Journal of Autism and Developmental Disorders

, Volume 48, Issue 2, pp 404–416 | Cite as

COMPASS for Hope: Evaluating the Effectiveness of a Parent Training and Support Program for Children with ASD

  • Grace M. KuravackelEmail author
  • Lisa A. Ruble
  • Robert J. Reese
  • Amanda P. Ables
  • Alexis D. Rodgers
  • Michael D. Toland
Original Paper


Despite the growing number of studies that demonstrate the importance of empowering parents with knowledge and skills to act as intervention agents for their children with autism spectrum disorder (ASD), there are limited examples of parent-mediated interventions that focus on problem behaviors. Additionally, access to ASD-trained clinicians and research supported delivery options for families in rural areas is severely limited. COMPASS for Hope (C-HOPE) is an 8-week parent intervention program that was developed with the option of telehealth or face-to-face delivery. Parents who received C-HOPE intervention reported a reduction in parenting stress and an increase in competence. Parents also reported significant reductions in child behavior problems, both when compared to pre-intervention levels and to a waitlist control condition.


Parent intervention Autism spectrum disorder Problem behavior Telehealth Parent-stress Parent efficacy 



We want to acknowledge our two telehealth coordinators at the rural sites Francis Feltner, DNP, MSN, R.N. Director of the UK Center for Excellence in Rural Health and Mary Horsley, R.N., CCRP, Clinical Trials/TeleDirector of St. Claire Regional Medical Center, our funding source (The University of Louisville and University of Kentucky Collaborative Research initiative), Tim Bickel, Telehealth Director at the University of Louisville and all the parents and families who participated in this project.

Author Contributions

GK conceived of the study, participated in its design, and coordination, interpretation of results and drafted the manuscript; LR conceived the study, participated in the design, coordination of the study, interpretation of the data and manuscript revisions; RR participated in conception of the study, the design and coordination of the study as well as manuscript revisions; AA participated in the design of the study, coordination of study and data collection; AR participated in its design, data collection and entry of data; MT participated in data analysis and interpretation of results. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 as revised in 2008. The Institutional Review Boards of the two collaborating universities (University of Louisville and University of Kentucky) approved this study (#13-0926-F4S).

Informed Consent

Written informed consent was obtained from all individual participants included in the study.


