Relationship Based Intervention with Young Children with Autism: Effects and Consequences on Parenting Stress and Depression

Background: There has been increasing use of Relationship Based Interventions (RBIs) to address the developmental and social emotional concerns of young children with autism. RBIs teach parents to use Responsive Interaction (RI) strategies to enhance their responsiveness and affect during their routine interactions with their children. Despite increasing evidence that RBIs are effective at addressing children's developmental and social emotional needs, there is concern that the demands of this type of intervention might exacerbate the high levels of parenting stress and depression that have been reported for parents of children with autism. The purpose of this presentation is to investigate the effects of two RBIs on the psychosocial functioning of parents of children with autism.  Do high levels of parent psychosocial dysfunction impede parent participation in RBIs; and how do RBIs effect parent psychosocial functioning?

Methods:  Results come from secondary analyses of Randomized Controlled Trials of two RBIs conducted with parents and preschool children with autism. One was an investigation of the PLAY Project Home Consultation Model (Solomon, et. al., 2014) with a sample of 112 parent-child dyads. Both Control and PLAY children received community standard treatments for autism. PLAY group parents received 12 monthly intervention sessions in which they were coached to use RI strategies to enhance their interactions with their children.  The second was an investigation of Responsive Teaching  (RT) (Alquraini, et. al., In Press) that was conducted with a sample of 28 children with autism and their parents from Saudi Arabia. Dyads were randomly assigned to a control group in which children and parents received treatment as usual, or to a RT group in which parent-child dyads received four months of weekly parent-child sessions during which parents were coached to use RI strategies to enhance their interactions with their children.

Both studies assessed parent’s style of interaction with their children and child development. In addition, measures of parenting stress (PSI) and depression (CES-D)were collected at the beginning and completion of both interventions.

Results.  At the beginning of intervention, 35% of PLAY parents and 100% of RT parents reported clinical levels of parenting depression. symptoms Similarly, 40% of PLAY parents and 70% of RT parents reported clinical levels of parenting stress. Across both investigations there were highly significant RBI effects on the responsive and affective quality of parents’ interactions as well as on children’s development.  Clinical levels of parenting stress or depression did not impede parents from modifying their interactions or enhancing their children's development.  These RBIs resulted in greater than a 50% reduction in the percentage of parents reporting clinical levels of depression. Furthermore there was a 70% reduction in the percentage of RT parents with clinical levels of parenting stress.

Implications. Results from these in investigations suggest that parent psychosocial dysfunction does not prevent parents from participating in RBIs, and that participation in RBIs may have a significant effect on reducing parents' psychosocial dysfunction.