Stepping Stones Triple P: A pilot study to evaluate acceptability of the program by parents of a child diagnosed with an Autism Spectrum Disorder

doi:10.1016/j.ridd.2005.05.003

Research in Developmental Disabilities

Volume 27, Issue 4, July–August 2006, Pages 364-380

https://doi.org/10.1016/j.ridd.2005.05.003 Get rights and content

Abstract

The experience of parents of children with Autism Spectrum Disorder (ASD) in standard parenting programs has not been researched, although anecdotal evidence suggests that they do not find them acceptable. Forty-two parents of children with ASD were asked to view a DVD explaining individual parenting strategies from Stepping Stones, a new branch of the Triple P program targeted specifically at parents of children with disabilities. Parents were asked to rate each strategy for acceptability, usability and behavioural intention, i.e., their intention to use the strategy. Additionally, parental attributions and parental perceived control were explored as possible barriers to positive evaluations of Stepping Stones parenting strategies. A focus group of parents was used to gather more detailed parent response to the program. Parent responses to the program were generally positive and attribution of the child's behaviour to uncontrollable factors was found to predict higher ratings of usability. The results were interpreted within the context of Weiner's attributional theory and the theory of reasoned action. The limitations of this study and suggestions for future research are discussed.

Section snippets

Epidemiology

Fombonne and Chakrabarti (2001) report the prevalence of ASD in a population of preschool children to be 62.6 per 10,000 children. In the same study, the prevalence of Autism was found to be 16.8 per 10,000 and the prevalence of other ASDs, including Asperger syndrome, 45.8 per 10,000. The higher prevalence of ASD in males was noted by both Kanner (1971) and Asperger (1991) and has since been supported by epidemiological studies. Kanner (1971) states that boys outnumber girls at a ratio of 4:1,

Parent training and Autistic Spectrum Disorders

The treatment of children with ASD has long incorporated the use of specific training programs, involving the training of parents and others as co-therapists in behavioural interventions (Koegel, Schreibman, Britten, Burke, & O’Neill, 1982). These programs have been developed to treat specific problems of children with ASD, aiming to improve social behaviour and language, as well as to decrease inappropriate behaviours. Lovaas, Koegel, Simmons, and Long (1973) demonstrated that training parents

Stepping Stones Triple P

Stepping Stones is a modified version of the Triple P Positive Parenting Program that specifically targets families of children with disabilities (Sanders, Mazzucchelli, & Studman, 2003). Triple P is a behavioural family intervention with social learning principles as the theoretical basis (Sanders, 1999). The Triple P approach to parenting focuses on providing children with positive attention and managing children's behaviour in a constructive way that does not hurt the child (Sanders et al.,

Barriers to acceptability of standard parenting programs

It is known from clinical experience with parents of children with ASD that there is often a belief that standard parenting programs will not work with their children (Sofronoff, 2003). Parental attributions and lack of perceived control are explored as two possible barriers to the acceptability of standard parenting programs by parents of children with ASD.

Research questions

The central aim of this study was to evaluate how parents of children with ASD rate the Stepping Stones parenting strategies in terms of acceptability, usability and behavioural intention (i.e., intention to try the strategy) and to explore in more depth, using a focus group, the reactions of parents to the Stepping Stones program. In addition, we were interested in evaluating whether the parent's ratings of Stepping Stones would predict attempts by parents to use the Stepping Stones strategies

Participants

Forty-two parents participated in the study and four parents participated in the focus group. Inclusion criteria for the study were a child with a paediatrician's diagnosis of ASD and an age range of 3–13 years. Participants were recruited through a general press release and a press release in the newsletters of Autism Association Queensland, Asperger Syndrome Support Network, and Autism Behavioural Intervention Queensland. In addition, posters were put on community noticeboards and notices on

Preliminary analyses

A missing value analysis was conducted which revealed that less than 5% of the data were missing and the pattern of missing data was random. However, there was a high amount of missing data for the third scenario of the Attribution and Control Questionnaire of which 9.5% was missing for item 1 and 14.3% was missing for items 2–9. The mean substitution method was used to deal with missing data. All necessary assumptions for regression analysis were met.

Comparison of pre-DVD and post-DVD ratings

Two-paired samples t-tests were performed.