  1. Abidin, R. (1995). Parenting Stress Index (3rd edn.). Lutz (FL): Psychological Assessment Resources, Inc.Google Scholar
  2. Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45(8), 1420–1430. doi: 10.1111/j.1469-7610.2004.00338.x.CrossRefPubMedGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  4. Anderson, D. J., Lakin, K. C., Hill, B. K., & Chen, T. (1992). Social integration of older persons with mental retardation in residential facilities. American Journal on Mental Retardation, 96(5), 488–501. Multiple imputation with Mplus. Retrieved from
  5. Asparouhov, T., & Muthén, B. (2010). Computing the strictly positive Satorra-Bentler chi-square test in Mplus. Mplus Web Notes: No. 12. January 24, 2012.Google Scholar
  6. Baggett, K. M., Davis, B., Feil, E. G., Sheeber, L. B., Landry, S. H., Carta, J. J., & Leve, C. (2010). Technologies for expanding the reach of evidence-based interventions: Preliminary results for promoting social-emotional development in early childhood. Topics in Early Childhood Special Education, 29(4), 226–238.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26(2), 109–160.CrossRefGoogle Scholar
  8. Barkley, R. A. (1997). Attention-deficit/hyperactivity disorder, self-regulation, and time: Toward a more comprehensive theory. Journal of Developmental and Behavioral Pediatrics, 18(4), 271–279. doi: 10.1097/00004703-199708000-00009.CrossRefPubMedGoogle Scholar
  9. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21(1), 37–46. doi: 10.1016/0010-0277(85)90022-8.CrossRefPubMedGoogle Scholar
  10. Baron-Cohen, S., Tager-Flusberg, H., & Cohen, D. J. (2000). Understanding other minds: Perspectives from developmental cognitive neuroscience (2nd edn.). New York, NY: Oxford University Press.Google Scholar
  11. Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., … Scahill, L. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. JAMA: Journal of the American Medical Association, 313(15), 1524–1533.CrossRefPubMedGoogle Scholar
  12. Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: diagnostic validity. The British Journal of Psychiatry: The Journal of Mental Science, 175, 444–451.CrossRefGoogle Scholar
  13. Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.CrossRefGoogle Scholar
  14. Braithwaite, K., & Richdale, A. (2000). Functional communication training to replace challenging behaviors across two behavioral outcomes. Behavioral Interventions, 15(1), 21–36.CrossRefGoogle Scholar
  15. Brookman-Frazee, L. I., Stahmer, A. C., Baker-Ericzen, M. J., & Tsai, K. (2006). Parenting interventions for children with autism spectrum and disruptive behavior disorders: Opportunities for cross-fertilization. Clinical Child and Family Psychology Review, 9(3–4), 181–200. doi: 10.1007/s10567-006-0010-4.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Buggey, T. (2005). Video self-modeling applications with students with autism spectrum disorder in a small private school setting. Focus on Autism and Other Developmental Disabilities, 20(1), 52–63. doi: 10.1177/10883576050200010501.CrossRefGoogle Scholar
  17. Buschbacher, P. W., & Fox, L. (2003). Understanding and intervening with the challenging behavior of young children with autism spectrum disorder. Language, Speech & Hearing Services in Schools, 34(3), 217–227. doi: 10.1177/10883576050200010501.CrossRefGoogle Scholar
  18. 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. doi: 10.1007/s10826-015-0193-8.CrossRefGoogle Scholar
  19. Cann, W., Rogers, H., & Worley, G. (2003). Report on a program evaluation of a telephone assisted parenting support service for families living in isolated rural areas. Australian e-Journal for the Advancement of Mental Health, 2(3), 201–207. doi: 10.5172/jamh.2.3.201.CrossRefGoogle Scholar
  20. Centers for Disease Control and Prevention. (2012a). Autism spectrum disorders(s). Retrieved from autism/signs.html.
  21. Chen, C., Liu, C., Su, W., Huang, S., & Lin, K. (2007). Factors associated with the diagnosis of neurodevelopmental disorders: a population-based longitudinal study. Pediatrics, 119(2), e435–e443.CrossRefPubMedGoogle Scholar
  22. Chen, Y., Rodgers, J., & McConachie, H. (2009). Restricted and repetitive behaviours, sensory processing and cognitive style in children with autism spectrum disorders. Journal of Autism & Developmental Disorders, 39(4), 635–642. doi: 10.1007/s10803-008-0663-6.CrossRefGoogle Scholar
