One of the core features of Autism Spectrum Disorder (ASD), social communication impairment, presents in a variety of ways, including reduced functional language use and social initiations, which often warrant intensive intervention services. Additionally, parents of children with ASD demonstrate increased levels of parenting stress when compared to parents of typically developing children and children with developmental delays (Hayes and Watson, 2013). Elevated parenting stress has been shown to diminish positive treatment outcomes (Osborne et al., 2008), which lends support to develop methodologies to concomitantly target child and parent behaviors. The current randomized control trial (RCT) uses a dual-pronged approach to directly target both child communication deficits and parenting stress within a group format. This RCT combined an empirically supported behavioral therapy, Pivotal Response Treatment (PRT), with components from Acceptance and Commitment Therapy and Mindful Parenting for reducing parenting stress. Fifteen pairs of caregivers and their minimally or pre-verbal child with diagnosed or suspected ASD were randomly assigned to one of the following supplemental conditions: mindfulness-enhanced PRT (mPRT; n = 8) or psychoeducation-enhanced PRT (pPRT; n = 7) as an active control condition. Of these, five pairs completed each condition. The current study assessed feasibility and acceptability in addition to demonstrating proof of concept in regard to additive effects of mPRT compared to pPRT. Results provided mixed support for feasibility and efficacy of a multi-component group treatment approach. There was a low retention rate and the small sample sizes significantly decreased power. However, parents endorsed high satisfaction, demonstrated fidelity of PRT implementation, and children significantly increased their expressive language abilities. In regard to group-level analyses for primary and exploratory aims, the mPRT group showed significant decreases in parenting stress and increases in mindfulness. At the individual level, some parents in both groups showed positive changes in mindfulness, positive feelings toward child, and child problem behavior. Future directions should continue to explore the additive effects of mindfulness-based intervention on group-based parent-mediated treatments using larger sample sizes. / Doctor of Philosophy / Social communication difficulties are one of the core components of Autism Spectrum Disorder (ASD) and many treatments are specifically designed to target these challenges. Additionally, parents of children with ASD report higher levels of parenting stress when compared to parents of typically developing children and children with developmental delays (Hayes & Watson, 2013). High parenting stress has been shown to decrease the likelihood of positive treatment outcomes (Osborne et al., 2008). As a result, creating a treatment that targets both parent and child difficulties simultaneously may lead to important outcomes for the family unit. The current study combined treatments that have been shown to increase child language and decrease parenting stress. Fifteen pairs of caregivers and their child with language delays and ASD were randomly assigned (i.e., similar to a flip of a coin) to receive Pivotal Response Treatment (PRT) and one of the following: mindfulness (mPRT; n = 8) or psychoeducation (pPRT; n = 7). Ten total families completed the treatment (5 per group). The current study measured the practicality and usefulness of adding either mindfulness or psychoeducation to PRT. Results provided mixed support for the practicality of a group treatment approach that combined two treatments. Approximately two-thirds of the families who started treatment finished treatment. The parents who completed treatment showed high satisfaction ratings and demonstrated that they could accurately perform the treatment techniques taught in group sessions. In addition, children increased their language abilities. Parents in the mindfulness group showed significant decreases in parenting stress and increases in mindfulness. At the individual level, some parents in both groups showed positive changes in mindfulness, positive feelings toward child, and child problem behavior. Future directions include measuring these changes with a larger number of families.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social and communication deficits, as well as restricted, repetitive, and stereotyped behaviors, interests, and activities (American Psychiatric Association, 2013). Although important relationships have been shown and described among the issues of challenging behavior, parent stress, and parenting sense of competence for families of children with ASD, there is a shortage of intervention programs appropriately suited for families which target these issues. Some programs have been developed and tested, but none is directly applicable for the target population. This is notable because of the connections drawn in the literature between families of children with ASD and the issues of challenging child behavior, parent stress, and parent sense of competence. 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. This study examined an asynchronous group discussion board adaptation of C-HOPE, which was developed to further support underserved families. Three main hypotheses were made: (1) Parents will report less challenging child behaviors post-intervention; (2) Parents will report lower levels of stress post-intervention; and (3) Parents will report higher sense of competency post-intervention. With a small sample size of 10, paired-samples t-tests were conducted and effect sizes were calculated to compare the pre- and post-intervention scores for challenging child behavior, parent stress, and parenting sense of competence. There was a statistically significant difference in the scores for challenging child behavior pre-intervention (M = 146.40, SD = 35.36) and post-intervention (M = 123.10, SD = 28.35); t(9) = 3.05, p = 0.01. The effect size for this analysis (d = 0.73) was found to fall between Cohen’s (1988) convention for a medium (d = 0.50) to large (d = 0.80) effect. There was also a statistically significant difference in the scores for parent stress pre-intervention (M = 122.60, SD = 25.73) and post-intervention (M = 109.50, SD = 26.47); t(9) = 2.51, p = 0.03. There was a medium effect size for this analysis (d = 0.50). There was not a significant difference in the scores for parenting sense of competence pre-intervention (M = 55.20, SD = 17.59) and post-intervention (M = 50.50, SD = 17.51); t(9) = 1.11, p = 0.30. Additionally, treatment adherence and social validity for the intervention were acceptable. The implications of these findings are discussed.

