Effect of Parent Training vs Parent Education on Behavioral Problems in Children With Autism Spectrum Disorder

Importance: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. Objective: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. Design, Setting, and Participants: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014. Interventions: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. Main Outcomes and Measures: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist_Irritability subscale (range, 0-45) and the Home Situations Questionnaire_Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. Results: At week 24, the Aberrant Behavior Checklist_Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, 3.9; 95% CI, 6.2 to 1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire_Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, 0.7; 95% CI, 1.1 to 0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression_Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). Conclusions and Relevance: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.