Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): New Parent Group Intervention

Background:  

Repetitive behaviours (RBs) can interfere with a child’s ability to learn new skills and engage in daily living activities. Parents report that RBs interfere with family functioning and are among the most stressful behaviours to manage. Parents rarely receive specific advice about their child’s RBs.

Objectives:  

This pilot randomised controlled trial (RCT) aimed to evaluate feasibility, acceptability and impact of a new 8-week group-based parent intervention which was developed in collaboration with parents of young children with ASD.

Methods:  

45 families of children with ASD (3 to 7years) were randomised to immediate or delayed intervention. The outcome measures include blinded expert clinician rated Clinical Global Impressions–Improvement (CGI-I) of child’s overall improvement in functioning; level of change in ‘target’ RRB (independently rated); and parent questionnaires measuring child RRBs & parents’ self-efficacy. Measures were taken at baseline, FU1 after 10 weeks, FU2 two months later, and FU3 two months later.

Results:  

Parents who attended the group reported that they found the course helpful, and that that it increased their knowledge and confidence in managing RBs; e.g. “I feel more relaxed with dealing with RBs”, “I am more confident, have a bank of strategies I can use”.

We found significant differences between groups in the primary outcome measure namely improvement in the child’s overall global functioning (CGI-I) t(36.76) = -2.602, p = .013, and in parents’ knowledge & confidence (self-efficacy), FU1 [t (43) = 2.79,  p = .008]; FU2 [t (42.24) = 2.83, p = .007] and  FU3 [t (43) = 4.90, p<.001]; with  the intervention increasing parent self-efficacy by 0.74 (95% CI: 0.34, 1.14).  Parents were also asked to choose two target RBs to focus on during the group. Results estimate using fitting trends models that the impact of the intervention was -0.58  (95% CI: -1.24, 0.07), an increase in improvement in the immediate group of over 0.5. The RB particularly sensitive to change was ‘Restricted Fixated Interests’; those in the immediate group who chose this RB as their target had significantly greater improvement than those with this behaviour in the delayed group at FU2 (p = .01) and FU3 (p = .002). Similarly a significant impact of intervention was found for RBQ2 factor 3 ‘preoccupation with restricted patterns of interest’ (FU1, p= .04, ηp2= .09; FU2, p= .02, ηp2= .12; i.e., moderate to large effect sizes), and for factor 4 ‘unusual sensory interest’ (p= .04, ηp2= .10).

Conclusions:  

The results of this pilot RCT suggest that a parent group intervention for managing RBs in young children with ASD has potential for beneficial impact. Parents were willing to be recruited and randomised, the format and content of the groups were feasible and acceptable and the outcome measures were appropriate. There is some evidence of greater treatment effect in  particular types of RB, suggesting that certain RBs may be more amenable to change than others. A fully powered multi-site trial is now required to establish the efficacy of this intervention.