Skip to main content
SpringerLink
Log in

Teaching Parents Behavioral Strategies for Autism Spectrum Disorder (ASD): Effects on Stress, Strain, and Competence

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

We report on parent outcomes from a randomized clinical trial of parent training (PT) versus psychoeducation (PEP) in 180 children with autism spectrum disorder (ASD) and disruptive behavior. We compare the impact of PT and PEP on parent outcomes: Parenting Stress Index (PSI), Parent Sense of Competence (PSOC), and Caregiver Strain Questionnaire (CGSQ). Mixed-effects linear models evaluated differences at weeks 12 and 24, controlling for baseline scores. Parents in PT reported greater improvement than PEP on the PSOC (ES = 0.34), CGSQ (ES = 0.50), and difficult child subdomain of the PSI (ES = 0.44). This is the largest trial assessing PT in ASD on parent outcomes. PT reduces disruptive behavior in children, and improves parental competence while reducing parental stress and parental strain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abbeduto, L., Seltzer, M. M., Shattuck, P., Krauss, M. W., Orsmond, G., & Murphy, M. M. (2004). Psychological well-being and coping in mothers of youths with autism, down syndrome, or Fragile X Syndrome. American Journal on Mental Retardation, 109(3), 237–254.

    Article  PubMed  Google Scholar 

  • Abidin, R. (1995). Manual for the parenting stress index. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Abikoff, H. B., Vitiello, B., Riddle, M. A., Cunningham, C., Greenhill, L. L., Swanson, J. M., … Wigal, S. B. (2007). Methylphenidate effects on functional outcomes in the preschoolers with attention-deficit/hyperactivity disorder treatment study (PATS). Journal of Child and Adolescent Psychopharmacology, 17(5), 581–592.

    Article  PubMed  Google Scholar 

  • Aman, M. G., McDougle, C. J., Scahill, L., Handen, B., Arnold, L. E., Johnson, C., … Wagner, A. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: Results from a randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 48(12), 1143–1154.

    Article  Google Scholar 

  • Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). Psychometric characteristics of the aberrant behavior checklist. American Journal of Mental Deficiency, 89(5), 492–502.

    PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorder: DSM-IV-TR. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Arbuckle, J. L. (2006). Amos (version 7.0) [computer program]. Chicago: SpSS.

    Google Scholar 

  • Barroso, N. E., Hungerford, G. M., Garcia, D., Graziano, P. A., & Bagner, D. M. (2016). Psychometric properties of the Parenting Stress Index-Short Form (PSI-SF) in a high-risk sample of mothers and their infants. Psychological Assessment, 28(10), 1331–1335. doi:10.1037/pas0000257.

    Article  PubMed  Google Scholar 

  • Bearss, K., Johnson, C., Handen, B., Smith, T., & Scahill, L. (2013). A pilot study of parent training in young children with autism spectrum disorders and disruptive behavior. Journal of Autism and Developmental Disorders, 43(4), 829–840.

    Article  PubMed  Google Scholar 

  • Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., … Scahill, L. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. Journal of the American Medical Association, 313(15), 1524–1533.

    Article  PubMed  Google Scholar 

  • Benson, P. R. (2014). Coping and psychological adjustment among mothers of children with ASD: An accelerated longitudinal study. Journal of Autism and Developmental Disorders, 44(8), 1793–1807.

    Article  PubMed  Google Scholar 

  • Boström, P., Broberg, M., & Bodin, L. (2011). Child’s positive and negative impacts on parents—A person-oriented approach to understanding temperament in preschool children with intellectual disabilities. Research in Developmental Disabilities, 32(5), 1860–1871.

    Article  PubMed  Google Scholar 

  • Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The caregiver strain questionnaire measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5(4), 212–222.

    Article  Google Scholar 

  • Chacko, A., Wymbs, B. T., Wymbs, F. A., Pelham, W. E., Swanger-Gagne, M. S., Girio, E., … Phillips, C. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child & Adolescent Psychology, 38(2), 206–218.

    Article  Google Scholar 

  • Coolican, J., Smith, I. M., & Bryson, S. E. (2010). Brief parent training in pivotal response treatment for preschoolers with autism. Journal of Child Psychology and Psychiatry, 51(12), 1321–1330.

    Article  PubMed  Google Scholar 

  • Danforth, J. S., Harvey, E., Ulaszek, W. R., & McKee, T. E. (2006). The outcome of group parent training for families of children with attention-deficit hyperactivity disorder and defiant/aggressive behavior. Journal of Behavior Therapy and Experimental Psychiatry, 37(3), 188–205.

    Article  PubMed  Google Scholar 

  • Dretzke, J., Davenport, C., Frew, E., Barlow, J., Stewart-Brown, S., Bayliss, S., … Hyde, C. (2009). The clinical effectiveness of different parenting programmes for children with conduct problems: A systematic review of randomised controlled trials. Child and Adolescent Psychiatry and Mental Health, 3(1), 1.

