Children with autism often display challenging behaviors, but new research suggests that parents can learn to better handle tantrums and aggression, which may improve their child's overall functioning.
"Parent training is one of the best, evidence-supported treatment interventions in child psychiatry for other conditions, such as for children with ADHD or children with oppositional defiant disorder," said senior study author Lawrence Scahill, a professor at Yale University School of Nursing and Child Study Center in New Haven, Conn. "But strangely enough, it had never really been tried with children with autism or with developmental disabilities, so we had to make our own manual."
The study involved 124 children aged 4 to 13 with an autism spectrum disorder and serious behavioral issues, including daily, prolonged tantrums, aggression or self-injurious behavior. The children were prescribed risperidone (Risperdal), an antipsychotic drug approved by the U.S. Food and Drug Administration for treating severe behavioral problems in children with autism.
Half the children and their parents were also assigned to a six-month, structured "parent training" program. Parents were asked to identify the most difficult, disruptive behaviors and to think about what preceded the incidents and why the child might do it. They then worked with counselors to devise strategies to avoid the triggers and help the child respond better to the everyday stressors.
Parents who underwent training reported a greater decrease in problem behaviors than the parents of children on medication alone, researchers found. By the end of the study, the average dose of risperidone was lower for kids in the parent-training group.
"On the tantrums, the aggression and the self-injury, the combination of medications and parent training was better," said Scahill. "How much better? Not a huge amount, but it was an incremental improvement over an already effective improvement."
Parents who received training also reported improvements on a test known as the Vineland Adaptive Behavior Scale, which measures how well a child does everyday activities, such as communicating, socializing, dressing, eating at the table and going to school.By diminishing serious problem behaviors, such as tantrums and aggression, children's skills in other areas improved, but the difference was not statistically significant.Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication, restricted interests and behaviors, repetitive behaviors and sometimes intellectual disability.
The study is published in the February issue of the Journal of the American Academy of Child & Adolescent Psychiatry.Researchers plan to share the manual with the public. The training involves in-person sessions with a parent-training therapist, phone sessions and home visits that take place over several months.
Dr. Joseph Horrigan, assistant vice president and head of medical research for Autism Speaks, said studies like this provide more evidence that parent training can help kids and their families cope with autism-related behavioral problems.The approach is "pragmatic and practical," he added. "We're all doing our best as parents, but we can all use a second set of eyes and an expert opinion to better our game, and this is shedding that light on the technique."
It also makes the point that medication isn't the only way to help kids with autism, he added.
In any case, not all children with autism should or would be prescribed risperidone, experts said. The drug, also used to treat schizophrenia and bipolar disorder, is for children with very serious behavioral issues that affect their ability to function in daily life in an extreme way, Scahill said.
Parents shouldn't take the term "parent training" to mean they are doing something wrong, Scahill said. Rather, with an expert's help they may learn tricks that make their life -- and their child's life -- a little easier.
"One of the first things I tell parents, we are not blaming the parents," he said. "Children with an autism spectrum disorder present unique challenges to parents. Children with autism spectrum disorder who also have disruptive behaviors present even more challenges."
"If a parent had a child with a serious medical condition like diabetes or asthma, there are all kinds of things that parent would have to learn that average parents don't, and so it is with children with autism spectrum disorder," he added. "There is no reason to think a parent would automatically know how to manage these problems."