Discussion

The central aim of this project was to evaluate the initial reactions of a cohort of parents of children with ASD to the Stepping Stones DVD. This involved firstly evaluating the ratings by the parents of the Stepping Stones parenting strategies in terms of acceptability, usability and behavioural intention. Overall, the parents rated Stepping Stones Triple P highly on acceptability, usability and behavioural intention. In addition, considering the parents were not trained in the use of

References (23)

H. Asperger
Autistic psychopathy
T. Attwood
Asperger's syndrome: A guide for parents and professionals
(1998)
D.A. Beale et al.
Predicting mother's intentions to limit frequency of infants’ sugar intake: Testing the theory of planned behavior
Journal of Applied Social Psychology
(1991)
T.H. Dix et al.
Parent attribution processes in the socialization of children
M. Fishbein et al.
Belief, attitude, intention and behavior: An introduction to theory and research
(1975)
E. Fombonne et al.
Pervasive developmental disorders in preschool children
Journal of the American Medical Association
(2001)
C. Gillberg
A guide to Asperger syndrome
(2002)
C. Gray
Social stories and comic strip conversations with students with Asperger syndrome and high functioning autism
P. Howlin
Children with autism and Asperger syndrome: Guide for practitioners and carers
(1998)
P. Howlin et al.
Treatment of autistic children
(1987)

L. Kanner

Follow-up study of eleven autistic children originally reported in 1943

Journal of Autism and Childhood Schizophrenia

(1971)

Cited by (50)

A therapeutic education program for parents of children with ASD: Preliminary results about the effectiveness of the ETAP program
2018, Encephale
Au quotidien, les Troubles du spectre de l’autisme (TSA) nécessitent des aménagements spécifiques pour la personne handicapée, mais aussi un accompagnement pour les proches-aidants. Dans cette optique, le dernier Plan Autisme 2013–2017 insiste sur la nécessité de former les familles, afin notamment d’éviter les situations d’épuisement. L’éducation thérapeutique (ETP) semble répondre à ces différents éléments en proposant une approche globale favorisant le développement de compétences d’auto-soin et de compétences d’adaptation psychosociale. Le programme ETAP (Éducation thérapeutique autisme et parentalité) comporte 7 séances groupales à thèmes, deux entretiens semi-structurés en individuel et une séance « booster » à 3 mois. L’objectif de cette étude est de tester l’efficacité du programme ETAP sur la qualité de vie et la symptomatologie anxiodépressive de parents d’enfant avec un TSA. Notre échantillon est composé 40 participants, dont 30 parents ayant participé au programme ETAP qui sont comparés à 10 parents contrôles inscrits sur liste d’attente. Nos résultats mettent en évidence une amélioration de la qualité de vie (WhoQol-bref) et de la symptomatologie dépressive (HADS) chez les participants. Ces données sont à interpréter avec précaution du fait de leur caractère préliminaire et compte tenu de la taille réduite de notre échantillon. Toutefois, les premières mesures sont encourageantes et viennent confirmer l’intérêt du modèle de l’éducation thérapeutique pour les parents d’enfant avec un TSA. Une adaptation du modèle de la conservation des ressources de Hobfoll et al. est proposée par les auteurs pour formuler des hypothèses sur les mécanismes d’action du programme ETAP.
Autism Spectrum Disorders (ASD) are characterized by particularities of cognitive and socio-adaptive functioning. Daily, they require specific interventions for the disabled person as well as support for parents who often report deterioration in their physical and mental health. To this end, the latest Autism Plan 2013–2017 highlights the need “to help families to be present and active alongside their loved ones, to avoid situations of exhaustion and stress and to enable them to play their role fully in the long term”. The support devices must therefore be based on an analysis of the parents’ needs and propose multiple intervention modalities, which respond to the complexity of the caregiving mission. Therapeutic education (TE) seems to answer to these different elements by proposing a global approach improving the development of child-centered skills and the educational challenges (self-care skills) but also of skills centered on the projects and the fulfillment of the parent (psychosocial skills). The ETAP (Therapeutic Education Autism and Parenting) program is an initial TE offer intended for parents of children with ASD aged between 3 and 10 years. It consists of seven group sessions and two semi-structured interviews, called educational diagnosis. A booster session is also proposed three months after the last session. It was developed following rigorously the guidelines on program construction, published by the High Authority of Health. In addition, it is based on an assessment of the needs of the parents, an in-depth analysis of the literature and the opinion of nine experts in this area. The objective of this study is to evaluate the effectiveness of the ETAP program on the quality of life and anxio-depressive symptoms of parents of a child with ASD. To our knowledge, the ETAP program is the first TE program in France for parents of children with an ASD that has been evaluated. Our sample is composed of 40 participants, including 30 parents who participated in the ETAP program (“ETAP Group”), compared to ten controls who did not participate, but who are on a waiting list (“Control Group”). Each participant completed a Quality of Life Questionnaire (WhoQol-Brief) and an Anxiety-Depressive Symptomatology Questionnaire (HADS) prior to the start of the program (T1) and after the session 7 (T2). Preliminary analyses show a good intergroup matching on socio-demographic and medical data. Moreover, the two groups are not significantly different at T1 over the set of dependent variables measured. Our results show an improvement in the quality of life of the depressive symptomatology in the participants. On the other hand, we did not notice any significant decrease in anxiety symptoms. However, when we consider the proportion of parents with a significant anxiety state (in terms of the clinical threshold of HADS, score ≥ 10), we see that it tends to decrease after the program only for the group ETAP. These data should be interpreted with caution because of their preliminary nature and the small size of our sample. However, the first steps are encouraging and confirm the value of the therapeutic education model for parents of children with ASD. The different information given during the sessions takes into account the previous representations, knowledge and skills of the parent. Thus the program promotes the upholding and the development of individual resources in parents. In addition, the psychosocial skills targeted also to make access easier to available environmental resources. Finally, in a more indirect way, the ETAP program also aims to maintain or restore a positive parenthood and individual identity and the progressive development of new ways of to interact with the environment. An adaptation of the Hobfoll resource conservation model is proposed by the authors to formulate hypotheses on the mechanisms of action of the ETAP program.
