This project tests the feasibility and preliminary proof of concept for a mindfulness-enhanced adaptation of Pivotal Response Treatment on parenting stress and child communication, using a randomized controlled design.
One of the core features of Autism Spectrum Disorder (ASD), social communication impairment, presents in a variety of ways, including reduced functional language use and social initiations, which often warrant intensive intervention services. Additionally, parents of children with ASD demonstrate increased levels of parenting stress when compared to parents of typically developing children and children with developmental delays. Elevated parenting stress has been shown to diminish positive treatment outcomes, which lends support to develop methodologies to concomitantly target child and parent behaviors. The current randomized control trial (RCT) uses a dual-pronged approach to directly target both child communication deficits and parenting stress within a group format. This RCT combined an empirically supported behavioral therapy, Pivotal Response Treatment (PRT), with components from Acceptance and Commitment Therapy and Mindful Parenting for reducing parenting stress. Caregivers and their minimally or pre-verbal child with diagnosed or suspected ASD were randomly assigned to one of the following supplemental conditions: mindfulness-enhanced PRT (mPRT) or psychoeducation-enhanced PRT (pPRT) as an active control condition. The current study assessed feasibility and acceptability in addition to demonstrating proof of concept in regard to additive effects of mPRT compared to pPRT.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
15
Group-based parent training to teach parents behavioral strategies based on principles of learning to motivate their child.
Virginia Tech Autism Clinic
Blacksburg, Virginia, United States
Therapist fidelity observation
observation at 30-second intervals; number out of 10 pivotal response therapy components observed for each 30-second interval of the recording and then averaged over the length of the recording (which were 5-10 minutes long)
Time frame: weekly, from start of treatment through 12 weeks
Child utterances - observation
level or amount of child utterances during a structured laboratory task observation
Time frame: pre-treatment at intake
Child utterances - observation
level or amount of child utterances during a structured laboratory task observation
Time frame: mid-treatment, at 6 weeks from start of treatment
Child utterances - observation
level or amount of child utterances during a structured laboratory task observation
Time frame: weekly, from start of treatment through 12 weeks
Child utterances - observation
level or amount of child utterances during a structured laboratory task observation
Time frame: post-treatment, at 12 weeks from start of treatment
Child utterances - observation
level or amount of child utterances during a structured laboratory task observation
Time frame: follow-up, at 3 months after the last treatment session
Parent fidelity observation
observation at 30-second intervals; number out of 10 pivotal response therapy components observed for each 30-second interval of the recording and then averaged over the length of the recording (which were 5-10 minutes long)
Time frame: weekly, from start of treatment through 12 weeks
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Parenting Stress Index, 4th edition
level of parent-reported stress;
Time frame: pre-treatment at intake
Parenting Stress Index, 4th edition
level of parent-reported stress
Time frame: mid-treatment, at 6 weeks from start of treatment
Parenting Stress Index, 4th edition
level of parent-reported stress
Time frame: post-treatment, at 12 weeks from start of treatment
Parenting Stress Index, 4th edition
level of parent-reported stress
Time frame: follow-up, at 3 months after last treatment session
Autism Parenting Stress Index
level of parent-reported stress specific for parents of young autistic children
Time frame: pre-treatment at intake
Autism Parenting Stress Index
level of parent-reported stress specific for parents of young autistic children
Time frame: mid-treatment, at 6 weeks from start of treatment
Autism Parenting Stress Index
level of parent-reported stress specific for parents of young autistic children
Time frame: post-treatment, at 12 weeks from start of treatment
Autism Parenting Stress Index
level of parent-reported stress specific for parents of young autistic children
Time frame: follow-up, at 3 months after last treatment session
Subjective Units of Parenting Stress Scale
level of parent-reported stress immediately following the structured lab observation, with 0 signifying no stress and 100 signifying extreme stress
