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Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder

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Abstract

We conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3–7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p = .05) and a 5.3 point difference between high and low Anxiety groups (p = .04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.

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References

  • Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985a). The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. American Journal of Mental Deficiency, 89, 485–491.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    Google Scholar 

  • Arnold, L. E., Gadow, K. D., Farmer, C. A., Findling, R. L., Bukstein, O., Molina, B. G., …, Aman, M. G. (2015). Comorbid anxiety and social avoidance in treatment of severe childhood aggression: Response to adding risperidone to stimulant and parent training; mediation of disruptive symptom response. Journal of Child and Adolescent Psychopharmacology, 25, 203–212.

  • Ashwood, K. L., Tye, C., Azadi, B., Cartwriht, S., Asherson, P., & Bolton, P. (2015). Brief report: adaptive functioning in children with ASD, ADHD, and ASD + ADHD. Journal of Autism and Developmental Disorders, 45, 2235–2242.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., & Edelbrock, C. (1987). Assessing situational variation in children’s problem behaviors: The home and school situations questionnaires. In R. Prinz (Ed.), Advances in behavioral assessment of children and families (pp. 157–176). Greenwich: JAI Press Inc.

    Google Scholar 

  • Bearss K., Johnson C., Handen, B., Butter, E., Lecavalier, L., Smith, T., & Scahill L. (2015a). RUBI autism network: Parent training for disruptive behavior [a treatment manual]. Publisher: Authors.

  • Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., …, Scahill, L. (2015b). Parent training for young children with autism spectrum disorder and disruptive behavior: A randomized clinical trial. Journal of the American Medical Association, 313, 1524–1533.

  • Bearss, K., Taylor, C. A., Aman, M. G., Whittmore, Lecavalier, L., …, Scahill, L. (2016). Using qualitative methods to guide scale development for anxiety in autism spectrum disorder. Autism, 20, 663–672.

  • Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005). Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73, 371–388.

    Article  PubMed  Google Scholar 

  • Beavers, G. A., Iwata, B. A., & Lerman, D. C. (2013). Thirty years of research on the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 46, 1–21.

    Article  PubMed  Google Scholar 

  • Chowdhury, M., Aman, M., Lecavalier, L., Smith, T., Johnson, C., …, Scahill, L. (2016). Factor structure and psychometric properties of the Home Situations Questionnaire for autism spectrum disorder: the home situations questionnaire – autism spectrum disorder. Autism, 20, 528–537.

  • Chronis, A. M., Chacko, A., Fabiano, G. A., Wymbs, B. T., & Pelham, W. E. (2004). Enhancements to the behavioral parent training paradigm for families of children with ADHD: review and future directions. Clinical Child and Family Psychology Review, 7, 1–27.

    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(7).

  • Elsabbagh, M., Divan, G., Koh, Y. J., Kim, Y. S., Kauchali, S., Marcin, C., …, Fombonne, E. (2012). Global prevalence of autism and other pervasive developmental disorders. Autism Research, 5, 160–179.

  • Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. Journal of Autism and Developmental Disorders, 34, 379–393.

    Article  Google Scholar 

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology (US Dept Health, Education, and Welfare publication (ADM), pp. 218–222). Rockville: National Institute of Mental Health. Clinical global impression (C.G.I.).

    Google Scholar 

  • Hallett, V., Lecavalier, L., Sukhodolsky, D. G., Cipriano, N., Aman, M. G., McCracken, J. T., …, Scahill, L. (2013). Exploring anxiety in Children With Pervasive Developmental Disorders Across a broad range of functioning. Journal of Autism and Developmental Disorders, 10, 2341–2352.

  • Handen, B. L., Aman, M. G., Arnold, L. E., Hyman, S. L., Tumuluru, R. V., Lecavalier, L., …, Smith, T. (2015). Effects of Atomoxetine, parent training, and their combination in children with autism spectrum disorder and ADHD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 905–915.

  • Jones, K., Daley, D., Hutchings, J., Bywater, T., & Eames, C. (2007). Efficacy of the incredible years basic parent training programme as an early intervention for children with conduct problems and ADHD. Child: Care, Health and Development, 33(6), 749–756.

