A Systematic Review of the Role of Parent Characteristics in Parent-Mediated Interventions for Children with Autism Spectrum Disorder

  • Rebecca A. Shalev
  • Caila Lavine
  • Adriana Di MartinoEmail author


Parent-mediated interventions (PMI) are increasingly being used to target skill deficits in children with Autism Spectrum Disorder (ASD). Evidence documenting the benefits of PMI is accumulating, however, little is known about whether parent characteristics impact children’s treatment outcomes. We reviewed the PMI literature using PRISMA guidelines to address this gap. We identified 115 PMI studies published between 1987 and September 2018; of these, only 11 examined the contributions of baseline parent/caregiver characteristics on children’s outcomes. These studies vary widely in regard to the interventions employed and outcome measures explored. Early intervention programs were the most common form of treatment and stress was the most frequently targeted parent/caregiver characteristic. Results indicated that stress, socioeconomic status, and the broad autism phenotype may be related to children’s outcomes, with varying effects depending on the specific treatment and outcome examined. These results underscore the need for systematic research on the role of parent baseline characteristics in PMI. A deeper understanding of the relationship between parent/caregiver variables and child outcomes may inform treatment selection and elucidate key mechanisms of therapeutic change.


Autism spectrum disorder Parent characteristics Parent-mediated intervention Parent stress 



This study was partially funded by NIMH award to ADM (R01MH105506).

Compliance with Ethical Standards

Ethical Approval

This study did not involve human subjects.

Conflict of Interest

All authors declare that they have no conflict of interest.


