Facilitating Behavioral Change: a Parent Based Program

Background: Families of children with Autism Spectrum Disorders (ASD’s) face unique stressors  (Gray and Holden 1992). Studies show that the greatest predictors of parental stress are variables associated with the behaviour, age and size of their child ( Rousey et al. 1990; Bromley & Blacher 1991; Kobe et al. 1991; Blacher et al. 1992).
Given the benefits evidenced in literature of parent programmes (Tonge et al 2006), there is surprisingly little written about the variables which both facilitate and obstruct the implementation of such programmes,  (Johnsone & Hastings 2001).  While many home-based psycho-educational interventions focus on teaching parents’ skills for managing their child’s behaviour they take little account of coping styles used by parents in challenging, low-control situations  (Mc Eachin et al, 1993). 

Objectives: The current study is collaboration between the National Autistic Society and the Scottish Government evaluating the impact of a parent based psycho-educational programme.  It hypothesises that by taking account of the dynamic relationship between stress and coping (Folkman and Lazarus, 1984) parents are more likely to establish behavioural change in their child while moderating their own stress.
The  study consisted of 2 workshops delivered 6 months apart covering; understanding autism, appraising behaviour, behaviour management, sensory issues, fear stress and anger, and obsessive and ritualistic behaviour.  Following each workshop, participants were issued a manual providing a more in depth discussion of the points covered as well as practical techniques to apply with their child.  The manual also utilised aspects of cognitive reframing techniques to assist parents in appraising their child’s behaviour and associated stressful encounters. 

Methods: Using measures of stress (Parental Stress Index; Abidin,1995) and coping (Ways of Coping revised;  Lazarus and Folkman, 1985), the study examined the impact of  2  the workshops and their  associated manuals on  > 90 families over 12 months sampled from 3 local government areas across Scotland.  In addition 20 families were selected from each local authority cohort and given 21 hours of  contact with facilitators trained in Motivational Interviewing Techniques (Miller & Rollnick, 1991).  Local government area Cohorts were identified to control for distribution across a number of demographics. Participants were parents of school aged children, with families being selected for facilitator involvement based on stress scores in the child domain of the Parenting Stress Index. The Study used an A-B design format, taking measures of stress and coping across the timescale of the intervention, with other qualitative measures used to assess the impact of the workshops alone. 
Results:

Narratives were recorded from parents, and preliminary findings using statistical analysis suggest changes in appraisal of stressful encounters.  Furthermore, an earlier study by one of the authors which evaluated the workshop and manual alone suggests a statistically significant result for individuals adapting their coping style relative to the appraised controllability of the situation. 
Conclusions: The study suggests that a goodness-of-fit approach (Terry & Hynes 1998) to stress appraisal and coping within this population of parents is likely to have more favourable outcomes when implementing any psycho-educational programme.