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Assessing the Effectiveness of Solution-Focused Brief Therapy for Couples Raising a Child with Autism: A Pilot Clinical Outcome Study

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The increased diagnostic rates and awareness of autism spectrum disorders (ASD) have led to more couples with children on the spectrum seeking professional services. Parents with a child with ASD have reported higher levels of marital dissatisfaction and parental stress than couples raising a child with other developmental disabilities. Unfortunately, there is a lack of research investigating the effectiveness of treatments for couples raising a child with ASD. In this pilot clinical outcome study, a multiple baseline design was used to identify the effectiveness of solution-focused brief therapy for couples raising a child with ASD.
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Journal of Couple & Relationship Therapy
Innovations in Clinical and Educational Interventions
ISSN: 1533-2691 (Print) 1533-2683 (Online) Journal homepage: https://www.tandfonline.com/loi/wcrt20
Assessing the Effectiveness of Solution-Focused
Brief Therapy for Couples Raising a Child with
Autism: A Pilot Clinical Outcome Study
Brie Turns, Sara Smock Jordan, Kevin Callahan, Jason Whiting & Nicole Piland
Springer
To cite this article: Brie Turns, Sara Smock Jordan, Kevin Callahan, Jason Whiting & Nicole
Piland Springer (2019): Assessing the Effectiveness of Solution-Focused Brief Therapy for Couples
Raising a Child with Autism: A Pilot Clinical Outcome Study, Journal of Couple & Relationship
Therapy
To link to this article: https://doi.org/10.1080/15332691.2019.1571975
Published online: 27 Feb 2019.
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Assessing the Effectiveness of Solution-Focused Brief
Therapy for Couples Raising a Child with Autism: A
Pilot Clinical Outcome Study
Brie Turns
a
, Sara Smock Jordan
b
, Kevin Callahan
c
, Jason Whiting
d
, and
Nicole Piland Springer
e
a
Marriage and Family Therapy, Fuller Theological Seminary Arizona, Phoenix, Arizona, USA;
b
Couple and Family Therapy Progam, University of Nevada-Las Vegas, Las Vegas, Nevada, USA;
c
University of North Texas Kristin Farmer Autism Center, Denton, Texas, USA;
d
Brigham Young
University, Provo, Utah, USA;
e
Texas Tech University, Lubbock, Texas, USA
ABSTRACT
The increased diagnostic rates and awareness of autism spec-
trum disorders (ASD) have led to more couples with children on
the spectrum seeking professional services. Parents with a child
with ASD have reported higher levels of marital dissatisfaction
and parental stress than couples raising a child with other devel-
opmental disabilities. Unfortunately, there is a lack of research
investigating the effectiveness of treatments for couples raising
a child with ASD. In this pilot clinical outcome study, a multiple
baseline design was used to identify the effectiveness of solu-
tion-focused brief therapy for couples raising a child with ASD.
KEYWORDS
Autism spectrum disorder;
couples therapy; solution-
focused brief therapy;
multiple baseline design
Autism spectrum disorder (ASD) is a neurodevelopmental disorder currently
affecting 1 of 59 children (Baio et al., 2018), and has been called the most
severe childhood behavioral disability (Newsom & Hovanitz, 2006). Individuals
with ASD display deficits in their communication and social interaction and
repetitive, restricted interests or patterns of behavior (American Psychiatric
Association [APA], 2013). Impairments may include limited social interactions,
a lack of shared emotion, or an inability to decipher some forms of communi-
cation, such as sarcasm. Repetitive, restricted interests or behavior can include
self-stimulatory behavior, such as hand-flapping, repetitive speech, or excessive
adherence to routine (APA, 2013). Although parents often notice impairments
around the childs first birthday (Hess & Landa, 2012), most children are
diagnosed around four years of age (Baio et al., 2018).
