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The Impact of a Two-Week in-Patient Parent Training for Autism Spectrum Disorder in India
The benefits of parent training for Autism Spectrum Disorder (ASD) on the child and family outcome are well proven. Most parent training interventions are similar in content but differ in the service delivery model. The present study was conducted at a tertiary child psychiatry centre in India. Most families seeking treatment at the centre belong to middle socio-economic status, are non-local residents, have poor understanding about their child’s problems, and lack resources locally. Majority of the children receive diagnosis of ASD for the first time at the tertiary centre, and are also diagnosed with multiple co-morbid disorders. Present study was conducted to assess the effect of brief parent training for ASD during the hospital admission.
Objectives:
To assess the impact of a two-week in-patient parent training for home based interventions for ASD on the parents.
Methods:
The sample consisted of families of twenty children between the ages of 3- 10 years, diagnosed of ASD and admitted in the centre. Baseline measures included Childhood Autism Rating Scale 2nd edition (CARS-2), Vineland Social Maturity Scale (VSMS), FISC-ASD (Family Interview for Stress and Coping -ASD), Autism Parenting Stress Index (APSI) and Autism Treatment Evaluation Checklist (ATEC). Parents received daily individualised sessions focusing on psycho-education, skills training, management of problem behaviour and alleviation of family stress. Parents were re-evaluated post intervention using ATEC, APSI and FISC-ASD. The FISC-ASD is a locally-developed, semi-structured tool. It has two sections: perceived stress and mediators of stress. Higher scores in section 1 and 2 mean higher family stress and lower awareness respectively. Parents were also asked to rate their experience of the intervention at the end through a feedback form.
Results: A total of thirty five caregivers (nineteen mothers, fourteen fathers and two grandparents) received the intervention. All the families were residents of other Indian States. Mean duration of stay was 15.5 ± 4.3 days. Mean age of children was 59.4 months (SD-21.8). Mean baseline scores were CARS-2 – 34.9 (SD-4.2), VSMS- 55.3 (SD-1.6), ATEC- 93.2 (SD-20.0) and APSI- 21.8 (SD-10.4). There was statistically significant improvement in the ATEC, APSI and FISC-ASD section on mediators of stress post intervention. There was no statistically significant change in the FISC-ASD section on perceived stress. There was no statistically significant correlation between pre-post scores of ATEC, APSI and FISC-ASD (mediators of stress). Eighty percent families reported that the training was very helpful to them.
Conclusions: A two week hospital admission helped to reduce parental stress, improve knowledge and child rearing practices of families across the socio-economic background. Majority of the parents perceived the training as very helpful. The main limitation of study was lack of a blind independent rater and matched control group. We propose that this in-patient service model is useful in a multidisciplinary, specialist setting where it may allow sufficient time to address the multiple issues (co morbid conditions, problem behaviour, poor parental knowledge) faced by the families and children with ASD.