Objectives: This study investigated the relation between parental reactions to their child’s diagnosis of autism and independent ratings of the working alliance between the parent and an interventionist.
Methods: Participants included 32 parents that participated in a clinical trial and were randomly assigned to one of two treatment conditions. Parents assigned to the experimental treatment were invited to participate in 12 in-home training sessions designed to encourage communication in children diagnosed with autism spectrum disorders. For each participant, we used an observational measure (Davis & Carter, 2003) to evaluate indicators of working alliance during two videotaped intervention sessions; data from both sessions were subsequently averaged to compute a single working alliance score. The modified working alliance scale consists of 7 individual rating scales and evaluates the parents’ alignment with intervention goals and level of trust toward the interventionist. Good inter-rater reliability was established based on 20 intervention sessions (ICC = .72).
Parental reactions to their child’s diagnosis of autism were assessed with the Reaction to Diagnosis Interview (RDI; Pianta & Marvin, 1992). The RDI is a structured interview asking parents to describe their diagnostic experience. Based on their responses, parents are classified as either ‘resolved’ or ‘unresolved’ with regards to the child’s diagnosis. Resolution is characterized by the parent: 1) having a balance between positive and negative descriptions of the experience, 2) describing a change in his or her feelings about the diagnosis after the initial reaction, and 3) suspending the search for existential causes of the disability. A research assistant and the third author established an agreement rate of 100%, kappa = 1 during 14 interviews, approximately 20% of the sample.
Results: Thirty-two parents were classified as resolved (n = 13) or unresolved (n = 19) based on the Reaction to Diagnosis Interviews; four parents were not interviewed due to scheduling conflicts. Parents who were resolved (M = 2.11; SD = .39) received higher ratings of working alliance than parents who were unresolved (M = 1.76; SD = .23), t(30) = -2.93, p < .01. The relation between RDI classifications and working alliance levels could not be explained by child’s ethnicity, chronological age, non-verbal IQ, or language abilities. They were also not explained by mother’s age, years of education, or household income.
Conclusions: Findings from this study suggest that parental reactions to their child’s autism diagnosis influence the parents’ ability to develop a strong working alliance with their child’s intervention providers. Helping parents to reach resolution concerning their child’s diagnosis may be an important component of successful parent education programs.