Format

Send to:

Choose Destination
See comment in PubMed Commons below
JAMA Pediatr. 2014 Jan;168(1):40-6. doi: 10.1001/jamapediatrics.2013.3445.

Improving maternal mental health after a child's diagnosis of autism spectrum disorder: results from a randomized clinical trial.

Author information

  • 1Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts2Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
  • 2Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
  • 3Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts4National Initiative for Children's Healthcare Quality, Boston, Massachusetts.
  • 4Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
  • 5Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
  • 6Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
  • 7Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts.

Abstract

IMPORTANCE:

The prevalence of psychological distress among mothers of children with autism spectrum disorder (ASD) suggests a need for interventions that address parental mental health during the critical period after the child's autism diagnosis when parents are learning to navigate the complex system of autism services.

OBJECTIVE:

To investigate whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child's diagnosis of ASD.

DESIGN, SETTING, AND PARTICIPANTS:

A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs that primarily serve low-income families. Participants were mothers of 122 young children (mean age, 34 months) who recently received a diagnosis of ASD. Among mothers assessed for eligibility, 17.0% declined participation. We report outcomes after 3 months of follow-up (immediate postdiagnosis period).

INTERVENTIONS:

Problem-solving education is a brief, cognitive intervention delivered in six 30-minute individualized sessions by existing staff (early intervention programs) or research staff without formal mental health training (autism clinic).

MAIN OUTCOMES AND MEASURES:

Primary outcomes were parental stress and maternal depressive symptoms.

RESULTS:

Fifty-nine mothers were randomized to receive PSE and 63 to receive usual care. The follow-up rate was 91.0%. Most intervention mothers (78.0%) received the full PSE course. At the 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%; adjusted relative risk [aRR], 0.17; 95% CI, 0.04 to 0.65). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance (5.7% vs 22.4%; aRR, 0.33; 95% CI, 0.10 to 1.08); however, the reduction in mean depressive symptoms was statistically significant (Quick Inventory of Depressive Symptomatology score, 4.6 with PSE vs 6.9 with usual care; adjusted mean difference, -1.67; 95% CI, -3.17 to -0.18).

CONCLUSIONS AND RELEVANCE:

The positive effects of PSE in reducing parenting stress and depressive symptoms during the critical postdiagnosis period, when parents are asked to navigate a complex service delivery system, suggest that it may have a place in clinical practice. Further work will monitor these families for a total of 9 months to determine the trajectory of outcomes.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT01021384.

PMID:
24217336
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk