Autism Spectrum Disorder
Conditions
Brief summary
This project tests the feasibility and preliminary proof of concept for a mindfulness-enhanced adaptation of Pivotal Response Treatment on parenting stress and child communication, using a randomized controlled design.
Detailed description
One of the core features of Autism Spectrum Disorder (ASD), social communication impairment, presents in a variety of ways, including reduced functional language use and social initiations, which often warrant intensive intervention services. Additionally, parents of children with ASD demonstrate increased levels of parenting stress when compared to parents of typically developing children and children with developmental delays. Elevated parenting stress has been shown to diminish positive treatment outcomes, which lends support to develop methodologies to concomitantly target child and parent behaviors. The current randomized control trial (RCT) uses a dual-pronged approach to directly target both child communication deficits and parenting stress within a group format. This RCT combined an empirically supported behavioral therapy, Pivotal Response Treatment (PRT), with components from Acceptance and Commitment Therapy and Mindful Parenting for reducing parenting stress. Caregivers and their minimally or pre-verbal child with diagnosed or suspected ASD were randomly assigned to one of the following supplemental conditions: mindfulness-enhanced PRT (mPRT) or psychoeducation-enhanced PRT (pPRT) as an active control condition. The current study assessed feasibility and acceptability in addition to demonstrating proof of concept in regard to additive effects of mPRT compared to pPRT.
Interventions
BEHAVIORALPivotal Response Treatment
Group-based parent training to teach parents behavioral strategies based on principles of learning to motivate their child.
Sponsors
Virginia Polytechnic Institute and State University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Intervention model description
randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Months to 6 Years
Healthy volunteers
Yes
Inclusion criteria
* For children: minimally verbal or nonverbal, 1.5 to 6 years old, current or suspected autism spectrum disorder diagnosis, demonstrated ability to make meaningful vocalizations * For parents: willingness to attend group treatment sessions, record weekly videos, and share videos in a group setting
Exclusion criteria
* For children, no active medical problems (e.g., unstable seizure disorders) * For parents, no severe mental health problems (e.g., suicidal intent, psychosis)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Subjective Units of Parenting Stress Scale | pre-treatment at intake | level of parent-reported stress immediately following the structured lab observation, with 0 signifying no stress and 100 signifying extreme stress |
| Therapist fidelity observation | weekly, from start of treatment through 12 weeks | observation at 30-second intervals; number out of 10 pivotal response therapy components observed for each 30-second interval of the recording and then averaged over the length of the recording (which were 5-10 minutes long) |
| Child utterances - observation | pre-treatment at intake | level or amount of child utterances during a structured laboratory task observation |
| Parent fidelity observation | weekly, from start of treatment through 12 weeks | observation at 30-second intervals; number out of 10 pivotal response therapy components observed for each 30-second interval of the recording and then averaged over the length of the recording (which were 5-10 minutes long) |
| Parenting Stress Index, 4th edition | pre-treatment at intake | level of parent-reported stress; |
| Autism Parenting Stress Index | pre-treatment at intake | level of parent-reported stress specific for parents of young autistic children |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Parent Feelings Questionnaire | pre-treatment, at intake | parent-report of positive and negative feelings toward the child; 5 point scale from definitely untrue for me to definitely true for me; higher scores mean higher levels of the feeling |
| Positive and Negative Affect Schedule | pre-treatment, at intake | parent-reported positive and negative affect in adults; 5 point scale from very slightly to extremely; higher scores mean higher levels of the feeling |
| Five Facet Mindfulness Questionnaire | pre-treatment, at intake | parent-reported propensity toward mindfulness in everyday life; 5 point scale from never true to always true; higher scores mean more mindfulness |
| Acceptance and Action Questionnaire | pre-treatment, at intake | parent-reported level of experiential avoidance, on a 7 point scale from never true to always true; higher scores indicate more avoidance |
| Child Behavior Checklist for ages 1.5 to 5 | mid-treatment, at 6 weeks from start of treatment | parent-reported measure of child emotional and behavioral concerns; converted to t-scores; higher scores indicate higher levels of the behavior problem |
Other
| Measure | Time frame | Description |
|---|---|---|
| Parent Treatment Satisfaction Questionnaire | post-treatment, at 12 weeks from start of treatment | Parent-reported satisfaction with the treatment protocol on a 5 point scale from would not recommend to strongly recommend; not at all helpful to very helpful; not at all difficult to very difficult; and too few sessions to too many sessions. |
Countries
United States
Outcome results
None listed