Parents raising a child with autism
An ASD diagnosis is complex and varied in its presentation and severity
level. It almost always has a significant effect on the family, particularly the
CONTACT Brie Turns brieturns@fuller.edu Fuller Theological Seminary Arizona, Marriage and Family
Therapy, 1110 E. Missouri Dr., Phoenix, AZ 85014, USA.
ß2019 Taylor & Francis Group, LLC
JOURNAL OF COUPLE & RELATIONSHIP THERAPY
https://doi.org/10.1080/15332691.2019.1571975
parental unit. Mothers and fathers of children with ASD report reduced
psychological well-being, increased social isolation, and emotional distress
(Higgins, Bailey, & Pearce, 2005). Parents also display increased vulnerabil-
ity to depression, anxiety, and pessimism (Davis & Carter, 2008).
Parents of children with ASD report higher levels of parenting stress
than o dparents of a child with Down syndrome, fragile X syndrome, or
cerebral palsy (Dabrowska & Pisula, 2010). Some of the most stressful fac-
tors of raising a child with ASD are the permanency of the diagnosis and
lack of acceptance of the childs behaviors by family members and society
(White, 2009). These challenges can often strain the marital relationship
(Benson & Kersh, 2011; Brobst, Clopton, & Hendrick, 2009; Hartley et al.,
2010). Although there is conflicting evidence regarding whether divorce
rates are higher (Freedman, Kalb, Zablotsky, & Stuart, 2012; Hartley et al.,
2010), parents of a child with autism report greater marital dissatisfaction
in comparison to parents of typically developing children, and more severe
symptoms of ASD are associated with higher reported levels of strain
among these parents (Brobst et al., 2009; Hastings & Johnson, 2001). For
example, parental stress and marital dissatisfaction are associated with defi-
cits in the childs social skills and increased self-injurious behaviors
(Hastings & Johnson, 2001). Thus, improving parentshealth and well-
being could increase the quality of care they provide to their children with
ASD (Keen, Couzens, Muspratt, & Rodger, 2010).
Treatment for parents raising a child with autism
One effective intervention for parents of a child with ASD is education
about their childs diagnosis and treatment (Koegel, Bimbela, &
Schreibman, 1996). Mothers who participated in an informational program
about ASD experienced larger decreases in depressive symptoms in com-
parison to mothers without treatment (Bristol, Gallagher, & Holt, 1993). In
another study, acceptance and commitment therapy (ACT) was provided to
parents raising a child with ASD in a 2-day, group workshop format
(Blackledge & Hayes, 2006). Results from this study a psychoeducation
and skills training program also showed improvements on the depression
and symptomatic distress scales.
Another effective model of therapy for parents raising a child with aut-
ism is emotionally focused couple therapy (i.e., Lee, Furrow, & Bradley,
2017; Ramisch, Timm, Hock, & Topor, 2013). Ramisch et al. (2013) pro-
vided 10-week, 1-hour in-home sessions of EFT and found that all three
couples had a better understanding of their conflict pattern. More recently,
seven couples who received twelve 75-minute sessions of EFT, reported
increased marital intimacy and decreased marital distress at post-treatment
2 B. TURNS ET AL.
and during a 6-month follow-up (Lee et al., 2017). Although EFT is shown
to be a suitable option for couples, there is still a need to identify other
effective models for working with couples raising a child with ASD.
Solution-focused brief therapy
Solution-focused brief therapy (SFBT; de Shazer, 1985) is an empirically
supported model that focuses on the clients resources and has been recom-
mended for parents of children with ASD (Brockman, Hussain, Sanchez, &
Turns, 2016; Jordan & Turns, 2016). Although SFBT has been shown to
help a variety of populations (McCollum & Trepper, 2001; Smock et al.,
2008), there is limited research investigating its effectiveness for couples
treatment. One study implemented a 6-week solution-focused group ther-
apy and found that, in comparison to the control group, couples receiving
SFBT improved in cohesion, consensus, and satisfaction, as measured with
the Dyadic Adjustment Scale. It should be noted that affectional expression
was not related to the independent variables. Participants also reported less
intense arguments, blaming their partner, more affection and problem-solv-
ing, and greater focus on solutions and the use of tools (Zimmerman,
Prest, & Wetzel, 1997).
