The Effect of Acceptance and Commitment Therapy
Condition: Autism, Infantile
MeSH terms: Autistic Disorder; Autism Spectrum Disorder
Study type: Interventional

Summary: 
      In this randomized control study, investigators will evaluate the effectiveness of the
      Acceptance and Commitment Therapy (ACT) matrix behavioral protocol compared to Parent
      Training (PT) programs in improving the psychological well-being of parents of children with
      Autism Spectrum Disorder (ASD). Twelve parents will be randomly and equitably assigned to two
      matched groups in which individuals will undergo 24 weekly ACT (experimental group) or
      conventional PT (control group) protocol meetings
    

Detailed description: 
      Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder characterized by
      core deficits in maladaptive behaviors, communication skills, and self-regulation
      im-pairments affecting the socio-relational performance of children, but also of their
      parents. It has widely been demonstrated that raising a child with autism involves chronic
      challenges consistently associated with high levels of psychological distress. Often parents
      become isolated from family and friends who may not understand the child's be-havior and
      disability. The chronic stress experienced by parents of children with ASD also reported to
      be greater than those experienced by parents of children with other disabilities, such as
      Down Syndrome, behavioral disorders and Fragile X Syndrome, and also associated with
      increased divorce rates.

      It is clear that family members, in this condition, should be supported in the development of
      new parenting skills useful to achieve targets of intervention while reducing psycho-logical
      distress. Indeed, reinforcement of parental resources has been considered as potential
      mediating factors of ASD treatment, which may reduce maladaptive behaviors in children. The
      present single-blind Randomized Controlled Trial (RCT) is aimed to compare, for the first
      time, the efficacy of the ACT approach in ASD parents with respect to the PT. Several papers
      reported the beneficial effects of PT groups as classic support to increase parenting skills
      in managing the behavior of children with ASD while reducing parental stress. Nevertheless,
      none has evalu-ated if ACT may be a more powerful approach to threat psychological reaction
      to the stress of caring for ASD children. The investigators hypothesized that psychological
      difficulties of parents of children with autism could decrease after a course with goals of
      transmitting behavioral educational techniques and promoting psychological adjustment through
      defusion and acceptance strategies. Primary outcome measures and secondary outcome measures
      will be collected. A pre/post-treatment assessment will be conducted regarding the
      measurement and change in parental psychological flexibility during the intervention. The
      primary outcome measures that will be used are the Acceptance and Action Questionnaire II
      (AAQ-II) to measure the person's psychological flexibility and ability to stay in touch with
      emotions and the Home Situation Questionnaire (HSQ-ASD) which give objective measures of the
      perception and influence of children's behavior in the parents' lives. Secondary outcome
      measures will be the Valued Living Questionnaire (VLQ) to identify areas important to the
      person, the Mindfulness Attention Awareness Scale (MAAS) which measures an individual's
      tendency toward intentional awareness, and the Parental Stress Index (PSI) to assess pre- and
      post-treatment stress levels.
    

Intervention name(s): ACT Matrix; PT Protocol
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The ACT protocol group performs exercises to improve the psychological well-being of parents. The matrix is an ACT protocol that is usually presented visually to patients and consists of two intersecting lines that make up four quadrants, which provide a "point of view" on one's psychological actions and experiences. The vertical line is the line of experience, the upper part corresponds to the experience of life linked to the five senses - sight, hearing, taste, smell and touch - (experience of the five senses), the lower part refers to the experiences internal as thoughts and feelings (internal/mental experience). The horizontal line is the behavior line, the left side concerns the actions that perform the function of moving us away from experiences, emotions, unwanted thoughts (experiential avoid-ance), the right side indicates the actions we take to get closer and go towards our values (committed action).; The PT protocol group received behavioral tasks related to child management. Parent training interventions carried out in groups can be a good solution to modify parent behavior by providing social support and new coping strategies. The intervention includes 24 weekly meetings lasting 90 minutes each. The total intervention is six months.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A single-blind, randomized controlled study was conducted at our CNR center in Messina. The first stage was based on the recruitment of the parents for the study. Next, the eligible individuals underwent a clinical examination at baseline [T0]. In the third stage, participants were randomly assigned to two groups using a computer-generated randomization code. The following people were all blinded to the group membership of the parents: the physicians (who carried out the clinical baseline assessment [T0] and post-treatment investigation [T1]), the primary researchers, and the data entry assistants. In the fourth stage, participants underwent ACT or PT training therapies. Treatments were carried on by expert therapists who were blinded to all clinical information and also to the aim of the study. At the end of treatment, participants from both groups were given a final evaluation [T1], using the same protocol as at a baseline.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Autism spectrum disorder; Psychological well-being