Experience and outcomes of stepping stones triple P for families of children with autism
2013, Research in Developmental Disabilities
Citation Excerpt :
This finding and the need for future research in this area is significant because parents of children with autism, as a group, differ from parents of children with other disabilities: they more often attribute disruptive behaviour to their child's diagnosis rather than typical childhood behavioural problems (Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001; Howlin & Rutter, 1987). Therefore, they often report that standard parenting programmes will not work for their child and family because the behaviours are internal to the child, and are not under their control (Whittingham, Sofronoff, & Sheffield, 2006). Sofronoff, Jahnel, and Sanders (2011) used a randomized, controlled trial (n = 53; 45% parents of children with autism) to investigate the effects of an adapted, 2 sessions, group-seminar SSTP format.
This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the “attribution of cause” of misbehaviour, (2) “Who's the boss?” reflecting a change to parents feeling more in charge of their child's behaviour, daily routines and choices, and (3) “Rewarding is rewarding!” reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed.
Do maternal attributions play a role in the acceptability of behavioural interventions for problem behaviour in children with autism spectrum disorders?
2013, Research in Autism Spectrum Disorders
Citation Excerpt :
The findings revealed no significant relationship between parents’ ratings of treatment acceptability and their child-referent attributions of internality, controllability, and stability. However, it should be noted that Whittingham, Sofronoff, & Sheffield (2006) assessed treatment acceptability only with a single-item scale in their study. Given the high prevalence of problem behaviour in children with ASD and the increasing availability of parent-focused behavioural interventions, an understanding of the relationship between parental attributions and treatment acceptability of behavioural interventions is particularly relevant for the ASD population.
The present study explored the relationship between parental attributions and treatment acceptability of behavioural interventions for problem behaviour in children with autism spectrum disorders (ASD). Mothers of children with ASD aged 3–9 years (N = 139) completed survey measures that assessed demographics, parental attributions, treatment acceptability of parent-focused and child-focused behavioural interventions, severity of their child's disruptive behaviour, and severity of their child's ASD symptoms. The results showed that parental attributions of parent-referent stability, but not the other attributional dimensions, negatively predicted treatment acceptability of a parent-focused behavioural intervention, even when severity of disruptive behaviour was statistically controlled. Conversely, no associations were found between any attributional dimension and treatment acceptability of a child-focused behavioural intervention. Preliminary analyses also revealed that mothers’ ratings of the severity of their child's disruptive behaviour were significantly negatively associated with the acceptability of both parent-focused and child-focused behavioural interventions. The findings have potential implications for professionals to identify and challenge distorted attributions of parent-referent stability to promote parental acceptance of a parent-focused behavioural intervention for problem behaviour in children with ASD.
Optimizing Parent Training to Improve Oral Health Behavior and Outcomes in Underserved Children with Autism Spectrum Disorder
2023, Journal of Autism and Developmental Disorders
Educators apply new teaching strategies despite initial attributions of autistic students’ controllability of their behaviors
2023, International Journal of Developmental Disabilities
Usefulness of Implementation Outcome Scales for Digital Mental Health (iOSDMH): Experiences from Six Randomized Controlled Trials
2022, International Journal of Environmental Research and Public Health

View all citing articles on Scopus

View full text

Stepping Stones Triple P: A pilot study to evaluate acceptability of the program by parents of a child diagnosed with an Autism Spectrum Disorder

Abstract

Section snippets

Epidemiology

Parent training and Autistic Spectrum Disorders

Stepping Stones Triple P

Barriers to acceptability of standard parenting programs

Research questions

Participants

Preliminary analyses

Comparison of pre-DVD and post-DVD ratings

Discussion

Autistic psychopathy

Asperger's syndrome: A guide for parents and professionals

Predicting mother's intentions to limit frequency of infants’ sugar intake: Testing the theory of planned behavior

Journal of Applied Social Psychology

Parent attribution processes in the socialization of children

Belief, attitude, intention and behavior: An introduction to theory and research

Pervasive developmental disorders in preschool children

Journal of the American Medical Association

A guide to Asperger syndrome

Social stories and comic strip conversations with students with Asperger syndrome and high functioning autism

Children with autism and Asperger syndrome: Guide for practitioners and carers

Treatment of autistic children

Follow-up study of eleven autistic children originally reported in 1943

Journal of Autism and Childhood Schizophrenia