To date, only one study has used SFBT specifically with parents raising a
child with ASD (Kenney, 2010). This pilot study assessed the effectiveness
of solution-focused interventions on cognitive distortions, parental stress,
and the therapeutic alliance. Results of this study demonstrated a reduction
in symptoms across all domains of stress and cognitive distortions in one
of three participants. Two of three participants experienced a reduction in
self-blame. Limitations of the study included a limited sample size of only
three participants and a lack of clarity about how therapists were trained in
solution-focused interventions (Kenney, 2010). An important limitation to
mention is the lack of investigation assessing for relationship satisfaction
and improvement, which the current study does seek to understand.
The purpose of the current pilot clinical outcome study was to investi-
gate the effectiveness of solution-focused brief couples therapy (SFBCT) on
marital satisfaction and well-being for parents raising a child with ASD.
This study also attempted to determine if a relatively short-duration parent
intervention could have an impact on overall quality of life.
Method
Design
The reporting of outcomes in therapy-based treatment studies traditionally
relies on pre- and post-measures and anecdotal reports by participants.
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 3
However, such research designs often lack clear and robust demonstrations
of experimental effect. In this study, a multiple baseline (MB) design across
subjects was used to investigate the effectiveness of SFBCT. An MB design
across subjects is an experimental design that begins with the concurrent
measurement of the dependent variables (DVs) for all participants during a
baseline (i.e., pre-intervention) condition. This is followed by the applica-
tion of the treatment variable to only one subject, while baseline conditions
remain in effect for all other subjects. Only after a significant change has
been observed for the first subject receiving treatment, the intervention is
delivered to a second subject. As before, all remaining subjects remain in
the baseline condition receiving no treatment, and the researchers continue
to collect measurements of the DVs on all subjects. After change occurs in
subject 2, the treatment is systematically delivered to subject 3, and so on.
In an MB design across subjects, experimental control is demonstrated
if each subject shows changes, when, and only when, the treatment variable
is introduced(Cooper, Heron, & Heward, 2007, p. 699). In this study, if
the hypothesized positive changes in the level of the DVs seen in baseline
were to occur only on the implementation of SFBCT, this replication of
effect could be attributed to the treatment rather than to random events
(Kazdin, 1982).
Multiple baseline designs are the most widely used experimental designs
for evaluating treatments within single-subject research (Cooper et al.,
2007). They are especially relevant as an alternative design for evaluating
complex therapeutic interventions where the number of participants is
expected to be relatively small, when it is impractical, undesirable, or
unethical to withdraw treatment in order to demonstrate experimental con-
trol, and when multiple opportunities to measure the impact of treatment
are preferred (Cooper et al., 2007). The multiple baseline design is ideally
suited to the evaluation of the progressive, multiple behavior changes
sought by many practitioners in applied settings(Cooper et al., 2007,p.
218; Hall, Cristler, Cranston, & Tucker, 1970). The relative simplicity of the
MB design and ease in conducting graphic visual analysis of the results are
other important advantages of using this design (Hall et al., 1970). Thus,
the MB design across subjects is considered especially appropriate for
determining the efficacy of therapeutic treatments such as SFBCT.
Participants
Couples raising a child with ASD
Participants for this pilot study had to be married, at least 18 years of age,
and currently raising a child between 4 and 16 years of age diagnosed with
ASD. Additional criteria included: (a) the couple was not currently
4 B. TURNS ET AL.
receiving couples therapy elsewhere; (b) the childs score for the Gilliam
Autism Rating Scale-3 (GARS-3) must indicate an Autism Index score of
55 or higher; (c) at least one member of the couple needed to score a 63 or
higher on the Outcome Questionnaire 45.2; and (d) at least one member of
the couple needed to score a 16 or lower on the Kansas Marital Satisfaction
Scale, indicating some degree of marital distress (Crane, Middleton, &
Bean, 2000). Table 1 details additional characteristics of the participants.
