Training Programs for Parents Tied to Better Behavior in Kids With Autism
Behavior management strategies seemed to make a difference, study found
TUESDAY, April 21, 2015 (HealthDay News) -- Training programs for parents can help improve the behavior of children with autism, a new study suggests.
After six months of either parent training or parent education, the children's behavior improved for parents in both groups, but the benefit was greater in the parent training group, the researchers found.
"Parent training has solid evidence for reducing disruptive behavioral problems in young children who do not have autism spectrum disorders. But to date, parent training had not been tested in children with autism spectrum disorders," said study author Lawrence Scahill, a professor of pediatrics at Emory University School of Medicine in Atlanta.
This new study is the largest randomized trial of a behavioral intervention in children with autism, Scahill added.
The findings were published April 21 in the Journal of the American Medical Association.
Autism spectrum disorders are a group of developmental problems that can cause significant social, communication and behavioral challenges, according to the U.S. Centers for Disease Control and Prevention. The CDC estimates that one in 68 U.S. children has an autism spectrum disorder.
Parents of children with developmental disorders may feel that a referral for parent training indicates they lack basic parenting skills, but that's not how parents should think of it, according to Stacey Broton, a social worker at Texas Children's Hospital in Houston, who was not involved with the study.
"Parents spend significantly more time with their child than any other therapist, and we need to empower parents to view themselves as an integral part of the intervention team," said Broton, who works in the hospital's Autism Center.
The high numbers of parents who participated and remained in both programs in this study implied they were satisfied with the programs, Broton added.
The researchers randomly assigned 89 parents to receive parent training and 91 parents to receive education on autism. The parents all had a child between ages 3 and 7 who had an autism spectrum disorder.
Both programs lasted six months and included approximately 12 in-person sessions and one or two home visits. But, the education program did not teach behavior management strategies.
Before and after the programs, parents rated how disruptive or non-compliant their child was on two rating scales. A drop of at least 25 percent on each was considered meaningful improvement.
The disruptive behavior of children whose parents received training declined 48 percent on one measure, compared to a 32 percent drop among children whose parents received education. On the other scale, scores were 55 percent lower for parent training and 34 percent lower for parent education, the results showed.
A clinician who didn't know which program each child's parents attended also rated the children's improvement. That improvement was 68.5 percent for the parent training group and 40 percent for the parent education group, according to the study.
The study authors said the improvements lasted for at least 48 weeks.
The parent training program was built on the ABC model, Scahill said. "A" represents the antecedent, the situation or event that comes before "B," the child's behavior. "C" is the consequence, the parent's response.
"We teach parents to identify the antecedent, which is key to understanding what's driving the behavior," Scahill said. "The parental response may inadvertently reinforce the maladaptive behavior."
He provided the following example: if a child has a major tantrum when the parent asks him or her to get dressed and the parent gives in and dresses the child, that response reinforces that the tantrum worked.
"Parents can learn how to encourage positive behavior in their children, intentionally ignore minor or annoying behaviors, and respond effectively to significantly disruptive behaviors," said Dinah Godwin, who's also a social worker at Texas Children's Hospital in Houston.
Godwin provided four examples of changes parents can make to their own behavior to influence better responses from their children:
- Learning to give clear instructions that are appropriate for their child's developmental level, not just their age,
- Establishing a consistent routine for daily activities, such as mealtime and bedtime,
- Paying attention to positive behavior instead of focusing solely on negative behavior,
- Establishing clear house rules with clear and consistent consequences for misbehavior.
Seven out of 10 children showed a positive response in the study, Scahill said. The researchers haven't yet completed analyzing why some children didn't improve. One reason might be if a family has other issues, such as financial problems or a lack of transportation that prevents them from fully participating in the program, Godwin suggested.
Broton said that parenting programs such as these are usually available in greater metropolitan areas. But families in rural or remote areas may have less access to services, including parent training.
Another barrier for some families may be cost, which varies greatly for these programs. Group sessions can be cheaper or even free, but individualized parent training with about 12 to 15 sessions delivered by clinicians with Master's degrees would likely cost about $100 to $150 per hour, Broton explained. Some, but not all, insurance plans may cover that cost.
To learn more about autism, visit the U.S. National Institute of Neurological Disorders and Stroke.