568900 research-article2015
AUT0010.1177/1362361314568900AutismDababnah and Parish
Original Article
Feasibility of an empirically based program for parents of preschoolers with autism spectrum disorder
Autism 1–11 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361314568900 aut.sagepub.com
Sarah Dababnah1 and Susan L Parish2
Abstract This article reports on the feasibility of implementing an existing empirically based program, The Incredible Years, tailored to parents of young children with autism spectrum disorder. Parents raising preschool-aged children (aged 3–6 years) with autism spectrum disorder (N = 17) participated in a 15-week pilot trial of the intervention. Quantitative assessments of the program revealed fidelity was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, play-based child behavior skills, parent stress management, social support, and visual resources. More work is needed to further refine the program to address parent self-care, partner relationships, and the diverse behavioral and communication challenges of children across the autism spectrum. Furthermore, parent access and retention could potentially be increased by providing in-home childcare vouchers and a range of times and locations in which to offer the program. The findings suggest The Incredible Years is a feasible intervention for parents seeking additional support for child- and family-related challenges and offers guidance to those communities currently using The Incredible Years or other related parenting programs with families of children with autism spectrum disorder. Keywords autism spectrum disorder, early intervention, family functioning and support, interventions—psychosocial/behavioral, parent stress, parent training, preschool children, The Incredible Years
The evidence of prevalent stress and depression among parents raising children with autism spectrum disorder (ASD) is vast, and parents of younger children are particularly vulnerable (e.g. see Davis and Carter, 2008; Estes et al., 2009). The association between negative child behavior and parent stress is well established (Lecavalier et al., 2006). Furthermore, emotion regulation, one of the earliest challenges parents identify for children with ASD (Gomez and Baird, 2005), has also been correlated with maternal stress (Davis and Carter, 2008). The impaired ability of children to regulate their emotions can lead to an increase in tantrums and exacerbate challenging behaviors common to ASD, such as repetitive behaviors and aggression (Mazefsky et al., 2012). Various coping mechanisms buffer parent stress related to ASD, including the promotion of parent emotion regulation (Pottie and Ingram, 2008) and social support (Carter et al., 2009). Early intervention for children with ASD can decrease parent stress (Baker-Ericzén et al., 2005). On the other hand, high parent stress negatively impacts child outcomes (Osborne et al., 2008). Karst and Van Hecke
(2012) note several barriers related to parent engagement in ASD interventions, including time and financial strain, which can cause significant family disruption. Measuring and addressing parents’ needs along with their children’s is important to improve ASD early intervention outcomes. Nonetheless, few ASD interventions assess parent outcomes, and even fewer focus on improving parent well-being (Karst and Van Hecke, 2012). The findings reported in Dababnah and Parish (submitted) only identified one randomized controlled trial of an early intervention program that addressed stress, depression, coping, or other parent- or family-related outcomes in the ASD population.
1University 2Brandeis
of Maryland, USA University, USA
Corresponding author: Sarah Dababnah, School of Social Work, University of Maryland, 525 West Redwood Street, Baltimore, MD 21201, USA. Email: [email protected]
2 While few approaches focus on parent outcomes, various programs exist in which parents deliver intervention techniques to their children. A recent Autism Speaks roundtable addressed the problem that some parentmediated interventions have fallen short of replicating expected child outcomes or had uneven parental responses (Siller and Morgan, 2013). Suggested strategies to meet the unique needs of parents of young children with ASD include offering a mix of learning modalities and parent network opportunities. Wainer and Ingersoll (2013) suggested that improved attention to intervention fidelity could also improve replication of empirically based ASD parent programs. Fidelity is the degree to which implementation adheres to the established intervention, and it is crucial to proper dissemination of empirically based practice (Fraser et al., 2009). However, it can be difficult to achieve fidelity when interventions are adapted for a new population (Fraser et al., 2009). Preliminary efforts have been made to adapt empirically based interventions designed for parents of children with behavioral challenges to the population with ASD. For example, Stepping Stones Triple P is a promising option to reduce both problem child behaviors and dysfunctional parenting practices with parents of young children with ASD (Whittingham et al., 2009). Similarly, The Incredible Years (IY) positively impacted child behavior and parent mental health for school-aged children with ASD and their parents (Garcia and Turk, 2007; Roberts and Pickering, 2010) and other developmental disabilities (McIntyre, 2008). Yet, its feasibility has not been tested with parents of young children with ASD. Thus, this research addresses the fact that little is known about the challenges parents experience when deciding to join or continue in IY, nor the suitability of program content to this population.
