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One of the most frequently asked questions about any type of therapy is “How much will this cost.” When it comes to finding skilled help, the costs can and will add up. We’d like to think that we’d spend as much as it takes to improve outcomes for ourselves and our loved ones, but not everyone has the privilege of thinking in these terms. Many times, to keep costs under control, we’ll try to do as much as we can ourselves. However, when it comes to complex tasks like occupational, physical, or behavioural therapy, many wonder if they’re capable. 

Yet consider this: who is more knowledgeable about your child? Who is with them, observing them the most? Who sees triggers first? Who knows what happens when they’re triggered? Parents and caregivers, that’s who. Given this simple fact, it’s likely that the best person to lead interventions and therapies with your child is … you. 

But … confusion and anxiety set in. “Don’t I need a license?” “How on earth can I do this with my already busy schedule?” “I’m no expert.” Well, yes. You are. When it comes to your child, you are THE expert.

 

Parent-led Interventions

Parent-led or parent-mediated interventions can take many forms. You might not know where to begin, but this topic has been studied for decades. There’s a large body of research out there that can help pave the way in your decision-making; not only if you’ll do it but what specifically you’ll do once you choose to take the lead with your child’s therapy. Let’s take a look at some of what’s out there.

One popular therapy is Parent-Child Interaction Therapy (PCIT). PCIT is an intervention developed by Sheila Eyberg to treat children between ages 2 and 7 with disruptive behaviour problems. Zlomke and Jeter (2020) examined the effectiveness of PCIT, comparing the outcomes for autistic and neurotypical youth. Their results indicate that PCIT significantly improves parent-reported disruptive behaviour in autistic children at levels comparable to neurotypical children.

Oono et al (2013) conducted a review of 17 studies from six countries (USA, UK, Australia, Canada, Thailand and China). Their review finds some evidence for the effectiveness of parent-led interventions, most particularly in proximal indicators within parent-child interaction, but also in more distal indicators of child language comprehension and reduction in behavioural severity. Their review reinforces the need for attention to be given to early intervention service models that enable parents to contribute skillfully to the treatments presented to their children.

But what about school-aged children? Is there a role for parents when schools administer therapeutic services? Rispoli et al (2019) examined Family–School Partnerships (FSPs). Their findings suggest a need for greater focus on measuring parent behavioural outcomes when evaluating intervention effectiveness and developing or refining interventions to include meaningful family–school partnering.

Then there’s COVID-19. How do parents receive the necessary training to successfully implement interventions at home if everyone is locked down? Parsons et al (2017) surveyed parent training programs to improve the social behaviour and communication skills of autistic done remotely. They found that there is evidence that parent-mediated intervention training delivered remotely may improve parent knowledge, increase parent intervention fidelity, and improve the social behaviour and communication skills of autistic children.

Althoff et al (2019) round out our efforts here with a systematic review of parent-mediated interventions for autistic children. Their results suggest that parent-mediated interventions for autistic children can improve various aspects of communication and behavioural symptoms. Published at around the same time, Trembath et al (2019) attempted to examine factors that may influence the feasibility, appropriateness, effectiveness, and generalizability of parent-mediated interventions for autistic children. In this review, they identified a range of child, parent, and study design factors that may influence intervention outcomes and ultimately the uptake of these approaches in the community. They suggested that research in this area could be further improved by ensuring that studies include diverse groups of children and parents, and by using study designs that help to establish not only if interventions work, but for whom they work best and why.

The thread that can be found in all the research is the importance of the willingness of parents to engage in the work. It seems obvious that the more parents are willing to cheerfully do the work, the better the outcomes will be. But working with children that have challenging behaviours can be stressful. Fung et al (2018) examined the impact of a brief Acceptance and Commitment Therapy (ACT) group intervention, led by parents, among a cohort of 33 mothers of autistic children. Their results provide preliminary evidence that improvements observed in depression and stress may be mediated by cognitive fusion and action-values consistency … meaning, help is out there.

To conclude, if you’re considering a parent-led intervention to address your child’s challenging behaviour, there’s a lot of evidence that (a) they work, and (b) you are the key to success. Don’t just take my word for it. Take a cruise through the references below and find out for yourselves.

 

If you’d like more information about this topic, contact the professionals at Autism360 who can connect you with the appropriate resources.

