Advertisement

Child-Adult Relationship Enhancement for Children with Autism Spectrum Disorders: CARE Connections

  • Robin H. GurwitchEmail author
  • Melanie M. Nelson
  • John Paul Abner
Chapter

Abstract

An estimated 1 in 59 children in the USA is diagnosed with an autism spectrum disorder (ASD; CDC, Morbidity and Mortality Weekly Report. Surveillance Summaries 67(6):1–23, 2018). While all children diagnosed with ASD experience some level of difficulty with social communication and restricted, repetitive interests, many also exhibit problematic disruptive behaviors across settings. Parents and other adults in the children’s lives (e.g., family members, teachers, medical and mental health professionals, community members) are important in helping children with ASD meet their potential. Although several interventions exist that target children with ASD, their parents, and teachers, there are no widely available, evidence-based programs designed to help other adults who interact with children with ASD but who do not have a major caretaking role. Child-Adult Relationship Enhancement (CARE) is an intervention for all adults in provider roles based on evidence-based parenting programs (including Parent-Child Interaction Therapy; PCIT) designed to strengthen social relationships and improve child compliance for minor to moderate difficulties. Early findings related to CARE show that it is a promising intervention for improving relationships and behavior in several populations. Specifically, CARE Connections is an adaptation developed for all adults interacting with children with ASD. CARE Connections incorporates adult learning principles, live feedback, and ASD-specific examples to increase program uptake and implementation for care providers in a child’s life. CARE Connections may be an important step for all adults to learn more effective means of communicating with children with ASD with the goal of improving the child’s overall development (e.g., social development).

