Initial Efficacy of Primary Care Stepping Stones Positive Parenting Program on Reducing Risk of Dysfunctional Parental Discipline of Children Newly Diagnosed with Autism Spectrum Disorder

Background:  Dysfunctional parental discipline practices have been implicated in the development and maintenance of disruptive externalizing behaviors by young children. Parents of children with autism spectrum disorder (ASD) commonly experience more disruptive behaviors from their children compared to parents of children without disabilities. Primary Care Stepping Stones Positive Parenting Program (SS-Triple P), a personalized, parent-mediated intervention that targets disruptive behaviors in their children newly diagnosed with ASD through the promotion of positive parenting practices.

Objectives:  To investigate whether participation in a brief, one-to-one parenting intervention designed to target discrete problem behaviors impacted the disciplinary styles of parents of children newly diagnosed with ASD.

Methods: A two-group, pre- and post-test, open trial design with random assignment to intervention (N=12) versus wait list control (WLC, N=9) was administered. Patients were recruited from an urban Midwestern Autism Speaks-Autism Treatment Network diagnostic clinic and surrounding community. Child inclusion criteria included receiving a DSM-V ASD diagnosis in the past year from a physician or psychologist, age between 2 and 12 years, and demonstrating moderate to severe behavior problems (Eyberg Intensity T-Score>60). Parental discipline was measured using the Parenting Scale (PS), by Arnold, O'Leary, Wolff and Acker (1993) (α=0.86). This 30-item questionnaire measures dysfunctional discipline styles in parents by asking about the probability with which the parent uses particular discipline strategies. All 30 items are scored on a 7 point Likert scale, with low scores indicating good parental discipline and high scores indicating dysfunctional parental discipline. The Parenting Scale yields a Total score and three factors: Laxness (permissive, inconsistent discipline); Over-reactivity (harsh, emotional, authoritarian discipline and irritability); and Hostility (use of verbal or physical force).

Results:  Parents who received 4 weeks of Stepping Stones Primary Care Triple P had a PS Total Score that on average was significantly lower than the PS Total Score of parents who had not yet received Triple P: F (2, 19) = 8.33, p < .01; Wilk's Λ = 10.709, partial η2 = .31. In addition, parents who received 4 weeks of Triple P had significantly lower measures of Over-reactivity than the parents who had not yet received Triple P: F (2, 19) = 4.95, p < .05; Wilk's Λ = 0.793, partial η2 = .21. No other subscale produced statistically significant findings.

Conclusions:  Initial results from this pilot study show that a brief, parent-mediated intervention for parents of children with ASD can bolster functional parental discipline styles and help parents avoid and reduce dysfunctional parental discipline styles. Specifically, parents who participated in the Triple P intervention were less likely to report using harsh, irritable, or authoritarian discipline compared to parents who had yet to receive the Triple P intervention. Because harsh discipline can exacerbate child behavior problems and because children with ASD commonly display some externalizing behaviors, interventions which bolster and reinforce good parental discipline strategies are important for families with children with ASD. Primary Care Stepping Stones Triple P is a brief (4 session) intervention that can improve parental discipline and be used long after treatment is complete.