The Shotgun Approach or Acceptance: Parents' Treatment Selection for Children with ASD

Background:  Coming to accept a child’s ASD diagnosis is a difficult process which often continues many years after first receiving the news.  With the importance of early intervention, however, parents often make important treatment decisions for their children before fully accepting the diagnosis.  As such, it has been hypothesized that parents with low acceptance of their children’s ASD diagnoses may be vulnerable to false claims made by empirically unsupported treatments. 

Objectives:  To explore the association between parents’ acceptance of their children’s ASD diagnoses and their treatment selection for their children with ASD.  Parents’ perspectives on the meaning of accepting the ASD diagnosis and factors influencing their acceptance will also be outlined.  

Methods:  One hundred twenty four parents (91.1% mothers; 79.8% White) of children with ASD (84.7% male; 74.2% White; M age = 8.83 years) completed an online survey composed of a demographic questionnaire (including treatments used), Acceptance and Action Questionnaire-II (Autism), and 10 open-ended items regarding their thoughts about ASD and treatments.  Participants were most commonly between the ages of 35 and 44 (49.2%), from the United States or Canada (70.2%), married or in common-law relationships (80.6%), college/university graduates (75.8%), and had an annual household income of over $75 000 (46%).  A subset of 10 parents also completed semi-structured telephone follow-up interviews regarding their conceptualizations of ASD, acceptance of their children’s diagnoses, and experiences selecting treatments.  Data were analyzed using correlational and thematic analyses.  

Results:  Quantitative results revealed that parents’ acceptance of their children’s ASD was significantly negatively correlated with the number of empirically unsupported treatments they selected for their children (r = -.211, p < .05, R² = 0.044), but was also significantly negatively correlated with the number of empirically supported treatments they selected for their children (r = -.179, p < .05, R² = 0.032).  In other words, low levels of acceptance of children’s ASD diagnoses were associated with a “shotgun approach” to treatment selection, whereby these parents selected more treatments for their children, regardless of empirical support.  Qualitative results indicated that parents define acceptance of their children’s ASD as: (a) having a balanced view of their children, (b) recognizing the children’s potential, and (c) resolving their grieving/mourning process.  They also noted the negative consequences of not accepting the ASD diagnosis.  Parents reported that the factors influencing their acceptance of their children’s ASD included: (a) community supports and barriers, (b) their knowledge of ASD, and (c) receiving the official diagnosis.  A minority of parents also reported that, upon first recognizing the symptoms, they accepted the future diagnosis.  Illustrative excerpts from parents’ interviews will also be highlighted.  

Conclusions:  Parents with low acceptance of their children’s ASD diagnoses often appear to take a “shotgun approach” to treatment selection.  Professionals should maintain open dialogues with parents about the process of accepting the diagnosis, focusing on increasing ASD knowledge/community supports and reducing community barriers.  Evidence-based interventions such as acceptance and commitment therapy may also lead parents to more selectively focus on empirically-supported interventions for their children with ASD.