Changes in Parenting Stress As a Predictor of Treatment Outcome

Background:  Social communication impairment is a hallmark characteristic of ASD that may manifest in delayed acquisition and use of functional language. These communication difficulties not only impact the individual (e.g. inability to express needs) but also caregivers. More specifically, parents of children with ASD have reported elevated levels of stress, in comparison to parents of typically developing children as well as parents of children with developmental disabilities. In addition, parent involvement in child directed therapies have become nearly commonplace, which results in increased amounts of time and resources on their child (e.g. therapy involvement, appointments, problem behaviors), leaving little time for them to focus on their own emotional and psychological needs. Several treatment studies have begun to target parent well-being and stress separately; however, it is important to note that multiple studies targeting specific parent characteristics correspond with increased levels of dropout rates. Pivotal Response Treatment (PRT) is an empirically based, naturalistic therapeutic approach that teaches parents how to elicit language for minimally verbal children with ASD. Previous studies by our group have demonstrated significant parent gains in treatment implementation as well as child gains in functional language skills through a group format. However, while improvement was noted, parenting stress remained at elevated levels during post treatment assessment. An important first step to understanding the relationship between parent stress and child outcomes is examining the change in parent stress over the course of treatment and its effects on treatment outcome (e.g. spontaneous child language).

Objectives:   This study evaluated the predictive nature of parent stress in relation to the parent-child relationship on the amount of spontaneous words produced during a Structured Laboratory Observation (SLO). Parents participated in a randomized controlled trial who were randomly assigned to either PRT group or parent psychoeducation control group.

Methods:  27 parents of children with ASD between the ages of 2.3 and 6.5 (M= 4.2, SD = 1.2) participated in a 12-week group PRT parent training to target child language. Parents completed the Parenting Stress Index, Short Form at baseline and week 12 of the training. Children’s frequency of spontaneous language was scored during SLO, which took place under standard conditions.  Parents were instructed to elicit child language during a 10-minute period of time.

Results:  A percent change score in parent stress related to dysfunctional parent-child relationship was computed for all parents who completed the PSI-SF at baseline and week 12. While controlling for age and gender, the change score in parent stress remained as a significant predictor of SLO spontaneous language for children at week 12 (B = -2.793, p = .033) and uniquely accounted for 19.2% of the variance in child spontaneous language at week 12.

Conclusions: Grounding parent-focused strategies squarely within a child intervention may increase levels of retention while still addressing important parental difficulties such as stress. Overall, the need for a treatment to concomitantly target parent and child difficulties appears to be imperative.