GREAT Expectations: The Influence of Parent Outcome Expectancies on Social Skills Gains in Children with Autism Spectrum Disorder

Background: Extensive research has been conducted on the influence of client expectancies on the therapeutic process in adult therapy.  However, when examining the influence of expectancies in child therapy, the expectations of the parent are critical because of the influential role of the parent.  Specifically, it is the parent who generally initiates, continues, and terminates treatment for the child.  To date, the literature on child therapy has primarily focused on parent expectancies on treatment protocol (treatment expectancies) rather than treatment outcomes (outcome expectancies; e.g., Burck, 1978; Nock & Kazdin, 2001).  Furthermore, the effect of parent expectancies on treatment outcomes has yet to be studied in interventions for children with autism spectrum disorder (ASD).  

Objectives:  This study investigated the relationship between parent outcome expectancies on in-session and parent-perceived therapeutic gains for children with ASD participating in a novel applied behavioral analysis (ABA) type intervention.  We predicted that higher parent outcome expectancies in the earlier stages of the intervention would lead to greater in-session and parent-perceived social skills gains.

Methods: Participants were 15 children with ASD and their parents.  Participants were involved in a larger study examining the influence of an interactive humanoid robot as a co-therapist in a novel ABA type intervention.  Parents completed an adapted version of the Credibility/Expectancy Questionnaire (Devilly & Borkovec, 2000) to assess outcome expectations.  Parents also completed the Autism Social Skills Profile (Bellini, 2006) to measure parent-perceived social skills gains.  In-session social skills gains were the frequency of appropriate responses, comments, and questions independently made by the child during the initial and final probes of the therapy session.   

Results: Parent outcome expectancies at pretest were positively correlated with parent-perceived social skills gains (r = .52, p < .05).  Parent outcome expectancies at midpoint were positively correlated with in-session (r = .64, p < .05) and parent-perceived (r = .74, p < .01) social skills gains.  When controlling for child’s IQ, ASD symptom severity, adaptive behavior functioning, and order of robot presentation in therapy, parent outcome expectancies at midpoint accounted for a significant proportion of variance of in-session [R² = .69, F(5, 9) = 4.05, p < .05] and parent-perceived [R² = .81, F(5, 9) = 7.56, p < .05] social skills gains.  Furthermore, parent outcome expectancies at midpoint predicted in-session (β = .64, p < .05) and parent-perceived (β = .59, p < .01) social skills gains at the end of the intervention. 

Conclusions: These data suggest that parent expectations of treatment outcomes are predictive of in-session and parent-perceived social skills gain over and above their child’s IQ, ASD symptom severity, adaptive behavior functioning, and order of robot presentation in therapy.   The influence of parent expectancies on in-session social skills gains may be attributed to an increased level of parent involvement, such as practicing skills outside the sessions.  These findings highlight the importance for professionals to monitor parents’ perceptions and beliefs of therapy, even after treatment has begun.  This study further supports the existing literature emphasizing the significance of parents in treatment for children with ASD.