    Article  Google Scholar 

  • Enders, C. K. (2001). A primer on maximum likelihood algorithms available for use with missing data. Structural Equation Modeling, 8(1), 128–141.

    Article  Google Scholar 

  • Falk, N. H., Norris, K., & Quinn, M. G. (2014). The factors predicting stress, anxiety and depression in the parents of children with autism. Journal of Autism and Developmental Disorders, 44(12), 3185–3203.

    Article  PubMed  Google Scholar 

  • Gibaud-Wallston, J., & Wandersman, L. P. (1978). Parenting sense of competence scale. Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Gilmore, L., & Cuskelly, M. (2009). Factor structure of the Parenting Sense of Competence scale using a normative sample. Child: Care, Health and Development, 35(1), 48–55.

    Google Scholar 

  • Greenberg, J. S., Seltzer, M. M., Hong, J., & Orsmond, G. I. (2006). Bidirectional effects of expressed emotion and behavior problems and symptoms in adolescents and adults with autism. American Journal on Mental Retardation, 111(4), 229–249.

    Article  PubMed  Google Scholar 

  • Hastings, R. P., Kovshoff, H., Brown, T., Ward, N. J., Espinosa, Degli, F., & Remington, B. (2005). Coping strategies in mothers and fathers of preschool and school-age children with autism. Autism: The International Journal of Research and Practice, 9(4), 377–391.

    Article  Google Scholar 

  • Hsiao, Y.-J. (2016). Pathways to mental health-related quality of life for parents of children with autism spectrum disorder: Roles of parental stress, children’s performance, medical support, and neighbor support. Research in Autism Spectrum Disorders, 23, 122–130.

    Article  Google Scholar 

  • Johnson, C. R., Handen, B. L., Butter, E., Wagner, A., Mulick, J., Sukhodolsky, D. G., … Aman, M. G. (2007). Development of a parent training program for children with pervasive developmental disorders. Behavioral Interventions, 22(3), 201–221.

    Article  Google Scholar 

  • Kaat, A. J., Lecavalier, L., & Aman, M. G. (2014). Validity of the Aberrant Behavior Checklist in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1103–1116.

    Article  PubMed  Google Scholar 

  • Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15(3), 247–277.

    Article  PubMed  Google Scholar 

  • Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149-e1158.

    Article  Google Scholar 

  • Lecavalier, L., Smith, T., Johnson, C., Bearss, K., Swiezy, N., Aman, M. G., … Scahill, L. (2017). Moderators of parent training for disruptive behaviors in young children with autism spectrum disorder. Journal of Abnormal Child Psychology, 45, 1235–1245.

    Article  PubMed  Google Scholar 

  • Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202.

    Article  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P., & Risi, S. (2002). Autism Diagnostic Observation Schedule: ADOS. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: Moderators and follow-up effects. Clinical Psychology Review, 26(1), 86–104.

    Article  PubMed  Google Scholar 

  • McArdle, J. J. (2009). Latent variable modeling of differences and changes with longitudinal data. Annual Review of Psychology, 60, 577–605.

    Article  PubMed  Google Scholar 

  • Moreland, A. D., Felton, J. W., Hanson, R. F., Jackson, C., & Dumas, J. E. (2016). The relation between parenting stress, locus of control and child outcomes: Predictors of change in a parenting intervention. Journal of Child and Family Studies, 25(6), 2046–2054.

    Article  Google Scholar 

  • Mullen, E. (1995). Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Service Inc.

    Google Scholar 

  • Postorino, V., Sharp, W. G., McCracken, C. E., Bearss, K., Burrell, T. L., Evans, A. N., & Scahill, L. (2017). A systematic review and meta-analysis of parent training for disruptive behavior in children with autism spectrum disorder. Clinical Child and Family Psychology Review, 1–12.

  • Pottie, C. G., & Ingram, K. M. (2008). Daily stress, coping, and well-being in parents of children with autism: A multilevel modeling approach. Journal of Family Psychology, 22(6), 855–864.

    Article  PubMed  Google Scholar 

  • Rao, P. A., & Beidel, D. C. (2009). The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning. Behavior Modification, 33(4), 437–451.

    Article  PubMed  Google Scholar 

  • Rezendes, D. L., & Scarpa, A. (2011). Associations between parental anxiety/depression and child behavior problems related to autism spectrum disorders: The roles of parenting stress and parenting self-efficacy. Autism Research and Treatment. doi:10.1155/2011/395190.

    PubMed  PubMed Central  Google Scholar 

  • Roid, G. H. (2003). Stanford-Binet Intelligence Scales. Itasca, IL: Riverside Publishing.

    Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism Diagnostic Interview-Revised. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Scahill, L., Bearss, K., Lecavalier, L., Smith, T., Swiezy, N., Aman, M. G., … Turner, K. (2016). Effect of parent training on adaptive behavior in children with autism spectrum disorder and disruptive behavior: Results of a randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 602–609.

    Article  Google Scholar 

  • Skotarczak, L., & Lee, G. K. (2015). Effects of parent management praining programs on disruptive behavior for children with a developmental disability: A meta-analysis. Research in Developmental Disabilities, 38, 272–287.