About the author: Jim Hoerricks, PhD is a non-verbal autistic researcher, lecturer, presenter, best-selling author, elected official, and credentialled special education teacher who resides in a small mountain community north of Los Angeles, California.

References

Althoff, C. E., Dammann, C. P., Hope, S. J., & Ausderau, K. K. (2019). Parent-Mediated Interventions for Children With Autism Spectrum Disorder: A Systematic Review. The American Journal of occupational therapy: official publication of the American Occupational Therapy Association, 73(3), 7303205010p1–7303205010p13. https://doi.org/10.5014/ajot.2019.030015 

Freitag, C. M., Jensen, K., Teufel, K., Luh, M., Todorova, A., Lalk, C., & Vllasaliu, L. (2020). Empirisch untersuchte entwicklungsorientierte und verhaltenstherapeutisch basierte Therapieprogramme zur Verbesserung der Kernsymptome und der Sprachentwicklung bei Klein- und Vorschulkindern mit Autismus-Spektrum-Störungen [Empirically based developmental and behavioral intervention programs targeting the core symptoms and language development in toddlers and preschool children with autism spectrum disorder]. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 48(3), 224–243. https://doi.org/10.1024/1422-4917/a000714 

Fung, K., Lake, J., Steel, L., Bryce, K., & Lunsky, Y. (2018). ACT Processes in Group Intervention for Mothers of Children with Autism Spectrum Disorder. Journal of Autism and developmental disorders, 48(8), 2740–2747. https://doi.org/10.1007/s10803-018-3525-x 

Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., Le Couteur, A., Leadbitter, K., Hudry, K., Byford, S., Barrett, B., Temple, K., Macdonald, W., Pickles, A., & PACT Consortium (2010). Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial. Lancet (London, England), 375(9732), 2152–2160. https://doi.org/10.1016/S0140-6736(10)60587-9 

Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and clinical psychology, 83(3), 554–563. https://doi.org/10.1037/a0039080 

Koly, K. N., Martin-Herz, S. P., Islam, M. S., Sharmin, N., Blencowe, H., & Naheed, A. (2021). Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review. PloS one, 16(3), e0247432. https://doi.org/10.1371/journal.pone.0247432 

Laugeson E. A. (2017). Disruptive behaviour may hinder the acquisition of daily living skills for youth with autism spectrum disorder. Evidence-based mental health, 20(1), e2. https://doi.org/10.1136/eb-2016-102534 

Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). The Cochrane Database of systematic reviews, (4), CD009774. https://doi.org/10.1002/14651858.CD009774.pub2 

Parsons, D., Cordier, R., Vaz, S., & Lee, H. C. (2017). Parent-Mediated Intervention Training Delivered Remotely for Children With Autism Spectrum Disorder Living Outside of Urban Areas: Systematic Review. Journal of medical Internet research, 19(8), e198. https://doi.org/10.2196/jmir.6651 

Rispoli, K. M., Mathes, N. E., & Malcolm, A. L. (2019). Characterizing the parent role in school-based interventions for autism: A systematic literature review. School psychology (Washington, D.C.), 34(4), 444–457. https://doi.org/10.1037/spq0000283 

Scahill, L., Bearss, K., Lecavalier, L., Smith, T., Swiezy, N., Aman, M. G., Sukhodolsky, D. G., McCracken, C., Minshawi, N., Turner, K., Levato, L., Saulnier, C., Dziura, J., & Johnson, C. (2016). Effect of Parent Training on Adaptive Behavior in Children With Autism Spectrum Disorder and Disruptive Behavior: Results of a Randomized Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 55(7), 602–609.e3. https://doi.org/10.1016/j.jaac.2016.05.001 

Trembath, D., Gurm, M., Scheerer, N. E., Trevisan, D. A., Paynter, J., Bohadana, G., Roberts, J., & Iarocci, G. (2019). A systematic review of factors that may influence the outcomes and generalizability of parent-mediated interventions for young children with autism spectrum disorder. Autism research: official journal of the International Society for Autism Research, 12(9), 1304–1321. https://doi.org/10.1002/aur.2168 

Zlomke, K. R., & Jeter, K. (2020). Comparative Effectiveness of Parent-Child Interaction Therapy for Children with and Without Autism Spectrum Disorder. Journal of autism and developmental disorders, 50(6), 2041–2052. https://doi.org/10.1007/s10803-019-03960-y

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