Mindfulness-Enhanced Pivotal Response Group Treatment on Parenting Stress

Not Applicable

Completed

Brief Summary: 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.

Detailed Description: 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.

Recruitment & Eligibility

Inclusion Criteria

For children: minimally verbal or nonverbal, 1.5 to 6 years old, current or suspected autism spectrum disorder diagnosis, demonstrated ability to make meaningful vocalizations
For parents: willingness to attend group treatment sessions, record weekly videos, and share videos in a group setting

Exclusion Criteria

For children, no active medical problems (e.g., unstable seizure disorders)
For parents, no severe mental health problems (e.g., suicidal intent, psychosis)

Arm && Interventions

Group	Intervention	Description
pPRT	Pivotal Response Treatment	psychoeducation-enhanced Pivotal Response Treatment: group pivotal response training for parents that is supplemented with psychoeducation about stress and stress reduction
mPRT	Pivotal Response Treatment	mindfulness-enhanced Pivotal Response Treatment: group pivotal response training for parents that is supplemented with mindfulness strategies

Primary Outcome Measures

Name	Time	Method
Therapist fidelity observation	weekly, from start of treatment through 12 weeks	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)
Child utterances - observation	follow-up, at 3 months after the last treatment session	level or amount of child utterances during a structured laboratory task observation
Parent fidelity observation	weekly, from start of treatment through 12 weeks	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)
Parenting Stress Index, 4th edition	follow-up, at 3 months after last treatment session	level of parent-reported stress
Autism Parenting Stress Index	follow-up, at 3 months after last treatment session	level of parent-reported stress specific for parents of young autistic children
Subjective Units of Parenting Stress Scale	follow-up, at 3 months after last treatment session	level of parent-reported stress immediately following the structured lab observation

Secondary Outcome Measures

Name	Time	Method
Parent Feelings Questionnaire	follow-up, at 3 months after last treatment session	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
Five Facet Mindfulness Questionnaire	follow-up, at 3 months after last treatment session	parent-reported propensity toward mindfulness in everyday life; 5 point scale from never true to always true; higher scores mean more mindfulness
Positive and Negative Affect Schedule	follow-up, at 3 months after last treatment session	parent-reported positive and negative affect in adults; 5 point scale from very slightly to extremely; higher scores mean higher levels of the feeling
Acceptance and Action Questionnaire	pre-treatment, at intake	parent-reported level of experiential avoidance, on a 7 point scale from never true to always true; higher scores indicate more avoidance
Child Behavior Checklist for ages 1.5 to 5	follow-up, at 3 months after last treatment session	parent-reported measure of child emotional and behavioral concerns; converted to t-scores; higher scores indicate higher levels of the behavior problem

Locations (1): Virginia Tech Autism Clinic
🇺🇸
Blacksburg, Virginia, United States