OARacle Newsletter

Problem behavior, such as self-injury, aggression, and disruptive behavior, which many autistic children demonstrate, can strain family relationships and result in challenges at school and other places. If not addressed, it can lower quality of life, limit the autistic child’s access to education and community activities and raise parental stress.

In a two-year OAR-funded study, Craig W. Strohmeier, Psy.D., BCBA-D, an assistant professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and a supervising psychologist in the Neurobehavioral Unit Outpatient Clinic Programs at Kennedy Krieger Institute, evaluated the effectiveness of the Defuse Experience Accept and Live (DEAL) protocol he developed. The goals of the study, Contextual Behavioral Strategies to Help Parents Adhere to Behavior Plans for Children with Autism, were to determine:  

• If the DEAL protocol increased parental adherence to the strategies to reduce severe problem behavior and decreased parental accommodation.
• How the protocol affected experiential avoidance and fusion. Cognitive fusion occurs when verbal, self-generated rules overshadow problem-solving strategies. For example, a parent may avoid the grocery store to keep their child from having a tantrum in the grocery aisle. But not going to the store also means being unable to shop for groceries and missing a chance to help their child develop tolerance for activities they don’t like. Experiential avoidance seeks to avoid a negative event or discussion of a negative event that ended in problem behavior.

Methodology

Dr. Strohmeier recruited 15 parents from the neurobehavioral unit at Kennedy Krieger’s outpatient clinic. Twelve participated in the study, six each in DEAL or in treatment as usual.

Two of the six parents in the DEAL group completed five weekly 45-minute sessions with a therapist who implemented the DEAL protocol. The protocol used components of acceptance and commitment therapy as well as behavioral activation to help parents adhere to behavioral treatment plan components. The sessions included education, experiential training, and homework assignments related to experiential avoidance and acceptance, cognitive fusion and defusion, committed action/behavioral action, and values clarification.

In the treatment-as-usual group, only two parents of the six completed the full study. The research team measured accommodation, adherence, parenting stress, experiential avoidance, and fusion before and after the five weekly sessions.

Outcomes

Of that group of four, the parents in the DEAL group completely eliminated accommodation after the five DEAL sessions. The parents in the treatment-as-usual group demonstrated slight increases in accommodation. Similarly, adherence to the strategies was greater for parents in the DEAL group versus those in the treatment-as-usual group. The participants’ self-reports on levels of stress, avoidance, and fusion remained mostly unchanged despite their behavior changes.

Practical Findings

Working with parents and caregivers of autistic individuals has historically involved skills training to increase adherence to behavioral treatment plans. Dr. Strohmeier’s research opens up the possibility that training focused on addressing avoidance of situations that arise because of severe problem behaviors may be more effective. Providing strategies that incorporate parents’ experiences of severe problems may produce sustained behavioral changes.

If parents and caregivers have the opportunity to receive interventions that identify patterns of avoidance and training for how to reduce avoidance through implementing behavioral treatment strategies, parents and children can expand their lives, opening up potential for new experiences.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.