Skip to main content

Advertisement

SpringerLink
Log in

Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Children with autism spectrum disorder (ASD) benefit from parent involvement in their therapy, and there is evidence that this involvement may improve parent functioning as well. We examined changes in parent mental health, parenting, and expressed emotion, following participation in a randomized controlled trial of cognitive behavior therapy for 57 children with ASD. Post-intervention, improvements occurred in the treatment group in parent depression and emotion regulation, compared to waitlisted parents. Treatment effects also occurred across all parents in depression, emotion regulation, perceptions of their children and mindful parenting. Though preliminary, these results have implications for intervention development and evaluation by focusing on parent outcomes in child treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. One child was included who had an overall IQ score of 79, as his verbal performance was higher than his nonverbal performance and it was felt that 79 was an underestimate of his ability.

References

  • Allik, H., Larsson, J. O., & Smedje, H. (2006). Health-related quality of life in parents of school-age children with Asperger syndrome or high-functioning autism. Health and Quality of Life Outcomes, 4(1), 1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Arnold, D. S., O’Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The parenting scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137–144.

    Article  Google Scholar 

  • Bader, S. H., Barry, T. D., & Hann, J. A. (2014). The relation between parental expressed emotion and externalizing behaviors in children and adolescents with an autism spectrum disorder. Focus on Autism and Other Developmental Disabilities, 30(1), 23–34.

    Article  Google Scholar 

  • Bayat, M. (2007). Evidence of resilience in families of children with autism. Journal of Intellectual Disability Research, 51(9), 702–714.

    Article  PubMed  Google Scholar 

  • Beaumont, R. (2013). Secret Agent Society-Operation Regulation (SAS-OR) manual. Brisbane, Australia: Social Skills Training Pty Ltd.

    Google Scholar 

  • Beer, M., Ward, L., & Moar, K. (2013). The relationship between mindful parenting and distress in parents of children with an autism spectrum disorder. Mindfulness, 4(2), 102–112.

    Article  Google Scholar 

  • Benson, P. R., Daley, D., Karlof, K. L., & Robison, D. (2011). Assessing expressed emotion in mothers of children with autism: The autism-specific five minute speech sample. Autism: The international journal of research and practice, 15(1), 65–82.

    Article  Google Scholar 

  • Bitsika, V., & Sharpley, C. F. (2004). Stress, anxiety and depression among parents of children with autism spectrum disorder. Australian Journal of Guidance and Counselling, 14(2), 151–161.

    Article  Google Scholar 

  • Bögels, S., Hoogstad, B., van Dun, L., de Schutter, S., & Restifo, K. (2008). Mindfulness training for adolescents with externalizing disorders and their parents. Behavioural and Cognitive Psychotherapy, 36(02), 193–209.

    Article  Google Scholar 

  • Bögels, S. M., Lehtonen, A., & Restifo, K. (2010). Mindful parenting in mental health care. Mindfulness, 1, 107–120.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, F. L., Whittingham, K., Boyd, R. N., McKinlay, L., & Sofronoff, K. (2014). Improving child and parenting outcomes following paediatric acquired brain injury: A randomised controlled trial of Stepping Stones Triple P plus Acceptance and Commitment Therapy. Journal of Child Psychology and Psychiatry, 55(10), 1172–1183.

    Article  PubMed  Google Scholar 

  • Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31.

    Article  PubMed  Google Scholar 

  • Cachia, R. L., Anderson, A., & Moore, D. W. (2016). Mindfulness, stress and well-being in parents of children with autism spectrum disorder: A systematic review. Journal of Child and Family Studies, 25(1), 1–14.

    Article  Google Scholar 

  • Conner, C. M., Maddox, B. B., & White, S. W. (2013). Parents’ state and trait anxiety: Relationships with anxiety severity and treatment response in adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 1811–1818.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale (SRS-2) (2nd ed.). Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Coyne, L. W., & Thompson, A. D. (2011). Maternal depression, locus of control, and emotion regulatory strategy as predictors of preschoolers’ internalizing problems. Journal of Child and Family Studies, 20(6), 873–883.

    Article  Google Scholar 

  • Crandall, A., Deater-Deckard, K., & Riley, A. W. (2015). Maternal emotion and cognitive control capacities and parenting: A conceptual framework. Developmental Review, 36, 105–126.

