A Strength-Focused Parenting Intervention May Be a Valuable Augmentation to a Depression Prevention Focus for Adolescents with Autism
High depression rates for adolescents with autism indicate a need for a comprehensive prevention approach. Parents can promote parent–child factors that buffer adolescents from depression. However, parenting adolescents with autism presents challenges which can diminish parental self-efficacy and mental wellbeing with potential negative sequelae for their adolescents. This proof-of-concept study investigated the value of adding a strength-focused parenting intervention to a depression-prevention intervention for adolescents with autism. A Consensual Qualitative Research framework analysed 15 parents’ intervention experience. Parents reported that feeling isolated and unsupported by existing services motivated their participation, and they valued interacting with other parent participants. They also reported that the program enhanced wellbeing and parenting efficacy, reduced isolation, increased ability to parent calmly, and improved parent-adolescent relationships.
KeywordsAutism spectrum disorder Autism Multilayered school-based intervention Parenting young adolescents with autism Parent self-efficacy and mental wellbeing Resourceful Adolescent Parent Program RAP-P-ASD
The authors are grateful to Rachel Aberdeen for transcribing the interviews, and to Kate McLisky for conducting the audit of the CQR process.
All authors conceived of the study and participated in its design. JO and BD coordinated the study and conducted the recruitment of participants. BD interviewed the participants. JO, BD, AW, and IS participated in the interpretation of the data. JO and IS drafted the manuscript. All authors read and approved the final manuscript.
This research is supported by the Australian Cooperative Research Centre for Living with Autism (Autism CRC) under Grant No. 2.029, awarded to Professor Ian Shochet and Associate Professor Beth Saggers. The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government’s Cooperative Research Centres Project.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
- Allen, J. (2008). The attachment system in adolescence. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 419–435). New York: The Guilford Press.Google Scholar
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.,. text revision ed.). Washington, DC: Author.Google Scholar
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.Google Scholar
- Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report: Surveillance Summaries, 63(2), 1–22.Google Scholar
- Chen, M. H., Pan, T. L., Lan, W. H., Hsu, J. W., Huang, K. L., Su, T. P., … Bai, Y. M. (2017). Risk of suicide attempts among adolescents and young adults with autism spectrum disorder: A nationwide longitudinal follow-up study. Journal of Clinical Psychiatry, 78, e117–e1179. https://doi.org/10.4088/JCP.16m11100.Google Scholar
- Coleman, P. K., & Karraker, K. H. (1998). Self-efficacy and parenting quality: Findings and future applications. Developmental Review, 18, 47–85.Google Scholar
- Côté, S., Tremblay, R., Boivin, M., Liu, X., Nagin, D., & Zoccolillo, M. (2009). Depression and anxiety symptoms: Onset, developmental course and risk factors during early childhood. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50, 1201–1208. https://doi.org/10.1111/j.1469-7610.2009.02099.x.Google Scholar
- Culpin, I., Mars, B., Pearson, R., Golding, J., Heron, J., Bubak, I., … Rai, D. (2018). Autistic traits and suicidal thoughts, plans, and self-harm in late adolescence: Population-based cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 57, 313–320. https://doi.org/10.1016/j.jaac.2018.01.023.Google Scholar
- Derguy, C., Michel, G., M’Bailara, K., Roux, S., & Bouvard, M. (2015). Assessing needs in parents of children with autism spectrum disorder: A crucial preliminary step to target relevant issues for support programs. Journal of Intellectual & Developmental Disability, 40, 156–166. https://doi.org/10.3109/13668250.2015.1023707.Google Scholar
- Francis, K. (2005). Autism interventions: A critical update. Developmental Medicine & Child Neurology, 47, 493–499. https://doi.org/10.1111/j.1469-8749.2005.tb01178.x.Google Scholar
- Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism & Developmental Disorders, 32, 299–306.Google Scholar
- Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.Google Scholar
- Hayes, S. A., & Watson, S. L. (2012). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 43, 629–642. https://doi.org/10.1007/s10803-012-1604-y.Google Scholar
- Hill, C. E. (2012). Consensual qualitative research: A practical resource for investigating social science phenomena. Washington, DC: American Psychological Association.Google Scholar
- Hoffman, C. D., Sweeney, D. P., Hodge, D., Lopez-Wagner, M. C., & Looney, L. (2009). Parenting stress and closeness: Mothers of typically developing children and mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 24, 178–187. https://doi.org/10.1177/1088357609338715.Google Scholar
- Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen Theory. New York: Norton.Google Scholar
- Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of Autism Spectrum Disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158. https://doi.org/10.1542/peds.2008-1057.Google Scholar
- Kovacs, M. (2003). Children’s Depression Inventory (CDI). Toronto: Multi–Health Systems (MHS).Google Scholar
