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

Original Paper

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.

Keywords

Autism spectrum disorder Cognitive behavior therapy Parenting Mental health Expressed emotion 

References

  1. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. Bayat, M. (2007). Evidence of resilience in families of children with autism. Journal of Intellectual Disability Research, 51(9), 702–714.CrossRefPubMedGoogle Scholar
  5. Beaumont, R. (2013). Secret Agent Society-Operation Regulation (SAS-OR) manual. Brisbane, Australia: Social Skills Training Pty Ltd.Google Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. Bögels, S. M., Lehtonen, A., & Restifo, K. (2010). Mindful parenting in mental health care. Mindfulness, 1, 107–120.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale (SRS-2) (2nd ed.). Torrance, CA: Western Psychological Services.Google Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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
  19. 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.Google Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. Guy, W. (1976). CGI clinical global impressions. EC-DEU Assessment Manual for Psychopharmacology, 76–338.Google Scholar
  29. Gross, J. J., & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2(2), 151–164.Google Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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
  34. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Sydney Psychology Edition.Google Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 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.CrossRefPubMedGoogle Scholar
  44. 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.CrossRefPubMedGoogle Scholar
  45. 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.CrossRefPubMedGoogle Scholar
  46. 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.CrossRefPubMedGoogle Scholar
  47. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 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.CrossRefGoogle Scholar
  49. 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.CrossRefPubMedGoogle Scholar
  50. 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.CrossRefPubMedGoogle Scholar
  51. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 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.CrossRefGoogle Scholar
  53. Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment system for children, (BASC-2) (2nd ed.). Bloomington, MN: Pearson Assessments.Google Scholar
  54. 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.CrossRefPubMedGoogle Scholar
  55. 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
  56. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 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.CrossRefGoogle Scholar
  58. 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.CrossRefGoogle Scholar
  59. 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.CrossRefGoogle Scholar
  60. 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.CrossRefPubMedGoogle Scholar
  61. 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.CrossRefPubMedGoogle Scholar
  62. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 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.CrossRefPubMedGoogle Scholar
  64. 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.PubMedCentralGoogle Scholar
  65. 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.CrossRefGoogle Scholar
  66. 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.CrossRefPubMedGoogle Scholar
  67. 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.CrossRefGoogle Scholar
  68. 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.CrossRefPubMedGoogle Scholar
  69. 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.CrossRefPubMedGoogle Scholar
  70. Wechsler, D. (2011). Wechsler abbreviated scale of intelligence (WASI-II) (2nd ed.). San Antonio, TX: NCS Pearson.Google Scholar
  71. 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.CrossRefGoogle Scholar
  72. 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.CrossRefGoogle Scholar
  73. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of PsychologyYork UniversityTorontoCanada

Personalised recommendations