Objectives: This project describes efforts by the Research Units in Pediatric Psychopharmacology (RUPP) Autism Network to assemble and pilot test a detailed manual for a structured behavioral parent training program. This was a necessary step, prior to conducting a study of the relative efficacy of drug treatment (risperidone) and combined treatment (risperidone and parent training) in children with ASDs and disruptive behavior problems.
Methods: The parent training manual was developed over a 6-month period by a group of psychologists with expertise in ASDs and applied behavior analysis. The manual drew from prior research, other parent program materials for children with autism, developmental disabilities, and other disruptive behavior disorders, and the group’s own materials accumulated from many years of behavior analytic clinical and research work in the field of autism and developmental disabilities. The final parent training program consisted of 11 core sessions, 3 optional modules, and procedures for two structured home visits. The sessions include didactic materials, video-taped vignettes, and role-play activities aimed at reducing disruptive behavior and increasing learning of adaptive behavior in children and adolescents with PDD. To evaluate the feasibility of the PT manual we conducted a pilot study with 17 families of children with ASDs whose current treatment regimens were stable. Parents participated in PT sessions on a weekly basis (75-90 minutes per session) for 14 weeks, followed by three “booster sessions,” offered at two-week intervals. Two home visits were also conducted.
Results: Parental attendance at sessions (93%), satisfaction with the program (92%), and adherence to homework assignments (80%) were excellent. The mean clinician treatment integrity score across sessions and therapists was 94.2%, with a range of 80.4% to 100%. Clinician ratings of treatment integrity for the 11 mandatory PMT sessions were 95.7% congruent with reliability scoring as indicated by the video tape review. Further, the video tape review showed that mean individual therapist reliability scores across all sessions ranged from 91.7% to 97.3%. Thus, the PT therapist appeared to implement most, and in many cases all, of the critical elements of the standardized PT protocol and rated their own tendencies to follow the treatment manual accurately.
Conclusions: Initial efficacy and feasibility of this manual provided support for its utility as an adjunct treatment in the large scale risperidone vs. risperidone plus parent training intervention trial. Results from that recently concluded trial indicated that the combination of medication and parent training resulted in a greater reduction of serious noncompliant and maladaptive behavior than medication alone in children with PDD.