References

  1. Abner, J. P. (2018, March). PCIT for children with autism spectrum disorders: The benefits of CDI. Presented at the Annual Washington State PCIT Convention, Seattle, WA.Google Scholar
  2. Abner, J. P., Bonney, E., Dugger, J., Lingerfelt, A., Michalk, E., & Suggs, J. (2008, October). CDI: An effective brief intervention for children with autism spectrum disorders? Presented at the National Parent-Child Interaction Therapy Conference, Sacramento, CAGoogle Scholar
  3. Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  4. Achenbach, T. M. (1992). Manual for the child behavior checklist/2-3 and 1992 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  5. Altiere, M. J., & von Kluge, S. (2009). Searching for acceptance: Challenges encountered while raising a child with autism. Journal of Intellectual and Developmental Disabilities, 34(2), 142–152. https://doi.org/10.1080/13668250902845202 CrossRefGoogle Scholar
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  7. Armstrong, K., DeLoatche, K. J., Preece, K. K., & Agazzi, H. (2015). Combining parent-child interaction therapy and visual supports for the treatment of challenging behavior in a child with autism and intellectual disabilities and comorbid epilepsy. Clinical Case Studies, 14, 3–14.CrossRefGoogle Scholar
  8. Bacon, E. C., Dufek, S., Schreibman, L., Stahmer, A. C., Pierce, K., & Courchesne, E. (2014). Measuring outcome in an early intervention program for toddlers with autism spectrum disorder: Use of a curriculum-based assessment. Autism Research and Treatment, 2014, 1–9.CrossRefGoogle Scholar
  9. Bagner, D. M., & Eyberg, S. M. (2007). Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 36, 418–429.CrossRefGoogle Scholar
  10. Beveridge, R. M., Fowles, T. R., Masse, J. J., Parrish, B. P., Smith, M. S., Circo, G., & Widdoes, N. S. (2015). The dissemination and implementation of parent-child interaction therapy (PCIT): Lessons learned from a state-wide system of care. Children and Youth Services Review, 48, 38–48.CrossRefGoogle Scholar
  11. Briere, J., Johnson, K., Bissada, A., Damon, L., Crouch, J., Gil, E., … Ernst, V. (2001). The trauma symptom checklist for young children (TSCYC): Reliability and association with abuse exposure in a multi-site study. Child Abuse & Neglect, 25, 1001–1014.CrossRefGoogle Scholar
  12. Brinkmeyer, M., & Eyberg, S. M. (2003). Parent-child interaction therapy for oppositional children. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 204–223). New York: Guilford.Google Scholar
  13. Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., et al. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4, 4–16.CrossRefGoogle Scholar
  14. Centers for Disease Control and Prevention [CDC]. (2018). Prevalence of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2014. Morbidity and Mortality Weekly Report. Surveillance Summaries, 67(6), 1–23.Google Scholar
  15. Conners, N. A., Whiteside-Mansell, L., Deere, D., Ledet, T., … Edwards, M. (2006). Measuring the potential for child maltreatment: The reliability and validity of the adult adolescent parenting inventory—2. Child Abuse & Neglect, 30, 39–53.CrossRefGoogle Scholar
  16. Eisenhower, A. S., Baker, B. L., & Blacher, J. (2005). Preschool children with intellectual disability: Syndrome specificity, behaviour problems, and maternal well-being. Journal of Intellectual Disability Research, 49, 657–671.CrossRefGoogle Scholar
  17. Eyberg, S., & Funderburk, B. (2011). Parent child interaction therapy protocol. Gainesville, FL: PCIT International, Inc.Google Scholar
  18. 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
  19. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Prevention Medicine, 14, 245–258.CrossRefGoogle Scholar
  20. Forehand, R. T., & McMahon, R. J. (1981). Helping the noncompliant child. New York: The Guilford Press.Google Scholar
  21. Forgatch, M. S., Bullock, B. M., & Patterson, G. R. (2004). From theory to practice: Increasing effective parenting through role-play. The Oregon Model of Parent Management Training (PMTO). In H. Steiner (Ed.), Handbook of mental health interventions in children and adolescents: An integrated developmental approach (pp. 782–814). San Francisco: Jossey-Bass.Google Scholar
  22. Fukumaru, Y. (2010). Introducing the CARE (Child-Adult Relationship Enhancement) to foster parents in Japan. Bulletin of Shiraume Gakuen University, 14, 23–28.Google Scholar
  23. Giangreco, M. F., Suter, J. C., & Doyle, M. B. (2010). Paraprofessionals in inclusive schools: A review of recent research. Journal of Educational and Psychological Consultation, 20(1), 41–57. https://doi.org/10.1080/10474410903535356 CrossRefGoogle Scholar
