Development and trial of an ACT workshop for Parents of a child with ASDAssociate Professor Kate Sofronoff

School of Psychology

University of Queensland

Acknowledgements

Workshop developed by Dr Jeanie Sheffield, Dr Koa Whittingham and Dr Kate Sofronoff (University of Queensland)

Workshop evaluated by Melissa Smith (University of Queensland)

Randomised controlled trial conducted by Dr Celia Bird and Dr Lize Andrews (University of Queensland)

Why ACT for Parents of a Child with Autism

Frequently ask parents to participate in effortful programs for their child

Do not account for parent’s own distress Many parents report that they struggle to accept the challenges faced by their child

Many parents report that they continue to be angry and/or sad about the challenges faced

Development of Workshop

Workshop developed based on the Blackledge and Hayes (2006) 2-day workshop for parents of children with ASD

Used a measure of Acceptance/Experiential Avoidance developed for ASD as suggested by Blackledge and Hayes (2006)

Workshop – 1 day Delivered by 3 psychologists

OVERVIEW OF THE WORKSHOP9.00 amWelcome and introduction to the workshop and a brief explanation that we would be doing some things that are a bit differentIntroductions – therapists and participantsStress and parenting -> battlefield metaphor

Weapons used – how workable – creative hopelessness

Values – as distinct from goalsExercises completed and group discussionMorning Tea 10.15 – 10.45

The struggle – quicksand metaphor + othersLetting go of the struggle – bus metaphor

Lunch 12.45 – 1.30Mindfulness and acceptance

Exercises – breath, emotions, thoughtsAfternoon Tea 3.00 – 3.15

Making a plan – acts towards valuesGroup discussion – acts, barriers and possible solutionsFinish 4.30

Sample Characteristics

Child characteristics as described by parent report on the SDQ indicated that 82.4% were placed in the abnormal range (Muris et al., 2003)

Parent distress scores indicated that 63.6% of these parents were in the range for adjustment problems

Significant correlation between difficult child behaviour and parenting distress .48

Significant inverse correlation between parenting distress and acceptance (AAAQ) -.77 – i.e. experiential avoidance

Parent Adjustment-DASS Total

Parent Adjustment- Depression

Qualitative Data

Values identified were across various domains 31% personal growth 27% health and physical well-being 19% friendship and social relationships 11% family relations These parents reported that they focused heavily on child-related activities to the exclusion of many other domains

Post and Follow-UP

Asked parents to identify 1-2 goals that they would like to move towards that would bring them closer to the values they had identified

Goal Achievement Scale At 4 weeks after the workshop

52% of the parents reported that they had moved 50% - 100% closer to achieving goals related to their stated values

At 3 months after the workshop 85.8% reported that they had moved 50% - 100% closer to

achieving goals related to their stated values

Aids to Change

Time management ‘Using time more wisely’

Acceptance ‘Thoughts, feelings regardless of whether or not they are wanted’

Commitment ‘Increased motivation to move in direction of what is important’

Personal growth ‘changes in views about what is important’

Family and children ‘knowing I need to take care of myself to take best care of my

children’

Most Helpful Strategies

Acceptance (33%) ‘Accepting the situation not avoiding’

Mindfulness (22%) ‘Breathing exercise where you bring your thoughts back’

Commitment (11%) ‘Being aware of values and making achievable goals’

Cognitive diffusion (11%) ‘Thoughts come and go, no extra effort to try to stop them’

Most Used Strategies

Mindfulness (39%) Using breathing to stay in the present

Emotion passing (22%) Letting thoughts come and go

Acceptance (26%) Accepting autism

Room for emotions (13%) Visualising fear, making room for it as an object

Conclusions

Results were promising but not as good as we had expected

Qualitative results better than quantitative Parents said they would like to do this in the context of a program for their children

So…..

A Randomised controlled Trial

Two ACT parent sessions prior to child and parent participation in an intervention to increase child use of appropriate affection and friendship behaviours

Same content as the workshop – 2 x 2 hour sessions

Groups randomised to intervention or wait-list 57 parents in the trial No significant differences found on any measure pre to post or follow-up in the RCT

Feedback from parents was very positive

Pooled data from total sample Significant change pre to post Depression Anxiety and Stress Scale – total

Depression Anxiety Stress

Parenting Stress Index AAAQ

DASS

Qualitative data - rct

Very similar to that of the workshop Most used strategies

Mindfulness (35%) Values (23%) Cognitive defusion (19.7%)

Most helpful strategies Mindfulness (28.3%) “mindfulness breathing exercise” Values and goals (25%) “parenting multiple kids with ASD can

mean we’re always in reactive mode and can lose sight of the big picture”

Cognitive defusion (22%) “silly voice breaks the authority of negative thoughts”

Goal attainment At post intervention – 67.8% rated between 50% and 100% - had

achieved goals that moved them closer to values. Another 35% had achieved 25% of where they wanted to be with goals towards values

Conclusions

We have continued to include the ACT components in trials with parents of children with a disability, both ASD and other disabilities

Parents relate very positively to the content and the processes of the ACT material

Qualitative data continues to be strong We are possibly not measuring the right outcomes to demonstrate the benefits of the ACT work in this context