IY Preschool Basic Parent Program IY Preschool Basic Parent Program (Webster-Stratton, 2001) is a group-based intervention intended to strengthen parent–child relationships, encourage positive discipline practices, develop children’s social and emotional skills, expand parents’ support networks and communication skills, and improve parent mental health. IY was originally developed to target typically developing children with severe behavioral problems and their parents, but it has since been used as a prevention as well as treatment program with populations at risk of challenging behaviors. The program has been tested in numerous randomized controlled trials (Webster-Stratton, 2011) and its use is widespread globally. It is informed by multiple, complementary theoretical perspectives on child development and parent functioning. While IY has separate versions for children of different ages, their caregivers, and teachers, this
Autism study focuses on the program used for parents of young children aged 3–6 years. Garcia and Turk (2007) published a case study of IY with parents of a 10-year-old Deaf child with ASD. While the program was geared toward children with hearing impairments, the authors suggested the program’s focus on emotions in part facilitated positive outcomes in parent stress and child behavior for the child with ASD. The school-age program (ages 5–11 years) has been piloted with eight parents of children with ASD (Roberts and Pickering, 2010). The researchers emphasized visual cues and “coaching” of child social and emotional skills and found promising reductions in challenging child behaviors and parent mental health. These encouraging preliminary findings suggest IY might be an appropriate program for families of young children with ASD. Garcia and Turk (2007) and Roberts and Pickering (2010) suggested IY was well-matched to the needs of children with ASD due in part to the program’s focus on emotion regulation. Children with ASD often have difficulty assessing their own emotional states (Rieffe et al., 2007), but IY helps parents to build skills in improving emotion recognition and regulation for themselves and their children. Another unique aspect of the program is the inclusion of materials focusing on parent stress, peer and social support, partner communication, and parent–teacher relationships, which are all germane to parents of children with ASD. In summary, parents raising preschoolers with ASD experience significant stress and poor outcomes, but few interventions address both parent and child needs. With other populations, IY has reduced children’s problem behaviors, enhanced children’s social skills and selfregulation, and improved parent stress and coping. Thus, the current research proposed a pilot study to test the feasibility of IY with parents of young children with ASD. The goal of feasibility studies is to assess implementation processes and acceptability, and to understand an intervention’s potential for more rigorous efficacy testing (Bowen et al., 2009). Findings related to the acceptability and short-term outcomes of IY with parents raising preschoolers with ASD are described in a separate report (Dababnah and Parish, 2014). The study utilized a pre–post design with no control group to collect parent stress outcomes and acceptability data. Overall, parents reported high acceptability of IY. Additionally, total parent stress significantly decreased (p
AUT0010.1177/1362361314568900AutismDababnah and Parish
Original Article
Feasibility of an empirically based program for parents of preschoolers with autism spectrum disorder
Autism 1–11 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1362361314568900 aut.sagepub.com
Sarah Dababnah1 and Susan L Parish2
Abstract This article reports on the feasibility of implementing an existing empirically based program, The Incredible Years, tailored to parents of young children with autism spectrum disorder. Parents raising preschool-aged children (aged 3–6 years) with autism spectrum disorder (N = 17) participated in a 15-week pilot trial of the intervention. Quantitative assessments of the program revealed fidelity was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, play-based child behavior skills, parent stress management, social support, and visual resources. More work is needed to further refine the program to address parent self-care, partner relationships, and the diverse behavioral and communication challenges of children across the autism spectrum. Furthermore, parent access and retention could potentially be increased by providing in-home childcare vouchers and a range of times and locations in which to offer the program. The findings suggest The Incredible Years is a feasible intervention for parents seeking additional support for child- and family-related challenges and offers guidance to those communities currently using The Incredible Years or other related parenting programs with families of children with autism spectrum disorder. Keywords autism spectrum disorder, early intervention, family functioning and support, interventions—psychosocial/behavioral, parent stress, parent training, preschool children, The Incredible Years
The evidence of prevalent stress and depression among parents raising children with autism spectrum disorder (ASD) is vast, and parents of younger children are particularly vulnerable (e.g. see Davis and Carter, 2008; Estes et al., 2009). The association between negative child behavior and parent stress is well established (Lecavalier et al., 2006). Furthermore, emotion regulation, one of the earliest challenges parents identify for children with ASD (Gomez and Baird, 2005), has also been correlated with maternal stress (Davis and Carter, 2008). The impaired ability of children to regulate their emotions can lead to an increase in tantrums and exacerbate challenging behaviors common to ASD, such as repetitive behaviors and aggression (Mazefsky et al., 2012). Various coping mechanisms buffer parent stress related to ASD, including the promotion of parent emotion regulation (Pottie and Ingram, 2008) and social support (Carter et al., 2009). Early intervention for children with ASD can decrease parent stress (Baker-Ericzén et al., 2005). On the other hand, high parent stress negatively impacts child outcomes (Osborne et al., 2008). Karst and Van Hecke
(2012) note several barriers related to parent engagement in ASD interventions, including time and financial strain, which can cause significant family disruption. Measuring and addressing parents’ needs along with their children’s is important to improve ASD early intervention outcomes. Nonetheless, few ASD interventions assess parent outcomes, and even fewer focus on improving parent well-being (Karst and Van Hecke, 2012). The findings reported in Dababnah and Parish (submitted) only identified one randomized controlled trial of an early intervention program that addressed stress, depression, coping, or other parent- or family-related outcomes in the ASD population.
