No description available.

People who live with Type 1 diabetes (T1D) have to carefully self-administer insulin to keep blood glucose levels in a safe healthy range – a complex and demanding task (WHO, 2016). Social support has been found to alleviate diabetes-stress and increase management behaviors (Mackey et al., 2016). Social support from family members is especially advantageous, however currently no single family-based intervention has been established to show reliable improvements in T1D outcomes (Rosland et al., 2010). A review of the literature reveals that social support promoting autonomy is associated with the best T1D outcomes; social support that undermines autonomy is associated with worse T1D outcomes (Kelly & Berg, 2018). These findings are consistent with the self-determination theory (SDT), which identifies autonomy as a psychological need (Ng et al., 2012). The findings of this literature review support the need for a disease-specific family-based intervention that is built on the foundations of SDT.

Previous research has demonstrated the efficacy of a behavioral parent training program for increasing the accuracy of trained skills; however, few studies have examined the extent to which those skills generalize to the natural environment (i.e., the home) and are used with the target individual (i.e., the child). In addition, little is known about the direct effect that caregiver implementation of the skills has on child behavior. A multiple baseline across participants design was used to (a) assess caregiver accuracy with implementation of three parenting skills, and (b) assess subsequent effects of the parenting skills on child behavior. Results demonstrated that three caregiver participants successfully generalized parenting skills taught during behavioral skills training (BST) to naturally occurring routines by recognizing appropriate and inappropriate child behaviors as opportunities to implement the trained skills. In addition, the behavior of each caregiver's child improved following BST, suggesting that the parenting skills were effective in addressing challenging child behavior. All caregivers rated the training and skills to be highly socially valid. Limitations and suggestions for future research are discussed.

Les enfants ayant un trouble du spectre de l’autisme (TSA) présentent parfois des comportements problématiques, comme des comportements agressifs ou stéréotypés. L’émission de tels comportements peut avoir des conséquences néfastes, tant pour l’enfant que pour son entourage. Ainsi, l’enfant peut être limité dans ses apprentissages et vivre de l’isolement social. Leurs parents peuvent quant à eux vivre un niveau élevé de stress parental. Afin de répondre à ces besoins, cette thèse doctorale vise l’évaluation d’une adaptation parentale du Prevent-Teach-Reinforce (PTR, Dunlap et al., 2010), un programme initialement conçu pour diminuer les comportements problématiques et augmenter les comportements désirables des enfants en milieu scolaire. Basé sur les principes du soutien comportemental positif, ce programme prévoit l’atteinte des objectifs suite à la mise en place d’une intervention comportementale qui tient compte de la fonction du comportement problématique. L’intervention comprend des stratégies d’intervention pour modifier les antécédents, pour enseigner des comportements désirables et pour modifier les conséquences. Une étude randomisée a montré l’efficacité du PTR auprès d’enfants en milieu scolaire et deux études l’ont évalué à l’aide de devis expérimentaux à cas uniques en milieu familial pour des enfants ayant des troubles développementaux. Cette thèse, comprenant trois articles, constitue la première évaluation randomisée du PTR en contexte familial pour diminuer les comportements problématiques d’enfants ayant un TSA. Le premier article décrit les adaptations apportées au programme initial en prévision d’une implantation en contexte d’intervention comportementale précoce et en milieu familial, pour les enfants ayant un TSA. De plus, un parallèle est fait entre le programme et les principes clés de l’intervention psychoéducative. Le deuxième article présente les principaux résultats du projet de thèse, dans lequel 24 familles ont reçu deux interventions distinctes : le PTR durant huit semaines ou une formation théorique d’environ trois heures. Des analyses de variance ont été menées afin de statuer sur l’efficacité du programme. En somme, les comportements problématiques des enfants appartenant aux deux groupes ont diminué et les comportements désirables ont augmenté. Il n’est donc pas possible de statuer sur l’efficacité unique du PTR à diminuer les comportements problématiques. Les parents ont implanté le PTR avec une grande fidélité et ont accordé un score élevé de validité sociale au programme. Le troisième article présente les résultats en lien avec le stress parental. Les scores initiaux de stress parental ont été associés à la sévérité des comportements problématiques, montrant une corrélation modérée entre les deux concepts. Par ailleurs, une analyse de variance a permis de montrer que le stress parental a diminué uniquement chez les parents qui ont implanté de PTR. En conclusion, cette thèse a montré que le PTR semble être efficace pour diminuer les comportements problématiques et augmenter les comportements désirables des enfants ayant un TSA lorsque leurs parents l’implantent, mais davantage d’études sont nécessaires pour confirmer cette hypothèse. Ces études devraient comporter davantage de sujets et comparer le PTR à un groupe ne recevant aucun type d’intervention pour diminuer les comportements problématiques. / Children with an Autism spectrum disorder (ASD) diagnosis sometimes show challenging behaviors such as aggressive or stereotyped behaviors. The presence of such behavior can have harmful consequences for both the children and the people living with them. For example, the child may be limited in his or her learning and experience social isolation. Parents may experience high levels of parental stress. In order to respond to these problems, this thesis evaluated a parental adaptation of the Prevent-Teach-Reinforce model (PTR; Dunlap et al., 2010), a program designed to reduce children’s challenging behaviors and increase their desirable behaviors in school settings. Based on the principles of positive behavioral support, this program aims to achieve its objectives by implementing a behavioral intervention taking into account the behavioral function of the challenging behavior. The intervention includes intervention strategies to modify the behavior’s antecedents, to teach desirable behaviors and to modify the behavior’s consequences. A randomized controlled study demonstrated the effectiveness of the PTR for school-aged children and two studies evaluated it in home settings for children with developmental disorders, using single case experimental designs. This thesis, comprising three articles, is the first randomized study evaluating the PTR in family settings to reduce challenging behaviors of children with ASD. The first article describes the adaptations made to the initial program in order to implement it with children with an ASD diagnosis receiving early intensive behavioral intervention or in family settings. In addition, a parallel was made between the PTR and the key principles from the psychoeducation field. The second article presents the main results of this thesis, with the 24 families which received two distinct interventions: the PTR for eight weeks or a theoretical training for about three hours. Analyzes of variance were conducted to evaluate the effectiveness of the PTR. In sum, children of both groups saw a reduction in challenging behaviors and an increase in desirable behaviors. It is therefore not possible to rule on the unique effectiveness of the PTR to reduce challenging behaviors. Parents implemented the PTR with great fidelity and rated the PTR with a very high level of social validity. The third article presents the results on parental stress. Initial parental stress scores were associated with the severity the child’s problem behaviors, showing a moderate correlation between the two concepts. On the other hand, an analysis of variance showed that parental stress only decreased for parents who implemented the PTR. In conclusion, this thesis has shown that PTR may be effective in decreasing problem behaviors and in increasing desirable behaviors of children with ASD. However, more studies are needed to confirm these hypotheses. These studies should include more subjects and compare the PTR to a group of children not receiving any type of intervention to reduce challenging behaviors.