New programs reduce parenting stress, challenging behavior in kids with autism

UNIVERSITY PARK, Pa. — Raising a child with autism spectrum disorder (ASD) can be difficult, especially when that child engages in challenging behavior.

"Parents report that challenging behavior is one of the most difficult parts of parenting a child with ASD," said Tracy Raulston, who stated that 40 to 60 percent of children with ASD exhibit some form of challenging behavior such as biting, hitting or hair-pulling.

"Parents of children with ASD are at an increased risk for parenting stress, with some studies suggesting their stress is four times greater than that of their peers," she said.

Raulston is an assistant professor of education (special education) in Penn State's College of Education and a board-certified behavior analyst. She studies the effectiveness of applied behavioral analytic (ABA) treatments in caregiver training programs that take place in home-based settings where families can embed what they have learned in their natural family environment.

"Strategies based in the science of ABA are effective to treat challenging behavior in young children with autism," Raulston said. "But a lot of times ABA is applied in a clinical-based setting and parents have reported that they're not able to adhere to the strategies over time, which makes them not sustainable and, therefore, less effective.

"This research is different in that we are applying ABA principles and strategies within the context of natural family routines," she explained.

Raulston worked with ABA expert Meme Hieneman, and Nell Caraway and Jordan Pennefather of Trifoia, a digital learning developer based in Eugene, Oregon, to conduct three studies that trained parents of children with ASD to implement ABA and mindfulness techniques to help improve their child’s behavior and their own stress. One was a small, experimental, direct behavior observation study; the remaining two were group studies using self-report measures conducted via online surveys. The studies sought to test the effectiveness of a mindfulness-infused, behavioral parent-training program developed specifically for caregivers of children with autism. Some of their findings have been published in the peer-reviewed medical journal Research in Autism Spectrum Disorders.

The program – Practiced Routines – was designed to train caregivers either in-person or online with the intent to improve children's challenging behavior while simultaneously decreasing parents' stress by teaching parents function-based behavioral strategies and mindfulness techniques.

There is a high correlation between parenting stress and child challenging behavior — as child challenging behavior increases so does parent stress. Decreasing both of these factors was a goal of Raulston's research.

"The idea is that if we can teach parents to increase their mindfulness, their awareness of their intentions — why is a specific family routine important — then it will allow them to follow through with parenting and behavior strategies and it also will align with their values," Raulston said.

Preliminary results show that various family, parent and child characteristics influence response to training. Variables such as socioeconomic status, family support, severity of autism and challenging behavior impact a family's ability to succeed with these types of interventions, Raulston said. Caregiver characteristics such as predisposition to mental health illnesses also can influence results.

"Depending on the state of residence, children with autism may only receive early intervention home visits a few times per month and depending on their insurance plan, they may not receive intensive ABA therapy at all," she said. "Access to services is especially an issue for those who live in rural areas or experience other barriers."

There also is a shortage of ABA behavior health service providers, which means that families are often placed on waitlists. Because of this, Raulston strove to develop a flexible program that included components such as instructional videos that parents complete on their own, and could be facilitated either by educational and behavioral health practitioners in person or online.

"Practiced Routines is different because its focus is on training parents in ABA and mindfulness strategies within the context of family routines to help with their child's challenging behavior and parent stress at the same time, not providing direct services," Raulston said. She argues that the addition of mindfulness training may enable a parent to maintain behavior strategies over time, which may make it more sustainable.

"We found that parents reported increasing their behavioral strategy use," Raulston said. "That means things like reinforcement, praising positive behavior, rearranging the environment using proactive strategies and teaching the child replacement skills. Also, parents reported that their stress decreased, as did their child's challenging behavior."

It's important to look at the effects of parent training programs in home and family settings, Raulston said, because that is where children spend most of their time.

"If a child is with a parent or caregiver the majority of their time, it is arguably most important to train the parent," she said. "We're hoping to find ways that we can treat both challenging behavior and parent stress at the same time to hopefully help parents sustain and adapt practices over time as their child develops and changes."

With autism rates on the rise — currently, one in 58 children are diagnosed with ASD in the United States — and a shortage of practitioners, it is increasingly important to find ways to reach families, especially those families on wait-lists, vulnerable families who rely on the educational system and for whom services are very low in dose, Raulston said.

"We need programs that can possibly prevent challenging behavior and stress from getting worse so that we can prevent children with ASD from developing chronic problem behaviors, social skills problems and academic problems, and so that we can help families live happier lives," she said.

Last Updated November 19, 2018