1University 2Brandeis
of Maryland, USA University, USA
Corresponding author: Sarah Dababnah, School of Social Work, University of Maryland, 525 West Redwood Street, Baltimore, MD 21201, USA. Email: [email protected]
2 While few approaches focus on parent outcomes, various programs exist in which parents deliver intervention techniques to their children. A recent Autism Speaks roundtable addressed the problem that some parentmediated interventions have fallen short of replicating expected child outcomes or had uneven parental responses (Siller and Morgan, 2013). Suggested strategies to meet the unique needs of parents of young children with ASD include offering a mix of learning modalities and parent network opportunities. Wainer and Ingersoll (2013) suggested that improved attention to intervention fidelity could also improve replication of empirically based ASD parent programs. Fidelity is the degree to which implementation adheres to the established intervention, and it is crucial to proper dissemination of empirically based practice (Fraser et al., 2009). However, it can be difficult to achieve fidelity when interventions are adapted for a new population (Fraser et al., 2009). Preliminary efforts have been made to adapt empirically based interventions designed for parents of children with behavioral challenges to the population with ASD. For example, Stepping Stones Triple P is a promising option to reduce both problem child behaviors and dysfunctional parenting practices with parents of young children with ASD (Whittingham et al., 2009). Similarly, The Incredible Years (IY) positively impacted child behavior and parent mental health for school-aged children with ASD and their parents (Garcia and Turk, 2007; Roberts and Pickering, 2010) and other developmental disabilities (McIntyre, 2008). Yet, its feasibility has not been tested with parents of young children with ASD. Thus, this research addresses the fact that little is known about the challenges parents experience when deciding to join or continue in IY, nor the suitability of program content to this population.
IY Preschool Basic Parent Program IY Preschool Basic Parent Program (Webster-Stratton, 2001) is a group-based intervention intended to strengthen parent–child relationships, encourage positive discipline practices, develop children’s social and emotional skills, expand parents’ support networks and communication skills, and improve parent mental health. IY was originally developed to target typically developing children with severe behavioral problems and their parents, but it has since been used as a prevention as well as treatment program with populations at risk of challenging behaviors. The program has been tested in numerous randomized controlled trials (Webster-Stratton, 2011) and its use is widespread globally. It is informed by multiple, complementary theoretical perspectives on child development and parent functioning. While IY has separate versions for children of different ages, their caregivers, and teachers, this
Autism study focuses on the program used for parents of young children aged 3–6 years. Garcia and Turk (2007) published a case study of IY with parents of a 10-year-old Deaf child with ASD. While the program was geared toward children with hearing impairments, the authors suggested the program’s focus on emotions in part facilitated positive outcomes in parent stress and child behavior for the child with ASD. The school-age program (ages 5–11 years) has been piloted with eight parents of children with ASD (Roberts and Pickering, 2010). The researchers emphasized visual cues and “coaching” of child social and emotional skills and found promising reductions in challenging child behaviors and parent mental health. These encouraging preliminary findings suggest IY might be an appropriate program for families of young children with ASD. Garcia and Turk (2007) and Roberts and Pickering (2010) suggested IY was well-matched to the needs of children with ASD due in part to the program’s focus on emotion regulation. Children with ASD often have difficulty assessing their own emotional states (Rieffe et al., 2007), but IY helps parents to build skills in improving emotion recognition and regulation for themselves and their children. Another unique aspect of the program is the inclusion of materials focusing on parent stress, peer and social support, partner communication, and parent–teacher relationships, which are all germane to parents of children with ASD. In summary, parents raising preschoolers with ASD experience significant stress and poor outcomes, but few interventions address both parent and child needs. With other populations, IY has reduced children’s problem behaviors, enhanced children’s social skills and selfregulation, and improved parent stress and coping. Thus, the current research proposed a pilot study to test the feasibility of IY with parents of young children with ASD. The goal of feasibility studies is to assess implementation processes and acceptability, and to understand an intervention’s potential for more rigorous efficacy testing (Bowen et al., 2009). Findings related to the acceptability and short-term outcomes of IY with parents raising preschoolers with ASD are described in a separate report (Dababnah and Parish, 2014). The study utilized a pre–post design with no control group to collect parent stress outcomes and acceptability data. Overall, parents reported high acceptability of IY. Additionally, total parent stress significantly decreased (p
