Category: Autism Spectrum and Developmental Disorders
Keywords: Autism Spectrum Disorders | Aggression / Disruptive Behaviors / Conduct Problems | Parent Training
Presentation Type: Symposium
Approximately 50% of children with Autism Spectrum Disorder (ASD) exhibit behavioral problems including tantrums, noncompliance, and aggression. Until recently, empirical support for parent training (PT) in children with ASD and disruptive behavior was sparse. The Research Units in Behavioral Interventions (RUBI) PT program demonstrated significant reductions in disruptive behavior of children with ASD compared to a Parent Education program when delivered 'one-to-one.' A promising expansion involves group delivery of RUBI-PT, as this modality could increase access to care and social support for families. This open-label pilot study evaluated the feasibility and preliminary efficacy of the RUBI PT program in a group format for parents of children with ASD and disruptive behavior. Feasibility indicators included therapist fidelity to treatment and parent attrition, attendance, in-session goal attainment and overall satisfaction with the program. Efficacy was evaluated through change on the parent-rated Aberrant Behavior Checklist-Irritability subscale (ABC-I) and Home Situations Questionnaire–Autism Spectrum Disorder (HSQ-ASD) as well as independent evaluator ratings of overall improvement on the Clinical Global Impression-Improvement (CGI-I) scale. Parents of children ages 3-8 with a community diagnosis of ASD and disruptive behavior were enrolled in the 24-week study (16 weeks of treatment; 8 week follow-up). The RUBI PT curriculum is based on principles of applied behavior analysis and provides parents with specific techniques to manage child behavioral problems. For group delivery, the protocol was modified to include 10 core, 1 supplemental (e.g. feeding, toileting, sleep) and 1 parent-child coaching session delivered across 16 weeks. Assessments occurred at Baseline, Weeks 8 and 16, with a two-month follow up at week 24. Eighteen children were screened, 16 met eligibility criteria and 15 were enrolled. Mean age was 5.8 ± 2.4 years; 53% were males; 60% were African American; 50% had an IQ < 70; mean baseline ABC-I=27.1 ± 7.65 and HSQ-ASD= 2.87 ± 1.64. Four cohorts of parents (3 to 4 parents per group) were enrolled in the study. Thirteen of 15 families (86.7%) completed the 16-week treatment. Feasibility outcomes show 95.8% therapist fidelity to treatment, high parental engagement in treatment (88.2% of core sessions attended) and 93.8% attainment of in-session goals. Parents reported greater confidence in managing problem behaviors. The ABC-I decreased 30.4% while the HSQ-ASD decreased 27.9%. Six of 15 (40%) participants were rated as much/very much improved on the CGI-I. Three families remain in follow-up; results will be included in the presentation. A critical priority in the ﬁeld is the translation of evidence-based interventions to sustainable community practice. Group based interventions provide the opportunity to increase access to services for families who otherwise face extensive barriers to care. Feasibility indicators suggest that the RUBI PT program is acceptable to parents and can be reliably delivered by therapists. Efficacy findings suggest lower positive response and change in primary outcomes as compared to prior trials. Discussion will include suggested modifications to enhance efficacy outcomes of the RUBI Group PT program in subsequent trials.
Saturday, November 18
1:45 PM – 3:15 PM
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