Skip to main content

Acceptance and Commitment Therapy for Caregivers of Children with Neurodevelopmental Disabilities: a Systematic Review


Purpose of review

This systematic review examined research on acceptance and commitment therapy (ACT) for caregivers of children with neurodevelopmental disabilities (NDDs). Specifically, we examined ACT delivery format, inclusion of treatment fidelity, facilitator/intervention acceptability measures, and effectiveness of the intervention immediately after ACT and at follow-up. We also summarized the type of outcome measures most commonly used.

Recent findings

ACT has been shown to increase psychological flexibility and decrease stress in caregivers of children with NDDs, which is important because this population often reports high stress.


A variety of strategies were used to facilitate ACT, including experiential exercises, role-playing, and discussions. Three articles discussed treatment fidelity, and two articles included facilitator/intervention acceptability measures. All articles that met inclusion criteria (N = 11) employed indirect outcome measures (e.g. questionnaires) to assess impacts of ACT on caregivers, with only one study also including direct outcomes. Findings are discussed in relation to future research directions.

This is a preview of subscription content, access via your institution.

Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dykens EM, Fisher MH, Taylor JL, Lambert W, Miodrag N. Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics. 2014;134:454–63.

    Article  Google Scholar 

  2. Estes A, Munson J, Dawson G, Koehler E, Zhou X, Abbott R. Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism. 2009;13:375–87.

    Article  PubMed  Google Scholar 

  3. Baker-Ericzén MJ, Brookman-Frazee L, Stahmer A. Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders. Res Pract Persons Severe Disabl. 2005;30:194–204.

    Article  Google Scholar 

  4. Lecavalier L, Leone S, Wiltz J. The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. J Intellect Disabil. 2006;50:172–83.

    CAS  Article  Google Scholar 

  5. Benson PR. The impact of child symptom severity on depressed mood among parents of children with ASD: the mediating role of stress proliferation. J Autism Dev Disord. 2006;36:685–95.

    Article  PubMed  Google Scholar 

  6. Gray DE. Autism and the family: problems, prospects, and coping with the disorder. Charles C. Thomas: Springfield, IL; 1998.

    Google Scholar 

  7. Horner RH, Carr EG, Strain PS, Todd AW, Reed HK. Problem behavior interventions for young children with autism: a research synthesis. J Autism Dev Disord. 2002;32:423–46.

    Article  PubMed  Google Scholar 

  8. Hahs AD, Dixon MR, Paliliunas D. Randomized controlled trial of a brief acceptance and commitment training for parents of individuals diagnosed with autism spectrum disorders. J Contextual Behav Sci. 2018;12:154–9. study demonstrated the effectiveness of a brief-ACT intervention for caregivers of children with ASD.

    Article  Google Scholar 

  9. Marcus LM, Kunce LJ, Schopler E. Working with families. In: Cohen DR, Volkmar FR, editors. Handbook of autism and pervasive developmental disorders. New York: Wiley; 1997.

    Google Scholar 

  10. Lunsky Y, Fung K, Lake J, Steel L, Bryce K. Evaluation of acceptance and commitment therapy (ACT) for mothers of children and youth with autism spectrum disorder. Mindfulness. 2018;9:1110–6. study included caregiver co-facilitators, working alongside a clinician and an intervention satisfaction measure.

    Article  Google Scholar 

  11. Volkmar FR, Reichow B, McPartland JC. Adolescents and adults with autism spectrum disorders. New York: Springer; 2014.

    Book  Google Scholar 

  12. Cadman T, Eklund H, Howley D, Hayward H, Clarke H, Findon J, et al. Caregiver burden as people with autism spectrum disorder and attention-deficit/hyperactivity disorder transition into adolescence and adulthood in the United Kingdom. J Am Acad Child Adolesc Psychiatry. 2012;51:879–88.

    Article  PubMed  Google Scholar 

  13. Friedman ND, Warfield ME, Parish SL. Transition to adulthood for individuals with autism spectrum disorder: current issues and future perspectives. Neuropsychiatry. 2013;3:181–92.

    Article  Google Scholar 

  14. Shattuck PT, Wagner M, Narendorf S, Sterzing P, Hensley M. Post–high school service use among young adults with an autism spectrum disorder. Arch Pediatr Adolesc Med. 2011;165:141–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and Commitment Therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25.

    Article  PubMed  Google Scholar 

  16. Bond FW, Hayes SC, Barnes-Holmes D. Psychological flexibility, ACT, and organizational behavior. J Organ Behav Manag. 2006;26:25–54.

    Article  Google Scholar 

  17. Zhang C, Leeming E, Smith P, Chung P, Hagger M, Hayes S. Acceptance and commitment therapy for health behavior change: A contextually-driven approach. Front Psychol. 2018;8:2350–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Harris R. ACT made simple: an easy-to-read primer on acceptance and commitment therapy. Oakland: New Harbinger Publications; 2009.

    Google Scholar 

  19. Eilenberg T, Hoffmann D, Jensen JS, Frostholm L. Intervening variables in group-based acceptance & commitment therapy for severe health anxiety. Behav Res Ther. 2017;92:24–31.

    Article  PubMed  Google Scholar 

  20. Spidel A, Lecomte T, Kealy D, Daigneault I. Acceptance and commitment therapy for psychosis and trauma: improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychol Psychother: Theory Res Prac. 2018;91:248–61.

