Influence of Adaptive Behavior Functioning of Individuals with Autism Spectrum Disorder On Parental Adherence to Treatment Recommendations

Background:   Parents are an integral component of treatment for individuals with autism spectrum disorder (ASD) as they provide continuity, maintenance, and generalization of learned skills.  It is crucial that when parents are involved in the delivery of treatment they adhere to prescribed recommendations to optimize treatment effectiveness.  Previous research has suggested an influence of child diagnosis on parental adherence; specifically, parents of children with a diagnosis of Asperger syndrome were less likely to adhere to behavioral treatment recommendations than parents of children with other ASD diagnoses (Moore & Symons, 2009).  It remains unclear, however, whether it is the actual diagnosis of the child that influences treatment adherence, or whether this difference is related to other factors, such as adaptive behavior functioning.     

Objectives:   This study investigated the relationship between current adaptive behavior functioning and parental adherence to behavioral and medical treatment recommendations.  We predicted that parents who reported higher levels of adaptive behavior functioning for their child were less likely to adhere to treatment recommendations than parents who reported lower levels.  We also hypothesized that overall adaptive behavior functioning would predict parental adherence to treatment recommendations over and above diagnosis alone.    

Methods:   Two hundred and two primary caregivers of individuals with ASD anonymously completed online questionnaires.  All participants were parents of individuals 21 years old or younger.  Accuracy of diagnosis was screened using the Social Communication Questionnaire Lifetime.  To measure current adaptive behavior functioning, parents completed the Adaptive Behavior Assessment System-Second Edition.  Parents also completed the Parental Adherence Questionnaire, which looked at parental adherence to behavioral and medical treatment recommendations for children with ASD (modified from Moore & Symons, 2009).   

Results:   Overall adaptive behavior functioning was negatively correlated with parental adherence to medical treatment recommendations (r = -.18, p < .05).  When controlling for diagnosis, overall adaptive behavior functioning accounted for a significant proportion of variance in parental adherence to medical treatment recommendations over and above the effects of diagnosis alone [R² = .10, F(1, 121) = 4.31, p < .05].  Overall adaptive behavior functioning was not correlated with parental adherence to behavioral treatment recommendations (r = -.08, p = .30).

Conclusions:  These data suggest current adaptive behavior functioning is predictive of parental adherence to medical treatment recommendations over and above diagnosis alone.  That is, parents who reported higher levels of adaptive behavior functioning for their child, as generally seen in individuals with a diagnosis of Asperger syndrome, were less likely to adhere to medical treatment recommendations.  Such deviations in treatment adherence may impede on treatment outcomes for the child.  Future research should examine the extent to which specific domains of adaptive behavior functioning (rather than an overall measure of adaptive behavior skills) influence parental adherence to treatment recommendations.