Time frame: pre-treatment at intake
Subjective Units of Parenting Stress Scale
level of parent-reported stress immediately following the structured lab observation, with 0 signifying no stress and 100 signifying extreme stress
Time frame: mid-treatment, at 6 weeks from start of treatment
Subjective Units of Parenting Stress Scale
level of parent-reported stress immediately following the structured lab observation, with 0 signifying no stress and 100 signifying extreme stress
Time frame: post-treatment, at 12 weeks from start of treatment
Subjective Units of Parenting Stress Scale
level of parent-reported stress immediately following the structured lab observation
Time frame: follow-up, at 3 months after last treatment session
Parent Feelings Questionnaire
parent-report of positive and negative feelings toward the child; 5 point scale from definitely untrue for me to definitely true for me; higher scores mean higher levels of the feeling
Time frame: pre-treatment, at intake
Parent Feelings Questionnaire
parent-report of positive and negative feelings toward the child; 5 point scale from definitely untrue for me to definitely true for me; higher scores mean higher levels of the feeling
Time frame: mid-treatment, at 6 weeks from start of treatment
Parent Feelings Questionnaire
parent-report of positive and negative feelings toward the child; 5 point scale from definitely untrue for me to definitely true for me; higher scores mean higher levels of the feeling
Time frame: post-treatment, at 12 weeks from start of treatment
Parent Feelings Questionnaire
parent-report of positive and negative feelings toward the child; 5 point scale from definitely untrue for me to definitely true for me; higher scores mean higher levels of the feeling
Time frame: follow-up, at 3 months after last treatment session
Positive and Negative Affect Schedule
parent-reported positive and negative affect in adults; 5 point scale from very slightly to extremely; higher scores mean higher levels of the feeling
Time frame: pre-treatment, at intake
Positive and Negative Affect Schedule
parent-reported positive and negative affect in adults; 5 point scale from very slightly to extremely; higher scores mean higher levels of the feeling
Time frame: mid-treatment, at 6 weeks from start of treatment
Positive and Negative Affect Schedule
parent-reported positive and negative affect in adults; 5 point scale from very slightly to extremely; higher scores mean higher levels of the feeling
Time frame: post-treatment, at 12 weeks from start of treatment
Positive and Negative Affect Schedule
parent-reported positive and negative affect in adults; 5 point scale from very slightly to extremely; higher scores mean higher levels of the feeling
Time frame: follow-up, at 3 months after last treatment session
Five Facet Mindfulness Questionnaire
parent-reported propensity toward mindfulness in everyday life; 5 point scale from never true to always true; higher scores mean more mindfulness
Time frame: pre-treatment, at intake
Five Facet Mindfulness Questionnaire
parent-reported propensity toward mindfulness in everyday life; 5 point scale from never true to always true; higher scores mean more mindfulness
Time frame: mid-treatment, at 6 weeks from start of treatment
Five Facet Mindfulness Questionnaire
parent-reported propensity toward mindfulness in everyday life; 5 point scale from never true to always true; higher scores mean more mindfulness
Time frame: post-treatment, at 12 weeks from start of treatment
Five Facet Mindfulness Questionnaire
parent-reported propensity toward mindfulness in everyday life; 5 point scale from never true to always true; higher scores mean more mindfulness
Time frame: follow-up, at 3 months after last treatment session
Acceptance and Action Questionnaire
parent-reported level of experiential avoidance, on a 7 point scale from never true to always true; higher scores indicate more avoidance
Time frame: pre-treatment, at intake
Child Behavior Checklist for ages 1.5 to 5
parent-reported measure of child emotional and behavioral concerns; converted to t-scores; higher scores indicate higher levels of the behavior problem
Time frame: mid-treatment, at 6 weeks from start of treatment
Child Behavior Checklist for ages 1.5 to 5
parent-reported measure of child emotional and behavioral concerns; converted to t-scores; higher scores indicate higher levels of the behavior problem
Time frame: post-treatment, at 12 weeks from start of treatment
Child Behavior Checklist for ages 1.5 to 5
parent-reported measure of child emotional and behavioral concerns; converted to t-scores; higher scores indicate higher levels of the behavior problem
Time frame: follow-up, at 3 months after last treatment session