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NIMHANS & JIPMER researchers prove PMTs to improve parental stress, and enhance coping

In India, the typical age of Autism Spectrum Disorder(ASD) diagnosis is roughly 3–6 years, and there is a two-year delay between symptom recognition and treatment commencement across various health care settings. Parents' involvement in the treatment of children with ASD is seen as a critical tactic. In resource-limited contexts, parents and parent-mediated interventions play a critical role in enhancing cost and accessibility.

When compared to parents of typically developing children, parents of children with ASD face higher levels of stress in the personal and social worlds. Parents with lower stress levels have been demonstrated to have better intervention outcomes, and treatment-related positive outcomes, in turn, have a favourable influence on parental stress. Parental stress was also found to be increased by the absence of progress in child-related outcomes.

The study looks at the acceptability and practicality of a brief parent-mediated home-based intervention for children with autism spectrum disorder (ASD) that may be delivered in resource-constrained settings, with a focus on alleviating parental stress from a socio-cultural standpoint. A total of 50 children (2–6 years old) with a DSM-5 diagnosis of ASD were randomly assigned to one of two groups: intervention or active control. The intervention was designed to be provided in five outpatient sessions over the course of 12 weeks and was based on a naturalistic developmental behavioural approach that focused on joint attention, imitation, and social and adaptive skills. The shortness and outpatient-based delivery were chosen to meet the needs of the patient community as well as the existing healthcare system. To relieve additional stress on participating families, the research exams and treatments were planned during usual outpatient visits.

The roadmap of the intervention looked like this:

  • Visits 1 and 2: Pre-intervention assessment, parent education, and stress management from a cultural standpoint

  • Intervention: Visits 1 through 3

  • Visits 3–5: Follow-up, intervention review, and ongoing support

At 4, 8, and 12 weeks, all of the children were followed. When compared to the control group, parents of children randomised to the intervention group reported larger improvements in parental stress and child outcome indicators. With high fidelity measures and retention rates, the intervention was shown to be acceptable and practicable.

One could summarize the findings as such-

  • Parental stress was reduced in the first four weeks of the trial, and parental competence improved dramatically from eight to twelve weeks. Reduced stress may have enhanced parental involvement in interventions, resulting in improved competence. As parents gain mastery of the learned intervention strategies, more involvement and comfort with them may have contributed to increasing competence. Improvements in perceived competence and the capacity to contribute successfully to their child's treatment process may have also contributed to a decrease in parental stress.

  • After 12 weeks of intervention, the majority of parents reported an improvement in perceived stress and coping, with a substantial difference in favour of the parent-mediated intervention group. Similar findings were obtained in studies where brief parent-mediated therapies (12 weeks) were found to dramatically reduce parental stress.

  • Parental stress has been studied from multiple perspectives in autism interventions, including (1) whether incorporating parents as therapists increase parental stress and (2) whether parental stress influences child-related outcomes. In comparison to the usual treatment group, studies on long-term outcomes (1–2 years) found no increase in parental stress in the parent-mediated intervention group.

  • Few Asian and Indian studies have employed CARS (Childhood Autism Rating Scale) to assess autism severity and found that three months of parent-mediated therapies resulted in a significant change in scores.

Thus, it is clear that parent-mediated treatments that can be delivered at the point of contact can help to alleviate delays in intervention commencement and prepare the family for more comprehensive centre-based therapies. The 'professional-as-consultant' and 'parent-as-therapist' models can help close the current gap in the healthcare system.

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Article Source: Manohar, H., Kandasamy, P., Chandrasekaran, V. et al. Brief Parent-Mediated Intervention for Children with Autism Spectrum Disorder: A Feasibility Study from South India. J Autism Dev Disord49, 3146–3158 (2019).

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