  1. Aarts, A. A., Anderson, J. E., Anderson, C. J., Attridge, P. R., Attwood, A., Axt, J., et al. (2015). Estimating the reproducibility of psychological science. Science, 349(6251), 1–8. Scholar
  2. Abbeduto, L., Seltzer, M. M., Shattuck, P., Krauss, M. W., Orsmond, G., & Murphy, M. M. (2004). Psychological well-being and coping in mothers of youths with autism, Down syndrome, or fragile X syndrome. Am J Ment Retard, 109(3), 237–254.<237:PWACIM>2.0.CO;2.
  3. Abidin, R. R. (1995). Parenting stress index (PSI) manual (3rd ed.). Charlottesville: Pediatric Psychology Press.Google Scholar
  4. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3 rd ed., rev.). Washington, DC: Author.Google Scholar
  5. Baker-Ericzen, M. J., Brookman-Frazee, L., & Stahmer, A. (2005). Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders. Research and Practice for Persons with Severe Disabilities, 30(4), 194–204. Scholar
  6. Baranek, G. T., Watson, L. R., Turner-Brown, L., Field, S. H., Crais, E. R., Wakeford, L., et al. (2015). Preliminary efficacy of adapted responsive teaching for infants at risk of autism spectrum disorder in a community sample. Autism Res Treat, 2015, 1–16. Scholar
  7. Bayley, N. (1993). Bayley Scales of Infant Development. San Antonio, TX: The psychological corporation, Harcourt brace & company.Google Scholar
  8. Benson, P., Karlof, K. L., & Siperstein, G. N. (2008). Maternal involvement in the education of young children with autism spectrum disorders. Autism, 12(1), 47–63. Scholar
  9. Berry, J. O., & Jones, W. H. (1995). The parental stress scale: Initial psychometric evidence. Journal of Social and Personal Relationships, 12(3), 463–472. Scholar
  10. Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236. Scholar
  11. Bishop, D. V. M., Maybery, M., Wong, D., Maley, A., Hill, W., & Hallmayer, J. (2004). Are phonological processing deficits part of the broad autism phenotype? American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 128B(1), 54–60.
  12. Blacher, J., & McIntyre, L. L. (2006). Syndrome specificity and behavioural disorders in young adults with intellectual disability: Cultural differences in family impact. Journal of Intellectual Disability Research, 50, 184–198. Scholar
  13. Bolton, P., Macdonald, H., Pickles, A., Rios, P., Goode, S., Crowson, M., Bailey, A., & Rutter, M. (1994). A case-control family history study of autism. Child Psychology & Psychiatry & Allied Disciplines, 35(5), 877–900.
  14. Brookman-Frazee, L., Vismara, L., Drahota, A., Stahmer, A., & Openden, D. (2009). Parent training interventions for children with autism spectrum disorders. In Applied behavior analysis for children with autism spectrum disorders (pp. 237–257). New York, NY: Springer Science + Business Media.CrossRefGoogle Scholar
  15. Burrell, T. L., & Borrego, J. (2012). Parents’ involvement in ASD treatment: What is their role? Cognitive and Behavioral Practice, 19(3), 423–432. Scholar
  16. 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(6), 643–652. Scholar
  17. Cohen, S., Doyle, W. J., & Baum, A. (2006). Socioeconomic status is associated with stress hormones. Psychosomatic Medicine, 68(3), 414–420. Scholar
  18. Crnic, K. A., & Booth, C. L. (1991). Mothers' and fathers' perceptions of daily hassles of parenting across early childhood. Journal of Marriage and the Family, 53(4), 1042–1050. Scholar
  19. Crnic, K. A., & Greenberg, M. T. (1990). Minor parenting stresses with young children. Child Development, 61(5), 1628–1637. Scholar
  20. Crockett, J. L., Fleming, R. K., Doepke, K. J., & Stevens, J. S. (2007). Parent training: Acquisition and generalization of discrete trials teaching skills with parents of children with autism. Research in Developmental Disabilities, 28(1), 23–36. Scholar
  21. Donovan, A. M. (1988). Family stress and ways of coping with adolescents who have handicaps: Maternal perceptions. American Journal of Mental Retardation, 92(6), 502–509.PubMedGoogle Scholar
  22. Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X. H., & Abbott, R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism, 13(4), 375–387. Scholar
  23. Estes, A., Olson, E., Sullivan, K., Greenson, J., Winter, J., Dawson, G., & Munson, J. (2013). Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders. Brain Dev, 35(2), 133–138. Scholar
  24. Factor, R. S., Swain, D. M., & Scarpa, A. (2018). Child autism spectrum disorder traits and parenting stress: The utility of using a physiological measure of parental stress. Journal of Autism and Developmental Disorders, 48(4), 1081–1091. Scholar