Participants were recruited through referrals, via email, sent from two
local autism education and research centers in the Southwestern United
States. Five of eight couples who completed the initial paperwork with the
primary researcher qualified for the study. All five of the couples who
began the study completed the entire program.
Marriage and family therapists
Two doctoral-level trained marriage and family therapy (MFT) interns
were recruited in order to provide the SFBCT. Inclusion criteria for the
therapists consisted of: (a) currently enrolled in the MFT doctoral program
where the research was taking place; (b) previously completed the SFBT
course offered at the university; and (c) previously participated in a 2-day
intensive training regarding families living with ASD conducted by the pri-
mary researcher. Therapists received 48 hours of manualized SFBT training
(Bavelas et al., 2013) and attended live, biweekly supervision from the
second author, a licensed marriage and family therapist supervisor. An add-
itional fidelity measure was the use of team members. At all sessions, two
other MFT interns observed and provided feedback during the study. All
therapists and observers attended supervision.
Procedures
Baseline condition
After participants provided consent and completed the first group of assess-
ments, the first three couplesscores were compared to identify the most
distressedcouple. Best practice in using the multiple baseline research
design dictates beginning the therapeutic intervention as soon as possible
with participants demonstrating the greatest need (Cooper et al., 2007).
Couple 1 began the intervention condition (SFBCT) first while the other
two couples stayed in baseline (no treatment). While couple 1 only com-
pleted one baseline session, couple 2 waited 3 weeks and couple 3 waited
8 weeks before beginning treatment.
Multiple baselines were then established by staggering the beginning of
the intervention across all of the couples as described above. Couples who
remained in the baseline condition were asked to complete questionnaires
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 5
Table 1. Participant Characteristics.
Parent Demographics Prior Therapeutic Experience Reason(s) for Participation Child Characteristics
Couple 1 Hispanic None Identify ways to cope; Learn how to
parent as a team
7-year-old male with ASD, receiving OT, counseling,
and medications
Couple 2 Caucasian Mother bipolar
disorder (untreated)
Father: None
Mother: Numerous previous
therapists and psychiatrists
Identify ways to enhance the
father-son relationship
11-year-old male with ASD;10-year-old typically
developing sibling, both receiving
individual counseling
Couple 3 Caucasian Both previously received
individual counseling
Identify ways to parent as a couple 15-year-old female with ASD, receiving counseling,
equine therapy, OT, and medications; two
typically developing siblings
Couple 4 Caucasian Father: None
Mother: Individual therapy
Work on marital relationship 9-year-old with ASD receiving Speech Therapy
and medications; twin 5-year-old typically
developing siblings
Couple 5 Caucasian
Father self-identified ASD
tendencies and characteristics
Both previously participated in
individual and family counseling
Improve parenting and marital skills;
Learn about external family stressors
8-year-old male with ASD receiving Play Therapy;
two younger typically developing siblings
6 B. TURNS ET AL.
once a week, with each partner completing the Outcome Questionnaire
45.2 (OQ-45.2) and Kansas Marital Satisfaction Scale (KMSS) individually.
Scores on these repeated dependent measures (KMSS and OQ-45.2) were
graphed and analyzed to determine appropriate starting points for each
couplesSFBCT. Per established guidelines for using the MB design, cou-
ples in subsequent baselines began treatment when their baseline data dem-
onstrated stability and an appropriate trend, and only after the prior couple
showed a change while receiving SFBCT. Thus, after couple 2 reported a
difference in the outcome variables, couple 3 began treatment. These proce-
dures were repeated when additional couples were added later in the study.
