Intervention Packages: Behavioral Parent Training

In the previous sections, specific EBPs were described relative to their use as interventions or intervention components related to challenging behavior exhibited by individuals with ASD. While important to understand which approaches to intervention are supported by empirical evidence, it is also important to be aware that these EBPs are often incorporated into manualized and/or more comprehensive treatment packages. In the information that follows, approaches supported by at least one randomized controlled trial (as reported in Tarver et al., 2019) are briefly described.

Behavioral Parent Training

For challenging behavior that does not result in immediate danger and/or harm, behavioral parent training (BPT) may be appropriate and helpful. BPT is a parent-centered intervention that: (a) emphasizes the parent as the primary change agent throughout the course of intervention, (b) is manualized, and (c) is time limited (typically requiring between 10 and 16 weeks to complete).

Most often, BPT is delivered across weekly sessions in which a clinician works directly with parents. There are several BPT programs with strong evidence for families of neurotypical children (e.g., Incredible Years, Parent Child Interaction Therapy, Parent Management Training). However, evidence for BPT for parents of children with ASD is only now emerging. Tarver et al. (2019) conducted a meta-analysis of BPT programs for addressing challenging behavior exhibited by children with ASD. Their results noted that BPTs, including Child Directed Interaction Training (CDIT; PCIT), reduced disruptive behavior in one or more randomized controlled trial.

Three interventions, CDIT, PCIT, and Parent Management Training, have been designed for and/or shown to be effective for children who demonstrate the ability to communicate verbally and/or demonstrate expressive language skills.

Child Directed Interaction Training (CDIT)

CDIT is a play-based intervention in which parents are taught to set up positive and proactive play experiences through which to model and reinforce desired skills. This intervention has been shown to be effective for families of children on the autism spectrum between the ages of 3 and 12 years old with demonstrated cognitive functioning at the age of 2 years or older and who could speak at least 3 words (Ginn et al., 2017).

Parent-Child Interaction Therapy (PCIT)

PCIT is a well-established BPT program that teaches parents both the skills of child-directed interaction and has a compliance training portion through which parents are taught to implement a timeout following noncompliance. Solomon et al. (2008) demonstrated that PCIT was effective for reducing disruptive behavior exhibited by young children (between the ages of 5 and 12) with IQ scores equal to or greater than 70 (average IQ) and with good receptive and expressive language skills.

Parent Management Training

Sofronoff et al. (2016) worked with parents of children who had a diagnosis of Asperger Syndrome using an intervention they termed Parent Management Training. Importantly, this intervention is distinct from the well-established Parent Management Training for Disruptive Behavior (Forehand & Long, 1988). This intervention involved teaching parents skills to prevent and respond to challenging behavior as well as how to use comic strip conversations (Gray, 1994a) and social stories (Gray, 1994b). This parent training intervention resulted in significant reductions in disruptive behavior.

Five interventions, C-HOPE, Triple P, SSTP, PCSSTP, and RUBI have efficacy supporting their use for broader range of families of children on the autism spectrum.

COMPASS for Hope (C-HOPE)

C-HOPE is a BPT program designed to be delivered in a combined group and individual family format via telehealth across 8 weeks. Parents are provided with psychoeducation regarding autism and evidence-based interventions and are taught strategies to promote desired behavior and reduce challenging behavior. Kuravackel et al. (2018) demonstrated that C-HOPE was effective for reducing disruptive behavior of children between the ages of 3 and 12 years old with ASD.

Triple P (Positive Parenting Program)

Triple P is a well-established parent training program that has been adapted for use by families of children with ASD.

Steppingstone Triple P (SSTP)

SSTP is delivered across 9 sessions delivered weekly in a combination of group and individual formats. Sessions focus on teaching parents strategies to encourage desired behavior and prevent and discourage challenging behavior and has been shown to reduce challenging behavior exhibited by children with ASD in a randomized controlled trial (Whittingham et al., 2009).

Primary Care Stepping Stones Triple P (PCSSTP)

PCSSTP is a brief version of SSTP. In PCSTTP, a clinician helps a parent identify one or two specific concerns (e.g., aggression) that are focused on across brief, 15- to 30-minute sessions. This intervention has been found to be effective in several randomized controlled trials (Tellegan & Sanders, 2014; Zand et al., 2018).

Research Units in Behavioral Intervention (RUBI)

RUBI is a 14- to 16-week parent training program through which clinicians teach parents specific skills to promote desired behavior and prevent challenging behavior. RUBI also includes optional sessions focused on common concerns such as addressing sleep problems, toileting, and mealtime concerns. RUBI has been found to be effective for reducing challenging behavior in a randomized controlled trial (Bearss et al., 2015) and is discussed on the following page.