Monday, September 28, 2009

Parental Education Program Improves Mental Health and Adjustment in Parents of Children with Autism

Research indicates that parents of children with autism experience a high level of stress. Parent training interventions reflect an attempt to address this stress and improve parental mental health. In Tonge et al.’s (2006) study, parents of preschool children recently diagnosed with autism were sampled from four geographically separate metropolitan and rural regional assessment services for young children suspected of having autism. The sample was assigned to either the intervention group (n=70) or control group (n=35). Parents from the intervention group were further randomly assigned to a parent education and behavior management (PEBM) group (n=35) or a parent education and counseling (PEC) group (n=35). Subjects were administered a questionnaire at pre-intervention, post-intervention, and six-month follow-up. Parental health was determined using the General Health Questionnaire, a widely-used reliable, and valid self-administered adult screening test designed to detect mental health issues in community settings. Results showed that both interventions improved the mental health and well-being of parents with children recently diagnosed with autism, especially among parents who had preexisting mental health problems. There were no statistically significant results supporting the superiority of either PEBM or PEC.

The authors anticipate several potential threats to validity, and attempt to minimize these threats through the study design. First, by sampling populations in geographically distant rural and urban communities, the investigators attempted to control cross-contamination of groups as a threat to validity. Second, the investigators made attempts to control for any threats to internal or construct validity by training therapists to strictly follow guidelines for the specific interventions and providing supervision and training to therapists throughout the study. Therapists also administered both treatments and were rotated between therapies. The investigators videotaped a random 10% of the intervention group for content review and intervention adherence. Third, the authors address timing of measurement as a potential threat to external validity by testing all subjects six months after the study. Consequently, results showed that alleviation of symptoms became more apparent over the long-term, reflecting a possible cumulative effect of treatment. Nevertheless, the study also exhibits limitations. By selecting samples from rural and urban communities, access to services may have created notable differences between the groups. Because parents were included in the study based on their children’s diagnosis, the group may exhibit wide variation in regards to mental health. This diversity of subject characteristics made it difficult for the investigators to determine a difference between groups. Overall, the study reveals promising findings about the effectiveness of parent training as an important element of interventions for children with autism.

Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., King, N., and Rinehart, N. (2006). Effects of parental mental health of an education and skills training program for parents of young children with autism: A randomized control trial. Journal of the American Academy of Child and Adoelscent Psychiatry, 45(5), 561-569.

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