Background. Mothers of children with Autism Spectrum Disorder (ASD) report high levels of stress, depression, and poor well-being, with little sense of social support due to the high demands of their child’s care. The Incredible Years® for Autism and Language Delays (IY-ASLD) program offers a unique model in that there is a dual focus on both child and parent outcomes. However, there is a dearth of literature on whether IY-ASLD can improve parental mental health outcomes.
While there is some evidence to suggest that in-vivo therapist-to-parent supportive statements reduce parental resistance to treatment, there remains a gap in the literature regarding whether these behaviors directly impact parental mental health outcomes. Therefore, the present study investigated the degree to which exposure to the IY-ASLD telehealth curriculum (total minutes in attendance across sessions) along with in-vivo therapist-parent group verbal support was related to parental mental health outcomes and parental verbal approval statements of the child at post-treatment after controlling for baseline mental health and verbal approval.
Methods. Participants were seventeen mother-child dyads, with children ages 2-years-8-months to 5-years-old recruited from a preschool utilizing an Applied Behavior Analysis (ABA) approach to schooling. All or virtually all children referred to this school by their school district are at-risk for or have been diagnosed with ASD. All of the children had an IEP or IFSP with mandated speech services, 71% of the children met criteria for ASD (N = 12) on the Childhood Autism Rating Scale- 2-SF, and 2/3 of the sample had adaptive behavior composites below a standard score of 70 on the Vineland Adaptive Behavior Scales- Third Edition Comprehensive Teacher Form (Sparrow et al., 2016).
Participants were assigned to one of four treatment groups based on language level of the child and convenience of the group meeting time. Groups met for 12-weekly IY-ASLD sessions via telehealth. Data were collected at the beginning, mid-point, and end of treatment in the form of a parent questionnaire covering demographics, parental well-being (World Health Organization- Five Well-Being Index; WHO, 1998), depressive symptoms (Patient Health Questionnaire; Kroenke et al., 2001), and parenting stress (Parenting Stress Index-Fourth Edition, Short Form; Abidin, 2012). At post-treatment, parents reported satisfaction with the IY-ASLD-T program (IY-ASLD Parent Program Satisfaction Questionnaire).
Data were also collected throughout treatment by recording IY-ASLD parent sessions. From the recorded parent sessions, two primary variables were developed. The first was treatment dosage, calculated as the total minutes each parent attended over the course of the 12-week intervention. The second was exposure to supportive therapist verbalizations during the first 10-minutes of each session, which was coded using the Therapy Process Code (TPC) to measure therapist supportive verbalizations during therapist-parent interaction (Chamberlain et al., 1986). Additionally, data were collected via a virtual parent-child play session (PCI) at the beginning, mid-point, and end of treatment, and later coded using the Verbal Behavior Developmental Language Coding System (VBDT) to measure parental verbal approval to child (Greer & Ross, 2008).
Results. Mothers in this study had low levels of depression (PHQ-9; M = 4.59, SD = 4.69), average parenting stress (PSI-4-SF; M = 78.12, SD = 23.78), and low levels of well-being (WHO-5; M = 12.82, SD = 4.47). There were no statistically significant changes in parental depression, parental stress, or observed verbal approval from pre- to post-treatment and the effect sizes were small based on the partial eta squared and Kendall’s W values as per Cohen’s (1988, 1994) guidelines (small = .20-.49, medium = .50-.79, large > .80). However, there was a statistically significant change in caregiver well-being from baseline, mid-treatment, to post-treatment and a small effect size based on Kendall’s W (W = .31). A Friedman test indicated that caregivers demonstrated significant improvements in well-being from baseline to mid-treatment, and the improvement remained at post-treatment, χ2 (2) = 10.04, p < .01. There was no significant relationship between treatment dosage or supportive verbalizations and change in caregiver well-being.
There was a significant negative correlation between treatment dosage and well-being at mid-treatment (r = -.493, p = .044), trending in the same direction at post-treatment (r = -.369, p = .146), possibly suggesting that parents with lower well-being, and therefore in greater need of support, attended IY-ASLD more frequently. An additional unexpected finding indicated that parents who were exposed to more supportive verbalizations had statistically significantly lower well-being at post-treatment. One explanation proposed by the authors is that parents who had lower well-being, and attended IY-ASLD sessions more frequently, received more supportive therapist verbalizations, possibly because they pulled for supportive verbalizations from the therapist.
Results from the Incredible Years satisfaction questionnaire indicated there was high satisfaction with the program and the group leaders. High ratings of satisfaction with the group leaders and the program overall indicated that group leaders in the program may have successfully accomplished providing a “good enough” sense of support and reinforcement to parents over the course of the intervention. Therefore, it’s possible that specific therapist-to-parent supportive verbalizations were less related to improvements in parental well-being, and rather, the overall sense of support from the therapist to the parents in the group, along with support between the parents in the group, were sufficient to result in improvements in maternal well-being over the course of the intervention.
Conclusions. Over the course of the IY-ASLD-T intervention, mothers demonstrated significant improvements in their overall well-being. While exposure to treatment and to supportive verbalizations from therapist to parents were not related to residualized change in well-being, these seem to be important factors in understanding the needs of parents with young children with ASD (e.g., parents with low well-being had higher attendance and received more supportive verbalizations). Taken together, the results suggest maternal well-being is an important and promising target for evidence-based behavioral parenting interventions such as IY-ASLD.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/p5qv-wg92 |
| Date | January 2024 |
| Creators | Ajodan, Eliana |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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