    Google Scholar 

  • Kaat, A. J., & Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents with autism spectrum disorders: a review of the prevalence, presentation, and treatment. Research in Autism Spectrum Disorders, 7, 1579–1594.

    Article  Google Scholar 

  • Kaat, A. J., Lecavalier, L., & Aman, M. G. (2014). Validity of the aberrant behavior checklist in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 1103–1116.

    Article  PubMed  Google Scholar 

  • Lecavalier, L., Gadow, K. D., DeVincent, C. J., Houts, C., & Edwards, M. C. (2011). Validity of DSM-IV syndromes in preschoolers with autism spectrum disorders. Autism, 15, 527–543.

    Article  PubMed  Google Scholar 

  • Lee, P., Niew, W., Yang, H., Chen, V. C., & Lin, K. (2012). A meta-analysis of behavioral parent training for children with attention deficit hyperactivity disorder. Research in Developmental Disabilities, 33, 2040–2049.

    Article  PubMed  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.

    Article  PubMed  Google Scholar 

  • Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2005). A meta-analysis of parent training: moderators and follow-up effects. Clinical Psychology Review, 26, 86–104.

    Article  PubMed  Google Scholar 

  • McIntyre, L. L. (2008). Parent training for young children with developmental disabilities: randomized controlled trial. American Journal on Mental Retardation, 113, 356–368.

    Article  PubMed  PubMed Central  Google Scholar 

  • Michelson, D., Daveport, C., Dretzke, J., Barlow, J., & Day, C. (2013). Do evidence-based interventions work when tested in the “real world?” A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clinical Child and Family Pychology Review, 16, 18–34.

    Article  Google Scholar 

  • MTA Cooperative Group. (1999). Moderators and mediators of treatment response for children with attention deficit/ hyperactivity disorder. Archives of General Psychiatry, 56, 1088–1096.

    Article  Google Scholar 

  • Mullen, E. (1995). Mullen scales of early learning (AGS Editionth ed.). Circle Pines: American Guidance Service.

    Google Scholar 

  • Ollendick, T. H., Jarrett, M. A., Grills-Taquechel, A. E., Hovey, L. D., & Wolf, J. C. (2008). Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders. Clinical Psychology Review, 28, 1447–1471.

    Article  PubMed  Google Scholar 

  • Owen R., Sikich L., Marcus R. N., Corey-Lisle, P., Manos, G. McQuade, R. D., …, Findling, R. H. (2009). A multicenter, double-blind, randomized, placebo controlled, flexible-dose, parallel-group study of aripiprazole in the treatment of irritability in children and adolescents (6–17 years) with autistic disorder. Pediatrics, 124, 1533–1540.

  • Pincus, D. B., Santucci, L. C., Ehrenreich, J. T., & Eyberg, S. M. (2008). The implementation of modified parent–child interaction therapy for youth with separation anxiety disorder. Cognitive and Behavioral Practice, 15, 118–125.

    Article  Google Scholar 

  • Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62, 1266–1274.

    Article  Google Scholar 

  • Rogers, S. J. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27, 168–179.

    Article  PubMed  Google Scholar 

  • Roid, G. H. (2003). Stanford-binet intelligence scales (5th ed.). Itasca: Riverside.

    Google Scholar 

  • RUPP Autism Network. (2002). Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine, 347, 314–321.

    Article  Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview revised. Torrance: Western Psychological Services.

    Google Scholar 

  • Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., …, Leckman, J. F. (1997). Children’s Yale–Brown obsessive compulsive scale: reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 844–852.

  • Scahill, L., McDougle, C. J., Williams, S. K., Dimitriopoulos, A., Aman, M. G., et al. (2006). The Children’s Yale–Brown obsessive compulsive scales modified for pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1114–1123.

    Article  PubMed  Google Scholar 

  • Scahill, L., McCracken, J. T., King, B. H. Rockhill, C., Shah, B., …, McDougle, C. J., and Research Units on Pediatric Psychopharmacology Autism Network. (2015). Extended-release guanfacine for hyperactivity in children with autism spectrum disorder. American Journal of Psychiatry, 172, 1197–1206.

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.

