Journal of Child and Family Studies

, Volume 28, Issue 3, pp 693–703 | Cite as

Enablers of Behavioral Parent Training for Families of Children with Autism Spectrum Disorder

  • Tracy J. RaulstonEmail author
  • Meme Hieneman
  • Nell Caraway
  • Jordan Pennefather
  • Naima Bhana
Original Paper



Children with autism spectrum disorder (ASD) are at an increased risk to develop problem behavior, which can have deleterious effects on child and parental well-being. Because of this, parents are often provided with Behavioral Parent Training (BPT). However, attrition rates in BPT are high, and there is a relative dearth of research investigating factors that influence parental engagement in BPT.


We ran seven semi-structured online focus groups with a total of 30 parents of children with ASD and related disabilities. Parents were interviewed in order to gain a greater understanding of variables that enable or pose barriers to parental engagement in BPT. An inductive qualitative analysis was conducted by two independent authors.


Our analyses revealed three themes indicating the need for (a) supportive, professional feedback; (b) accessible, flexible, and affordable training; and (c) social-emotional support and community connection in BPT for parents of children with ASD.


Results from this study suggest that parental engagement in BPT for children with ASD may be enhanced if it is relevant to the needs of families, facilitated by responsive professionals, flexible, and readily accessible. Additionally, parents may benefit from BPT that includes social and emotional support, such as assistance connecting with other families and evidence-based strategies to manage the stress associated with parenting a child with ASD and challenging behavior.


Autism spectrum disorder Behavioral parent training Parental engagement Support Families 



Author Contributions

T.J.R.: collaborated with the design, recruited participants and executed the study, conducted data analyses, and wrote the paper. M.H.: designed and executed the study, conducted data analyses, and collaborated in writing the paper. N.C.: designed and executed the study, conducted data analyses, collaborated with writing the paper. J.P.: collaborated with the design and writing the paper. N.B.: conducted data analyses, collaborated in the writing and editing of the final manuscript.


This research was funded in part by the National Institutes of Health, grant #2R44MH102845-02, awarded to IRIS Educational Media (now Trifoia). The first author received leadership grant funds from the U.S. Department of Education Office of Special Education.