L’augmentation du nombre d’enfants avec un trouble du spectre de l’autisme (TSA) accroît les demandes sur le réseau de la santé et des services sociaux du Québec. Les programmes d’accompagnement parental semblent une alternative intéressante pour répondre aux besoins des familles ayant un jeune enfant avec un diagnostic ou une suspicion de TSA. Par contre, peu de chercheurs se sont intéressés à l’expérience des parents qui sont pourtant les acteurs-clés de ce type d’intervention. Cette étude mixte séquentielle explicative vise à évaluer un programme d’accompagnement parental de 12 semaines pour des enfants de 12 à 30 mois avec une suspicion de TSA en considérant autant les effets sur l’enfant que son parent. Méthodologie : Pour le volet quantitatif (essai clinique randomisé croisé), les 19 dyades parent-enfant ont été randomisées dans le groupe Intervention (immédiatement) ou le groupe Liste d’attente qui devait attendre trois mois avant de recevoir l’intervention. Les données collectées via des questionnaires et par observation directe réalisés trois à quatre fois en fonction du groupe de randomisation ont été analysées à l’aide de statistiques descriptives, de comparaisons inter- et intra-groupe. Pour le volet qualitatif (exploratoire), une analyse thématique a été complétée pour le contenu des entrevues semi-dirigées effectuées auprès d’un sous-échantillon de 6 parents. Résultats : Globalement, le programme a été fortement apprécié (score médian = 3,625/4). Plus spécifiquement, le programme met en évidence un effet positif significatif de l’intervention sur l’engagement dyadique (p = 0,012; taille d’effet = 0,51). De plus, les habiletés cognitives (p = 0,010; taille d’effet = 0,57) et motrices (p = 0,071; taille d’effet = 0,38) des enfants se normalisent suite à la participation au programme. La quasi-absence d’effet sur le bien-être parental pourrait être améliorée en offrant davantage de soutien directement aux parents pendant les interventions plutôt que de se concentrer uniquement sur le développement des habiletés nécessaires à la stimulation de leur enfant. Conclusion : L’intervention d’accompagnement parental a eu des effets bénéfiques prometteurs sur la variable proximale (interactions parent-enfant) et, dans une moindre mesure, sur les variables distales (développement de l’enfant, bien-être parental et validité sociale). L’intervention gagnerait toutefois à être bonifiée afin de mieux répondre aux besoins de soutien des parents. / Abstract: The increase in the prevalence of autism spectrum disorder (ASD) puts pressure on the healthcare system. Parent-mediated interventions are an interesting alternative to answer the needs of families having a toddler with a diagnosis or a suspicion of ASD. However, few researchers have looked at parents’ experience during parent-mediated interventions even though parents are the main actors of these interventions. This sequential explanatory mixed study aims to evaluate a 12-week parent-mediated intervention for young children with a suspicion of ASD aged between 12 and 30 months by considering both parents’ and children’s outcomes. Methods: For the quantitative part (crossover randomized controlled trial), the 19 parent-child dyads were randomized either in the Intervention group or the Waitlist group (participants in this group had to wait three months before getting access to the intervention). Data were collected through questionnaires and direct observation three to four times depending on the group allocation. Quantitative data were analyzed using descriptive statistics as well as between and within group comparisons. For the qualitative part (exploratory), semi-directed interviews conducted with a subsample of six participants were analyzed thematically. Results: The program was globally highly appreciated (median score = 3.625/4). Specifically, there was a significant positive effect of the intervention on parent-child dyadic engagement (p = .012; effect size = .51). Furthermore, there was a normalization of children’s cognitive (p = .010; effect size = .57) and motor abilities (p = .071; effect size = .38) after the 12-week program. The near absence of effect on parental well-being could be fixed by targeting specifically parental support rather than focusing on their skills development. Conclusion: The parent-mediated intervention brings promising benefits on the proximal outcome (parent-child interactions) and, to a lesser extent, on distal outcomes (children development, parental well-being and social validity). Still, the intervention should be adapted to better answer parental needs.