Treatment condition
The intervention phase consisted of the therapist conducting six 1-hour
sessions of SFBCT based upon the manual (Bavelas et al., 2013). Appendix
Adescribes each intervention and provides an example.
Measurements
Treatment effectiveness
The Outcome Questionnaire 45.2 (Lambert et al., 1996) is a self-report
measure designed for repeated assessments of client status throughout ther-
apy. The 45-items are rated on a five-point Likert-like scale: 0 (never)to4
(almost always), yielding a possible total score from 0 to 180. High scores
indicate greater distress (e.g., anxiety, depression, somatic problems, and
stress) as well as interpersonal difficulties in social roles and overall quality
of life. A total score of 63 is considered clinically significant. The OQ-45.2
has shown sensitivity to changes in clients between sessions, while remain-
ing stable in untreated individuals, and is considered to be a reliable instru-
ment (a¼.93; Lambert et al., 2001).
Marital satisfaction
The Kansas Marital Satisfaction Scale (KMSS; Schumm, Nichols,
Schectman, & Grisby, 1983) is a self-report measure consisting of three
items on an 8-point Likert-like scale, ranging from 0 (extremely dissatisfied)
to 7 (extremely satisfied). The items are averaged to determine the overall
score, with a higher score indicating greater marital satisfaction. A score of
16 or lower indicates some degree of marital distress. Cronbachs alpha
ranges from .84 to .98 on clinical populations (Schumm et al., 1983). The
KMSS is also sensitive to change in clients between sessions and is appro-
priate for repeated measures during therapy. Test-retest correlations of .71
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 7
were reported over a 10-week interval with a range of .62 to .72 over
6 months.
Childs autism diagnosis and severity levels
The Gilliam Autism Rating Scale-Third Edition (GARS-3; Gilliam, 2014)
was used to confirm the autism diagnosis and to assess severity of the
childs ASD symptoms. The GARS-3 has adequate reliability and validity
(Gilliam, 2014) and is used to identify autism, assess its severity, and deter-
mine appropriate intervention. It has 58 items measured on a 4-point
Likert-like scale from 0 (not at all like the individual)to3(Very much like
the individual). The Total Score of the GARS-3 provides an Autism Index
and Severity Level.
Marriage and family therapist skill level
The Family Therapist Rating Scale (Piercy, Laird, &, Mohammed, 1983)
was developed to ensure treatment quality and fidelity among therapists
and used to assess the therapistsskill level. Two independent raters, mas-
ters-level MFT interns, scored one randomly selected video-recorded ses-
sion of each of the studys therapists using the Family Therapist Rating
Scale. No formal training was required to complete the scale. The scale
consists of 50 items scored on a 6-point Likert-like scale from 0 (not pre-
sent)to6(maximally effective). The reliability of this scale is high (.77;
Piercy, et al., 1983).
Therapist adherence to SFBCT
Fidelity of intervention was assessed by measuring therapistsadherence to
SFBCT. Smock et al. (2008) developed this checklist to ensure the standar-
dized delivery of the therapeutic model. The checklist consists of five essen-
tial SFBCT components scored yesor no.Every yesrating is given a
score of 1 and noratings receive a zero. Therapist adherence to the
model is considered to be present if the average score of the raters was 4
or higher (Smock et al., 2008). Two masters-level students, who were
unaware of the purpose of this study, were asked to complete the Family
Therapist Rating Scale and the adherence to SFBCT checklist.
Intervention
The first three couples were randomly assigned to a doctoral-level therapist
who provided SFBCT to each couple until six sessions were completed. The
remaining two couples were randomly assigned to a different therapist. The
therapists followed the Solution-Focused Brief Therapy Association
8 B. TURNS ET AL.
(SFBTA)s manual (Baveles et al., 2013), which is available for download
(www.sfbta.org). This manual has been used among various populations.
The therapist participants were provided an outline for the session formats.
After each session, the primary investigator entered the room, the therapist
exited, and the couple completed the OQ-45.2 and KMSS.
