Stepping Stones Cerebral Palsy Study: Optimising outcomes for children with Cerebral Palsy through a randomised controlled trial of a parenting intervention

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It is well understood that parenting a child with a disability, such as CP, brings additional challenges e.g. increased burden of care and grief. Mothers of children with CP experience greater parental stress and anxious/depressive symptoms. In addition, children with CP are more likely to face behavioural and emotional problems which is in turn associated with further increases in parental stress. Parental stress and child behavioural problems are likely to impact on the optimising of physical, behavioural and educational outcomes in children with CP over and above the impact of the initial brain lesion on disability. Behavioural Family Interventions aim to improve child behaviour and adjustment through changes in the family environment and are well established for improving child behavioural outcomes in typically developing children. The behavioural family intervention Triple P (Positive Parenting Program) has been developed and evaluated extensively over the past 30 years and is implemented in Australia and 19 other countries. The results of three independent meta-analyses using 55 evaluation studies confirm that Triple P has significant positive effects on child behaviour and parenting style. The effect size of Triple P with high-risk groups such as parents of children with ADHD is large (mean d = 0.88). Stepping Stones Triple P (SSTP) is a new variant of Triple P that targets families of children with disabilities. SSTP has a meaningful treatment effect with families of children with developmental disabilities and is efficacious for families of children with Autism Spectrum Disorder (ASD). SSTP has not yet been validated specifically with parents of children with CP. In addition, we will specifically target parenting stress with a parental stress intervention based on Acceptance and Commitment Therapy. ACT is a new cognitive behavioural intervention model that incorporates mindfulness (psychological contact with the present moment) and acceptance (of emotional and cognitive responses). The goal is to increase psychological flexibility- the ability to persist or change in the service of chosen values. ACT has the ability to contribute to parenting interventions by addressing the emotional context of parenting including increasing the parent’s ability to foster their child’s emotional regulation skills and to improve the parent child relationship. Mindfulness and acceptance have been found to decrease distress in parents of children with disabilities however, research has yet to focus on the additive benefit of ACT to Behavioural Family Interventions. This study aims to assess the efficacy of the Behavioural Family Intervention Stepping Stones Triple P with families of children with Cerebral Palsy. In addition, we aim to test the additive effects of an ACT-based parental stress management intervention. It is predicted that Stepping Stones Triple P will be associated with reductions in child behavioural problems. It is predicted that the addition of an ACT-based parental stress management intervention will lead to additive effects on parental adjustment.

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