Compliance with ethical standards

Conflict of interest

This research was funded in part by a grant from the National Institutes of Health (2R44MH102845-02). IRIS Educational Media developed a parent training product using results from this study. Additionally, the first author received leadership grant funds from The U.S. Department of Education Office of Special Education Programs. The remaining authors declare that they have no conflict of interest.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. 5th edn. Washington, DC: Author.CrossRefGoogle Scholar
  2. Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough. Journal of Applied Behavior Analysis, 33, 373–391.CrossRefGoogle Scholar
  3. Baghdadli, A., Pascal, C., Grisli, S., & Aussilloux, C. (2003). Risk factors for self-injurious behaviours among 222 young children with autistic disorders. Journal of Intellectual Disabilities Research, 47, 622–627.CrossRefGoogle Scholar
  4. Bernheimer, L. P., Gallimore, R., & Weinser, T. S. (1990). Ecocultural theory as a context for the individual family service plan. Journal of Early Intervention, 14, 219–233.CrossRefGoogle Scholar
  5. Blackledge, J. T., & Hayes, S. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child and Family Behavior Therapy, 28, 1–18.CrossRefGoogle Scholar
  6. Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: comparisons to mental retardation. Journal of Autism and Developmental Disorders, 30, 237–243.CrossRefGoogle Scholar
  7. Boyd, B. A. (2002). Examining the relationship between stress and lack of social support in mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 17, 208–215.CrossRefGoogle Scholar
  8. Carr, T., Shih, W., Lawton, K., Lord, C., King, B., & Kasari, C. (2016). The relationship between treatment attendance, adherence, and outcome in a caregiver-mediated intervention for low-resourced families of young children with autism spectrum disorder. Autism, 20, 643–652.CrossRefGoogle Scholar
  9. Chacko, A., Jensen, S. A., Lowry, L. S., Cornwell, M., Chimklis, A., Chan, E., Lee, D., & Pulgarin, B. (2016). Engagement in behavioral parent training: review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19, 204–215.CrossRefGoogle Scholar
  10. Cho, J. Y., & Lee, E. H. (2014). Reducing confusion about grounded theory and qualitative content analysis. Similarities and differences. The Qualitative Report, 19, 1–20.Google Scholar
  11. Croen, L. A., Shankute, N., Davignon, M., Massolo, M. L., & Yoshida, C. (2017). Demographic and clinical characteristics associated with engagement in behavioral health treatment among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47, 3347–3357.CrossRefGoogle Scholar
  12. Dababnah, S., & Parish, S. (2016). Incredible Years Program tailored to parents of preschoolers with autism: pilot results. Research on Social Work Practice, 26, 372–385.CrossRefGoogle Scholar
  13. Dabrowska, A., & Pisula, E. (2010). Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome. Journal of Intellectual and Developmental Disability Research, 54, 266–280.CrossRefGoogle Scholar
  14. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4, 1–15.CrossRefGoogle Scholar
  15. Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: an application of diffusion of innovation theory. Journal of Autism and Developmental Disorders, 41, 597–609.CrossRefGoogle Scholar
  16. Division for Early Childhood (2014). DEC recommended practices in early intervention/early childhood special education 2014. Retrieved from
  17. Dunlap, G., Strain, P., Lee, J. K., Joseph, J., & Leech, N. (2018). A randomized controlled evaluation of Prevent-Teach-Reinforce for young children. Topics in Early Childhood Special Education, 37, 195–205.CrossRefGoogle Scholar
  18. Durand, V. M., Hieneman, M., Clarke, S., Wang, M., & Rinaldi, M. L. (2012). Positive family intervention for severe challenging behavior: a multisite randomized clinical trial. Journal of Positive Behavior Interventions, 15, 133–143.CrossRefGoogle Scholar
  19. Eikeseth, S. (2009). Outcome of comprehensive psycho-educational interventions for young children with autism. Research in Developmental Disabilities, 30, 158–178.CrossRefGoogle Scholar
  20. Fettig, A., & Barton, E. E. (2014). Parent implementation of function-based intervention to reduce children’s challenging behavior: A literature review. Topics in Early Childhood Special Education, 34, 49–61.CrossRefGoogle Scholar
  21. Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).Google Scholar
  22. Frantz, R., Hansen, S. G., & Machalicek, W. (2017). Interventions to promote well-being in parents of children with autism: a systematic review. Review Journal of Autism and Developmental Disorders, 5, 1–20.Google Scholar
  23. Gerow, S., Hagan-Burke, S., Rispoli, M., Gregori, E., Mason, R., & Ninci, J. (2017). A systematic review of parent-implemented functional communication training for children with ASD. Behavior Modification, 42, 335–363.CrossRefGoogle Scholar