    Article  PubMed  PubMed Central  Google Scholar 

  • Daley, D., & Benson, P. R. (2008). Manual for coding expressed emotion in parents of children with autism spectrum disorders: The autism-specific five minute speech sample. Boston: Center for Social Development and Education, University of Massachusetts Boston.

    Google Scholar 

  • Duncan, L. G. (2007). Assessment of mindful parenting among parents of early adolescents: Development and validation of the Interpersonal Mindfulness in Parenting scale. Unpublished dissertation.

  • Dunlop, W. P., Cortina, J. M., Vaslow, J. B., & Burke, M. J. (1996). Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods, 1, 170–177.

    Article  Google Scholar 

  • Faso, D. J., Neal-Beevers, A. R., & Carlson, C. L. (2013). Vicarious futurity, hope, and well-being in parents of children with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(2), 288–297.

    Article  Google Scholar 

  • Fritz, C. O., Morris, P. E., & Richler, J. J. (2012). Effect size estimates: Current use, calculations, and interpretation. Journal of Experimental Psychology: General, 141(1), 2–18.

    Article  Google Scholar 

  • Garcia-Lopez, L. J., del Mar Díaz-Castela, M., Muela-Martinez, J. A., & Espinosa-Fernandez, L. (2014). Can parent training for parents with high levels of expressed emotion have a positive effect on their child’s social anxiety improvement? Journal of Anxiety Disorders, 28(8), 812–822.

    Article  PubMed  Google Scholar 

  • Garnefski, N., & Kraaij, V. (2006). Cognitive emotion regulation questionnaire–development of a short 18-item version (CERQ-short). Personality and Individual Differences, 41(6), 1045–1053.

    Article  Google Scholar 

  • Giallo, R., Wood, C. E., Jellett, R., & Porter, R. (2013). Fatigue, wellbeing and parental self-efficacy in mothers of children with an autism spectrum disorder. Autism: The International Journal of Research and Practice, 17(4), 465–480.

    Article  Google Scholar 

  • Glidden, L. M., Billings, F. J., & Jobe, B. M. (2006). Personality, coping style and well-being of parents rearing children with developmental disabilities. Journal of Intellectual Disability Research, 50(12), 949–962.

    Article  PubMed  Google Scholar 

  • Greenberg, J., Seltzer, M., Hong, J., & Orsmond, G. L. (2006). Bidirectional effects of expressed emotion and behaviour problems and symptoms in adolescents and adults with autism. American Journal on Mental Retardation, 111, 229–249.

    Article  PubMed  Google Scholar 

  • Guy, W. (1976). CGI clinical global impressions. EC-DEU Assessment Manual for Psychopharmacology, 76–338.

  • Gross, J. J., & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2(2), 151–164.

    Google Scholar 

  • Hastings, R. P., Kovshoff, H., Brown, T., Ward, N. J., Degli Espinosa, F., & Remington, B. (2005). Coping strategies in mothers and fathers of preschool and school-age children with autism. Autism: The International Journal of Research and Practice, 9(4), 377–391.

    Article  Google Scholar 

  • Hastings, R. P., & Taunt, H. M. (2002). Positive perceptions in families of children with developmental disabilities. American Journal on Mental Retardation, 107(2), 116–127.

    Article  PubMed  Google Scholar 

  • Henry, J. D., & Crawford, J. R. (2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.

    Article  PubMed  Google Scholar 

  • Jazaieri, H., Urry, H. L., & Gross, J. J. (2013). Affective disturbance and psychopathology: An emotion regulation perspective. Journal of Experimental Psychopathology, 4(5), 584–599.

    Google Scholar 

  • Keeton, C. P., Ginsburg, G. S., Drake, K. L., Sakolsky, D., Kendall, P. C., Birmaher, B., Albano, A. M., March, J. S., Rynn, M., Piacentini, J., & Walkup, J. T. (2013). Benefits of child-focused anxiety treatments for parents and family functioning. Depression and Anxiety, 30(9), 865–872.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357.

    Article  Google Scholar 

  • Levine, T. R., & Hullett, C. R. (2002). Eta squared, partial eta squared, and misreporting of effect size in communication research. Human Communication Research, 28(4), 612–625.

    Article  Google Scholar 

  • Lewallen, A. C., & Neece, C. L. (2015). Improved social skills in children with developmental delays after parent participation in MBSR: The role of parent–child relational factors. Journal of Child and Family Studies, 24(10), 3117–3129.

