Families of Youth with ASD and Other Developmental Disabilities: A Theory-Based Intervention

Background:  Few evidence-based programs exist to support families that include a child with Autism Spectrum Disorder (ASD) or other intellectual or developmental disability (IDD), despite documented evidence of their risk for heightened stress and conflict. Parents in these families are at heightened risk for increased stress, marital conflict, and parenting difficulties, particularly with the typically developing (TD) siblings. TD siblings are at risk for maladjustment and relationship problems. A critical need exists for an evidence-based program to ameliorate the impact of family stress and conflict on the overall well-being of parents and TD siblings.  

Objectives:  Our objective is to test the efficacy for parents, TD siblings, and children with ASD or other IDDs of the adaptation of a psycho-educational and communication training approach (Cumming & Schatz, 2012) and to examine the mechanisms associated with change processes that occur as a result of the program.

Methods:  Participants were 30 families with a child with IDD and a TD sibling (11-17 years old) in a pilot intervention program designed to improve family communication.  The majority of participants (N=20) were diagnosed with ASD (confirmed with the ADOS-2, Social Communication Questionnaire, and clinical judgment).  Families were randomly assigned to either: 1) a parent-sibling (PS) treatment condition, or 2) a self-study (SS) control condition.  Families completed prescreen, baseline, and posttest assessments of marital quality/satisfaction, parent-child communication and attachment, emotional security and adjustment, and dyadic (marital) and quadratic (i.e. parents, TD sibling and child with IDD) problem-solving tasks that were coded for constructive and destructive conflict tactics and resolution.  Families in the PS condition made four visits to the laboratory, during which parents and TD siblings received psychoeducational training and practiced a communication technique with a trained coach.  Individuals with IDD in the PS condition participated in a structured activity during the first three weeks, which was incorporated into a family-wide psychoeducational session at week 4.  Parents in the SS condition were given a syllabus and research-based materials to review over three weeks.  

Results:  Mixed ANOVAs revealed differences in the quality of dyadic and quadratic interactions from the pretest to posttest. Consistent with expectations, a statistically significant interaction was found between condition and time on observed constructiveness in family-wide interactions including the parents, TD sibling, and child with IDD, F(1,11) = 5.16, p = .04, with treatment families using more constructive strategies than control families at the posttest. In dyadic interactions, the degree of resolution for fathers, F(1, 37) = 12.27, p = .001, and mothers, F(1,37) = 14.84, p < .001, and constructiveness for mothers, F(1,37) = 5.03, p = .03, improved over time. Improvement in constructiveness of marital conflict was associated with increases in adolescents’ emotional security at the posttest, F(1,15) = 14.40, p < .001. 

Conclusions:  Preliminary data showed promising benefits for both parents and TD siblings of individuals with ASD and other IDDs.  The expected outcome of this study is an evidence-based, cost-effective intervention that is readily transferable to community-based centers, but additional research is needed with a larger sample size.