Development of a Resiliency Training Program for Parents of Children With Autism Spectrum Disorder

According to the Center for Disease Control in 2012, 14.6 per 1,000 children aged 8 years old
have a diagnosis of Autism Spectrum Disorder (ASD). Having a child with ASD is associated
with medical expenditures of 4.1-4.6 times more than having a child without autism, and
associated with 8.4-9.5 times greater general expenditures. Furthermore, children with ASD
are more likely to use out-of-school behavioral health services than children without
developmental or psychiatric diagnoses. Parents of children with ASD consistently show high
levels of perceived distress and anxiety related to child-parent relationships, intellectual
functioning, adaptive behaviors, in addition to poorer health than parents of children of
typical development. These parents also exhibit significant stress related to the emotional
and financial challenges of putting together treatment and future-related plans for their
children. Recent studies have found a positive relationship between caregivers' stress levels
while raising a child with ASD and child behavioral and conduct problems.

There is growing literature on the increased levels of parental stress associated with caring
for children with ASD. One study found that caregivers of children with ASD with behavioral,
hyperactivity, and emotional problems displayed atypical cortisol patterns, a biological
marker of increased stress. A review article provides a comprehensive overview of the links
between high levels of parental stress among parents of children with intellectual and
developmental disabilities and child health and well-being. In addition to social phobias
associated with children with ASD, one study even found that caring for a child with ASD
showed higher stress levels for the parents correlated with the child's social impairment
severity. Finally, recent studies have also found that many parents of children with ASD
exhibit psychological and physical depressive symptoms. Therefore, having a children with ASD
is associated with an increased risk of problems with emotional and physical health and
social well-being. Resiliency is a multidimensional construct that refers to the ability to
maintain adaptation and effective functioning when faced with stressors.

Resiliency provides a framework for understanding the adjustment to stress as a dynamic
process. Allostasis refers to the capacity to maintain stability of physiological systems in
the face of adversity. When exposed to chronic stressors, such as care for a child with ASD,
individuals expend a great deal of energy attempting to maintain allostasis; this can lead to
the metabolic wear and tear described as allostatic load. Evidence is accumulating that this
wear and tear is mediated by changes in basal stress system activity and by effects of these
changes on dependent systems. Allostatic load and resilience can therefore be assessed by
measuring basal stress system activity (HPA axis and salivary alpha-amylase).

Thus, research to reduce these parents' exposure to stress and, moreover, improve parental
responses to stress, may improve the wellbeing of both parents and their children. Yet, a
treatment focused on the psychosocial needs in relation to stress and allostatic load of
parents of children with ASD has not been developed. Research is warranted to examine and
intervene upon parental stress. This study aims to design and develop a resiliency
intervention to provide support to parents of children with ASD.

This intervention will be a modified version of Dr. Park's evidence-based 8-week multimodal
treatment which is designed to promote adaptation to stress and promotion of resiliency. The
program is an 8 session, 1-1.5 hours a week multi modal intervention that incorporates
relaxation techniques, stress awareness discussion, and adaptive strategies for coping with
stress. This study will refine an 8-session group virtual-delivered resiliency treatment
program consisting of 8 virtual group 1-1.5 hour sessions. The goal of this study would be to
advance our ultimate objective to implement a national parental resiliency program.

Inclusion Criteria:

1. Being the parent of at least one child with a diagnosed autism spectrum disorder

2. Age 18 or older

Exclusion Criteria:

1. Unable or unwilling to sign the informed consent documents