Data analysis
A combination of visual and basic statistical analyses were used in this
study to evaluate the relationship between the independent variable (IV;
SFBCT) and DVs (KMSS for marital satisfaction and OQ-45.2 for overall
well-being). Interpretation of data in an MB design is based on graphic
presentation and visual analysis (Au et al., 2017; Center & Leach, 1984).
Replication of experimental effect across subjects and at different points in
time is considered evidence of a causal relationship between treatment and
positive outcomes. A line graph was constructed for each couple represent-
ing the session-by-session measurement of the OQ-45.2 and KMSS.
Evaluation of treatment effectiveness was accomplished by visual inspection
of the graphed data for differences between the baseline and intervention
phases for each couple (Center & Leach, 1984). Specifically, changes in the
levels, trends, and latency of the data were investigated in order to assess
the differences in client outcomes between baseline and intervention
phases. Thus, our visual analyses considered changes in the overall levels of
reported marital satisfaction and overall well-being between baseline and
treatment, the direction in trend lines (i.e., whether the observed trends
were therapeutic, level, or counter-therapeutic), and latency (the time it
took for the couples scores to begin changing after SFBCT
was introduced).
Results
Overall well-being
First, the OQ-45.2 showed a downward trend during the intervention
phase, indicating an improvement in the individuals overall well-being (see
Figures 1 and 3). Table 2 indicates the means of each couples baseline
scores. The overall baseline mean score on the OQ-45.2 across all partici-
pants was 80.5. Prior to intervention, 8 out of 10 participants scored above
the OQ-45.2 distress cutoff score of 63. Two fathers (couple 2 and couple
4) scored below this. The baseline mean score for the combined group of
mothers was significantly higher than for fathers (mothers ¼93.2; fathers
¼67.9), although the mean scores for both were above the cutoff score
level on the OQ-45.2 before intervention. The baseline data for all couples
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 9
Figure 1. OQ-45.2 scores for couple 1 through 3.
Note: Horizontal scale indicates weeks and vertical scale indicates range of OQ-45.2 score. ¼
Female; m¼Male; SFBCT ¼Solution-Focused Brief Couples Therapy ---¼weeks missed
10 B. TURNS ET AL.
were stable and demonstrated appropriate trends, permitting the beginning
of treatment at the appropriate times as prescribed by the MB design.
Following treatment, the mean OQ-45.2 score for all participants was
73.0, with scores decreasing (i.e., improving) for six of the 10 participants.
Scores for four of five mothers and two of five fathers improved after the
6-week intervention. The scores for three of the five fathers increased
Figure 2. KMSS scores for Couple 1-3.
Note: Horizontal scale indicates weeks and vertical scale indicates range of KMSS score. ¼
Female; m¼Male; SFBCT ¼Solution-Focused Brief Couples Therapy ---¼weeks missed
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 11
following treatment, including the two fathers whose baseline scores
reflected lower levels of initial distress. However, overall group means
decreased for both mothers and fathers after intervention (mothers ¼83.0;
fathers ¼62.8), with the average score for fathers after treatment falling
below the cutoff score of 63 for clinically significant distress.
Analysis of trends indicates the predicted direction of outcomes if the
intervention was extended beyond the end of data collection (Cooper et al.,
2007). For the OQ-45.2, a therapeutic trend is observed by a descending
trend line in the intervention phase. Linear regression provides an accurate
Figure 3. OQ-45.2 scores for Couple 4-5.
Note: Horizontal scale indicates weeks and vertical scale indicates range of OQ-45.2 score. ¼
Female; m¼Male; SFBCT ¼Solution-Focused Brief Couples Therapy; --¼weeks missed
12 B. TURNS ET AL.
depiction of trends in single-subject analyses (Stocks, n.d.), and was used to
determine trends in the treatment phase for all participants. On the OQ-
45.2, seven of 10 participants demonstrated a therapeutic trend during
intervention. All trend lines for mothers were therapeutic, while fathers
demonstrated therapeutic trends in only two of five cases.