  24. Ginn, N. C., Clionsky, L. N., Eyberg, S. M., Warner-Metzger, C., & Abner, J. P. (2015). Child-Directed Interaction training for young children with autism spectrum disorders: Parent and child outcomes. Journal of Clinical Child & Adolescent Psychology, 46(1), 101–109.CrossRefGoogle Scholar
  25. Green, G. (1996). Early behavioral intervention for autism: What does the research tell us? In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral interventions for young children with autism (pp. 29–44). Austin, TX: PRO-ED.Google Scholar
  26. Greenspan, S. I. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges. Madison, CT: International University Press.Google Scholar
  27. Gurwitch, R., Messer, E. P., Masse, J., Olafson, E., Boat, B., & Putnam, F. (2016). Child-adult relationship enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges. Child Abuse and Neglect, 53, 138–145. https://doi.org/10.1016/j.chiabu.2015.10.016 CrossRefPubMedGoogle Scholar
  28. Gurwitch, R. H. (2017a, April). Strengthening relationships in military families: Adaptation of parent-child interaction therapy (PCIT). In M. Bellehsen (Chair) Expanding and adapting care for military and veteran families. Symposium Presented at the Meeting of the National Child Traumatic Stress Network, Washington, DC.Google Scholar
  29. Gurwitch, R. H. (2017b, November). Child adult relationship enhancement (CARE) for families who serve. Symposium Presented for the North Carolina National Guard and Reserve State Family Programs, Raleigh, NC.Google Scholar
  30. Gurwitch, R. H. & Abner, J. P. (2017, October). Child adult relationship enhancement (CARE) in the classroom. Workshop Presented for the South Carolina Association of School Psychologists, Columbia, SC.Google Scholar
  31. Gurwitch, R. H. & Masse, J. (2018, March). Child adult relationship enhancement (CARE): Expanding the reach of PCIT and other evidence-based parenting program principles. Keynote Address Presented at the Annual Washington State PCIT Conference, Seattle, WA.Google Scholar
  32. Gurwitch, R. H., Messer, E. P., Warner-Metzger, C. M., & Berkowitz, S. (2017, November). Child-adult relationship enhancement (CARE): Building skills to strengthen trauma recovery in children and youth. Pre-Meeting Institute Presented at the Annual Meeting of the International Society for Traumatic Stress Studies, Chicago, ILGoogle Scholar
  33. Gurwitch, R. H., Messer, E. P., Warner-Metzger, C. M., Masse, J., & Abner, J. P. (2017, September). Child adult relationship enhancement (CARE): Expanding capacity of PCIT principles. Symposium Presented at the PCIT International Convention, Travers City, MI.Google Scholar
  34. 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, 423–446.CrossRefGoogle Scholar
  35. Janney, A., Masse, J., & King, K. (2014). Early findings in the state-wide dissemination of teacher-child interaction training (TCIT). Poster Presented the 48th Annual Meeting of the Association or Behavioral and Cognitive Therapies, Philadelphia, PA.Google Scholar
  36. Kaat, A. J., & Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents with autism spectrum disorders: A review of the prevalence, presentation, and treatment. Research in Autism Spectrum Disorders, 7, 1579–1594.CrossRefGoogle Scholar
  37. Koegel, R. L., Koegel, L. K., & Brookman, L. I. (2003). Empirically supported pivotal response interventions for children with autism. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 341–357). New York: Guilford Press.Google Scholar
  38. Koegel, R. L., O’Dell, M. C., & Koegel, L. K. (1987). A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders, 17, 187–200.CrossRefGoogle Scholar
  39. LeBuffe, P. A., & Naglieri, J. A. (2012). Devereux early childhood assessment for preschoolers (2nd ed.). Lewisville, NC: Kaplan Early Learning Company.Google Scholar
  40. Lovaas, O. L. (1987). Behavioral treatment and normal education and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.CrossRefGoogle Scholar
  41. Lucas, E. & Embaye, F. (2017, March). CARE coaching pilot project: Child Adult Relationship Enhancement coaching in an early learning setting. Symposium presented at the Voices for Ohio’s Children Summit, Columbus, OH.Google Scholar
  42. Ludlow, A., Skelly, C., & Rohleder, P. (2012). Challenges faced by parents of children diagnosed with autism spectrum disorder. Journal of Health Psychology, 17(5), 702–711. https://doi.org/10.1177/1359105311422955 CrossRefPubMedGoogle Scholar
