Abstract
The ParentShip protocol is a multidimensional intervention for parents of adolescents with high-functioning autism spectrum disorder. Results from a pilot study display a significant improvement in adolescents’ participation and heightened parental resilience. Preliminary feasibility supports ParentShip as a strength-based family-centered intervention program. OT practitioners can benefit from this structured protocol, which enables parents to achieve their prioritized goals.
Primary Author and Speaker: Batel Wachspress
Additional Authors and Speakers: Tal Mazor-Karsenty
Contributing Authors: Adina Maeir
Parents of adolescents with Autism Spectrum Disorder (ASD) report significantly greater burden of care and concern for their children’s success than parents of adolescents with other developmental disorders and parents of younger children with ASD. There is a need for a direct and structured intervention for parents of adolescents with High Functioning ASD (HFASD) in which parents are the main target of intervention. The Parentship protocol is a validated short-term occupational therapy intervention for parents of adolescents with HFASD that aims to promote parental resilience and enhance adolescents’ participation in daily life. The aim of this study is to examine the Parentship feasibility.
Ten parents of adolescents with HFASD who reported difficulties or unmet functional needs in relation to raising their child participated in this pre-post pilot study. Participants were recruited using convenience sampling from community based autism centers and social media. All the adolescents (five males and five females) were between the ages of 12-17 and received a score indicating non typical functioning in at least one of the following areas: sensory processing, executive function, or social-communication skills. Adolescents with an untreated neurologic or psychiatric comorbidity that has a debilitating effect on functioning were excluded from the study.
An assessment of the adolescent’s multi-dimensional profile was made in the following dimensions: sensory-motor (Sensory Profile 2), cognitive-behavioral (The Behavior Rating Inventory of Executive Function–Parent), social- communicative (Social Skills Improvement System), and motivational (A questionnaire designed for this study). Each family participated in a series of 13 individual weekly sessions of 90 minutes each. During the sessions parents and therapist analyzed the adolescent’s personal profile, examined daily situations and identified barriers and bridges in the parent, the adolescent and the environment. In addition, parents set measurable and functional goals and practiced structured problem solving. Study results were analyzed at three time points- before intervention, immediately after intervention, and three months post intervention, using two outcome measures: The Autism: Parenting Questionnaire (APQ), measuring parental resilience, and the Canadian Occupational Performance Measure (COPM).
Preliminary results show significant improvement in COPM performance score from time 1 to time 2 for parents (Z= 2.66, p= .008) and adolescents (Z= 2.67, p= .008). Furthermore, results were maintained at time 3 for parents (Z= .67, p=NS) and adolescent (Z=.95, p=NS). APQ total scores improved from time 1 (M= 98.7, SD=8) to time 2 (M= 104, SD=9; Z=1.37, p= .17) and showed significant improvement from time 2 to time 3 (M= 111, SD=11) (Z=2.2, p= .028). Moreover, APQ results showed a medium effect size from time 1 to time 2 (Cohen’s d= 0.62) and from time 2 to time 3 (Cohen’s d= 0.65).
Results support the ParentShip as a strength-based family centered intervention program that provides parents of adolescents with HFASD with a deep understanding of their child’s unique profile, an opportunity to analyze everyday situations, and promotes them in acquiring practical tools and strategies for coping with everyday functional challenges. The Parentship intervention leads to significant improvement in adolescents’ participation and heightened parental resilience. The implications of this study on occupational therapy practice are that direct and structured work with parents, without the presence of the adolescent, can be an effective way to promote participation of adolescents with HFASD and parents as change agents for their children.
Lee, L. C., Harrington, R. A., Louie, B. B., & Newschaffer, C. J. (2008). Children with autism: Quality of life and parental concerns. Journal of Autism and Developmental Disorders, 38(6), 1147–1160. doi: 10.1007/s10803-007-0491-0
Wachspress, B., Maeir, A., & Mazor-Karsenty, T. (2018). Content Validity of the Parentship Protocol: A Multidimensional Intervention for Parents of Adolescents with High-Functioning Autism Spectrum Disorder. Physical & occupational therapy in pediatrics, doi:10.1080/01942638.2018.1500968
De Schipper, E., Lundequist, A., Coghill, D., de Vries, P. J., Granlund, M., Holtmann, M., ... & Singhal, N. (2015). Ability and disability in autism spectrum disorder: A systematic literature review employing the international classification of functioning, disability and health‐children and youth version. Autism Research, 8(6), 782-794. doi:10.1002/aur.1485
Bekhet, A. K., Johnson, N. L., & Zauszniewski, J. A. (2012). Resilience in family members of persons with autism spectrum disorder: A review of the literature. Issues in Mental Health Nursing, 33(10), 650-656. doi:10.3109/01612840.2012.671441