News and Knowledge

In October 2016, OAR’s Board of Directors authorized funding for six new applied autism research studies in 2017. These new grants, totaling $178,866, bring OAR’s total research funding to over $3.6 million since 2002. This is the final of six previews featured in “The OARacle” this year.

A quick Google search of “parental stress and autism” yields more than 300,000 hits. That will likely not surprise the parent of a child with autism spectrum disorder (ASD). In fact, research has shown that parents of children with ASD report elevated levels of stress in comparison to parents of children with another type of developmental disability and typical development.

The social communication impairment that is a hallmark of ASD is one factor in that stress. Additionally, parent involvement in child-directed therapies has become nearly commonplace, which results in increased time and resources being spent on the child with ASD, leaving little time for parents to focus on their own psychological needs.

An OAR-funded research study, “RCT of Mindfulness-Enhanced Pivotal Response Treatment Group Training for Parents of Children with ASD,” currently being conducted by Angela Scarpa, Ph.D., director of the Virginia Tech Center for Autism Research and co-director of the Virginia Tech Autism Clinic, targets parent mindfulness as a way to reduce stress. Her study will incorporate mindfulness training into a program to provide an empirically supported child-focused group behavioral therapy, pivotal response treatment (PRT). PRT is used to increase children’s social communication.

Mindfulness is conceptualized as the ability to nonjudgmentally bring awareness to the present moment and may serve as a cognitive tool to impact the stress response. Mindfulness-based strategies may be instrumental in promoting psychological flexibility, which is thought to reduce emotional reactivity to stressful situations.

Methodology

The study will take place in three phases over two years. Thirty parents (or sets of parents) of minimally verbal or non-verbal children ages 2 to 6 will be recruited. Each group will have five to six families participating. The group treatment approach, as opposed to traditional implementation of PRT with one family at a time, reaches an increased number of parents in need of support and provides more efficient treatment.

Parents and children will be assigned to either a mindfulness-enhanced PRT group or a psycho-education enhanced PRT group as the control condition. For the mindfulness component, Dr. Scarpa and her research team will use evidence-based components from acceptance and commitment therapy (ACT), which uses mindfulness, commitment, and behavior change strategies to reduce parental stress.

One or two clinicians who have received training in PRT and ACT will lead the weekly groups. The training will include eight two-hour group sessions for parents and four one-hour individual parent-child sessions to teach PRT. Parents will also receive three two-hour sessions of group supplemental treatment that specifically targets parent stress either by mindfulness-based techniques or by psycho-education.

Parents will be asked to keep a weekly log of PRT daily practice and to record one 10-minute segment of implementing PRT with their child each week of the training. These videos will be shown during the group sessions, and clinicians will provide implementation feedback. The research team will also collect and measure reports of psychological flexibility and parent stress during each week of the training.

Outcomes

Dr. Scarpa hopes that this study will not only decrease parental stress, but also lead to faster understanding and implementation of PRT skills and shed light on the impact of directly targeting both parent and child in a single treatment program. More specifically, the results will illuminate the direct and indirect effects of mindfulness-based practice on parent stress and child outcomes respectively. Identifying mechanisms of change within parent-implemented therapies can provide valuable guidelines for future family-centered therapy approaches.

Dr. Scarpa expects that parents participating in the mindfulness training component will develop increased psychological flexibility, which in turn will allow them to develop acceptance and mindfulness skills to implement in stressful situations, involving but not limited to parenting their child with ASD. In fostering the skills of staying in the present moment, increased self-compassion, decreased self-judgment, and increased flexibility of response, parents can learn to work towards their goals and values despite the unwanted feelings and sensations of stress, guilt, and depression.

Parental stress in families affected by ASD is widely acknowledged but rarely addressed within treatment. Integrating cognitive behavioral treatment that addresses parental stress into an established evidence-based behavioral intervention for young children with ASD may provide an evidence-based method to help children with ASD and their parents at the same time.