Empirical researchEvaluating the effects of Acceptance and Commitment Training on the overt behavior of parents of children with autism☆
Introduction
Raising a child with autism involves chronic challenges consistently associated with high levels of psychological distress in parents (Eikeseth et al., 2015, Estes et al., 2009, Grindle et al., 2009, Hayes and Watson, 2013). Such distress can significantly impact a parent's ability to manage their child's behavior and reduce the effectiveness of behavioral interventions (Osborne et al., 2008, Robbins et al., 1991, Strauss et al., 2012). From a behavior analytic perspective, “psychological distress” might be conceptualized as experiencing high levels of aversive private events evoked by environmental stressors. The term “private events” refers to any covert stimulus (e.g., thought, image, physical sensation, emotion) or response (thinking, visualizing, remembering) (Skinner, 1974). Private events, like public events, can have an impact on future behavior and are undoubtedly an important aspect of parent experience. The role of private events in parenting, however, has been largely ignored in the parent training literature thus far (Coyne and Wilson, 2004, Snyder et al., 2011).
Section snippets
Private events and parenting
Whereas contingency-shaped behavior is controlled by direct exposure to environmental contingencies (e.g., burning one's hand when touching a hot stove), rule-governed behavior (RGB) is under the control of contingencies that are verbally described. Put simply, the person engages in a particular behavior because they were told to do so, rather than learning by consequences. Previous research suggests that RGB can be problematic, since it is much less sensitive to environmental contingencies
Acceptance and Commitment Therapy
ACT (Hayes et al., 2003) is a contemporary behavior analytic approach to addressing problematic private events, founded in radical behaviorism, functional contextualism, Relational Frame Theory (RFT; Barnes-Holmes, Hayes, Barnes-Holmes, & Roche, 2002), and Applied Behavior Analysis (ABA). The goal of ACT is to create psychological flexibility in service of valued living. Psychological flexibility can be considered a behavioral repertoire that is sensitive to the presence and function of private
Participants and setting
All sessions were conducted by the first author in the participant's home. Three mothers with one child diagnosed with autism participated. Parents’ primary language was English. Participants were receiving in-home ABA services from a community-based treatment provider, and were referred for training by senior clinical staff. Parents had no prior exposure to ACT and did not receive any other psychotherapeutic or ACT services during the study. Participants were not currently receiving
Research design
A non-concurrent multiple baseline across participants design was used (Kazdin, 2011), consisting of four phases: Baseline, Training, Post-training, and follow-up. In addition, pre- and post- training self-report measures were collected.
Direct observation data
The dependent variable was frequency of values-directed parent behaviors per calendar day. Values-directed behavior was defined as any action resulting in a tangible outcome directly related to an individual parent-identified value. The specific topography of behaviors varied across participants depending on the parent's individual values and goals. The parent and ACT trainer identified target behaviors during an initial interview, prior to collecting baseline behavior data. Table 1 provides a
Interobserver Agreement (IOA)
Interobserver agreement was obtained for parent-collected behavior data. Verification was obtained only for behavior occurrences, not for non-occurrences. Given that researchers could not directly monitor parent behavior outside of training sessions, independent verification of parent values-directed behaviors was obtained from a third person (significant other, friend, therapeutic instructor, nanny, etc.), in addition to other permanent products indicating that the event had occurred (e.g.,
Procedures
Sessions were scheduled on a day and time convenient to the parent. Since research on ACT for parents of children with autism is extremely limited, there is currently no “gold standard” in terms of training duration or format. Parents of children with autism often have extremely full schedules, thus training was limited to six, 90-min sessions. Delivery on a 1:1 basis was chosen since this is the model of parent training most typically utilized within ABA treatment settings. The 1:1 format also
Results
Fig. 1 depicts cumulative rates of values-directed behavior across successive calendar days and Fig. 2 depicts frequency of behaviors per week, during baseline, training, post-training and follow-up. Weekly and cumulative rates of behavior were steady (at zero levels) for all three participants throughout a 3–7 week baseline (M = 0). During the 6 −7 week training phase, Gemma and Hannah began to engage in values-directed behaviors (M = 6.54 and M =1.49, respectively). Sarah's data did not
Discussion
The results of the current study suggest that a six-week ACT protocol may produce robust increases in values-directed overt behaviors in parents of children with autism. This study is the first (to our knowledge) to use ACT to produce changes in clinically meaningful overt behaviors in parents of children with autism. Furthermore, increases in values-directed behavior were maintained and even accelerated at follow-up, suggesting long-term maintenance of gains, with cumulative benefits over
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This study was completed as partial fulfillment for the first author's doctoral dissertation at The Chicago School for Professional Psychology, Los Angeles. The authors would like to thank the families that participated and inspired this work.