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Parent training boosts medication effect for autism [Updated]

November 20, 2009 | 12:50 pm

Life with a child who has a pervasive developmental disorder such as autism or Asperger's syndrome is often a storm of tantrums, irritability, impulsive behavior and obstinacy — a challenge that has child psychiatrists casting about for ways to help the stressed-out families of their patients, as well as the patients themselves. 

The antipsychotic medication risperidone is approved for those with autism to reduce irritability, and many other medications are widely used to rein in the defiance and explosive behavior that often come with a PDD diagnosis. But a group of researchers, spurred by the National Institute of Mental Health, set out to see if parent training could help children already on medication to further temper their negative behaviors, and bring an added measure of peace to their families.

Compared with kids on medication alone, the behavior of children whose parents got a battery of training sessions improved more and by several measures. The success of the program prompted the authors of the study — researchers from Ohio State University, Indiana University, Yale University and the University of Pittsburgh as well as with NIMH — to declare they will make the parent-training manual, homework assignments and therapist scripts broadly available. Their study is published in the Journal of the American Academy of Child & Adolescent Psychiatry. [Updated 5:45 p.m. Nov. 24] (An earlier version of this article included an incorrect name for this publication. It now has the correct name.)

"Because parents are the agents of change, parent training is less expensive than many other forms of psychosocial intervention," the researchers concluded. The growing population of kids with PDD, they added, makes the availability of "effective behavioral interventions" an urgent need.

Over 24 weeks, the parents of children with pervasive developmental disorder attended as many as 17 sessions, 60 to 90 minutes long, aimed at teaching them to help the child acquire and consolidate self-management and communication skills and to be more flexible and compliant. Parents learned to use visual schedules to ease transitions, to use positive reinforcement effectively, to teach their kids how to communicate their needs and be more flexible. A behavior therapist came to the home twice and made two telephone calls to answer questions and give support. 

— Melissa Healy

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Comments (4)

I find it interesting that these parents managed on their own with 2 visits and phone calls for support. The real question is this: How long did their program of improvement last? Will they be checked on in 2 years, and the child's behaviors evaluated for developmentally appropriate improvement?

Training for parents is invaluable, but it means the parent has to be open to recognizing their mistakes, admitting them, and correcting them consistently and as a united front with other caregivers. For many families, doing it alone isn't an option, no matter how strong your training is.

I work in wraparound services in PA where we apply child-centered therapy but transfer skills to the parents as we go - things like reinforcement, schedules and how to deal with tantrums. Our services are there as a stepping-stone to parent and child independence in cases where the parents can't do it alone, and are often used in combination with medication and other early-intervention programs. Unfortunately I see a lot of parents who can not make the transition from letting the child have their way, or anticipating every need to pushing the child to name their wants and needs, or putting their foot down and saying 'no' even once. The trainings are a great idea and a resource I would gladly point my co-workers and the families I work with towards, but you have to remember that no one can change someone else - change always has to come from the inside, and no amount of training will help someone who refuses to apply it.

Behavior-based intervention has already proven to be effective in treating kids with autism. This study is not evidence that parent training "boosts the effect of medication." It is further evidence that ABA works with or without drugs.

Quote:
"Life with a child who has a pervasive developmental disorder such as autism or Asperger's syndrome is often a storm of tantrums, irritability, impulsive behavior and obstinacy..."

And violence. Let's not forget the violence that adolescents with PDD may inflict upon family members who do not have domestic violence laws to protect them. Laws in the US are designed to help children being abused by their parents...not the other way around. Point of fact, there is nothing to help these parents.

Thanks for the post. This is interesting indeed.

Our son also has tantrums all the time so we took him to a psychiatrist. He was diagnosed autistic, but we talk to him with an application called Voice4u on the iPhone. When we were able to talk to him through it, he has been having less tantrums. Voice4u has their own site so check it out: voice4uaac.com/

From our experience, visual guidance, logic, and evenness are key to stay our son calm and keep focusing on his stuff (plus minimum tantrums).



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