Therapy Satisfaction As a Predictor of Parent Improvement Following Cognitive Behavioral Therapy for Children with Autism Spectrum Disorder

Background: Parents of children with autism spectrum disorder (ASD) can experience significant stress, anxiety and depression (Estes et al., 2009). There is evidence that parent involvement in child-focused therapy may indirectly improve parent functioning (Silverman et al., 2009), but little research to elucidate factors contributing to this change. For family CBT programs, aspects of the therapy experience, such as parent engagement, have been shown to be associated with improved child outcomes (Podell & Kendall, 2010), and for adult participants in therapy, program satisfaction is also related to symptom reduction (Atkisson & Zwick, 1982). As such, it may be useful to examine the therapy experience when investigating predictors of change for parents.

Objectives:  The current study aimed to test whether post-intervention changes in parent mental health were predicted by program experience ratings, controlling for parents’ pre-intervention scores.

Methods:  Participants included 52 parents (82.7% mothers; M age=43.5, SD=4.2) of children with ASD participating in a randomized controlled trial of CBT, targeting child emotion regulation. To assess mental health, parents completed the self-report Depression Anxiety and Stress Scale(DASS-21, Lovibond & Lovibond, 1995) at baseline and immediately following intervention. To assess therapy experiences, parents completed post-intervention surveys that asked about a) their level of confidence supporting their child, b) perception of child change due to intervention involvement, c) satisfaction with therapist, d) mean satisfaction with pragmatic aspects of the program (location, session length, dates/times program was offered), and e) their child’s enjoyment of the program. Responses were provided on a scale from 0 (not at all satisfied) to 5 (very satisfied). To test whether therapy experiences predicted change in parent functioning, a series of multiple regressions were calculated to predict post-intervention DASS scores, each entering the pre-intervention DASS score and one of the therapy experience measures as predictors.

Results: Post-intervention, there were significant improvements in parents’ reported depression (t(49)=2.23, p=.03), and there was a trend toward improvement in total DASS (t(49)=1.74, p=.09). After controlling for pre-intervention total DASS scores, parent confidence emerged as a significant predictor, explaining 10% of the variance in post-intervention total DASS scores (t(41)=-2.22, p=.03). There was also a trend toward parent ratings of program pragmatics being a predictor of post-intervention DASS total scores (ΔR²=.10, t(41)=-2.00, p=.06). Additional trends emerged when examining post-intervention depression, with program pragmatics (ΔR²=.14, t(41)=-1.94, p=.06), and parent perception of child change (ΔR²=.16, t(41)=-1.96, p=.06) predicting post-intervention depression scores.

Conclusions:  Improvements in overall parent mental health and depression following participation in a family-based CBT program were related to their perceptions of therapy. Though correlational, results support the hypothesis that parents’ experience of their child’s treatment may impact how they benefit from an intervention (Osbourne et al., 2008). The results of the current study provide further support for this model and will be discussed with regard to implications for intervention development and evaluation.