Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., . . . Scahill, L. (2015). Effect of parent training vs. parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. Journal of the American Medical Association, 313(15), 1524-1533.

Reviewed by
Sarah Luem
and
Catherine Kishel,
Rutgers University

Why research this topic?

In addition to the core features of autism, 50% of children with ASD also have behavioral problems, including tantrums, noncompliance, aggression, and self-injury. These disruptive behaviors interfere with children’s daily living, and educational and therapy services. They also increase caregiver stress. Parent training is a time-limited intervention that teaches parents specific techniques to manage their child’s behavior problems. While parent training is a scientifically supported intervention for parents of children with disruptive behaviors without ASD, it
has not been investigated in large-scale randomized trials for parents of children with ASD. The current study is the first to do so.

What did the researcher do?

Participants were 180 individuals diagnosed with ASD aged 3 to 7. All had a history of challenging behavior, assigned to two randomized groups: parent training (n=89) and parent education (n=91). In the parent training condition, parents received 24 weeks of behavioral skills training. Training topics included basic functional assessment procedures, preventative intervention strategies, differential reinforcement, extinction, and teaching techniques. Sessions consisted of direct instruction, video models, practice activities, and role-plays with feedback. The parent education condition was used to determine if information alone was sufficient to improve disruptive child behavior. The parent education condition provided relevant behavioral information over 24 weeks. Information provided included developmental challenges, educational planning, advocacy, current treatments, and the importance of evaluations. Both the parent training and parent education manual included word-for-word scripts and instructions for therapists to ensure treatment integrity.

Two parent-rated outcome measures were used to assess problem behaviors: the Aberrant Behavior Checklist-Irritability (ABC-I) subscale and the Home Situations Questionnaire- Autism Spectrum Disorder (HSQ-ASD). For both measures, a 25% decrease from baseline was set as the criterion for clinically meaningful improvement. The clinician-rated Clinical Global Impression-Improvement (CGI-I) scale was used as a secondary outcome measure to assess behavioral improvements. The clinician was blinded to treatment assignment.

What did the researchers find?

At week 24, the ABC-I subscale declined 47.7% in parent training compared to 31.8% in parent education. The HSQ-ASD declined 55% in parent training compared to 34.2% in parent education. However, the difference in primary outcome ratings between the two groups did not meet predetermined standards for clinical importance. For the CGI-I, 68.5% responded positively in the parent training group, while 39.6% responded positively in parent education. Participants in both groups maintained improvements at 48-weeks follow-up.

What are the strengths and limitations of the study?

Strengths of the study include its large sample size, random assignment to conditions, blinded clinician assessment of the secondary outcome, and long-term follow up. Additionally, the multi-site nature of the study demonstrates that the intervention can be delivered with integrity by multiple therapists. Limitations include reliance on ratings from parents who were not blind to treatment condition. Additionally, there was a failure to demonstrate a difference between the two treatment conditions that had clear clinical significance, although they both produced improvements for children with ASD. Future research should evaluate implementation of parent training in other naturalistic settings to determine if parent training remains an effective intervention in less-than-optimal study conditions.

What do the results mean?

Although both interventions led to improvements, these results indicate that parent training may be superior to parent education in reducing disruptive behavior in children with ASD. Although not as effective as parent training, parent education may be more effective than initially predicted by the researchers. Overall, the results provide scientific support for implementation of this parent training intervention for young children with disruptive behaviors and ASD.

Citation for this article:

Luem, S., & Kishel, C. (2017). Research synopses: Effect of parent training vs. parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. Science in Autism Treatment, 14(3), 28-29.

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