How are parental mental health and parenting practices associated with externalizing behaviors among young children with autism in China? A cross-sectional study and indirect effect analysis.

Children with autism are more likely to exhibit externalizing behaviors than children without autism. A cross-sectional study was undertaken to investigate how parental mental health status and parenting practices contributed to the variance in externalizing behaviors among families of young children with autism in Chinese mainland, and whether parenting behaviors had any indirect effects on the relationship between parental mental health symptoms and externalizing behaviors. Data were drawn from the baseline assessment of a quasi-experimental study of a parent training program delivered to Chinese caregivers of children with autism aged 3 to 6 from diverse backgrounds (N = 111). Results showed that parental mental health symptoms and parenting behaviors explained the variance in child externalizing behaviors. Parental mental health problems and parental over-reactivity were linked to higher levels of child externalizing behaviors, whereas positive parenting was associated with less frequent externalizing behaviors. Positive parenting partially explained the relationship between parental mental health symptoms and externalizing behaviors. The findings of this study highlight the importance of actively attending to the psychological and parenting needs of caregivers in autism treatment programs. It points to the need for the development of culturally sensitive strategies to promote parental mental health and increase the use of positive parenting skills among parents of children with autism.

Parenting Interventions That Promote Child Protection and Development for Preschool-Age Children with Developmental Disabilities: A Global Systematic Review and Meta-Analysis.

Global guidelines emphasize the critical role of responsive caregiving in terms of reducing violence against children and promoting early childhood development. However, there is an absence of global evidence synthesis on the effects of early childhood parenting programs for children with developmental disabilities. This systematic review and meta-analysis aims to investigate the effectiveness of parenting interventions delivered for preschool-age children with developmental disabilities in reducing violence against children, altering violence-related factors, and promoting child development. We searched for randomized controlled trials with inactive control. Estimates were pooled using robust variance estimations. Meta-regressions were conducted to explore sources of heterogeneity. In all, 33 studies met the inclusion criteria. The results showed that parenting programs improved child behavior, parental mental health, parenting practices, parental self-efficacy, parent-child interaction, child language skills, and child social skills post-intervention. No studies provided data on the actual occurrence of violence against children. Effects might vary by diagnosis, delivery modality, and world region. The findings supported the delivery of parenting programs to alter factors associated with violence against children and promote child language and social skills for families of young children with developmental disabilities, especially attention deficit hyperactivity disorder, autism, intellectual disability, and language disorders. More research using rigorous methods, long-term follow-ups, and transparent reporting is needed, particularly within more low- and middle-income countries.

Controlled Trial of a Short-term Intensive Parent Training Program within the Context of Routine Services for Autistic Children in China.

Recent systematic reviews found limited rigorous research conducted to date of the effectiveness of parent training programs in reducing behavioral problems for autistic children in low- and middle-income countries. This study is aimed at evaluating the effectiveness of a short-term intensive parent training program for autistic children aged three to six in the context of routine service provision in China. A quasi-experiment was conducted involving the local implementing organization and using a waitlist control. Data were collected at baseline and immediate post-intervention. The primary outcome was child behavioral problems measured using the Child Behavior Checklist Externalizing scale. Between-group comparisons used a difference-in-differences design with propensity score weighting to reduce sources of bias. A process evaluation was undertaken in parallel to assess participant involvement, program acceptability, and delivery. The protocol was prospectively registered with ClinicalTrials.gov (NCT04257331). The final sample size was 111 (treatment: 63; comparison: 48). Results suggest that the program was associated with improvements in child externalizing behaviors (b = -2.71, 95% CI [-5.23, -0.18]), parental mental health symptoms (b = -5.96, 95% CI [-11.74, -0.17]), over-reactive parenting (b = -0.63, 95% CI [-0.98, -0.27]), and parental knowledge (b = 2.08, 95% CI [2.07, 2.17]). Exploratory analysis of factors related to implementation indicated that baseline parental mental health was related to participant engagement, and that satisfaction and engagement levels were potentially linked to positive treatment effects. Findings suggest that short-term intensive parent training programs that are provided by trained non-specialists, could potentially be used as an alternative to traditional prohibitively costly services that are delivered intensively for consecutive years in low-resource contexts. Follow-ups are needed to investigate its long-term benefits.

En revisiones sistemáticas recientes apenas se han encontrado investigaciones rigurosas que se hayan llevado a cabo hasta la fecha sobre la eficacia de los programas de formación parental para disminuir los problemas comportamentales de niños autistas en países de renta baja y media. En este estudio se pretende analizar la eficacia de un programa de formación parental intensivo a corto plazo para niños autistas de entre tres y seis años en el contexto de la prestación rutinaria de servicios en China. Se llevó a cabo un cuasiexperimento con la organización local a cargo de la aplicación y como control una lista de espera. Se recogieron datos de línea base e inmediatamente posteriores a la intervención. El resultado primario fueron los problemas comportamentales del niño medidos con la "Child Behavior Checklist Externalizing scale". Para las comparaciones entre grupos se utilizó un diseño de "diferencia en diferencias" con ponderación de la puntuación de propensión para disminuir las fuentes de error. En paralelo se llevó a cabo una evaluación de procesos para medir la implicación de los participantes, la aceptación del programa y su aplicación. El protocolo se registró prospectivamente en ClinicalTrials.gov (NCT04257331). La muestra final quedó constituida por 111 sujetos (de los cuales 63 constituían el grupo de tratamiento y 48 el de comparación). Los resultados indican que el programa se asociaba con la mejora de los comportamientos externalizadores infantiles (b = -2.71, 95% CI [-5.23, -0.18]), la salud mental parental (b = -5.96, 95% CI [-11.74, -0.17]), parentalidad sobrerreactiva (b = -2.71, 95% CI [-5.23, -0.18]) y conocimientos parentales (b = 2.08, 95% CI [2.07, 2.17]). El análisis exploratorio de los factores relativos a la aplicación indicaba que la salud mental parental en la línea base se relacionaba con la implicación de los participantes y que el grado de satisfacción y de compromiso se relacionaba potencialmente con los efectos positivos del tratamiento. Los resultados indican que los programas de formación parental intensivos a corto plazo impartidos por personal no especialista entrenado podrían utilizarse potencialmente como alternativa a los servicios con un coste prohibitivo dispensados de modo intensivo en años consecutivos en contextos de recursos limitados. Se necesitan estudios de seguimiento para valorar sus ventajas a largo plazo.

A virtuous circle: Stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China.

LAY ABSTRACT: While much knowledge about autism derives from high-income countries, most people diagnosed with autism reside in low- and middle-income countries, where little is documented in terms of local interventions. This is also true for parent training programmes for families of autistic children. An evaluation was conducted to understand the effects of a short-term intensive parent training programme delivered in routine services for families of autistic children in China. This study reported results from the in-depth interviews with 14 participating caregivers and group discussions with eight group leaders. The interviews and discussions were aimed at learning (1) to what extent the programme components were deemed acceptable, (2) what affected caregivers' attendance and engagement in the programme and (3) what affected group leaders' delivery of the programme. Findings suggested that future parent training programmes provide adequate opportunities for caregivers to practice and receive feedback; group support; coaching experience tailored to individual challenges; more autism-related knowledge, resources and activities for children and extended family members; and organisational support to group leaders. This study highlights the value of qualitative research and points to the need for more empirical studies to address the recommendations, so that research findings can be better utilised to promote practices.