technology to make parent training more accessible: Randomized trial of in-person versus online executive function training for parents of autistic children

Adapting a coach-assisted web-based intervention for parents of adolescents who refuse school: qualitative study with users of the Partners in Parenting Plus programme

BACKGROUND

School refusal is a heterogenous problem which typically emerges in adolescence and co-occurs with internalising disorders. A substantial proportion of adolescents do not respond to existing treatment modalities; thus, novel, effective intervention options are needed. Partners in Parenting Plus (PiP+) is a coach-assisted, web-based intervention designed to empower parents to respond to adolescent internalising disorders.

AIMS

To conduct a process evaluation of PiP+ and identify programme adaptations required to meet the needs of parents of adolescents who refuse school.

METHOD

Semi-structured interviews were conducted with 14 Australian mothers who had: (a) received the PiP+ programme (not tailored for school refusal) during a prior research trial; and (b) reported that their adolescent was refusing school during their participation in PiP+. Inductive thematic analysis was used to analyse interview transcripts.

RESULTS

Participants were 41-53 years old (M = 47.8) and parenting adolescent children aged 14-17 years (M = 14.9). Three themes illustrated how PiP+ features met or could better meet the needs of parents of adolescents who were refusing school: (a) feeling heard, supported and respected; (b) relevance to me and my context; and (c) seeing positive changes. Participants had favourable views of PiP+, especially coached components. Participants requested programme enhancements to better meet the needs of parents of neurodiverse adolescents and discussed the impact of cumulative help-seeking 'failures' on self-efficacy and locus of control.

CONCLUSIONS

PiP+ was highly acceptable to the majority of parents navigating the issue of school refusal. This has implications for the enhancement of coach-assisted parenting interventions and the context-specific adaptation of PiP+ for school refusal.

Assessing the Effectiveness of Real-Time Online Parent Training for Parents of Children with Diverse Neurodevelopmental Disorders Residing in the Community

Background

Parents residing in the community have children with diverse neurodevelopmental disorders. Thus, developing online parent training that is effective for various types of neurodevelopmental disorders, not just for a single one, is essential. This study investigated the effects of real-time online group parent training developed for parents of children with various neurodevelopmental disorders.

Methods

Twenty-two parents (two males and 20 females) of children with diagnosed or suspected neurodevelopmental disorders participated. We developed real-time online group parent training based on the Tottori University parent training (TUPT-ON), which can be implemented online as a pilot study. Parenting stress, parenting attitudes, mental health, and children's inappropriate behavior scores were measured before and after the intervention and analyzed using paired t-test.

Results

The average participation rate was 75.5%, and the average homework submission rate was 66.6%. The intervention significantly improved parents' quality of life and negative parenting. Moreover, significant improvements were found in the total problems age-standardized scores (T-scores) of the Child Behavior Checkl List in participants' children. In response to five questions about the acceptability of our online group parent training, participants rated most items as four or higher out of five.

Conclusion

The implementation of TUPT-ON showed some improvements in children's outcomes and brought about positive changes in parental outcomes across various neurodevelopmental disorders. This result suggests the potential effectiveness of this intervention for different types of neurodevelopmental disorders. TUPT-ON could provide parent training and support for parents dealing with their children's various neurodevelopmental disorders, regardless of location, as long as they have a stable internet connection. However, the lack of a control group and the small sample size of certain diseases warrant caution in interpreting these findings, and a rigorous validation design should be employed and revalidated in the future.

Emotion Regulation and Executive Function: Associations with Depression and Anxiety in Autism

Background

Adolescents and young adults with autism spectrum disorder (ASD) are prone to experience co-occurring mental health conditions such as mood or anxiety disorders, as well as impairments in emotion regulation and executive functioning. However, little research has examined inter-relationships among these constructs, despite evidence of additional stressors and increased risk of internalizing disorders at this age, relative to non-autistic individuals. If either emotion regulation or executive functioning are shown to have patterns of association with mental health, this can inform mechanism-based intervention.

Method

Fifty-seven autistic adolescents and adults (16-25 years) with ASD in a transition intervention completed questionnaires and clinician-administered measures at baseline. Analyses assessed whether executive functioning impairment, above and beyond emotion regulation impairment, were associated with depression and anxiety symptoms.

Results

ASD characteristics, emotion regulation, anxiety, and depression were significantly correlated. ASD characteristics was a significant contributor to depression and emotion regulation impairments were significant contributors to anxiety and depression. Findings indicated that inhibition difficulties did not uniquely contribute to depression or anxiety above emotion regulation impairment. Difficulties in cognitive flexibility were associated with depression above and beyond ASD characteristics, IQ, and emotion regulation, but not associated with anxiety.

Conclusions

Although preliminary, findings suggest that inflexibility and regulatory impairment should be considered in depression remediation approaches. Improving ER, on the other hand, may have broader transdiagnostic impact across both mood and anxiety symptoms in ASD.