This category includes interventions that are primarily aimed at equipping families with the skills, knowledge and support they need to facilitate positive outcomes for their children. This category includes programs such as Hanen ‘More than Words’, Earlybird programs and other parent training interventions. Results of individual studies and systematic reviews are presented in Table 2.
Table 2: Review of recent (2005–May 2011) research literature on family based studies and autism
Whittingham, K.S.K., Sheffield, J. & Sanders, M.R. (2009). Stepping Stones Triple P: an RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. Journal of Abnormal Child Psychology, 37(4), 469–480.
Stepping Stones Triple P, randomised controlled trial. This was a good quality study (SMRS = 3.95) with significant reductions in child behaviour problems, improvement in parenting styles, greater parental efficacy at follow up.
Keen, D., Couzens, D., Muspratt, S & Rodger, S. (2010). The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence. Research in Autism Spectrum Disorders, 4(2), 229–241.
Good quality study (3.72) comparing parent supported intervention (workshops & visits) with self-directed video based activities. Greater social communication skills reduced parenting stress levels.
Osterling, I., Visser, J., Swinkels, S., Rommelse, N., Donders, R., Woudenberg, T., et al. (2010). Randomized controlled trial of the focus parent training for toddlers with autism: 1-year outcome. Journal of Autism & Developmental Disorders, 40(12), 1447–1458.
Good quality study (3.76) comparing groups of children accessing good quality intervention, with one group receiving additional focused parent training. No difference was found between parent training group and care as usual (though ‘care as usual’ was very comprehensive).
Carter, A., Messinger, D.S., Stone, W.L., Celimli, S., Nahmias, A.S. & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry 52(7), 741–752.
Hanen More Than Words, good quality study (4.15). No main effect for child outcomes (compared with control group) but results indicated better outcomes for children with lower interest in toys and other play objects at time 1.
Pillay, M., Alderson-Day, B., Wright, B., Williams, C. & Urwin, B. (2011). Autism Spectrum Conditions – Enhancing Nurture and Development (ASCEND): An evaluation of intervention support groups for parents. Clinical Child Psychology and Psychiatry, 16(1), 5–20.
Parent training course, low quality study (2.26). All data parent self-report. No comparison group. Reported improvements in parent knowledge and child behaviour but interpret with caution.
McConachie, H. & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120–129.
Overall outcome: Due to a number of methodological shortcomings in all studies and small sample sizes, it was not possible to establish the effectiveness of parent-mediated intervention for young children with autism at this time. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression. All studies included were performed before 2005 (outside this review’s criteria).
2.4.1 Summary of current research evidence for family based interventions
The current review identified a small number of good quality studies indicating some positive outcomes of family based interventions on a number of outcomes. These outcomes included significant reductions in child behaviour problems, improvement in parenting styles, and greater parental efficacy following the Triple P ‘Stepping Stones’ parent training, and greater social communication, reduced parenting stress levels for parent intervention group compared when compared to a video training group. However a further two good quality studies found no positive effects compared to their comparison groups. Of note, each of the studies evaluated different interventions so caution is required in interpreting overall outcomes and more research is required.
The recent Comparative Effectiveness Review by Warren et al (2011) also identified a small number of studies of parent training and low intensity interventions, including the recent ‘PACT’ (Preschool Autism Communication Trial) research (Green et al., 2010) and concluded that “Less intensive interventions to provide parent training for bolstering social communication skills and managing challenging behaviours may be useful for younger children with ASDs, particularly to improve social communication, language use, and potentially symptom severity and family functioning. However, while parent training programs can modify parenting behaviours during interactions, data are limited about their contribution to specific child improvements in the short- and long-term beyond simple language gains for some children”(p.101).