Parent and Child Factors Related to Homework Completion in Cognitive-Behaviour Therapy for Children with ASD

Background:  Homework is recognized as a crucial component of participation in cognitive behavioural therapy (CBT) for children as it provides opportunities to practice techniques outside of the therapy environment, aiding in skill-mastery (Kazantzis, Deane, Ronan & L'Abate, 2005). Empirical evidence suggests that treatment outcomes are enhanced with CBT that includes homework, in comparison to programs that only involve in-session work (Mausbach, Moore, Roesch, Cardenas & Patterson, 2010). There are a number of parent and child factors related to poor participation (i.e. uncompleted homework), such as parent stress and psychopathology, and child functioning (Kazdin & Wassell, 1999), however research has yet to explore this relation in participants with ASD. With the increasing use of CBT to treat anxiety and behavioural concerns in children with ASD (Danial & Wood, 2013), it is important to understand barriers to participation that could have implications on treatment outcomes.

Objectives: To identify parent and child characteristics that relate to homework completion in CBT for children with ASD

Methods: Data were collected from 56 children with ASD (89.3% male) and their parents (82.1% female) as part of a larger, randomized controlled CBT trial. Children were 8 to 12 years of age (M = 9.66, SD = 1.23) with average IQ (M = 102.15, SD = 14.78, Range: 79-140). Parents were 35 to 54 years of age (M = 43.61, SD = 4.33). Prior to treatment, parents completed measures of child psychopathology, emotion regulation, and autism-symptom severity, as well as a self-report measure of depression, anxiety and stress. Children completed a self-report measure of emotion regulation. Homework completion was reported by session therapists as either incomplete, partially completed, or fully completed. A mean completion score was calculated for nine sessions.

Results: Challenges with emotional regulation were significantly related to less homework completion on both parent-report (r (49) = -.42, p = .003) and child self-report (r (48) = -.47, p = .001) measures. Child internalizing problems were also significantly related to less homework completion (r (48) = -.33, p = .02). Externalizing problems, ASD symptoms severity, and parent self-reported depression, anxiety or stress were not related to homework completion. The overall model of child characteristics accounted for 30% of variance in homework completion, F(3, 39) = 6.86, p = .001.

Conclusions: Pre-treatment difficulties with emotion regulation and internalizing problems in children with ASD may have implications for their capacity to complete homework in CBT. To support children in completing homework, clinicians should work with families to modify between-session tasks as needed, in order to promote constructive treatment participation.