Parent-Implemented Instruction and Intervention
The recognized struggles parents face in raising youth with ASD have led to increased interest in the development of evidence-based, parent-focused interventions for ASD. In parent training (PT), caregivers are taught to implement specific procedures designed to improve parent-child interactions, decrease behavioral problems, and increase prosocial behaviors. Parent training is a fitting treatment model for several reasons:
- It is traditionally a time-limited approach (typically 10–20 sessions) delivered during brief (1–1.5 hour) weekly sessions;
- it has demonstrated efficacy in treating disruptive behavior in neurotypical children;
- it empowers caregivers by emphasizing their role as the change agent;
- it is more effective compared to interventions delivered by a therapist alone;
- it is deliverable in a wide range of service settings.
Finally, there is increased recognition that intensive interventions are costly and specialized and may not be available in all communities. Teaching caregivers to be the therapist for their child allows for delivery of treatment across settings and contexts. Find examples from literature here.
Intervention type
With guidance from a therapist, caregivers are taught to address disruptive behavior by attending to the child's prosocial behaviors, ignoring inappropriate behaviors, decreasing the use of punitive and coercive discipline strategies, and increasing the use of effective, appropriate, non-coercive child management strategies. These essential components are the centerpiece of PT for reducing behavioral problems. Common PT elements include role playing, guided implementation with the child in session to support parental skill acquisition, homework so that parents can practice applying strategies in real life, and follow up sessions to review and refine the behavioral techniques.
Behavioral mechanism(s)
Following education on the Antecedent-Behavior-Consequence model and functions of behavior, therapists may review with caregivers the following approaches: antecedent management strategies, consequence-based approaches, skill acquisition, and generalization and maintenance to promote stable change in the child and to enhance the caregivers’ abilities to apply skills learned in future situations and settings.
Severity and behavioral function considerations
PT is an approach that is well-suited for autistic youth who display mild to moderate behavioral problems and is delivered to caregivers who can apply in-session didactic and interactive teaching materials into home and community settings. PT may be more challenging for individuals who have severe behavioral problems (e.g., high frequency and intensity self-injurious behaviors) or in situations where the caregiver may report difficulties applying strategies consistently in the home or community. For example, a caregiver attempting an extinction procedure with an older individual who may be physically bigger and/or stronger than his parent may be better suited for trials conducted in well-controlled settings, with a high level of support provided by the therapist.
Caregiver, context and practical considerations