  24. Hartley, S. L., Sikora, D. M., & McCoy, R. (2008). Prevalence and risk factors of maladaptive behaviour in young children with autistic disorder. Journal of Intellectual Disability Research, 52, 1–11.CrossRefGoogle Scholar
  25. Hieneman, M., & Fefer, S. A. (2017). Employing the principles of positive behavior support to enhance family education and intervention. Journal of Child and Family Studies, 26, 2655–2688.CrossRefGoogle Scholar
  26. Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. American Journal on Intellectual and Developmental Disabilities, 114, 23–41.CrossRefGoogle Scholar
  27. Ibanez, L. V., Kibak, K., Swanson, A., Wallace, L., Warren, Z., & Stone, W. L. (2018). Enhancing interactions during daily routines: a randomized controlled trial of a web-based tutorial for parents of young children with ASD. Autism Research, 11, 667–678.CrossRefGoogle Scholar
  28. Ingersoll, B., Shannon, K., Berger, N., Pickard, K., & Holtz, B. (2017). Self-directed telehealth parent-mediated intervention for children with autism spectrum disorder: examination of the potential reach and utilization in community settings. Journal of Medical Internet Research, 19, 1–11.CrossRefGoogle Scholar
  29. Ingersoll, B., Wainer, A. L., Berger, N. I., Pickard, K. E., & Bonter, N. (2016). Comparison of a self-directed and therapist-assisted telehealth parent-mediated intervention for children with ASD: a pilot RCT. Journal of Autism and Developmental Disorders, 46, 2275–2284.CrossRefGoogle Scholar
  30. Kanne, S. M., & Mazurek, M. O. (2011). Aggression in children and adolescents with ASD: prevalence and risk factors. Journal of Autism and Developmental Disorders, 41, 926–937.CrossRefGoogle Scholar
  31. Klintwall, L., & Eikeseth, S. (2014). Early and intensive behavioral intervention (EIBI) in autism. In V. B. Patel, V. R. Preedy, & C. R. Martin (eds), Comprehensive guide to autism (pp. 117-137). New York, NY: Springer.Google Scholar
  32. Kuhlthau, K. A., Kahn, R., Hill, K. S., Srilakshmi, G., & Ettner, S. L. (2010). The well-being of parental caregivers of children with disabilities. Maternal and Child Health Journal, 14, 155–163.CrossRefGoogle Scholar
  33. Kumpfer, K. L., & Alvarado, R. (2003). Family-strengthening approaches for the prevention of youth problem behaviors. American Psychologist, 58, 457–465.CrossRefGoogle Scholar
  34. Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183.CrossRefGoogle Scholar
  35. Lindgren, S., Wacker, D., & Suess, A. (2016). Telehealth and autism: treating challenging behavior at lower cost. Pediatrics, 137, 167–175.CrossRefGoogle Scholar
  36. Liptak, G. S., Benzoni, L. B., Mruzek, D. W., Nolan, K. W., Thingvoll, M. A., Wade, C. M., & Fryer, G. E. (2008). Disparities in diagnosis and access to health service for children with autism: data from the National Survey of Children’s Health. Journal of Developmental & Behavioral Pediatrics, 29, 152–160.CrossRefGoogle Scholar
  37. Love, J. R., Carr, J. E., Almason, S. M., & Petursdottir, A. I. (2009). Early and intensive behavioral intervention for autism: a survey of clinical practices. Research in Autism Spectrum Disorders, 3, 421–428.CrossRefGoogle Scholar
  38. Lowe, K., Allen, D., Jones, E., Brophy, S., Moore, K., & James, W. (2007). Challenging behaviours: prevalence and topographies. Journal of Intellectual Disability Research, 51, 625–636.CrossRefGoogle Scholar
  39. Lucyshyn, J. M., Binnendyk, L., Fossett, B., Cheremshynski, C., Lohrmann, S., Elkinson, L., & Miller, L. (2009). Toward an ecological unit of analysis in behavioral assessment and intervention with families of children with developmental disabilities. In W. Sailor, G. Dunlap, G. Sugai & R. Horner (Eds.), Handbook of positive behavior support (pp. 73–106). Baltimore: Paul H. Brookes.Google Scholar
  40. Lucyshyn, J. M., Fossett, B., Bakeman, R., Cheremshynski, C., Miller, L., Lohrmann, S., & Irvin, L. K. (2015). Transforming parent-child interaction in family routines: longitudinal analysis with families of children with developmental disabilities. Journal of Child and Family Studies, 24, 3526–3541.CrossRefGoogle Scholar
  41. Machalicek, W., Lequia, J., Pinkelman, S., Knowles, C., Raulston, T., Davis, T., & Alresheed, F. (2016). Behavioral telehealth consultation with families of children with autism spectrum disorder. Behavioral Interventions, 31, 223–250.CrossRefGoogle Scholar
  42. Madsen, W. C. (2007). Collaborative therapy with multi-stressed families: Second edition. New York, NY: The Guilford Press.Google Scholar
  43. McConnell, D., Parakkal, M., Savage, A., & Rempel, G. (2015). Parent-mediated intervention: adherence and adverse effects. Disability and Rehabilitation, 37, 864–872.CrossRefGoogle Scholar