  25. Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates, E., Hartung, J. P., et al. (1993). MacArthur communicative development inventories (CDI). Baltimore, MD: Paul H. Brookes Publishing.Google Scholar
  26. Fenson, L., Pethick, S., Renda, C., & Cox, J. L. (2000). Short-form versions of the MacArthur communication developmental inventories. Applied PsychoLinguistics, 21, 95–116.CrossRefGoogle Scholar
  27. Friedrich, W. N., Greenberg, M. T., & Crnic, K. (1983). A short-form of the questionnaire on resources and stress. American Journal of Mental Deficiency, 88(1), 41–48.PubMedGoogle Scholar
  28. Gantman, A., Kapp, S. K., Orenski, K., & Laugeson, E. A. (2012). Social skills training for young adults with high-functioning autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, 42(6), 1094–1103. Scholar
  29. Gau, S. S. F., Chou, M. C., Chiang, H. L., Lee, J. C., Wong, C. C., Chou, W. J., & Wu, Y. Y. (2012). Parental adjustment, marital relationship, and family function in families of children with autism. Research in Autism Spectrum Disorders, 6(1), 263–270. Scholar
  30. Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., le Couteur, A., Leadbitter, K., Hudry, K., Byford, S., Barrett, B., Temple, K., Macdonald, W., Pickles, A., & PACT Consortium. (2010). Parent-mediated communication-focused treatment for preschool children with autism (PACT); a randomised controlled trial. The Lancet, 375, 2152–2160. Scholar
  31. Harrop, C. (2015). Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors. Autism, 19(6), 662–672. Scholar
  32. Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. Scholar
  33. Hodge, D., Hoffman, C. D., & Sweeney, D. P. (2011). Increased psychopathology in parents of children with autism: Genetic liability or burden of caregiving? Journal of Developmental and Physical Disabilities, 23(3), 227–239. Scholar
  34. Holroyd, J., & McArthur, D. (1976). Mental retardation and stress on the parents: A contrast between Down's syndrome and childhood autism. American Journal of Mental Deficiency, 80(4), 431–436.PubMedGoogle Scholar
  35. Hurley, R. S. E., Losh, M., Parlier, M., Reznick, J. S., & Piven, J. (2007). The broad autism phenotype questionnaire. Journal of Autism and Developmental Disorders, 37(9), 1679–1690. Scholar
  36. Ingersoll, B., & Dvortcsak, A. (2010). Teaching social communication to children with autism: A practitioner's guide to parent training. New York, NY: Guilford Press.Google Scholar
  37. Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15(3), 247–277. Scholar
  38. Kasari, C., & Sigman, M. (1997). Linking parental perceptions to interactions in young children with autism. Journal of Autism and Developmental Disorders, 27(1), 39–57.CrossRefGoogle Scholar
  39. Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620. Scholar
  40. Kasari, C., Gulsrud, A. C., Wong, C. C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056. Scholar
  41. Kasari, C., Lawton, K., Shih, W., Barker, T. V., Landa, R., Lord, C., Orlich, F., Wetheby, A., & Senturk, D. (2014a). Caregiver-mediated intervention for low-resourced preschoolers with autism: An RCT. Pediatrics, 134(1), e72–e79. Scholar
  42. Kasari, C., Siller, M., Huynh, L., Shih, W., Swanson, M., Hellemann, G., & Sugar, C. (2014b). Randomized controlled trial of parental responsivenss intervention for toddlers at high risk for autism. Infant Behavior and Development, 37, 711–721. Scholar
  43. Kazdin, A. E., & Weisz, J. R. (2003). Evidence-based psychotherapies for children and adolescents. New York, NY: Guilford Press.Google Scholar
  44. Koren-Karie, N., & Oppenheim, D. (1997). The insightfulness assessment coding manual. Center for Research in Child Development, University of Haifa. Haifa, Israel.Google Scholar
  45. Krug, D., Arick, J., & Almond, P. (1993). Autism screening instrument for educational planning. Austin, TX: Pro-Ed.Google Scholar
  46. Lafasakis, M., & Sturmey, P. (Eds.). (2007). Training parent implementation of discrete-trial teaching: Effects on generalization of parent teaching and child correct responding. Journal of Applied Behavior Analysis, 40(4), 685–689.
  47. Landa, R., Piven, J., Wzorek, M. M., Gayle, J. O., Chase, G. A., & Folstein, S. E. (1992). Social language use in parents of autistic individuals. Psychological Medicine, 22(1), 245–254. Scholar
  48. Laugeson, E. A., Frankel, F., Mogil, C., & Dillon, A. R. (2009). Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(4), 596–606. Scholar
  49. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule (ADOS). Los Angeles, CA: Western Psychological Services.Google Scholar
  50. 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. J of Autism Dev Disord, 30(3), 205–223.