    Article  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., Pickles, A., & Rutter, M. (2000). The autism diagnostic observation schedule—generic: A standard measure of social communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    Article  PubMed  Google Scholar 

  • Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Sydney Psychology Edition.

    Google Scholar 

  • Lunsky, Y., Robinson, S., Reid, M., & Palucka, A. (2015). Development of a mindfulness-based coping with stress group for parents of adolescents and adults with developmental disabilities. Mindfulness, 6(6), 1335–1344.

    Article  Google Scholar 

  • Magana, A. B., Goldstein, M. J., Karno, M., Miklowitz, D. J., Jenkins, J., & Falloon, I. R. H. (1986). A brief method for assessing expressed emotion in families of psychiatric patients. Psychiatry Research, 17(3), 203–212.

    Article  PubMed  Google Scholar 

  • Mahan, S., & Matson, J. L. (2011). Children and adolescents with autism spectrum disorders compared to typically developing controls on the behavioral assessment system for children, second edition (BASC-2). Research in Autism Spectrum Disorders, 5(1), 119–125.

    Article  Google Scholar 

  • Moore, P. S., Whaley, S. E., & Sigman, M. (2004). Interactions between mothers and children: Impacts of maternal and child anxiety. Journal of Abnormal Psychology, 113(3), 471.

    Article  PubMed  Google Scholar 

  • Neece, C. L. (2014). Mindfulness-based stress reduction for parents of young children with developmental delays: Implications for parental mental health and child behavior problems. Journal of Applied Research in Intellectual Disabilities, 27, 174–186.

    Article  PubMed  Google Scholar 

  • Ollendick, T. H., Halldorsdottir, T., Fraire, M. G., Austin, K. E., Noguchi, R. J., Lewis, K. M., Jarrett, M. A., Cunningham, N. R., Canavera, K., Allen, K. B., & Whitmore, M. J. (2015). Specific phobias in youth: A randomized controlled trial comparing one-session treatment to a parent-augmented one-session treatment. Behavior Therapy, 46(2), 141–155.

    Article  PubMed  Google Scholar 

  • Olsson, M. B., & Hwang, C. P. (2001). Depression in mothers and fathers of children with intellectual disability. Journal of Intellectual Disability Research, 45(6), 535–543.

    Article  PubMed  Google Scholar 

  • Parent, J., McKee, L. G., Rough, J. N., & Forehand, R. (2016). The association of parent mindfulness with parenting and youth psychopathology across three developmental stages. Journal of Abnormal Child Psychology, 44(1), 191–202.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pruitt, M. M., Willis, K., Timmons, L., & Ekas, N. V. (2016). The impact of maternal, child, and family characteristics on the daily well-being and parenting experiences of mothers of children with autism spectrum disorder. Autism: The International Journal of Research and Practice, 20(8), 973–985.

    Article  Google Scholar 

  • Puleo, C. M., & Kendall, P. C. (2011). Cognitive-behavioral therapy for typically developing youth with anxiety: Autism spectrum symptoms as a predictor of treatment outcome. Journal of Autism and Developmental Disorders, 41, 275–286.

    Article  PubMed  Google Scholar 

  • Reaven, J. (2011). The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: Developmental considerations for parents. Brain Research, 1380, 255–263.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reaven, J. A., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders a pilot study. Focus on Autism and Other Developmental Disabilities, 24(1), 27–37.

    Article  Google Scholar 

  • Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment system for children, (BASC-2) (2nd ed.). Bloomington, MN: Pearson Assessments.

    Google Scholar 

  • Santomauro, D., Sheffield, J., & Sofronoff, K. (2016). Depression in adolescents with ASD: A pilot RCT of a group intervention. Journal of Autism and Developmental Disorders, 46(2), 572–588.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV.: Parent interview schedule (Vol. 1). Oxford: Oxford University Press.

    Google Scholar 

  • Silverman, W. K., Kurtines, W. M., Jaccard, J., & Pina, A. A. (2009). Directionality of change in youth anxiety treatment involving parents: An initial examination. Journal of Consulting and Clinical Psychology, 77, 474–485.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 & Adolescent Psychiatry, 47(8), 921–929.

    Article  Google Scholar 

  • Singh, N. N., Lancioni, G. E., Winton, A. S., Fisher, B. C., Wahler, R. G., Mcaleavey, K., & Sabaawi, M. (2006). Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14, 169–177.