  44. McIntrye, L. L. (2008a). Adapting Webster-Stratton’s incredible years parent training for children with developmental delay: findings for a treatment group only study. Journal of Intellectual Disability Research, 52, 1176–1192.CrossRefGoogle Scholar
  45. McIntrye, L. L. (2008b). Parent training for young children with developmental disabilities: randomized controlled trial. American Journal on Mental Retardation, 113, 356–368.CrossRefGoogle Scholar
  46. McIntyre, L. L., & Brown, M. (2016). Examining the utilization and usefulness of social support for mothers with young children with autism spectrum disorder. Journal of Intellectual & Developmental Disability, 43, 93–101.CrossRefGoogle Scholar
  47. Miles, M. B., & Huberman, A. M. (1994). Qualitative Data Analysis. 2nd edn. Thousand Oaks, CA: Sage Publications.Google Scholar
  48. Moes, D. R., & Frea, W. D. (2002). Contextualized behavioral support in early intervention for children with autism and their families. Journal of Autism and Developmental Disorders, 32, 519–533.CrossRefGoogle Scholar
  49. Moore, T. R., & Symons, F. J. (2011). Adherence to treatment in a behavioral intervention curriculum for parents of children with autism spectrum disorder. Behavior Modification, 35, 570–594.CrossRefGoogle Scholar
  50. Murphy, O., Healy, O., & Leader, G. (2009). Risk factors for challenging behaviors among 157 children with autism spectrum disorder in Ireland. Research in Autism Spectrum Disorders, 3, 474–482.CrossRefGoogle Scholar
  51. National Autism Center. (2015). Findings and conclusions: National Standards Project, Phase 2. Retrieved from
  52. National Implementation Research Network. (2015). Implementation science defined. Retrieved from
  53. National Professional Development Center on Autism Spectrum Disorders. (2014). Evidence based practices for children, youth, and young adults with autism spectrum disorder. Retrieved from
  54. National Research Council. (2001). Educating children with autism. Washington, DC: The National Academies Press.Google Scholar
  55. Neece, C. L., Green, S. A., & Baker, B. L. (2012). Parenting stress and child behavior problems: A transactional relationship across time. American Journal on Intellectual and Developmental Disabilities, 117, 48–66.CrossRefGoogle Scholar
  56. Osborne, L. A., McHugh, L., Saunders, J., & Reed, P. (2008). Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum. Journal of Autism and Developmental Disorders, 38, 1092–1103.CrossRefGoogle Scholar
  57. Palinkas, L. A. (2014). Qualitative and mixed methods in mental health services and implementation research. Journal of Clinical Child & Adolescent Psychology, 43, 851–861.CrossRefGoogle Scholar
  58. Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.Google Scholar
  59. Rogers, E. (2003). Diffusion of innovation. 5th edn. New York, NY: Free Press.Google Scholar
  60. Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37, 8–38.CrossRefGoogle Scholar
  61. Serketich, W. J., & Dumas, J. E. (1996). The effectiveness of behavioral parent training to modify antisocial behavior in children: A meta-analysis. Behavior Therapy, 27, 17–186.CrossRefGoogle Scholar
  62. Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., Myers, R. E., Latham, L. L., & Singh, J. (2014). Mindfulness-based positive behavior support (MBPBS) for mothers of adolescents with autism spectrum disorder: Effects on adolescents’ behavior and parental stress. Mindfulness, 5, 646–657.CrossRefGoogle Scholar
  63. Substance Abuse and Mental Health Services Administration. (2011). Interventions for disruptive behavior disorders: evidence-based and promising practices. HHS Pub. No. SMA-11-4634, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.Google Scholar
  64. Totsika, V., Hastings, R. P., Emerson, E., Lancaster, G. A., & Berridge, D. M. (2011). A population-based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability. Journal of Child Psychology and Psychiatry, 52, 91–99.CrossRefGoogle Scholar
  65. Turnbull, R., & Turnbull, A. (2017). Family engagement: An analysis of IDEA Part C and B requirements. Retrieved from:
  66. Wacker, D. P., Lee, J. F., Padilla Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., & Waldron, D. B. (2013). Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism. Journal of Developmental and Physical Disabilities, 25, 35–48.CrossRefGoogle Scholar
  67. Wallace, K. S., & Rogers, S. J. (2010). Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51, 1300–1320.CrossRefGoogle Scholar
  68. Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: a comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951–1966.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tracy J. Raulston
    • 1
    Email author
  • Meme Hieneman
    • 2
  • Nell Caraway
    • 3
  • Jordan Pennefather
    • 3
  • Naima Bhana
    • 1
  1. 1.The Pennsylvania State UniversityUniversity ParkUSA
  2. 2.Positive Behavior Support ApplicationsPalm HarborUSA
  3. 3.TrifoiaEugeneUSA

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