  23. Childres, J. L., Shaffer-Hudkins, E., & Armstrong, K. (2012). Helping our toddlers, developing our children’s skills (HOT DOCS): A problem-solving approach for parents of young children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 34(6), S9-S10.Google Scholar
  24. Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98–101. doi: 10.1111/1467-8721.ep10768783.CrossRefGoogle Scholar
  25. Colvin, A., Eyberg, S. M., & Adams, C. D. (1999). Restandardization of the eyberg child behavior inventory. Gainesville, FL: University of Florida, Child Study Laboratory.Google Scholar
  26. Crone, R., & Mehta, S. S. (2016). Parent training on generalized use of behavior analytic strategies for decreasing the problem behavior of children with autism spectrum disorder: A data-based case study. Education and Treatment of Children, 39(1), 64–94.Google Scholar
  27. Dudding, C. C. (2009). Digital videoconferencing: Applications across the Disciplines. Communication Disorders Quarterly, 30(3), 178–182.CrossRefGoogle Scholar
  28. Dumont-Mathieu, T., & Fein, D. (2005). Screening for autism in young children: The modified checklist for autism in toddlers (M-CHAT) and other measures. Mental Retardation & Developmental Disabilities Research Reviews, 11(3), 253–262. doi: 10.1002/mrdd.20072.CrossRefGoogle Scholar
  29. Duncan, B. L., & Miller, S. D. (2007). The group session rating scale. Jensen Beach, FL: Author.Google Scholar
  30. Enders, C. K., Mistler, S., A., & Keller, B. T. (2016). Multilevel multiple imputation: A review and evaluation of joint modeling and chained equations imputation. Psychological Methods, 21(2), 222–240. doi: 10.1037/met000006.CrossRefPubMedGoogle Scholar
  31. Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory and sutter-eyberg student behavior inventory-revised: Professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  32. Frea, W., Arnold, C., & Vittimberga, G. (2001). A demonstration of the effects of augmentative communication on the extreme aggressive behavior of a child with autism within an integrated preschool setting. Journal of Positive Behavior Interventions, 3(4), 194–198.CrossRefGoogle Scholar
  33. Funderburk, B. W., Eyberg, S. M., Rich, B. A., & Behar, L. (2003). Further Psychometric evaluation of the eyberg and behar rating scales for parents and teachers of preschoolers. Early Education and Development, 14(1), 67–81.CrossRefGoogle Scholar
  34. Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., … Pickles, A. (2010). Parentmediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. Lancet, 375(9732), 2152–2160. doi: 10.1016/s0140-6736(10)60587-9.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Happe, F., Briskman, J., & Frith, U. (2001). Exploring the cognitive phenotype of autism: Weak “central coherence” in parents and siblings of children with autism: I. Experimental tests. Journal of Child Psychology and Psychiatry, 42(3), 299–307.CrossRefPubMedGoogle Scholar
  36. Happe, F., & Frith, U. (1996). The neuropsychology of autism. Brain, 119(4), 1377–1400. doi: 10.1093/brain/119.4.1377.CrossRefPubMedGoogle Scholar
  37. 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. doi: 10.1007/s10803-012-1604-y.CrossRefPubMedGoogle Scholar
  38. Heitzman-Powell, L. S., Buzhardt, J., Rusinko, L. C., & Miller, T. M. (2014). Formative evaluation of an ABA outreach training program for parents of children with autism in remote areas. Focus on Autism and Other Developmental Disabilities, 29(1), 23–38.CrossRefGoogle Scholar
  39. Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders, 32(5), 423–446.CrossRefPubMedGoogle Scholar
  40. Hsieh, H., Wilder, D. A., & Abellon, O. E. (2011). The effects of training on caregiver implementation of incidental teaching. Journal of Applied Behavior Analysis, 44(1), 199–203.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Iovannone, R., Dunlap, G., Huber, H., & Kinkaid, D. (2003). Effective educational practices for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 150–165.CrossRefGoogle Scholar
  42. Johnston, C., & Mash, E. J. (1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology, 18(2), 167–175.CrossRefGoogle Scholar
  43. Kasari, C., Gulsrud, A. C., Wong, 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. doi: 10.1007/s10803-010-0955-5.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Kazdin, A. E. (2005). Evidence-based assessment for children and adolescents: Issues in measurement development and clinical application. Journal of Clinical Child Adolescent Psychology, 34(3), 548–558. doi: 10.1207/s15374424jccp3403_10.CrossRefPubMedGoogle Scholar
