Publication year
2015
Citation Title
Effect of parent training vs parent education on behavioral problems in children with Autism Spectrum Disorder.
Journal Name
JAMA
Journal Volume
313
Issue Number
15
Page Numbers
1524-1533
DOI
10.1001/jama.2015.3150
Summary
Children with autism spectrum disorder often show disruptive and noncompliance behaviors and many parents may need support as they deal with these behaviors. A 24-week parent training program which provided specific strategies to manage disruptive behaviors was compared to a 24-week parent education program that only provided information about autism. Results revealed that the parent training program was more effective than parent education program in reducing problem behaviors.
Key Findings
At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47% for the parent training group, and 32% for the parent education group.
Similarly, the Home Situations Questionnaire declined 55% and 34% for the parent training and parent education groups, respectively.
About two thirds (69%) of participants in the parent training group gave positive responses about the program, compared to 40% in the parent education group.
Implications for Military Professionals
Educate military parents about symptoms of autism spectrum disorder to help them identify symptoms as early as possible
Provide extra assistance to military children with autism spectrum disorder
Implications for Program Leaders
Offer support groups for military parents whose children were diagnosed with autism spectrum disorder
Design parent training and parent education curricula regarding autism spectrum disorder, and make them accessible to military families
Implications for Policy Makers
Support parent training and parent education programs that can help military parents cope with children’s problem behaviors
Recommend trainings for professionals who work with military family regarding the early identification of autism spectrum disorder
Methods
Participants were recruited from six sites (e.g., Emory University, University of Pittsburgh).
Participants were randomly assigned to the parent training group (N = 89) or the parent education group (N = 91); the parent training program provided specific strategies to reduce problem behaviors, whereas the parent education program only provided information about autism but no intervention.
Each participant was assessed at baseline, every four weeks throughout the program, and after treatment at weeks 36 and 48; the primary outcomes included two questionnaires that assessed children’s disruptive behaviors.
Participants
The sample included 180 children (86% White, 88% male) with autism spectrum disorder and moderate to severe disruptive behaviors.
The average age of the children was 4.7 years (age range = 3-7 years, SD = 1.1).
Children in the parent training and parents education groups were similar in demographics at baseline except for maternal education level.
Limitations
The parents were not blinded to treatment assignment, therefore their perspectives may result in a bias in favor of parent training.
All the treatment outcomes relied on ratings from one source (parents), so the results may be hard to generalize to the classroom.
It is unclear what child and family characteristics may predict success with the parent training and parent education programs.
Avenues for Future Research
Measure children’s disruptive and noncompliant behaviors from both parents and teachers to get a thorough understanding
Identify parent and child characteristics that may predict success with the programs
Examine the effects of the programs on other aspects of autistic problems, such as social interaction and emotion regulation
Focus
Civilian
Target Population
Population Focus
Abstract
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.
Abstract Document
PRTW Document
Attach