- Laursen, B., & Collins, W. (2009). Parent–child relationships during adolescence. In R. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology: Vol. 2. Contextual influences on adolescent development (3rd ed., pp. 3–42). New York: Wiley.Google Scholar
- Losh, M., Childress, D., Lam, K., & Piven, J. (2008). Defining key features of the broad autism phenotype: A comparison across parents of multiple- and single-incidence autism families. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 147B(4), 424–433. https://doi.org/10.1002/ajmg.b.30612.Google Scholar
- Mackay, B. A., Shochet, I. M., & Orr, J. A. (2017). A pilot randomised controlled trial of a school-based resilience intervention to prevent depressive symptoms for young adolescents with autism spectrum disorder: A mixed methods analysis. Journal of Autism and Developmental Disorders, 47, 3458–3478. https://doi.org/10.1007/s10803-017-3263-5.Google Scholar
- Merry, S., McDowell, H., Wild, C. J., Bir, J., & Cunliffe, R. (2004). A randomized placebo-controlled trial of a school-based depression prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 538–547. https://doi.org/10.1097/00004583-200405000-00007.Google Scholar
- Piven, J., & Palmer, P. (1999). Psychiatric disorder and the broad autism phenotype: Evidence from a family study of multiple incidence autism families. The American Journal of Psychiatry, 156, 557–563.Google Scholar
- Rueter, M., Scaramella, L., Wallace, L., & Conger, R. (1999). First onset of depressive or anxiety disorders predicted by the longitudinal course of internalizing symptoms and parent-adolescent disagreements. Archives of General Psychiatry, 56, 726–732. https://doi.org/10.1001/archpsyc.56.8.726.Google Scholar
- Seltzer, M. M., Greenberg, J. S., Hong, J., Smith, L. E., Almeida, D. M., Coe, C., & Stawski, R. S. (2010). Maternal cortisol levels and child behavior problems in families of adolescents and adults with ASD. Journal of Autism and Developmental Disorders, 40, 457–469. https://doi.org/10.1007/s10803-009-0887-0.Google Scholar
- Shochet, I. M., & Ham, D. (2004). Universal school-based approaches to preventing adolescent depression: Past findings and future directions of the resourceful adolescent program. International Journal of Mental Health Promotion, 6, 17–25. https://doi.org/10.1080/14623730.2004.9721935.Google Scholar
- Shochet, I. M., Holland, D., Osgarby, S. M., & Whitefield, K. (1998). The resourceful family project: Parent program. Brisbane: Griffith University.Google Scholar
- Shochet, I. M., Mackay, B., & Wurfl, A. (2011). Resourceful Adolescent Program: Autism spectrum disorders supplement. Brisbane: School of Psychology and Counselling, Queensland University of Technology.Google Scholar
- Shochet, I. M., Saggers, B. R., Carrington, S. B., Orr, J. A., Wurfl, A. M., Duncan, B. M., & Smith, C. L. (2016). The Cooperative Research Centre for Living with Autism (Autism CRC) conceptual model to promote mental health for adolescents with ASD. Clinical Child and Family Psychology Review, 19, 94–116. https://doi.org/10.1007/s10567-016-0203-4.Google Scholar
- Shochet, I. M., & Wurfl, A. (2015a). Resourceful Adolescent Program: Group leader’s manual. Brisbane: School of Psychology and Counselling, Queensland University of Technology.Google Scholar
- Shochet, I. M., & Wurfl, A. (2015b). Resourceful Adolescent Program: Participant’s workbook. Brisbane: School of Psychology and Counselling, Queensland University of Technology.Google Scholar
- Shochet, I. M., & Wurfl, A. (2016a). Resourceful Adolescent Parent Program: Group Leader’s manual. Brisbane: School of Psychology and Counselling, Queensland University of Technology.Google Scholar
- Shochet, I. M., & Wurfl, A. (2016b). Resourceful Adolescent Parent Program: Participant’s workbook. Brisbane: School of Psychology and Counselling, Queensland University of Technology.Google Scholar
- Smetana, J. G. (2011). Adolescents’ social reasoning and relationships with parents: Conflicts and coordinations within and across domains. In E. Amsel & J. Smetana (Eds.), Adolescent vulnerabilities and opportunities: Constructivist and developmental perspectives (pp. 139–158). New York: Cambridge University Press.Google Scholar
- Stern, D. N. (2004). The present moment in psychotherapy and everyday life (Norton series on interpersonal neurobiology). New York: Norton.Google Scholar
- Stice, E., Shaw, H., Bohon, C., Marti, N., C., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77, 486–503. https://doi.org/10.1037/A0015168.Google Scholar
- Stockings, E. A., Degenhardt, L., Dobbins, T., Lee, Y. Y., Erskine, H. E., Whiteford, H. A., & Patton, G. (2016). Preventing depression and anxiety in young people: A review of the joint efficacy of universal, selective and indicated prevention. Psychological Medicine, 46, 11–26. https://doi.org/10.1017/S0033291715001725.Google Scholar
- Titelman, P. (Ed.). (2014). Differentiation of self: Bowen family systems theory. New York: Routledge.Google Scholar
- Tucker, C. J., McHale, S. M., & Crouter, A. C. (2003). Conflict resolution: Links with adolescents’ family relationships and individual well-being. Journal of Family Issues, 24, 715–736.Google Scholar
- Weiss, J. A., Robinson, S., Fung, S., Tint, A., Chalmers, P., & Lunsky, Y. (2013). Family hardiness, social support, and self-efficacy in mothers of individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 1310–1317. https://doi.org/10.1016/j.rasd.2013.07.016.Google Scholar