The Influence of Parental Stress, Parental Inclusion and Parental Treatment Fidelity In Cross-Setting Complementary Staff and Parent Mediated Early Intensive Behavioral Intervention for Young Children with ASD

Background:  

Research indicates that parental stress counteract the effectiveness of EIBI programs. Recent results suggest both, that stress decreases when parents provide intervention as well as that involvement increases stress. Less research focused on factors interfering with changes in parent’s stress over time during implementing interventions and its relation to treatment outcomes. It is supposed that stress does not directly impact the child’s outcome, rather than it is mediated by a function of intense inclusion and parental stress.

Objectives:  

To determine how parental stress change during a 6 month period out of a 1 year program and if parent stress affect the child’s outcome. Further, to determine how parent’s involvement and treatment fidelity interfere the relationship between parental stress levels and child outcomes. 

Methods:  

12 children with ASD (10M:2F; M_age= 46.6 month, SD = 16.4), received a staff- and parent-mediated EIBI treatment based on ABA-VB in centre-based one-to-one, play room and home sessions (ABA-VB-group). Treatment followed a 1 week centre – 3 weeks home rhythm for 12 month to accomplish maintenance and generalization of skills. Initial 3 weeks parent training included intensive theoretical and practical training. Outcomes of the ABA-VB group was compared with 10 children (9M:1F; M_age= 43.7 month, SD = 12.5) that received eclectic interventions (psicomotricity, speech therapy, uncontrolled in-home ABA). Repeated measures have been calculated using paired T-tests, influences on outcomes using linear regressions.

Results:  

After 6 month, parental stress decreased significantly in the eclectic group (p.<.05) while remained stable in the ABA-VB group with having significantly more stress (p<.01). While decreased stress positively impact the eclectic group in language (CDI comprehension p<.001, CDI speaks p<.001) and developmental state (GMDS-ER QS p<.001), such effect does not appear in the ABA-VB group. Findings are incoherent since the ABA-VB group showed better outcome for ADOS (total: p<.001), GMDS-ER 2-8 (QS: p<.01), and CDI language skills (comprehension: p.<01, speaks: p.<05) while the eclectic group did not significantly change. Consistent with our focus on parent inclusion, in average 174 targets have been worked on (SD=75.5, range 55-343) with an average of 60% introduced, mastered and generalized by the parent (SD=15.9; range 29.5%-81.6%). The treatment fidelity of parents increased in data collection (p<.001), facilitated play (p.<01), training of new targets (p<.01) and mastered targets (p<.01). Intensity of treatment application and treatment fidelity of parents does not interfere neither with parental stress nor with child’s outcome.

Conclusions:  

Parental stress, treatment fidelity and intensity does not directly interfere child’s outcome nor parental stress directly derived by parents treatment fidelity or effort to provide treatment. A detailed evaluation of the child’s treatment progress has been followed controlling weekly the mastery and generalization of introduced targets, providing variables such as speed of learning and change of acquisition rates over time, appropriateness of targets chosen by the supervisor and effectiveness of the parent-supervisor relation in controlling and forwarding child’s progress. A progress model is aimed to include those variables and is charged to explain how our treatment effects are mediated. Results will be presented at the conference.