Parent Variables in Responder Status in a CBT for Children with ASD

Background:  Many studies highlight the crucial role that parents play in interventions for children with Autism Spectrum Disorder (ASD) (Hassenfeldt, Lorenzi, & Scarpa, 2014). Further, parental confidence, or self-efficacy, has been indicated as an important factor related to child problem behaviors and stress (Rezendes & Scarpa, 2011).  Lecavalier (2006) estimated that more than 60% of children with ASD present with emotion regulation difficulties. The Stress and Anger Management Program (STAMP), a cognitive behavioral therapy (CBT) with an active parent training component, provides strategies for emotion regulation for children ages 5-7 with ASD (Scarpa, Wells, & Attwood, 2013).  A small RCT showed group level differences (STAMP vs. wait-list control) in emotion regulation and coping skills.  STAMP views parents as co-facilitators who are critical to their child generalizing self-regulatory skills to contexts beyond therapy groups (Hassenfeldt, Lorenzi, & Scarpa, 2014).  While this program is designed to reduce emotional outbursts, it is important to study differences between responders and nonresponders.

Objectives:  The primary objective is to examine the role of parental confidence in both themselves and their child in domains related to STAMP (anger and anxiety), as well as their perception of the material, in relation to responder status.

Methods: Thirteen children (86.4% male), ranging from 58-90 months (M =78.62, SD = 2.73), participated in STAMP. Originally, eligibility criteria included an ASD diagnosis; however, one transdiagnostic group included two children with other clinical diagnoses that involved emotion regulation issues.  The intervention involved nine one-hour weekly child and parent group sessions.  Parents completed measures pre- and post-treatment.  Responder status was determined by meeting two of four criteria, which included a statistically significant decrease (RCI) in the Lability/Negativity subscale on the Emotion Regulation Checklist (Shields & Cicchetti, 1997), or a 20% decrease in meltdown intensity, frequency, or duration, as measured by a behavioral monitoring form.  

Results:  Based on the responder status criteria, 8 children were identified as responders and 5 as non-responders.  Significant differences in parental confidence were found within groups.  Specifically, parental confidence in the responder group increased from pre to post treatment in all domains, which included confidence in themselves in dealing with anger (z = -2.375,  p = .018) and anxiety (z = -2.032, p = .042), as well as in their child dealing with anger (z = -2.388, p = .017) and anxiety (z = -2.388, p = .017).  There were no significant changes in non-responders.  Further, on Parent Satisfaction Surveys, there were significant differences in the difficulties parents expressed in learning cognitive skills (U = 5.5, p = .030), in addition to the degree to which they found these cognitive tools to be useful (U = 4.0, p =.019), such that non-responder parents found them to be more difficult and less useful.

Conclusions:  This illustrates the importance of parental confidence and their perspective on the material in treatment outcomes.  Increasing parental confidence and understanding of material may be key to treatment success, and further supports the value of parent involvement in intervention.