    Article  PubMed  Google Scholar 

  • Smith, T., & Iadarola, S. (2015). Evidence base update for autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 44(6), 897–922.

    Article  Google Scholar 

  • Strauss, K., Vicari, S., Valeri, G., D’Elia, L., Arima, S., & Fava, L. (2012). Parent inclusion in early intensive behavioral intervention: The influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes. Research in Developmental Disabilities, 33(2), 688–703.

    Article  PubMed  Google Scholar 

  • Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., King, N., & Rinehart, N. (2006). Effects on parental mental health of an education and skills training program for parents of young children with autism: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 45(5), 561–569.

    Article  Google Scholar 

  • Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., & Rinehart, N. (2014). A randomised group comparison controlled trial of ‘preschoolers with autism’: A parent education and skills traning intervention for young children with autistic disorder. Autism: The International Journal of Research and Practice, 18(2), 166–177.

    Article  Google Scholar 

  • Vasilopoulou, E., & Nisbet, J. (2016). The quality of life of parents of children with autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 23, 36–49.

    Article  Google Scholar 

  • Wells, K. C., Epstein, J. N., Hinshaw, S. P., Conners, C. K., Klaric, J., Abikoff, H. B., … Greenhill, L. L. (2000). Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): An empirical analysis in the MTA study. Journal of Abnormal Child Psychology, 28(6), 543–553.

    Article  PubMed  Google Scholar 

  • Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Stepping Stones Triple P: An RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. Journal of Abnormal Child Psychology, 37(4), 469–480.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank our team for their contributions to this project: Jill Pritchett at Ohio State University; Laura Simone at Yale TrialDB; Yanhong Deng, Saankari Anusha Challa, Denis Sukhodolsky, James Dziura, and Allison Gavaletz at Yale; Carrie McGinnis at Indiana University; Rachael Davis, David McAdam, Bridget Reynolds, Melissa Sturge-Apple, and Amit Chowdhry at University of Rochester Medical Center. We also thank the Data and Safety Monitoring Board: Gerald Golden, M.D. (retired pediatric neurologist), Christopher Young, M.D. (Medical Director of Wellmore Behavioral Health, Waterbury, CT and Martin Schwartzman father of a child with autism).

Funding

This work was funded by the National Institute of Mental Health by the following grants: Yale University/Emory University MH081148 (principal investigator: L. Scahill); University of Pittsburgh/University of Florida MH080965 (principal investigator: C. Johnson); Ohio State University MH081105 (principal investigator: L. Lecavalier); Indiana University MH081221 (principal investigator: N. Swiezy); University of Rochester MH080906 (principal investigator: T. Smith). Additional support was provided by MH079130 (principal investigator: D Sukhodolsky), the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1 TR000454 (Emory University), UL1 TR000042 (University of Rochester), UL1 RR024139 (Yale University) and the Marcus Foundation. We thank the families who participated in this study.

Author information

Authors and Affiliations

  1. University of Rochester Medical Center, Rochester, NY, USA

    Suzannah Iadarola, Lynne Levato, Bryan Harrison & Tristram Smith

  2. Ohio State University, Columbus, OH, USA

    Luc Lecavalier

  3. University of Florida, Gainesville, FL, USA

    Cynthia Johnson

  4. Indiana University, Indianapolis, IN, USA

    Naomi Swiezy

  5. University of Washington, Seattle, WA, USA

    Karen Bearss

  6. Emory University, Atlanta, GA, USA

    Lawrence Scahill

  7. Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 671, Rochester, NY, 14642, USA

    Suzannah Iadarola

Authors
  1. Suzannah Iadarola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynne Levato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bryan Harrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tristram Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luc Lecavalier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cynthia Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naomi Swiezy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Karen Bearss
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lawrence Scahill
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SI participated conceived of the current study analyses, participated in its design and coordination, and drafted the manuscript; LL conceived of the current study analyses and drafted the manuscript; BH participated in the study design, performed the statistical analyses, and assisted in drafting the manuscript; TS conceived of the original study, participated in its design and coordination, assisted with data interpretation and helped to draft the manuscript; LL conceived of the original study, participated in its design and coordination, assisted with data interpretation and helped to draft the manuscript; CJ conceived of the original study, participated in its design and coordination, assisted with data interpretation and helped to draft the manuscript; NS conceived of the original study, participated in its design and coordination, assisted with data interpretation and helped to draft the manuscript; KB conceived of the original study, participated in its design and coordination, assisted with data interpretation and helped to draft the manuscript; LS conceived of the original study, participated in its design and coordination, assisted with data interpretation and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Suzannah Iadarola.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIF 2864 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iadarola, S., Levato, L., Harrison, B. et al. Teaching Parents Behavioral Strategies for Autism Spectrum Disorder (ASD): Effects on Stress, Strain, and Competence. J Autism Dev Disord 48, 1031–1040 (2018). https://doi.org/10.1007/s10803-017-3339-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3339-2

Keywords

Search

Navigation