  51. Losh, M., Adolphs, R., Poe, M. D., Couture, S., Penn, D., Baranek, G. T., & Piven, J. (2009). Neuropsychological profile of autism and the broad autism phenotype. Archives of General Psychiatry, 66(5), 518–526. Scholar
  52. Luiz, D., Barnard, A., Knoesen, N., Kotras, N., Horrocks, S., McAlinden, P., Challis, D. & O’Connell, R (2006). GMDS-ER 2–8—Griffith mental developmental scales-extended revised: 2 to 8 years. Hogrefe, Oxford: The Test Agency.Google Scholar
  53. Mahoney, G., & Macdonald, J. (2007). Autism and developmental delays in young children: The responsive teaching curriculum for parents and professionals. Austin: PRO-ED.Google Scholar
  54. Mahoney, G., & Solomon, R. (2016). Mechanism of developmental change in the PLAY project home consultation intervention program: Evidence from a randomized control trial. Journal of Autism and Developmental Disorders, 46(5), 1860–1871. Scholar
  55. McConachie, H., Randle, V., Hammal, D., & Le Couteur, A. (2005). A controlled trial of a training course for parents of children with suspected autism spectrum disorder. The Journal of Pediatrics, 147(3), 335–340. Scholar
  56. McGuire, J. & Richman, N. (1988). Preschool behaviour checklist handbook. Windsor, Berkshire: NFER-Nelson.Google Scholar
  57. McKinney, B., & Peterson, R. A. (1987). Predictors of stress in parents of developmentally disabled children. Journal of Pediatric Psychology, 12(1), 133–150. Scholar
  58. Moes, D. (1995). Parent education and parenting stress. In R. L. Koegel & L. K. Koegel (Eds.), Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities (pp. 79–94). Baltimore, MD: Brookes.Google Scholar
  59. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement. PLoS Medicine, 6, e1000097. Scholar
  60. Mullen, E. M. (1995). Mullen scales of early learning. Circle pines, MN. American Guidance Service.Google Scholar
  61. National Research Council. (2001). Educating children with autism. Committee on educational interventions for children with autism, division of behavioral and social sciences and education. National Academy Press.Google Scholar
  62. Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, 4, CD009774. Scholar
  63. Parr, J. R., Gray, L., Wigham, S., McConachie, H., & LeCouteur, A. (2015). Measuring the relationship between the parental broader autism phenotype, parent-child interaction, and children's progress following parent mediated intervention. Research in Autism Spectrum Disorders, 20, 24–30. Scholar
  64. Piven, J., Palmer, P., Landa, R., Santangelo, S., Jacobi, D., & Childress, D. (1997). Personality and language characteristics in parents from multiple-incidence autism families. American Journal of Medical Genetics, 74(4), 398–411.<398:AID-AJMG11>3.0.CO;2-D.CrossRefPubMedGoogle Scholar
  65. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. Scholar
  66. Reaven, J., Blakely-Smith, A., Zapapas, L., & Ridge, K. (2009). Cognitive behavioral group treatment for adolescents with high-functioning autism spectrum disorders and anxiety: A pilot study. The Journal of Psychological Practice, 15, 217–243. Scholar
  67. Reaven, J., Blakeley-Smith, A., Nichols, S., & Hepburn, S. (2011). Facing your fears: Group therapy for managing anxiety in children with high-functioning autism spectrum disorders. Baltimore, MD: Brookes.Google Scholar
  68. Reaven, J., Washington, L., Moody, E. J., Stern, J. A., Hepburn, S. L., & Blakeley-Smith, A. (2015). Examining the relationship between parental anxiety and treatment response in children and adolescents with autism spectrum disorder and anxiety. Journal of Autism and Developmental Disorders, 45(8), 2464–2473. Scholar
  69. Reed, P., Howse, J., Ho, B., & Osborne, L. A. (2017). Relationship between perceived limit-setting abilities, autism spectrum disorder severity, behaviour problems and parenting stress in mothers of children with autism spectrum disorder. Autism, 21(8), 952–959. Scholar
  70. Rickards, A. L., Walstab, J. E., Wright-Rossi, R. A., Simpson, J., & Reddihough, D. S. (2007). A randomized, controlled trial of a home-based intervention program for children with autism and developmental delay. Journal of Developmental and Behavioral Pediatrics, 28(4), 308–316. Scholar
  71. Rubenstein, E., & Chawla, D. (2018). Broader autism phenotype in parents of children with autism: A systematic review of percentage estimates. Journal of Child and Family Studies, 27(6), 1705–1720. Scholar
  72. Ruppert, T., Machalicek, W., Hansen, S. G., Raulston, T., & Frantz, R. (2016). Training parents to implement early interventions for children with autism spectrum disorders. In Early intervention for young children with autism spectrum disorder (pp. 219–256). Cham, Switzerland: Springer International Publishing.Google Scholar
