Investigation of the RUPP Parent Training Program for Pre-School Children with ASDs and Disruptive Behavior

Background: Autism Spectrum Disorders (ASDs) are characterized by deficits in social interaction, impaired communication, and repetitive behavior affecting as many as 20 children per 10,000. In addition, 50 to 70% of children with ASDs have co-occurring behavioral problems such as tantrums, aggression, and noncompliance and most show deficiencies in adaptive functioning. As the number of identified cases of ASDs has grown, so have the challenges for serving this group of children and their families. Parent training is an intervention that has received much interest due to the central role parents have in promoting the development of their children with autism and the need for strategies to alleviate the high burden these parents face.

Objectives: With early intervention being key to optimal outcomes for children with ASDs, this study describes the development of a downward extension of the 24-week Research Units in Pediatric Psychopharmacology-Parent Training (RUPP-PT) manual. The RUPP-PT program was developed with school-age children in mind. This study aimed to develop a structured, exportable parent training manual for preschool-age children (ages 3-0 to 6-11) with ASDs and mild to moderate behavioral problems and then evaluate its feasibility and preliminary efficacy.

Methods: Study investigators adapted the RUPP-PT program to insure it was appropriate for preschool age children. Modifications included changing text so that discussion examples were age appropriate and recreating video vignettes to reflect common behavioral issues encountered with preschool age children. Sixteen families with a preschool age child with ASD and disruptive behaviors were then enrolled in an open label pilot trial of the updated PT program. Primary outcomes of interest included a) changes in the parent-rated Aberrant Behavior Checklist – Irritability and Hyperactivity Subscales and Home Situations Questionnaire (HSQ), which are designed to assess the degree of the child’s irritable and noncompliant behavior; and b) improvements on the Vineland, which is designed to assess the child’s communication, socialization, and daily living skills.

Results: To date, 13 families have completed treatment, 2 terminated early, and 1 remains in treatment. Subjects include 7 children with autism, 9 with PDD-NOS. Mean age is 4-11 years. 81% are Caucasian, 14% Latino, 7% other. Most (63%) have an IQ above 70. None are on medication. After 24 weeks of PT, mean scores on the parent-rated Home Situations Questionnaire (HSQ) for the 11 families changed from 3.1 ± 1.1 to 1.3 ± 1.2 (p < 0.001; 59% reduction), mean scores on the parent-rated Aberrant Behavior Checklist (ABC) Irritability subscale changed from 17.3 ± 9.6 to 7.5 ± 6.3 (p < 0.001; 57% reduction), while age equivalent gains on the Vineland ranged from 6 to 13 months. Eighty-eight percent of families enrolled completed the 6 month intervention and parents attended 94% of the 11 core sessions.

Conclusions: Preliminary data from this study provide support for the effectiveness and acceptability of a structured parent training manual for young children with autism. Results from this study were utilized to support a recently funded large-scale multi-site randomized trial of this parenting intervention compared to a parent psychoeducational control group