An opportunistic 2-year follow-up of a parenting intervention for young children with autism spectrum disorder (ASD) found small, but significant results. These findings were published in the Journal of the American Academy of Child & Adolescent Psychiatry.
The Autism Spectrum Treatment and Resilience (ASTAR) study was a pilot randomly controlled trial that was part of the Improving Autism Mental Health (IAMHealth) program in the United Kingdom. Parents of 62 children with ASD were recruited between 2017 and 2018 and randomly assigned to receive predictive parenting (n=31) or psychoeducation (n=31) interventions.
In reaction to the COVID-19 pandemic, the parents were recontacted between June and September 2020 and asked to complete a questionnaire about the impact of COVID-19 and a subset of parents were invited to participate in semi-structured interviews conducted online between August and October 2020. For this analysis, the magnitude of the original ASTAR interventions during a period of stress (COVID-19) were assessed.
The children of parents randomly assigned to receive predictive parenting or psychoeducation had mean ages of 6.5 (SD, 1.2) and 6.8 (SD, 1.1) years at baseline, 81% and 81% were boys, 52% and 55% were White, and 35% and 35% attended special education schools, respectively.
During the pandemic, 12.9%-16.1% of parents worked more hours than usual, 6.5%-12.9% of parents were furloughed, 3.2%-12.9% of parents worked fewer hours than usual, and 3.2%-9.7% of parents were dismissed from work. The parents reported a level of financial concern of 2.00-2.28 points on a 5-point scale; and 40.0%-62.5% of children were able to attend school in-person on some days.
At the conclusion of the ASTAR trial, no significant effect of the interventions on Aberrant Behavior Checklist (ABC) scores were reported (d, -0.03; 95% CI, -0.26 to 0.21; P =.834). However, a significant effect of predictive parenting was observed during the COVID-19 pandemic (d, -0.33; 95% CI, -0.65 to -0.01; P =.046).
Similarly, no effect on Autism Parenting Stress Index (APSI) scores were reported at the trial conclusion (d, -0.01; 95% CI, -0.32 to 0.33; P =.973), but the predictive parenting intervention was favored during COVID-19 (d, -0.31; 95% CI, -0.59 to -0.03; P =.029).
These effect sizes were small and were attenuated in the area under the curve (AUC) analyses for both ABC (coefficient, -170.79; P =.146) and APSI (coefficient, -133.89; P =.270) outcomes.
During the survey, the parents who received predictive parenting reported that they learned tools that became useful in the pandemic, such as use of family rules and routines, praise, simplifying language, using sensory items and strategies, and parental self-care.
These findings may have been biased by relying only on parent self-report.
Study authors concluded, “Our findings from this opportunistic follow-up study highlight the need for careful consideration of measuring the effects of behavioral parenting interventions in autistic child populations (ie, how much time after intervention is needed for parents to adaptively implement novel strategies, and in what contexts effects are most likely to be demonstrated).”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Palmer M, Leno VC, Hallett V, et al. Effects of a parenting intervention for emotional and behavioral problems in young autistic children under conditions of enhanced uncertainty: two-year follow-up of a pilot randomized controlled trial cohort (ASTAR) during the United Kingdom COVID-19 pandemic. J Am Acad Child Adolesc Psychiatry. 2023;S0890-8567(22)01979-7. doi:10.1016/j.jaac.2022.09.436