Impact of Mindfulness-Enhanced Pivotal Response Group Treatment on Parenting Stress: A Randomized Controlled Trial
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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 (Hayes and Watson, 2013). Elevated parenting stress has been shown to diminish positive treatment outcomes (Osborne et al., 2008), 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. Fifteen pairs of 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; n = 8) or psychoeducation-enhanced PRT (pPRT; n = 7) as an active control condition. Of these, five pairs completed each 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. Results provided mixed support for feasibility and efficacy of a multi-component group treatment approach. There was a low retention rate and the small sample sizes significantly decreased power. However, parents endorsed high satisfaction, demonstrated fidelity of PRT implementation, and children significantly increased their expressive language abilities. In regard to group-level analyses for primary and exploratory aims, the mPRT group showed significant decreases in parenting stress and increases in mindfulness. At the individual level, some parents in both groups showed positive changes in mindfulness, positive feelings toward child, and child problem behavior. Future directions should continue to explore the additive effects of mindfulness-based intervention on group-based parent-mediated treatments using larger sample sizes.
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