Acceptance and Commitment Therapy for the Parents of Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: La thérapie d’acceptation et d’engagement pour les parents d’enfants et d’adolescents atteints de troubles du spectre de l’autisme : une revue systématique et une méta-analyse d’essais contrôlés à répartition aléatoire

Abstract

Background

Parents of children with autism spectrum disorder (ASD) experience significantly higher levels of stress, anxiety and depression. Acceptance and Commitment Therapy (ACT) has emerged as a promising intervention; however, the evidence remains inconsistent. This meta-analysis aims to evaluate the efficacy of ACT-based interventions in parents of children and adolescents with ASD.

Methods

In February 2026, we conducted a systematic search of PubMed, Scopus, Web of Science, Cochrane Library and Embase for randomized controlled trials (RCTs) assessing ACT-based interventions in parents of children/adolescents with ASD. For the meta-analysis, we used R software (version 4.5.0) with RStudio (2024.12.1 + 563) and the meta package.

Results

We included seven RCTs with a total of 698 participants. Acceptance and Commitment Therapy significantly reduced parenting stress compared to control conditions, as measured by the Parenting Stress Index – Short Form Total Stress (mean difference [MD] = −7.05, 95 per cent CI −9.90 to −4.19, p < 0.0001, I² = 0 per cent), with consistent improvements across all subscales (Parental Distress, Parent–Child Dysfunctional Interaction and Difficult Child). Acceptance and Commitment Therapy also significantly improved psychological flexibility on the Acceptance and Action Questionnaire-II and Parenting Sense of Competence scale. For child outcomes assessed in our analysis, ACT significantly reduced total difficulties on the Strengths and Difficulties Questionnaire (MD = −2.80, 95 per cent CI −4.71 to −0.88, P = 0.004, I² = 0 per cent) and conduct problems (MD = −0.98, 95 per cent CI −1.62 to −0.33, P = 0.003, I² = 0 per cent).

Conclusion

Acceptance and Commitment Therapy-based interventions may be effective for reducing parenting stress, improving psychological flexibility, enhancing parenting competence and reducing child behavioural difficulties in parents of children with ASD. However, the limited number of studies and clinical heterogeneity might limit our findings, highlighting the need for future large-scale RCTs with longer follow-up.

Plain Language Summary Title

Does acceptance and commitment therapy help parents of children with autism?

Plain Language Summary

Parents of children with autism often experience high levels of stress, anxiety and emotional challenges. This study looked at whether a type of psychological support called Acceptance and Commitment Therapy (ACT) can help improve parents’ well-being.

We reviewed results from seven high-quality studies involving 698 parents. These studies compared ACT with usual care or no treatment. We found that parents who received ACT had lower stress levels and felt more confident in their parenting. They were also better able to handle difficult thoughts and emotions, which helped them cope more effectively with daily challenges. In addition, children of parents who received ACT showed some improvements in behavior, especially fewer conduct problems and overall difficulties. However, ACT did not significantly improve all areas of children’s emotional or social functioning. Overall, ACT appears to be a helpful approach for supporting parents of children with autism. It focuses on helping parents accept difficult feelings, stay present, and act according to their values, rather than trying to eliminate stress completely. However, the number of studies was small, and the programs varied in how they were delivered. More research is needed to confirm these findings and to understand long-term effects.