  45. Keeling, K., Myles, Smith, Gagnon, B., E., & Simpson, R. (2003). Using the power card strategy to teach sportsmanship skills to a child with autism. Focus on Autism and Other Developmental Disabilities, 18(2), 103–109.CrossRefGoogle Scholar
  46. Krakovich, T. M., McGrew, J. H., Yu, Y., & Ruble, L. A. (2016). Stress in parents of children with autism spectrum disorder: An exploration of demands and resources. Journal of Autism and Developmental Disorders, 46(6), 2042–2053. doi: 10.1007/s10803-016-2728-2.CrossRefPubMedGoogle Scholar
  47. Lundahl, B. W., Nimer, J., & Parsons, B. (2006). Preventing child abuse: A meta-analysis of parent training programs. Research on Social Work Practice, 16(3), 251–262.CrossRefGoogle Scholar
  48. MacKenzie, K. R. (1998). The alliance in time limited group psychotherapy. In J. D. Safran & J. C. Muran (Eds.), The therapeutic alliance in brief psychotherapy (pp. 193–215). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  49. Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116(6), 1480–1486.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research Developmental Disabilities: A Multidisciplinary Journal, 28(4), 341–352.CrossRefGoogle Scholar
  51. McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120–129. doi: 10.1111/j.1365-2753.2006.00674.x.CrossRefPubMedGoogle Scholar
  52. McCrimmon, A., Rostad, K. (2014). Test review: Lord, C., Luyster, C., Gotham, R. J., K., & Guthrie, W. (2012). “Autism diagnostic observation schedule, second edition (ADOS-2) manual (Part II): Toddler module.” Torrance, CA: Western Psychological Services, 2012. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. “Autism diagnostic observation schedule, second edition.” Torrance, CA: Western Psychological Services, 2012. Journal of Psychoeducational Assessment, 32(1), 88–92.CrossRefGoogle Scholar
  53. McGrew, J. H., Ruble, L. A., & Smith, I. M. (2016). Autism spectrum disorder and evidence-based practice in psychology. Clinical Psychology: Science And Practice, 23(3), 239–255. doi: 10.1111/cpsp.12160.Google Scholar
  54. Mello, M. P., Goldman, S. E., Urbano, R. C., & Hodapp, R. M. (2016). Services for children with autism spectrum disorder: Comparing rural and non-rural communities. Education and Training in Autism and Developmental Disabilities, 51(4), 355–365.Google Scholar
  55. Murphy, M. A., & Ruble, L. A. (2012). A comparative study of rurality and urbanicity on access to and satisfaction with services for children with autism spectrum disorders. Rural Special Education Quarterly, 31(3), 3–11.CrossRefGoogle Scholar
  56. Muthén, L. K., & Muthén, B. O. (1998–2015). Mplus (version 7.4) [Computer software]. Los Angeles, CA: Authors.Google Scholar
  57. National Research Council (NRC) (2001). Educating students with autism. Washington, DC: National Academy Press.Google Scholar
  58. Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37(1), 51–87.CrossRefPubMedGoogle Scholar
  59. Pillay, M., Alderson-Day, B., Wright, B., Williams, C., & Urwin, B. (2011). Autism spectrum conditions-enhancing nurture and development (ASCEND): An evaluation of intervention support groups for parents. Clinical Child Psychology and Psychiatry, 16(1), 5–20.CrossRefPubMedGoogle Scholar
  60. Pisula, E., & Kossakowska, Z. (2010). Sense of coherence and coping with stress among mothers and fathers of children with autism. Journal of Autism and Developmental Disorders, 40(12), 1485–1494.CrossRefPubMedGoogle Scholar
  61. Quirk, K., Miller, S., Duncan, B., & Owen, J. (2013). ‘Group Session Rating Scale: Preliminary psychometrics in substance abuse group interventions’: Corrigendum. Counselling & Psychotherapy Research, 13(3), i. doi: 10.1080/14733145.2013.764658.CrossRefGoogle Scholar
  62. Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent training efficacy for child externalizing behavior problem: A meta-analytic review. Journal of Child Psychology and Psychiatry, 47(1), 99–111.CrossRefPubMedGoogle Scholar
  63. Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). Reply to Charman et al.’s commentary on the modified checklist for autism in toddlers. Journal of Autism & Developmental Disorders, 31(2), 149.CrossRefGoogle Scholar
