Mindfulness for Parents of Children With Autism Spectrum Disorder Autism Spectrum Disorder

Families of children with Autism Spectrum Disorder (ASD) experience heightened risk due to
elevated rates of clinically-significant parenting stress and child externalizing behavior
problems. Parenting stress is a robust predictor of subsequent externalizing challenges in
children with ASD. Nonetheless, few evidenced-based treatments exist for reducing parenting
stress in these families. The mechanisms through which parenting stress influence child
externalizing problems are also unclear, although preliminary evidence suggests the potential
role of negative parenting behaviors. This study comprehensively addresses these
considerations by testing the efficacy of Mindfulness-Based Stress Reduction (MBSR) as an
intervention to reduce parenting stress, lessen parental reactivity and negativity, and
decrease child externalizing behaviors.

MBSR is particularly well-suited for parents of children with ASD given the intervention
emphasis on teaching participants to manage reactivity in the context of persistent stress.
However, the efficacy of MBSR has yet to be established for this population. The present
investigation extends preliminary investigations of mindfulness approaches by: 1) conducting
a stringent test of MSBR using an active psychoeducational (PE) control, 2) developing
population-specific content and testing the efficacy of MSBR for parents of children with
ASD, 3) utilizing a highly diverse, underserved community-based sample, 4) examining the
mechanisms underlying observed treatment effects, and 5) employing multi-method longitudinal
measurement from multiple sources in order to examine immediate and long-term treatment
effects.

The current study is a randomized controlled trial of 138 families of preschool-aged children
with ASD. Parents will be randomized to MBSR or to a PE support group matched for clinical
contact and dosage. Families will participate in laboratory assessments at baseline and
immediately post-treatment, as well as at 6 months and 12 months post-treatment. Measures
include standardized and validated parent and teacher questionnaires, gold-standard
psychological assessments, and observational and interview ratings.

The MBSR intervention includes eight weekly 2.5-hour group sessions, a day-long (6hr)
meditation retreat on the weekend during week six, 45 minutes of daily home practice guided
by instructional audio CDs (portable CD players will be provided when necessary), and an MBSR
parent workbook. Formal mindfulness exercises aim to increase the capacity for mindfulness
(present-moment awareness with a compassionate, non-judgmental stance) and include a body
scan, mindful yoga, and sitting meditation. Participants are also taught to practice
mindfulness informally in everyday activities. In session, didactic instruction on stress
physiology and using mindfulness for coping with stress in daily life is provided.
Participants practice formal mindfulness exercises, break into dyads to discuss their daily
homework practice, and meet as a larger group to ask questions related to the practice of
mindfulness in everyday life.

In order to provide a rigorous test of the contributions of mindfulness techniques, the
current investigation will control for therapeutic effects associated with clinician contact
and group support by comparing MBSR to a PE support condition matched for dosage. The PE
condition also consists of 8-weekly 2.5-hour sessions, a day-long (6hr) Family Resource Fair
during week six (wherein families will attend talks by professionals, explore available local
resources, and meet with service providers), daily homework that includes monitoring progress
on goals identified at the end of each session, and a workbook for parents of children with
special needs that provides parents with information regarding their child's development,
disability, and associated considerations.

Establishing an efficacious stress reduction intervention to target mechanisms linking
parenting stress, negative parenting behaviors, and child externalizing problems will advance
clinical science and optimize outcomes for children with ASD and their families.

Inclusion Criteria:

- Child community diagnosis of ASD confirmed by study administered assessments

- Age 3 to 5 years

- Elevated parenting stress as indexed by a total score above the recommended cutoff at
the 85th percentile on the Parenting Stress Index-4 (Abidin, 1995)

- Abbreviated Battery IQ (ABIQ) score above 35 on the Stanford-Binet Intelligence Scales
5th Edition ABIQ to ensure task validity (SB5 ABIQ; Roid, 2003)

Exclusion Criteria:

- Positive screen for active parental psychosis, substance abuse, or suicidality
according to the associated modules of the Structured Clinical Interview for DSM
Disorders, SCID, Research Version Non-Patient Edition (First, Spitzer, Gibbon, &
Williams, 2002)

- Parent participation in an auxiliary mental health treatment or support group

- < 3 years or > 5 years of age