  73. Sears, K. M., Blair, K. S., Iovannone, R., & Crosland, K. (2013). Using the prevent-teach-reinforce model with families of young children with ASD. Journal of Autism and Developmental Disorders, 43(5), 1005–1016. Scholar
  74. Siller, M., Hutman, T., & Sigman, M. (2013). A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: A randomized clinical trial. Journal of Autism and Developmental Disorders, 43(3), 540–555. Scholar
  75. Silva, L. M. T., & Schalock, M. (2012). Autism parenting stress index: Initial psychometric evidence. Journal of Autism and Developmental Disorders, 42(4), 566–574. Scholar
  76. Silva, L. M. T., Schalock, M., & Gabrielsen, K. (2011). Early intervention for autism with a parent-delivered ongoing massage program: A randomized controlled trial. American Journal of Occupational Therapy, 65(5), 550–559. Scholar
  77. Sivberg, B. (2002). Family system and coping behaviors: A comparison between parents of children with autistic spectrum disorders and parents with non-autistic children. Autism, 6(4), 397–409. Scholar
  78. Smith, L. E., Hong, J., Seltzer, M. M., Greenberg, J. S., Almeida, D. M., & Bishop, S. L. (2010). Daily experiences among mothers of adolescents and adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 40(2), 167–178. Scholar
  79. Sofronoff, K., Silva, J., & Beaumont, R. (2017). The secret agent society social-emotional skills program for children with a high-functioning autism spectrum disorder: A parent-directed trial. Focus on Autism and Other Developmental Disabilities, 32(1), 55–70. Scholar
  80. Sparrow, S., Balla, D., & Cicchetti, D. V. (1984). Vineland adaptive behavior scales – interview edition. Circle pines, MD. American Guidance Service.Google Scholar
  81. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior scales. Circle Pines, MN: AGS Publishing.Google Scholar
  82. Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state–trait anxiety Inventory STAI (Form Y). Palo Alto, CA: Mind Garden.Google Scholar
  83. Stadnick, N. A., Drahota, A., & Brookman-Frazee, L. (2013). Parent perspectives of an evidence-based intervention for children with autism served in community mental health clinics. Journal of Child and Family Studies, 22(3), 414–422. Scholar
  84. Stadnick, N. A., Stahmer, A., & Brookman-Frazee, L. (2015). Preliminary effectiveness of project ImPACT: A parent-mediated intervention for children with autism spectrum disorder delivered in a community program. Journal of Autism and Developmental Disorders, 45(7), 2092–2104. Scholar
  85. Strauss, K., Vicari, S., Valeri, G., D'Elia, L., Arima, S., & Fava, L. (2012). Parent inclusion in early intensive behavioral intervention: The influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes. Research in Developmental Disabilities, 33(2), 688–703. Scholar
  86. Sussman, F. (1999). More than words: Helping parents promote communication and social skills in children with autism spectrum disorder. Toronto. In ON. Canada: The Hanen Centre.Google Scholar
  87. de Veld, D. M. J., Howlin, P., Hoddenbach, E., Mulder, F., Wolf, I., Koot, H. M., Lindauer, R., & Begeer, S. (2017). Moderating effects of parental characteristics on the effectiveness of a theory of mind training for children with autism: A randomized controlled trial. Journal of Autism and Developmental Disorders, 47(7), 1987–1997. Scholar
  88. Wallace, K. S., & Rogers, S. J. (2010). Intervening in infancy: Implications for autism Spectrum disorders. Journal of Child Psychology and Psychiatry, 51(12), 1–30. Scholar
  89. Watson, L. R., Crais, E. R., Baranek, G. T., Turner-Brown, L., Sideris, J., Wakeford, L., et al. (2017). Parent-mediated intervention for one-year-olds screened as at-risk for autism spectrum disorder: A randomized controlled trial. Journal of Autism and Developmental Disorders, 47(11), 3520–3540. Scholar
  90. Wetherby, A. M., & Woods, J. (2008). Developmental approaches to treatment. In Autism spectrum disorders in infants and toddlers: Diagnosis, assessment, and treatment (pp. 170–206). New York, NY: Guilford Press.Google Scholar
  91. World Health Organization. (2016). Questions and answers about autism spectrum disorders (ASD). Retrieved from: (accessed 1 June 2016).

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rebecca A. Shalev
    • 1
  • Caila Lavine
    • 2
  • Adriana Di Martino
    • 3
    Email author
  1. 1.Child and Adolescent Psychiatry, Child Study Center at NYU Langone HealthNew YorkUSA
  2. 2.Arizona College of MedicineTucsonUSA
  3. 3.Autism Center, Child Mind InstituteNew YorkUSA

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