Effect of Parent Expectancies of CHILD Therapy On Perceived Therapy Outcomes in Children with Autism Spectrum Disorder

Background: Previous research on client expectations has shown that a client will report greater therapy outcomes when there are higher expectations at the start of treatment (Dew & Bickman, 2005). One explanation for this association is through expectancy effects; that is, a client who believes they will see a better outcome at the conclusion of therapy often will see better treatment outcomes (Barker, Funk, & Houston, 1988). Research on this effect has primarily looked at adults’ expectancies of their own psychotherapy for generalized anxiety disorder and depression. However, it is unclear if expectancy effects also occur in child therapy, specifically in therapy for children with autism spectrum disorder (ASD). In therapy for children with ASD, parents are essential for the continuity, maintenance, and generalization of learned skills. Therefore, we wanted to see if parents’ expectations of therapy for their child with ASD (via expectancy effects) would be associated with greater parent-reported treatment outcomes at the end of therapy.

Objectives: This study looked at whether parents' expectations of the outcome of child therapy would be related to their perception of the child’s progress in therapy. We predicted that higher parent expectations at the start of therapy would lead to greater parent-reported child progress at the end of the therapy.

Methods: Participants were parents of 15 children participating in a study that used an interactive humanoid robot in addition to a therapist to teach social skills to children with ASD in Applied Behavior Analysis therapy. Parents were given an adapted version of the Credibility/Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000) prior to therapy, after the middle session, at the end of therapy, and at the three-month follow-up. Parents recorded their child’s frequency of displayed social skills in the home environment through a social behavior tracking sheet measured over three days prior to therapy, after every two sessions, at the end of therapy, and at the three-month follow-up. A percent increase or decrease in social skills was calculated from the earliest to the latest available tracking sheet from each parent and was compared to the percent increase in social skills the parents expected to see, as reported through the CEQ prior to therapy.

Results: Using Spearman’s Rank Order Correlation, parents’ expectations of the outcome of therapy were significantly related to the progress they reported seeing in their child at the end of therapy (ρ=.765, p<.001). This suggests that higher parent expectations are related to parent-reported improvement in social skills from the start to the end of therapy. In-session data are currently being analyzed and will also be considered in relation to parent expectations.

Conclusions: These data suggest that expectancy effects are held not just by the client in therapy but are also manifested by parents of children with ASD in therapy. Expectations held by a parent have a significant influence on the subjective progress they observe in their child during therapy. Further research should examine the effect these expectations have on the objective measure of their child’s outcome in therapy.