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A Novel Group Parenting Intervention for Emotional and Behavioral Difficulties in Young Autistic Children: Autism Spectrum Treatment and Resilience (ASTAR): A Randomized Controlled Trial

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Tony Charman, Melanie Palmer, Dominic Stringer, Victoria Hallett, Joanne Mueller, Renee Romeo, Joanne Tarver, Juan Paris Perez, Lauren Breese, Megan Hollett, Thomas Cawthorne, Janet Boadu, Fernando Salazar, Mark O'Leary, Bryony Beresford, Martin Knapp, Vicky Slonims, Andrew Pickles, Stephen Scott, Emily Simonoff

Bibliographical note

Funding Information: The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. This trial summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-1211-20016). The views expressed in this presentation are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health. Additional funding for intervention materials was received from the Maudsley Charity (1157). M.K. receives support from the NIHR School for Social Care Research . A.P. and E.S. received support from the NIHR through a Senior Investigator Award (NF-SI-0617-10120, NF-SI-0514-10073) and from the NIHR Biomedical Research Centre at South London and Maudsley Foundation Trust (IS-BRC-1215-20018). Funding Information: The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. This trial summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-1211-20016). The views expressed in this presentation are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health. Additional funding for intervention materials was received from the Maudsley Charity (1157). M.K. receives support from the NIHR School for Social Care Research. A.P. and E.S. received support from the NIHR through a Senior Investigator Award (NF-SI-0617-10120, NF-SI-0514-10073) and from the NIHR Biomedical Research Centre at South London and Maudsley Foundation Trust (IS-BRC-1215-20018).Disclosure: Prof. Charman has received grant or research support from the Medical Research Council (UK), the National Institute for Health Research, Horizon 2020 and the Innovative Medicines Initiative (European Commission), Autistica, Epilepsy Research UK, the Baily Thomas Charitable Fund, the Charles Hawkins Fund, and the Waterloo Foundation. He has served as a consultant to F. Hoffmann-La Roche Ltd. and Servier. He has received royalties from Sage Publications and Guilford Publications. Prof. Pickles has received questionnaire royalties from Western Psychological Services. Prof. Simonoff has received grant or research support from the UK National Institute of Health Research, the European Commission, the UK Economic and Social Research Council, the UK Medical Research Council, the National Institute of Health Research Biomedical Research Centre at South London and Maudsley Foundation, the Psychiatry Research Trust, the Guy's and St. Thomas? Charitable Foundation Trust, and the Maudsley Charity. She has served on the advisory boards of the European ADHD Guidelines Group, Eunethydis, the Autistica Mental Health Steering Group, the National Autism Project Board, the Medical Research Council Neuroscience and Mental Health Board, the Central Institute for Mental Health, Manheim, Germany, and the Oak Foundation. She is author of the assessment tools Assessment of Concerning Behavior (copyright, Santosh and Simonoff, manuscript in preparation) and Observation Schedule for Children with Autism (in preparation). She has served on the editorial board of the British Journal of Psychiatry. She has received honoraria from the Royal College of Physicians as Senior Clinical Advisor for the National Institute of Health and Care Excellence. Drs. Palmer, Hallett, Mueller, Romeo, Tarver, Breese, Salazar, O'Leary, Profs. Beresford and Knapp, Dr. Slonims, Prof. Scott, Messrs. Stringer and Perez, Ms. Hollett, Mr. Cawthorne, and Ms. Boadu have reported no biomedical financial interests or potential conflicts of interest. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Objective: To examine the feasibility and preliminary efficacy of a group behavioral parenting intervention for emotional and behavioral problems (EBPs) in young autistic children. Method: This was a feasibility pilot randomized controlled trial comparing a 12-week group behavioral parenting intervention (Predictive Parenting) to an attention control (Psychoeducation). Parents of 62 autistic children 4 to 8 years of age were randomized to Predictive Parenting (n = 31) or Psychoeducation (n = 31). The primary outcome was a blinded observational measure of child behaviors that challenge. Secondary outcomes were observed child compliance and parenting behaviors; parent- and teacher-reported child EBPs; self-reported parenting practices, stress, self-efficacy, and well-being. Cost-effectiveness was also explored. Results: Recruitment, retention, completion of measures, treatment fidelity, and parental satisfaction were high for both interventions. There was no group difference in primary outcome: mean log of rate 0.18 lower (d, 90% CI = −0.44 to 0.08) in Predictive Parenting. Differences in rates of child compliance (0.44, 90% CI = 0.11 to 0.77), facilitative parenting (0.63, 90% CI = 0.33 to 0.92) and parent-defined target symptom change (−0.59, 90% CI −0.17 to −1.00) favored Predictive Parenting. There were no differences on other measures. Predictive Parenting was more expensive than Psychoeducation, with a low probability of being more cost-effective. Conclusion: Feasibility was demonstrated. There was no evidence from this pilot trial that Predictive Parenting resulted in reductions in child EBPs beyond those seen following Psychoeducation; in addition, the effect size was small, and it was more expensive. However, it showed superiority for child compliance and facilitative parenting with moderate effect sizes. Future, definitive studies should evaluate whether augmented or extended intervention would lead to larger improvements. Clinical trial registration information: Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com/ISRCTN91411078.

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