Leveraging Technology To Develop a Feasible,Acceptable,and Effective Alternative to In-Person Parent Education Sessions

PURPOSE: Parenting a child on the autism spectrum can be complex and stressful, and parents often face significant demands on their time and financial resources. However, parenting a child on the autism spectrum can also be associated with positive meaning, stronger families, and resilience (Bayat, 2007). In addition, parents are effective with using professional guidance to implement supports and interventions that improve outcomes for their child with ASD (Wong et al., 2015).

Unstuck and On Target is a cognitive behavioral intervention that has been developed for school- and home-based settings. Through two randomized comparison trials, Unstuck and On Target has been shown to improve executive functions (EF) and classroom behavior among children on the autism spectrum (Kenworthy, et al., 2014; Anthony et al., in prep). For the purposes of those trials, two in-person parent education sessions were provided to support parent implementation of the intervention. However, in-person trainings like these are often unfeasible for many families, risking additional barriers and related disparities in access. We developed an online parent education platform (e-Unstuck) to provide parents with a low-cost, accessible way to practice with EF strategies and connect their daily life experiences with their child to EF concepts through dynamic, interactive opportunities to individualize materials and videos that show: concepts in action; videos that highlight the lived experience of autism through interviews with an autistic self-advocate; interviews with other parents; and strategies in use with children. In this study, we explore whether e-Unstuck is an effective alternative to in-person parent education sessions.

DESIGN: We randomly assigned 85 parents of children on the autism spectrum (mean age= 10.3 years; mean IQ= 104) to participate in e-Unstuck (n=41) or two in-person education sessions (n=44).

METHOD: Outcome measures were all parent-rated, including: self-ratings of sense of parenting strain, empowerment, and competence in addition to ratings of their child’s EF difficulties and their contribution to challenges in daily life.

RESULTS: ANCOVAs assessing change over time as a result of parent training while controlling for pre-training baseline scores, child IQ, and parent education, revealed no group differences in outcomes (all p’s>0.27). Significant improvement in all parent self-ratings (Cohen’s d range=0.28-0.53), as well as parent ratings of their child’s executive function difficulties (Cohen’s ds=0.26,0.28), indicated that families in both groups benefitted from the training they received (all p’s<0.01). Parents rated acceptability and feasibility positively in both groups, with no significant differences between the groups.

CONCLUSION: e-Unstuck is an effective, feasible, and acceptable alternative to in-person parent education sessions. It uses the advantages of technology to improve access to training and support for families seeking to promote the generalization of EF skills.

References

Bayat, M. (2007). Evidence of resilience in families of children with autism. Journal of Intellectual Disability Research, 51(Pt 9), 702-714. doi:10.1111/j.1365-2788.2007.00960.x

Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., . . . Schultz, T. R. (2015). Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review. Journal of Autism and Developmental Disorders, 45(7), 1951-1966. doi:10.1007/s10803-014-2351-z

Kenworthy, L., Anthony, L. G., Naiman, D. Q., Cannon, L., Wills, M. C., Luong-Tran, C., . . . Wallace, G. L. (2014). Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. Journal of Child Psychology and Psychiatry and Allied Disciplines, 55(4), 374-383. doi:10.1111/jcpp.12161

Anthony et al., (in press). An Exploration of Possible Moderators in an Addressing Disparities Comparative Effectiveness Trial for Elementary Students with ASD or ADHD