    Article  Google Scholar 

  • Singh, N. N., Lancioni, G. E., Winton, A. S., 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.

    Article  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 46(11), 1152–1160.

    Article  PubMed  Google Scholar 

  • Sofronoff, K., Attwood, T., Hinton, S., & Levin, I. (2007). A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. Journal of Autism and Developmental Disorders, 37(7), 1203–1214.

    Article  PubMed  Google Scholar 

  • Solomon, M., Ono, M., Timmer, S., & Goodlin-Jones, B. (2008). The effectiveness of parent–child interaction therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders, 38(9), 1767–1776.

    Article  PubMed  PubMed Central  Google Scholar 

  • Steensel, F. J. A., & Bögels, S. M. (2015). CBT for anxiety disorders in children with and without autism spectrum disorders. Journal of Consulting and Clinical Psychology, 83(3), 512–523.

    Article  PubMed  Google Scholar 

  • Steensel, F. J. A., Zegers, V. M., & Bögels, S. M. (2016). Predictors of treatment effectiveness for youth with ASD and comorbid anxiety disorders: It all depends on the family? Journal of Autism and Developmental Disorders. doi:10.1007/s10803-016-2956-5.

    PubMed Central  Google Scholar 

  • Storch, E. A., Arnold, E. B., Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S., Mutch, P. J., Selles, R. R., & Murphy, T. K. (2013). The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 132–142.

    Article  Google Scholar 

  • Thomson, K., Riosa, P. B., & Weiss, J. A. (2015). Brief report of preliminary outcomes of an emotion regulation intervention for children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(11), 3487–3495.

    Article  PubMed  Google Scholar 

  • Ung, D., Selles, R., Small, B. J., & Storch, E. A. (2015). A systematic review and meta-analysis of cognitive-behavioral therapy for anxiety in youth with high-functioning autism spectrum disorders. Child Psychiatry & Human Development, 46(4), 533–547.

    Article  Google Scholar 

  • Van der Oord, S., Bögels, S. M., & Peijnenburg, D. (2012). The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. Journal of Child and Family Studies, 21(1), 139–147.

    Article  PubMed  Google Scholar 

  • Volker, M. A., Lopata, C., Smerbeck, A. M., Knoll, V. A., Thomeer, M. L., Toomey, J. A., & Rodgers, J. D. (2010). BASC-2 prs profiles for students with high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(2), 188–199.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (2011). Wechsler abbreviated scale of intelligence (WASI-II) (2nd ed.). San Antonio, TX: NCS Pearson.

    Google Scholar 

  • Weis, R., & Ash, S. E. (2009). Changes in adolescent and parent hopefulness in psychotherapy: Effects on adolescent outcomes as evaluated by adolescents, parents, and therapists. The Journal of Positive Psychology, 4(5), 356–364.

    Article  Google Scholar 

  • Weiss, J. A., Viecili, M. A., & Bohr, Y. (2014). Parenting stress as a correlate of cognitive behavior therapy responsiveness in children with autism spectrum disorders and anxiety. Focus on Autism and Other Developmental Disabilities, 30(3), 154–164.

    Article  Google Scholar 

  • Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Stepping Stones Triple P: An RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. Journal of Abnormal Child Psychology, 37(4), 469–480.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the many families and graduate students who participated in this research.

Funding

This study was funded by the Chair in Autism Spectrum Disorders Treatment and Care Research to Dr. Weiss (#RN284208; Canadian Institutes of Health Research in partnership with NeuroDevNet, the Sinneave Family Foundation, the Canadian Autism Spectrum Disorders Alliance, Autism Speaks Canada and Health Canada). Additional funds from York University.

Author information

Authors and Affiliations

  1. Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada

    Andrea L. Maughan & Jonathan A. Weiss

Authors
  1. Andrea L. Maughan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan A. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AM conceived of the study, participated in its design and data interpretation, performed the statistical analyses, and drafted the manuscript; JW developed the larger study design, oversaw the data collection, statistical analyses and interpretation, and assisted in manuscript preparation. Both authors approved the final manuscript.

Corresponding authors

Correspondence to Andrea L. Maughan or Jonathan A. Weiss.

Ethics declarations

Conflict of interest

The authors declare 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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maughan, A.L., Weiss, J.A. Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder. J Autism Dev Disord 47, 3166–3179 (2017). https://doi.org/10.1007/s10803-017-3224-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3224-z

Keywords

Search

Navigation