  64. Ruble, L. A., Dalrymple, N. J., & McGrew, J. H. (2010). The effects of consultation on individualized education program outcomes for young children with autism: The collaborative model for promoting competence and success. Journal of Early Intervention, 32(4), 286–301.CrossRefPubMedPubMedCentralGoogle Scholar
  65. Ruble, L. A., Dalrymple, N. J., & McGrew, J. H. (2012). Collaborative model for promoting competence and success for students with ASD. New York, NY: Springer.CrossRefGoogle Scholar
  66. Ruble, L. A., McGrew, J. H., Toland, M. D., Dalrymple, N. J., & Jung, L. A. (2013). A randomized controlled trial of COMPASS web-based and face-to-face teacher coaching in autism. Journal of Consulting and Clinical Psychology, 81(3), 566–572. doi: 10.1037/a0032003.CrossRefPubMedPubMedCentralGoogle Scholar
  67. Rutter, M., Bailey, A., & Lord, C. (2003). The social communication questionnaire: Manual. Los Angeles: Western Psychological Services.Google Scholar
  68. Schafer, J. L., & Yucel, R. M. (2002). Computational strategies for multivariate linear mixed effects models with missing data. Journal of Computational and Graphical Statistics, 11, 437–457.CrossRefGoogle Scholar
  69. Schilling, D., & Schwartz, I. (2004). Alternative seating for young children with autism spectrum disorder: Effects on classroom behavior. Journal of Autism and Developmental Disorders, 34(4), 423–432.CrossRefPubMedGoogle Scholar
  70. Schopler, E., & Reichler, R. J. (1971). Parents as cotherapists in the treatment of psychotic children. Journal of Autism and Childhood Schizophrenia, 1(1), 87–102.CrossRefPubMedGoogle Scholar
  71. Snow, A. V., & Lecavalier, L. (2008). Sensitivity and specificity of the modified checklist for autism in toddlers and the social communication questionnaire in preschoolers suspected of having pervasive developmental disorders. Autism: The International Journal of Research and Practice, 12(6), 627–644.CrossRefGoogle Scholar
  72. Sofronoff, K., Leslie, A., & Brown, W. (2004). Parent management training and Asperger Syndrome: A randomized controlled trial to evaluate a parent based intervention. Autism: The International Journal of Research and Practice, 8(3), 301–317.CrossRefGoogle Scholar
  73. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales, (2nd edn.). Circle Pines, MN: AGS.Google Scholar
  74. Turnbull, I. I. I., Wilcox, H. R., B. L., & Stowe, M. J. (2002). A brief overview of special education law with focus on autism. Journal of Autism & Developmental Disorders, 32(5), 479.CrossRefGoogle Scholar
  75. Turner, J. W. (2003). Telemedicine: Expanding health care into virtual environments. In T. L. Thompson, A. M. Dorsey, K. I. Miller, R. Parrott, T. L. Thompson & A. M. Dorsey, …R. Parrott (Eds.), Handbook of health communication (pp. 515–535). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.Google Scholar
  76. U.S. Census Bureau. (2015). American community survey (ACS). Retrieved September 21, 2016, from
  77. Vismara, L. A., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment. doi: 10.1155/2012/121878.PubMedPubMedCentralGoogle Scholar
  78. Wainer, A., & Ingersoll, B. R. (2015). Increasing access to an ASD imitation intervention via a telehealth parent training program. Journal of Autism & Developmental Disorders, 45(12), 3877–3890. doi: 10.1007/s10803-014-2186-7.CrossRefGoogle Scholar
  79. West, E. A., Travers, J. C., Kemper, T. D., Libertry, L. M., Cote, D. L., McCollow, M. M., & Stansberrry Brusnahan, L. L. (2016). Racial and ethnic diversity of participants in research supporting evidence-based practices for learners with Autism Spectrum Disorder. The Journal of Special Education, 50, 151–163. doi: 10.1177/0022466916632495.CrossRefGoogle Scholar
  80. 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
  81. Yalom, I. D. (1995). The theory and practice of group psychotherapy (4th edn.). New York: Basic Books.Google Scholar
  82. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th edn.). New York, NY: Basic Books.Google Scholar
  83. Zisser, A., & Eyberg, S. (2010). Parent-child interaction therapy and the treatment of disruptive behavior disorders. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd edn., pp. 179–193). New York, NY: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Louisville School of MedicineLouisvilleUSA
  2. 2.Department of Educational, School, and Counseling PsychologyUniversity of KentuckyLexingtonUSA

Personalised recommendations