The social communication impairment that prevents children with ASD from expressing themselves or asking for what they need not only negatively affects their well being, it also contributes to elevated stress for parents. The time and money required for therapies for their children also may prevent many parents from devoting resources to their own self-care.
A two-year OAR-funded research study, “RCT of Mindfulness-Enhanced Pivotal Response Treatment Group Training for Parents of Children with ASD,” led by Angela Scarpa, Ph.D., director of the Virginia Tech Center for Autism Research and co-director of the Virginia Tech Autism Clinic, used a dual-pronged approach to directly target both child communication deficits and parenting stress within a group format. The study, which took place between 2017 and 2019, incorporated mindfulness training into a child-focused group behavioral therapy, pivotal response treatment (PRT), which is used to increase children’s social communication.
Mindfulness is defined as the ability to bring awareness to the present moment: to thoughts, feelings, bodily sensations, and the surrounding environment without judgment. It has been used extensively as a means of reducing stress. Mindfulness-based strategies may be instrumental in promoting psychological flexibility, which is thought to reduce emotional reactivity to stressful situations.
A total of 26 pairs of parents along with their children with diagnosed or suspected autism spectrum disorder (ASD) and who were either minimally verbal or pre-verbal participated in the study. Fourteen of those sets of participants were assigned to a psychoeducational group as a control while 12 were assigned to a group that received mindfulness training.
For the mindfulness component, Dr. Scarpa used evidence-based components from acceptance and commitment therapy (ACT), which uses mindfulness, commitment, and behavior change strategies to reduce parental stress.
Clinicians trained in PRT and ACT led the weekly groups, which included eight 2-hour group sessions for parents and four 1-hour individual parent-child sessions to teach PRT. Parents also received three 2-hour sessions of group supplemental treatment that specifically targeted stress either by mindfulness-based techniques or by psychoeducation.
Parents kept a weekly log of PRT daily practice and recorded one 10-minute video of implementing PRT with their child each week of the eight-week training. During group sessions, clinicians used those videos to provide implementation feedback. The research team also collected and measured reports of psychological flexibility and parent stress during each week of the training.
In an analysis of 15 of the sets of participants, eight in the mindfulness group and seven in the control group, the mindfulness group showed significant decreases in parenting stress and increases in mindfulness. At the individual level, some parents in both groups showed positive changes in mindfulness, positive feelings toward their child, and decreases in reports of child problem behavior.
Parents who completed the study reported high levels of satisfaction, showed that they could complete the child-based treatment to an acceptable level of fidelity, and noted less stress. Children increased their language use and showed decreased problem behaviors. Because the current sample is small, results are preliminary and need to be replicated with more families.
The impact of ASD on caregivers and families is often direct and lifelong. As a result, intervening early can result in immediate and long-term benefits for parents, children and families. This study provides initial support to provide group-based services that target both child outcomes (e.g., social communication) and parent outcomes (e.g., stress).