Behavioral Interventions to Increase Parent Adherence With Behavior Plans

Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Status: Completed

Conditions: Family Accommodation; Behavior Problem; Nonadherence

Treatments: Behavioral: DEAL

Study type: Interventional

Funder types: Other

Identifiers

NCT05238766

IRB00292589

Details and patient eligibility

About

Many children with autism demonstrate severe problem behavior (SPB) in the form of self-injury, aggression, and disruptive behavior. Conducting a functional analysis and implementing derived treatments can produce effective behavior plans. Nonetheless, skills training and an effective plan may not be sufficient to produce parent adherence. This applied research proposal describes an approach to target the negative maintaining contingencies supporting parent reinforcement of problem behavior (accommodation) and nonadherence. The intervention, borrowed from Acceptance and Commitment Therapy and Behavioral Activation strategies, is matched specifically to the hypothesized function of the problematic caregiver responses (negative reinforcement). Parents who participate in the proposed investigation will be assigned to either the Defuse Experience Accept Live intervention (DEAL) protocol group or treatment as usual. Five 45-min DEAL sessions will 1) introduce caregivers to behavior change strategies that maximize contact with positive-maintaining contingencies related to adherence, while undermining the contingencies that maintain accommodation, and 2) provide caregivers with new treatment-related committed actions that are sensitive to positive changes in parent-child interactions. Within and between participant analyses will be conducted to determine the effectiveness of the DEAL protocol.

Enrollment: 12 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Child under the age of 18 years,
• Child is diagnosed with ASD, as confirmed by the Gilliam Autism Rating Scale-3,
• Child problem behavior is socially-maintained as identified via functional analysis,
• Parent is English-speaking, and
• Parent attendance of at least 80% of appointments at entry into the study.

Exclusion criteria

• Child is older than 18 years of age,
• Child does not have ASD,
• Child's problem behavior is not socially-maintained,
• Parent does not speak English, and
• Parent attendance at time of study entry is less than 80%.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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12 participants in 2 patient groups

Treatment as Usual

No Intervention group

Description:

This arm does not receive any intervention. It will serve as a comparison for the experimental arm.

Treatment + DEAL

Experimental group

Description:

Parents in the Treatment plus Defuse Experience Accept Live (T+DEAL) arm will attend five 45-min DEAL sessions with a therapist. Across the five sessions, the therapist will 1) introduce caregivers to behavior change strategies that maximize contact with positive-maintaining contingencies related to adherence, while undermining the contingencies that maintain accommodation, and 2) provide caregivers with new treatment-related committed actions that are sensitive to positive changes in parent-child interactions.

Treatment:

Behavioral: DEAL