Effect of Parent Training vs Parent Education on Behavioral Problems in Children With Autism Spectrum Disorder: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE: To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS: This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014. INTERVENTIONS: Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. MAIN OUTCOMES AND MEASURES: Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS: At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01233414.
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Research interventions have demonstrated the efficacy of PT interventions to improve the behavioral performance of children, increase parents' ability to manage children, and decrease the presence of problem behaviors.
“Research interventions have demonstrated the efficacy of these interventions to improve the behavioral performance of children, increase parents’ ability to manage children, and decrease the presence of problem behaviors [17].”
From The effect of acceptance and commitment therapy for improving psychological well‐being in parents of individuals with autism spectrum disorders: A randomized controlled trial (2021) · cites this paper as [17]
The Results report greater reductions in disruptive behavior and noncompliance with parent training than with parent education among children with autism spectrum disorder. The Methods > Treatments section describes teaching parents management strategies, but the reported outcomes do not establish that parents’ ability to manage their children increased. The claim also describes children generally, whereas this trial studied children with autism spectrum disorder and behavioral problems. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNumerous studies have examined the effectiveness of PT interventions to improve health outcomes for children with ASD.
“Numerous studies have examined the effectiveness of PT interventions to improve health outcomes for children with ASD [17,37,38].”
There is some evidence for the use of CBT for effectively treating anxiety in people with ASD who do not have cognitive delays or language problems.
“There is some evidence for the use of cognitive-behavioural therapy (CBT) for effectively treating anxiety in people with ASD who do not have cognitive delays or language problems”
From Autism spectrum disorder (2020) · cites this paper as [197]
The Discussion describes a trial of parent training versus parent education for disruptive behavior in children with ASD, not CBT for anxiety. Searches for CBT, anxiety, and cognitive or language limitations found no passage addressing the attributed claim. The Methods mention a receptive-language exclusion criterion, but it does not establish the claimed treatment effect. (LLM, conf=0.76)
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“Numerous studies have examined the effectiveness of PT interventions to improve health outcomes for children with ASD [17,37,38].”
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- Authors
- Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., McAdam, D. B., Butter, E., Stillitano, C., Minshawi, N., Sukhodolsky, D. G., Mruzek, D. W., Turner, K., Neal, T., Hallett, V., Mulick, J. A., Green, B., Handen, B., Deng, Y., Dziura, J., & Scahill, L.
- Affiliations
- Emory University (US)
- University of Pittsburgh (US)
- University of Rochester Medicine (US)
- The Ohio State University (US)
- Indiana University Indianapolis (US)
- Nationwide Children's Hospital (US)
- Yale University (US)
- Arizona State University (US)
- King's College London (GB)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2015-04-21
- Volume
- 313
- Issue
- 15
- Pages
- 1524
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC9078140
- OpenAlex
- W2162520210
- Cited by
- 454
- References
- 26
- Citations by year
- 2026: 46 · 2025: 53 · 2024: 41 · 2023: 37 · 2022: 51 · 2021: 58 · 2020: 46 · 2019: 36 · 2018: 29 · 2017: 27 · 2016: 24 · 2015: 6
- FWCI
- 17.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000042)
- National Institute of Mental Health (MH080965, R01MH080965, MH081221, R01MH080906, MH081148, R01MH081105, MH081105, U54MH066397, K01MH079130, R01MH081221, MH080906, MH079130, R01MH081148)
- National Center for Research Resources (UL1RR025008, KL2RR024138, UL1RR024139)
- National Center for Advancing Translational Sciences
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, disruptive behavior, parent training, parent education, behavioral interventions, irritability, non-compliance, Aberrant Behavior Checklist, children, parent-mediated intervention, home visits, treatment efficacy, Clinical Global Impression Scale, treatment discontinuation
- MeSH terms
- Behavior Therapy, Child, Child Behavior Disorders, Child Development Disorders, Pervasive, Female, Health Education, Humans, Male, Parents, Single-Blind Method
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