Evaluating a Web Delivered Behavioral Parent Training Intervention for Rural Parents of Children With Autism Spectrum Disorder

There has been notable increases in the prevalence of autism spectrum disorder (ASD) both in the United States and worldwide over the past few decades. For comparison, the latest prevalence rate in the US is 1 in 54 where as just 10 years prior the rate was 1 in 110. Multiple theories have been proposed to explain the steady rise in ASD prevalence including changes in diagnostic criteria, public awareness, early screening, and etiological factors. Although there remains a significant need to improve our understanding of effective treatment for children with ASD, the science and knowledge around behavioral and psychopharmacologic interventions for the treatment of ASD has progressively grown within the past few decades. Yet, parents of children with ASD living in rural areas face additional obstacles to obtain support, resources, and services for ASD due to the lack of ASD specialists and mental health care providers in their area. Despite the similar prevalence rate of ASD between urban and rural areas, and the prevalence rate of total developmental disorders in rural areas being significantly higher, children in rural areas are less likely to see a mental health professional or receive Special Education. Parents of children with ASD also report poorer mental and physical health compared to parents of neurotypical child and parents of children with other chronic or neurodevelopmental conditions. A negative correlation has also been noted between the severity of ASD and child problem behaviors with parental mental health. Therefore, interventions aimed at decreasing the severity of child disruptive behaviors may also be beneficial to parental mental health.

Behavioral parent training (PT) programs improve child and parent outcomes for children with ASD. However, families of children with ASD face barriers in accessing PT and there is an inequity in access for families residing in rural areas. PT interventions delivered via telehealth have been examined with various treatments of children with ASD. Traditionally telehealth services have required a clinician that is highly trained in the treatment of ASD. Therefore, telehealth services may reduce geographical barriers, but it does not address the disparity of treatment providers seen throughout the US.

Attend Behavior is self-administered mobile or web-based PT intervention that educates and encourages the use of evidence-based parenting skills for children with multiple behavior problems such as hyperactivity, impulsivity, mild aggression, and emotional dysregulation. Attend Behavior includes ten modules that encompass parenting strategies to reduce disruptive child behaviors. Parents take an assessment that allows Attend Behavior to tailor the intervention material to the individual parent's needs. Attend Behavior sends automatic notifications to remind the parent to engage and apply parenting skills in their everyday life. Therefore, Attend Behavior can be used by the parent independently and other health care providers such as nurses, case managers, and primary care providers have the ability to use this intervention with parents of children with ASD without prior expertise in ASD treatment.

The purpose of the proposed study is to determine the acceptability, feasibility, and preliminary effects of the Attend Behavior PT intervention with parents residing in rural areas. To accomplish this, we will use a single-group, mixed methods pre/post-test design with rural parents (N = 40) of children (2-11 years old) with ASD. Parents will be recruited from community mental health offices and schools. Data will be collected on child problem behaviors (disruptive behaviors and child noncompliance in the home), parent mental health (parenting stress and depressive symptoms), sociodemographic variables, and intervention feasibility and acceptability. Parents will complete one module of Attend Behavior weekly for 12 weeks. Data will be collected at baseline and post-intervention (12-weeks post-baseline). Parents will complete a 1:1 interview with the study PI via phone or video conference in the post-intervention period to discuss acceptability, feasibility, and satisfaction with the intervention.

Aim 1: Evaluate the acceptability and feasibility of the Attend Behavior PT intervention with rural parents of young children with ASD. 1a. Acceptability will be assessed by the Acceptability of Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM), and 1:1 interview. 2a. Feasibility will be measured with the Feasibility of Intervention Measure (FIM), intervention recruitment, retention and completion monitoring, and 1:1 interview.

Aim 2: Determine the effects of Attend Behavior on parental mental health (depression and stress) and child outcomes (disruptive behavior and noncompliance in the home) from baseline to post-intervention.

We are testing the feasibility, acceptability, and preliminary effects of the mobile and/or web-delivered PT intervention, Attend Behavior, for rural parents of children with ASD.