    Article  Google Scholar 

  21. Luoma JB, Kohlenberg BS. Hayes SC, & Fletcher L Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. J Consult Clin Psychol. 2012;80:43–53.

    Article  PubMed  Google Scholar 

  22. Kemani MK, Kanstrup M, Jordan A, Caes L, Gauntlett-Gilbert J. Evaluation of an intensive interdisciplinary pain treatment based on acceptance and commitment therapy for adolescents with chronic pain and their parents: a nonrandomized clinical trial. J Pediatr Psychol. 2018;43:981–94.

    Article  PubMed  Google Scholar 

  23. Frögéli E, Djordjevic A, Rudman A, Livheim F, Gustavsson P, Frögéli E. A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses. Anxiety Stress Coping. 2016;29:202–18.

    Article  PubMed  Google Scholar 

  24. Brinkborg H, Michanek J, Hesser H, Berglund G. Acceptance and commitment therapy for the treatment of stress among social workers: a randomized controlled trial. Behav Res Ther. 2011;49:389–98.

    Article  PubMed  Google Scholar 

  25. Losada A, Márquez-González M, Romero-Moreno R, Mausbach BT, López J, Fernández-Fernández V, et al. Cognitive–behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: results of a randomized clinical trial. J Consult Clin Psychol. 2015;83:60.

    Article  Google Scholar 

  26. Szabo TG. Acceptance and commitment training for reducing inflexible behaviors in children with autism. J Contextual Behav Sci. 2019;12:178–88.

    Article  Google Scholar 

  27. Summers RF, Barber JP. Therapeutic alliance as a measurable psychotherapy skill. Acad Psychiatry. 2003;27:160–5.

    Article  PubMed  Google Scholar 

  28. Huey SJ Jr, Henggeler SW, Brondino MJ, Pickrel SG. Mechanisms of change in multisystemic therapy: reducing delinquent behavior through therapist adherence and improved family and peer functioning. J Consult Clin Psychol. 2000;68:451–67.

    Article  PubMed  Google Scholar 

  29. DiGennaro Reed FDD, Reed DD, Baez CN, Maguire H. A parametric analysis of errors of commission during discrete-trial training. J Appl Behav Anal. 2011;44:611–5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Blackledge JT, Hayes SC. Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child Family Behav Ther. 2006;28:1–18.

    Article  Google Scholar 

  31. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1–9 Retrieved from

    Article  Google Scholar 

  32. Fung K, Lake J, Steel L, Bryce K, Lunsky Y. ACT processes in group intervention for mothers of children with autism spectrum disorder. J Autism Dev Disord. 2018;48:2740–7. study included caregivers as co-facilitators with clinicians for an ACT intervention for caregivers of children with ASD.

    Article  PubMed  Google Scholar 

  33. Joekar S, Farid AAA, Birashk B, Mohammadian M. Effectiveness of acceptance and commitment therapy in the support of parents of children with high-functioning autism. Int J Human Cult Stud. 2016;2:10 Retrieved from

    Google Scholar 

  34. Poddar S, Sinha V, Mukherjee U. Challenges of parents having developmentally challenged children: an intervention approach using acceptance and commitment therapy. J Family Med Prim Care. 2015b;4:604. Retrieved from

  35. Poddar S, Sinha V, Mukherjee U. Acceptance and commitment therapy on parents of children and adolescents with autism spectrum disorders. Int J Educ Psychol Res. 2015a;1:221.

  36. Brown FL, Whittingham K, Boyd RN, McKinlay L, Sofronoff K. Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial. Behav Res Ther. 2015;73:58–66.

    Article  PubMed  Google Scholar 

  37. Whittingham K, Sanders MR, McKinlay L, Boyd RN. Parenting intervention combined with acceptance and commitment therapy: a trial with families of children with cerebral palsy. J Pediatr Psychol. 2016;41:531–42. study included treatment integrity measures for the ACT intervention.

    Article  PubMed  Google Scholar 

  38. Corti C, Pergolizzi F, Vanzin L, Cargasacchi G, Villa L, Pozzi M, et al. Acceptance and commitment therapy-oriented parent-training for parents of children with autism. J Child Fam Stud. 2018;27:2887–900. study included treatment integrity measures for the ACT intervention, along with an intervention satisfaction measure.

    Article  Google Scholar 

  39. Gould ER, Tarbox J, Coyne L. Evaluating the effects of acceptance and commitment training on the overt behavior of parents of children with autism. J Contextual Behav Sci. 2018;7:81–8. study included indirect and direct measures of value-directed behaviours, in addition to including modeling and role-play when delivering ACT.

  40. Kahng S, Ingvarsson AM, Secklinger KE, Teichman HM. Defining and Measuring Behaviour. In: Fisher WW, Piazza CC, Roane HS, editors. Handbook of applied behavior analysis: Guilford Press; 2011.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kendra Thomson.

Ethics declarations

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

Carly Magnacca, Kendra Thomson and Amanda Marcinkiewicz declare no conflicts of interest relevant to this manuscript.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Magnacca, C., Thomson, K. & Marcinkiewicz, A. Acceptance and Commitment Therapy for Caregivers of Children with Neurodevelopmental Disabilities: a Systematic Review. Curr Dev Disord Rep 8, 152–160 (2021).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Acceptance and commitment therapy
  • Caregiver training
  • Neurodevelopmental disabilities