Feasibility and Initial Efficacy of Primary Care Stepping Stones Positive Parenting Program (Triple P) on Reducing Maladaptive Behaviors in Children Newly Diagnosed with Autism Spectrum Disorder

Background:  Concomitant behavioral problems, including tantrums, noncompliance, aggression and self-injury^1,2are common among children with Autism Spectrum Disorder (ASD).  These behaviors can be of comparable or greater concern to parents than the core symptoms of ASD and often are chief motivating factors for seeking diagnosis and treatment. While emerging parent mediated interventions (PMI) exist to address maladaptive behaviors among children with ASD, no evidence based practices exist for intervening with parents at the time of initial ASD diagnosis in a systematic, strength based, parent driven, and practitioner guided manner. 

Objectives:  To determine the feasibility and preliminary efficacy of a manualized, one-on-one, 4 session PMI (Triple P) with parents of children (ages 2 to 12 years) newly diagnosed with ASD.

Methods:  A two-group, pre- post-test, open trial design with random assignment to intervention (N= 9) versus treatment as usual control (TAU; N=6) was employed. Eligible parents were recruited from an urban Autism Speaks-Autism Treatment Network diagnostic clinic, as well as from the surrounding community.  Parent inclusion criteria consisted of being at least 18 years of age, being the child’s legal guardian, having primary responsibility for raising the child, and having a specific behavioral concern about their child. Child inclusion criteria consisted of receiving a DSM 5 ASD diagnosis within the past year from either a psychologist or physician, being > 2 years and < 12 years old, and displaying moderate to severe behavior problems (Eyberg Intensity T-Score > 60).

Results:  Compared to TAU, parents who received the intervention, reported statistically and clinically significant changes 4 weeks post-baseline in: child externalizing behaviors, ECBI Intensity F(1,13) = 5.16,  p < .05, partial η² = .31;  parenting competence F(1,13) = 6.64,  p < .05, partial η² = .36; parenting resilience F(1,13) = 6.52,  p < .05, partial η² = .35; family functioning F(1,13) = 6.03, p < .05, partial η² = .35; overall parenting stress F(1,13) = 19.38,  p < .001, partial η² = .66;  and parent-child interaction stress F(1,13) =6.66,  p < .05, partial η² = .40. Analyses indicated a 93% level of fidelity to the intervention, and high participant satisfaction with services (M = 6.6, SD = .41).

Conclusions:  For children newly diagnosed with ASD, a 4 session PMI was superior to TAU in improving child behaviors, fostering parenting competence, reducing parenting stress, and improving family functioning.  The intervention’s focus on empowering parents is an innovative approach to current service delivery models, and holds the potential for assisting in the development and use of more family friendly, strength-based, patient-centered practices for working with parents of children newly diagnosed with ASD to diminish problematic child behavior.