  43. Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. (2005). Characteristics of children with autistic spectrum disorders served in comprehensive community-based mental health settings. Journal of Autism and Developmental Disorders, 35, 313–321.CrossRefGoogle Scholar
  44. Masse, J. J., McNeil, C. B., Wagner, S., & Quetsch, L. B. (2016). Examining the efficacy of parent-child interaction therapy with children on the autism spectrum. Journal of Child and Family Studies, 25(8), 2508–2525.CrossRefGoogle Scholar
  45. Masse, J. J., McNeil, C. B., Wagner, S. M., & Chorney, D. B. (2007). Parent-child interaction therapy and high functioning autism: A conceptual overview. Journal of Early and Intensive Behavior Intervention, 4(4), 714–735.CrossRefGoogle Scholar
  46. Messer, E. P. (2016, November). CARE updates in the United States and Japan. Symposium presented to the Mayerson Center for Safe and Healthy Families, Cincinnati, OH.Google Scholar
  47. Messer, E.P., Greiner, M.V., Beal, S.J., Eismann, E.A., Cassedy, A., Gurwitch, R.H., Boat, B.W., Bensman, H., Bemerer, J., Hennigan, M., Greenwell, S., & Eiler-Sims, P. (2018). Child adult relationship enhancement (CARE): A brief, skills-building training for foster caregivers to increase positive parenting practices. Children and Youth Services Review, 90, 74–82.CrossRefGoogle Scholar
  48. Mrachko, A. A., & Kaczmarek, L. A. (2016). Examining paraprofessional interventions to increase social communication for young children with ASD. Topics in Early Childhood Special Education, 37(1), 4–15.CrossRefGoogle Scholar
  49. Ohio Child Welfare Training Program. (2007). Foster caregiver training requirements. Retrieved from http://ocwtp.net/Requirements.htm#FCs. Accessed 8 Apr 2015.
  50. Parris, S. R., Dozier, M., Purvis, K. B., Whitney, C., Grisham, A., & Cross, D. R. (2015). Implementing Trust-Based Relational Intervention® in a charter school at a residential facility for at-risk youth. Contemporary School Psychology, 19, 157–164. https://doi.org/10.1007/s40688-014-0033-7 CrossRefGoogle Scholar
  51. PCIT International. Therapist guidelines. Retrieved from www.pcit.org. March 21, 2018.
  52. Rispoli, M., Neely, L., Lang, R., & Ganz, J. (2011). Training paraprofessionals to implement interventions for people with autism spectrum disorder: A systematic review. Developmental Neurorehabilitation, 14(6), 378–388. https://doi.org/10.3109/1758423.2011.620577 CrossRefPubMedGoogle Scholar
  53. Rodgers, J., Glod, M., Connolly, B., & McConachie, H. (2012). The relationship between anxiety and repetitive behaviours in autism spectrum disorder. Journal of Autism and Developmental Disorders, 42, 2404–2409.CrossRefGoogle Scholar
  54. Schilling, S., French, B., Berkowitz, S. J., Dougherty, S. L., Scribano, P. V., & Wood, J. N. (2017). A randomized trial of a parent training to improve parenting skills and reduce child behavior problems. Academic Pediatrics, 17, 53–60.CrossRefGoogle Scholar
  55. Schopler, E. (1994). A statewide program for the treatment and education of autistic and related communication handicapped children (TEACCH). Psychoses and Pervasive Developmental Disorders, 3, 91–103.Google Scholar
  56. Siller, M., & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32, 77–89.CrossRefGoogle 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 and Adolescent Psychiatry, 47, 921–929.CrossRefGoogle Scholar
  58. Smith, T., & Iadarola, S. (2015). Evidence base update for autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 44, 897–922.CrossRefGoogle Scholar
  59. 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, 1767–1776.CrossRefGoogle Scholar
  60. Webster-Stratton, C., & Hammond, M. (1998). Conduct problems and level of social competence in head start children: Prevalence, pervasiveness and associated risk factors. Clinical Child Psychology and Family Psychology Review, 1, 101–124.CrossRefGoogle Scholar
  61. Webster-Stratton, C., & Reid, M. J. (2003). Treating conduct problems and strengthening social and emotional competence in young children: The Dina Dinosaur Treatment Program. Journal of Emotional and Behavioral Disorders, 11(3), 130–143.CrossRefGoogle Scholar
  62. Wood, J. N., Dougherty, S. D., Long, J., Messer, E. P., & Rubin, D. (2017). A pilot investigation of a novel intervention to improve behavioral well-being for children in foster care. Journal of Emotional and Behavioral Disorders. https://doi.org/10.1177/1063426617733715 CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Robin H. Gurwitch
    • 1
    Email author
  • Melanie M. Nelson
    • 2
  • John Paul Abner
    • 3
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.University of Florida College of MedicineGainesvilleUSA
  3. 3.Milligan CollegeJohnson CityUSA

Personalised recommendations