Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial

Karen Bearss; Cynthia Johnson; Tristram Smith; Luc Lecavalier; Naomi Swiezy; Michael Aman; David B. McAdam; Eric Butter; Charmaine Stillitano; Noha Minshawi; Denis G. Sukhodolsky; Daniel W. Mruzek; Kylan Turner; Tiffany Neal; Victoria Hallett; James A. Mulick; Bryson Green; Benjamin Handen; Yanhong Deng; James Dziura; Lawrence Scahill

doi:10.1001/jama.2015.3150

Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial

Karen Bearss, Cynthia Johnson, Tristram Smith, Luc Lecavalier, Naomi Swiezy, Michael Aman, David B. McAdam, Eric Butter, Charmaine Stillitano, Noha Minshawi, Denis G. Sukhodolsky, Daniel W. Mruzek, Kylan Turner, Tiffany Neal, Victoria Hallett, James A. Mulick, Bryson Green, Benjamin Handen, Yanhong Deng, James DziuraLawrence Scahill^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

251 Citations (Scopus)

Abstract

IMPORTANCE: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials.

OBJECTIVE: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior.

DESIGN, SETTING, AND PARTICIPANTS: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.

INTERVENTIONS: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies.

MAIN OUTCOMES AND MEASURES: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25%reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS: At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95%CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2%in parent education (3.8 to 2.5) (treatment effect, -0.7; 95%CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001).

CONCLUSIONS AND RELEVANCE: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01233414.

Original language	English
Pages (from-to)	1524-1533
Number of pages	10
Journal	JAMA : the journal of the American Medical Association
Volume	313
Issue number	15
DOIs	https://doi.org/10.1001/jama.2015.3150
Publication status	Published - 21 Apr 2015

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10.1001/jama.2015.3150

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Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., McAdam, D. B., Butter, E., Stillitano, C., Minshawi, N., Sukhodolsky, D. G., Mruzek, D. W., Turner, K., Neal, T., Hallett, V., Mulick, J. A., Green, B., Handen, B., Deng, Y., ... Scahill, L. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. JAMA : the journal of the American Medical Association, 313(15), 1524-1533. https://doi.org/10.1001/jama.2015.3150

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title = "Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial",

abstract = "IMPORTANCE: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.INTERVENTIONS: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. MAIN OUTCOMES AND MEASURES: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25%reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS: At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95%CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2%in parent education (3.8 to 2.5) (treatment effect, -0.7; 95%CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01233414.",

author = "Karen Bearss and Cynthia Johnson and Tristram Smith and Luc Lecavalier and Naomi Swiezy and Michael Aman and McAdam, {David B.} and Eric Butter and Charmaine Stillitano and Noha Minshawi and Sukhodolsky, {Denis G.} and Mruzek, {Daniel W.} and Kylan Turner and Tiffany Neal and Victoria Hallett and Mulick, {James A.} and Bryson Green and Benjamin Handen and Yanhong Deng and James Dziura and Lawrence Scahill",

year = "2015",

month = apr,

day = "21",

doi = "10.1001/jama.2015.3150",

language = "English",

volume = "313",

pages = "1524--1533",

journal = "JAMA : the journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association (AMA)",

number = "15",

}

Bearss, K, Johnson, C, Smith, T, Lecavalier, L, Swiezy, N, Aman, M, McAdam, DB, Butter, E, Stillitano, C, Minshawi, N, Sukhodolsky, DG, Mruzek, DW, Turner, K, Neal, T, Hallett, V, Mulick, JA, Green, B, Handen, B, Deng, Y, Dziura, J & Scahill, L 2015, 'Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial', JAMA : the journal of the American Medical Association, vol. 313, no. 15, pp. 1524-1533. https://doi.org/10.1001/jama.2015.3150

Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. / Bearss, Karen; Johnson, Cynthia; Smith, Tristram et al.
In: JAMA : the journal of the American Medical Association, Vol. 313, No. 15, 21.04.2015, p. 1524-1533.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder

T2 - A randomized clinical trial

AU - Bearss, Karen

AU - Johnson, Cynthia

AU - Smith, Tristram

AU - Lecavalier, Luc

AU - Swiezy, Naomi

AU - Aman, Michael

AU - McAdam, David B.

AU - Butter, Eric

AU - Stillitano, Charmaine

AU - Minshawi, Noha

AU - Sukhodolsky, Denis G.

AU - Mruzek, Daniel W.

AU - Turner, Kylan

AU - Neal, Tiffany

AU - Hallett, Victoria

AU - Mulick, James A.

AU - Green, Bryson

AU - Handen, Benjamin

AU - Deng, Yanhong

AU - Dziura, James

AU - Scahill, Lawrence

PY - 2015/4/21

Y1 - 2015/4/21

N2 - IMPORTANCE: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.INTERVENTIONS: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. MAIN OUTCOMES AND MEASURES: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25%reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS: At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95%CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2%in parent education (3.8 to 2.5) (treatment effect, -0.7; 95%CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01233414.

AB - IMPORTANCE: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.INTERVENTIONS: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. MAIN OUTCOMES AND MEASURES: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25%reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS: At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95%CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2%in parent education (3.8 to 2.5) (treatment effect, -0.7; 95%CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01233414.

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Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial

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