Parental STRESS and TREATMENT Priorities In the PROCESS of Parent-MEDIATED EIBI INTERVENTION

Background:  

Research demonstrated that the inclusion of parents in treatment provision leads to lasting child behavior changes in children with ASD. Although it was shown that parent-treatment provision and parental stress are associated, there are considerable variability of its influence on child outcome. Findings vary from positive child outcome regardless treatment condition of a clinic- or parent-directed treatment, to increased parental stress due to high-intensive treatment provision, leading to reduced child outcomes. We did recently, extend previous research, and demonstrated that high parental stress interferes with professional decision making in treatment planning, leading to reduced behavior target difficulty regardless child’s skill level. Anyway, target choice due to parental stress rather than child pathology was shown to be dysfunctional, predicting an increase in child problem behaviors and decreased child performance on behavior targets. Research on parent treatment priorities, indicated that parent selected priorities had not yet been sufficiently effective addressed in treatment planning, with parents following mainly a deficit-based logic rather than a strength-based logic in selecting high priority areas. 

Objectives:

The current study investigates (1) the association of parenting stress and selection of parent treatment priorities (2) how this association change in time, in a group of parents that followed a staff-and parent-mediated EIBI model for one year. 

Methods:  

Children and their parents (N=40) followed a cross-setting staff- and parent-mediated EIBI treatment, following a 1 week center – 3 weeks home rhythm for 10 month. At treatment intake, after 5 month and at termination of treatment, parent identified their treatment priorities in relation to the child’s level of ability across a 8 domains of adaptive skills and problem behaviors, and indicated whether or not that skills was currently addressed in their child’s treatment program. The treatment priority survey was adapted from Pituch et al. (2011). Further, parents rated their level of parental stress on the Parenting Stress Index, Short Form. At 5 month and at the end of treatment parents rated their satisfaction with treatment on a survey adapted from Ingersoll and Dvortcsak (2006).

Results:  

We do expect that parental distress is associated with selection of treatment priorities and respective unmet needs in treatment provision, influencing parent satisfaction with treatment. It is supposed that an increase in parenting stress is related to a deficit-based selection of treatment priorities and related amount of unaddressed skills in the child’s treatment program, whereas a decrease of parental stress is only achieved when the introduction of program targets are in accordance with parents indicated treatment needs. 

Conclusions:  

Results offer insight in the relation of parental stress and the inclusion of parent-selected treatment priorities in treatment planning, deepen the current knowledge of a negative influence of parental stress on professional behavior target choice. Further analysis needs to examine a probable lack of concordance in selecting treatment priorities between staff and parent’s selection progress and how such lack of concordance counteract professional decision making in choosing appropriate treatment objectives.