Emily Feinberg1, Marilyn Augustyn2, Elaine Fitzgerald3, Jenna Sandler4, Zhandra Ferreira-Cesar Suarez5, Ning Chen2, Howard Cabral6, William Beardslee7, Michael Silverstein2. 1. Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts2Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. 2. Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. 3. Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts4National Initiative for Children's Healthcare Quality, Boston, Massachusetts. 4. Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. 5. Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. 6. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts. 7. Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts.
Abstract
IMPORTANCE: The prevalence of psychological distress among mothers of children with autism spectrum disorder (ASD) suggests a need for interventions that address parental mental health during the critical period after the child's autism diagnosis when parents are learning to navigate the complex system of autism services. OBJECTIVE: To investigate whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child's diagnosis of ASD. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs that primarily serve low-income families. Participants were mothers of 122 young children (mean age, 34 months) who recently received a diagnosis of ASD. Among mothers assessed for eligibility, 17.0% declined participation. We report outcomes after 3 months of follow-up (immediate postdiagnosis period). INTERVENTIONS: Problem-solving education is a brief, cognitive intervention delivered in six 30-minute individualized sessions by existing staff (early intervention programs) or research staff without formal mental health training (autism clinic). MAIN OUTCOMES AND MEASURES: Primary outcomes were parental stress and maternal depressive symptoms. RESULTS:Fifty-nine mothers were randomized to receive PSE and 63 to receive usual care. The follow-up rate was 91.0%. Most intervention mothers (78.0%) received the full PSE course. At the 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%; adjusted relative risk [aRR], 0.17; 95% CI, 0.04 to 0.65). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance (5.7% vs 22.4%; aRR, 0.33; 95% CI, 0.10 to 1.08); however, the reduction in mean depressive symptoms was statistically significant (Quick Inventory of Depressive Symptomatology score, 4.6 with PSE vs 6.9 with usual care; adjusted mean difference, -1.67; 95% CI, -3.17 to -0.18). CONCLUSIONS AND RELEVANCE: The positive effects of PSE in reducing parenting stress and depressive symptoms during the critical postdiagnosis period, when parents are asked to navigate a complex service delivery system, suggest that it may have a place in clinical practice. Further work will monitor these families for a total of 9 months to determine the trajectory of outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01021384.
RCT Entities:
IMPORTANCE: The prevalence of psychological distress among mothers of children with autism spectrum disorder (ASD) suggests a need for interventions that address parental mental health during the critical period after the child's autism diagnosis when parents are learning to navigate the complex system of autism services. OBJECTIVE: To investigate whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child's diagnosis of ASD. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs that primarily serve low-income families. Participants were mothers of 122 young children (mean age, 34 months) who recently received a diagnosis of ASD. Among mothers assessed for eligibility, 17.0% declined participation. We report outcomes after 3 months of follow-up (immediate postdiagnosis period). INTERVENTIONS: Problem-solving education is a brief, cognitive intervention delivered in six 30-minute individualized sessions by existing staff (early intervention programs) or research staff without formal mental health training (autism clinic). MAIN OUTCOMES AND MEASURES: Primary outcomes were parental stress and maternal depressive symptoms. RESULTS: Fifty-nine mothers were randomized to receive PSE and 63 to receive usual care. The follow-up rate was 91.0%. Most intervention mothers (78.0%) received the full PSE course. At the 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%; adjusted relative risk [aRR], 0.17; 95% CI, 0.04 to 0.65). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance (5.7% vs 22.4%; aRR, 0.33; 95% CI, 0.10 to 1.08); however, the reduction in mean depressive symptoms was statistically significant (Quick Inventory of Depressive Symptomatology score, 4.6 with PSE vs 6.9 with usual care; adjusted mean difference, -1.67; 95% CI, -3.17 to -0.18). CONCLUSIONS AND RELEVANCE: The positive effects of PSE in reducing parenting stress and depressive symptoms during the critical postdiagnosis period, when parents are asked to navigate a complex service delivery system, suggest that it may have a place in clinical practice. Further work will monitor these families for a total of 9 months to determine the trajectory of outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01021384.
Authors: Sarabeth Broder-Fingert; Sarah Qin; Julia Goupil; Jessica Rosenberg; Marilyn Augustyn; Nate Blum; Amanda Bennett; Carol Weitzman; James P Guevara; Ada Fenick; Michael Silverstein; Emily Feinberg Journal: Autism Date: 2018-11-08
Authors: Christy Haakonsen Smith; Erin Turbitt; John Muschelli; Lori Leonard; Katie L Lewis; Brian Freedman; Michelle Muratori; Barbara B Biesecker Journal: J Genet Couns Date: 2017-09-06 Impact factor: 2.537