    Article  PubMed  Google Scholar 

  • Sprafkin, J., Volpe, R. J., Gadow, K. D., Nolan, E. E., & Kelly, K. (2002). A DSM-IV-referenced screening instrument for preschool children: the early childhood inventory-4. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 604–612.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Van Den Hoofdakker, B. J., Van der Veen-Mulder, L., Sytema, S., Emmelkamp, P. M. G., Minderaa, R. B., & Nauta, M. H. (2007). Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1263–1271.

    Article  PubMed  Google Scholar 

  • Webster-Stratton, C. H., Reid, M. J., & Beauchaine, T. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child & Adolescent Psychology, 40, 191–203.

    Article  Google Scholar 

  • Wong, C., Odom, S. L., Hume, K. Cox, A. W., Fettig, A., Kucharczyk, S., …, Schultz, T. R. (2014). Evidence-based practices for children, youth, and young adults with Autism spectrum disorder. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, Autism Evidence-Based Practice Review Group.

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Acknowledgements

We thank the families who participated in this study. We thank Jill Pritchett for assistance with manuscript preparation. We also thank the Data and Safety Monitoring Board: Gerald Golden, MD (retired pediatric neurologist), Christopher Young, MD (Medical Director of Wellmore Behavioral Health, Waterbury, CT) and Martin Schwartzman father of a child with autism).

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Authors and Affiliations

  1. Nisonger Center and Department of Psychology, Ohio State University, 371D McCampbell Hall, 1581 Dodd Dr., Columbus, OH, 43210, USA

    Luc Lecavalier

  2. University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 671, Rochester, NY, 14642, USA

    Tristram Smith

  3. Department of Clinical and Health Psychology, 1225 Center Dr., Room 3130, PO Box 100165, Gainesville, FL, 32610-0165, USA

    Cynthia Johnson

  4. Department of Psychiatry and Behavioral Sciences, 4909 25th Ave NE, Seattle, WA, 98105, USA

    Karen Bearss

  5. Indiana University Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA

    Naomi Swiezy

  6. Ohio State University, 1581 Dodd Dr., Columbus, OH, 43210, USA

    Michael G. Aman

  7. Yale Child Study Center, 230 South Frontage Road, PO Box 207900, New Haven, CT, 06520-7900, USA

    Denis G. Sukhodolsky

  8. Yale Center for Analytical Sciences, 300 George Street Suite 555, New Haven, CT, 06511, USA

    Yanhong Deng & James Dziura

  9. Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA, 30329-4010, USA

    Lawrence Scahill

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  1. Luc Lecavalier
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  2. Tristram Smith
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  3. Cynthia Johnson
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  6. Michael G. Aman
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  7. Denis G. Sukhodolsky
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  8. Yanhong Deng
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  10. Lawrence Scahill
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Correspondence to Luc Lecavalier.

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Conflict of Interest

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). The project described in this publication also was supported 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. Author (d) serves as a consultant for The Autism Foundation. Author (j) serves as a consultant for the following research organizations: Neuren, Coronado, Roche and Supurnus Pharmaceuticals. Additionally, author (j) receives royalties from Oxford and Guilford Press and receives research funds from The Marcus Foundation. Author (f) has received a research grant from The Autism Treatment Network (#UA3MC11054). Author (f) served as a consultant, served on the advisory board and participated in investigator training for: Cogstate, Inc., Confluence Pharmaceutica; Cogstate Clinical Trials, Ltd., Coronado Biosciences, Forest Research, Hoffman-La Roche, Lumos Pharma, Medavante, Inc., Novarti’s, Pfizer, Prophase LLC and Supernus Pharmaceuticals. Author (b) has received research grants from HRSA, NIH, NIMH, Autism Speaks, U.S. Department of Education, NIH/UCLA and AIR-B/HRSA. All other authors have declared 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.

Additional information

Trial Registration: Clinicaltrials.gov #NCT01233414 http://clinicaltrials.gov/show/NCT01233414

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Lecavalier, L., Smith, T., Johnson, C. et al. Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder. J Abnorm Child Psychol 45, 1235–1245 (2017). https://doi.org/10.1007/s10802-016-0233-x

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