Group-Based Interventions for Parents of Children with ASD: Impact on Psychological and Physiological Outcomes

Background: Parents of children with autism spectrum disorder (ASD) report exceptionally high levels of stress as compared to their counterparts, and parental stress exerts bidirectional effects on child outcomes. Caregiving stress likely results in poor health outcomes for parents, but we know very little about parental objective health profiles, given that most intervention studies rely on parental self-report outcomes. Parent-focused interventions (e.g., psychoeducation, behavioral education, mind-body interventions, social support) in ASD have been tested and demonstrated as helpful in addressing child outcomes, but the data on parent outcomes are equivocal.

Objectives: Evaluate the feasibility and preliminary efficacy of two group-based interventions (i.e., psychoeducation and mindfulness) for parents of children with ASD, with a focus on psychological and physiological outcomes.

Methods: Twenty-two parents of children with ASD (17 completers) with high baseline parental stress (i.e., above the 90^thpercentile) were enrolled in a pilot, randomized clinical trial on parent-focused interventions. Participants were randomized to 8 weeks of either a group psychoeducation program (GPEP) or a group mindfulness-based intervention (MBI). Parental self-report on psychological outcomes (parental stress, caregiver strain, perceived health) and physiological health outcomes were collected at baseline and post-treatment. Physiological/clinical outcomes were assessed in a laboratory setting (heart rate variability, blood pressure) and in the participant’s home environment (sleep, via actigraphy).

Results: Regarding feasibility outcomes, we met recruitment goals and had approximately 21% attrition, which is comparable to other parent training programs. Post-treatment, parents in GPEP demonstrated significant reductions in total stress (p=.04) and on the Parental Distress (p=.05) and Difficult Child Interactions (p>.01) domains. Parents in MBI improved only on the Difficult Child domain (p=.05). Between-group comparisons revealed that GPEP parents showed greater change post-treatment than MBI for parental stress (p>.01). In contrast, the MBI group showed significant improvement in perceived physical and emotional health (p=.02), whereas the GPEP group showed no change. Neither group demonstrated change in caregiver strain. No differences were observed in either group on physiological or clinical health outcomes.

Conclusions: Parent-focused interventions that are delivered in group formats and that are evaluated via multiple approaches to outcomes are important, but significantly understudied in ASD. The current study preliminary supports the feasibility of adapting individual intervention into group-based treatments and collecting objective data on functional and clinical health outcomes. In this small pilot sample, both psychoeducation and mindfulness effectively addressed different aspects of parental stress and perceived health. Along with previous research, this highlights the importance of including mediator and moderator analyses in parent interventions to identify what factors might influence treatment response. In this sample, no changes in physiological outcomes were observed, suggesting that parent perceptions of improved stress and health may not necessarily translate into change in objective health outcomes. This was a very small pilot sample, so the results are not conclusive. However, they do suggest the feasibility and importance of continuing parent-focused interventions that considers multiple outcomes.