Marital satisfaction
The KMSS was used to assess marital satisfaction and was interpreted using
the same visual analysis as for the OQ-45.2. On the KMSS, upward trends
indicate an increase in marital satisfaction, with a score of 16 being the cut-
off for clinical significance (see Figures 2 and 4). At baseline, the KMSS
scores for nine of 10 participants fell below the cutoff level for marital sat-
isfaction; with an overall mean score of 12.8. The baseline mean score for
fathers was 12.0, and the mean for mothers was 13.6, indicating slightly
higher marital satisfaction by mothers prior to intervention. Baseline data
were stable, with appropriate trends, for all couples.
Following treatment, KMSS scores for five of 10 participants increased.
The overall mean score for all participants after the 6-week intervention
increased to 14.0. The post-treatment mean scores for both fathers and
mothers increased (to 13.0 and 14.9, respectively). Marital satisfaction
scores for three of the fathers and two mothers increased following inter-
vention. Trend lines during intervention were therapeutic in seven of 10
cases, suggesting that scores would be predicted to continue to improve if
therapy was sustained beyond 6 weeks.
Effect size
In addition to visual analyses, a measure of effect size was calculated to
provide an objective measure of the magnitude of treatment outcomes
(Parker & Hagan-Burke, 2007). Reporting of effect size is an indicator of
Table 2. Means of Couples Baseline and Intervention Scores
Partner OQ-45.2 KMSS
BIBI
Couple 1 Father 64 43.5 11 14.7
Mother 80 46.7 15 19.8
Couple 2 Father 60 64.5 CT 10.7 12.3
Mother 99.7 94.3 12.3 11.8 CT
Couple 3 Father 81.4 66 12.4 15
Mother 78.9 69.3 16.2 14.6 CT
Couple 4 Father 40 43.2 CT 11 10.2 CT
Mother 100 96.8 11 15
Couple 5 Father 94 97.3 CT 15 13 CT
Mother 107.3 108 CT 13.7 13.5 CT
Note: B¼Baseline; I¼Intervention; OQ-45.2 ¼Treatment Outcome Scale; KMSS ¼Marital Satisfaction Scale;
CT ¼counter-therapeutic.
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 13
high-quality and robust research in autism (Reichow, Doehring, Cicchetti,
& Volkmar, 2011). Effect size calculations also provide increased precision
in the measurement of intervention effects when the results are generally
not large and obvious using visual analysis alone (Dunst, Hamby, &
Figure 4. KMSS scores for Couple 4-5.
Note: Horizontal scale indicates weeks and vertical scale indicates range of KMSS score. ¼
Female; m¼Male; SFBCT ¼Solution-Focused Brief Couples Therapy; ---¼weeks missed
Table 3. Pre- and Post-Intervention Scores for GARS.
Pre-Intervention Post-Intervention
Childs Age ASD Index SL ASD Index SL
Couple 1 7 125 3 117 3
Couple 2 11 117 3 86 2
Couple 3 15 112 3 93 2
Couple 4 9 108 3 100 2
Couple 5 8 111 3 109 3
Note: GARS-3 ¼Gilliam Autism Rating Scale; SL ¼severity level.
14 B. TURNS ET AL.
Trivette, 2004). Effect sizes can be interpreted by being grouped into cate-
gories with associated values. Smalleffect sizes range from .00 to .32,
mediumeffect sizes range from .33 to .55, and largeeffect sizes are .56
and greater (Lipsey, 1990). A commonly reported measure of effect size
within studies using single-subject research designs is Cohensdindex
(Dunst et al., 2004). This measure of effect size was calculated for all partic-
ipants across baseline and intervention phases for both the OQ-45.2 and
the KMSS using the following formula:
MIMB
ðÞ
ffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
SD2
IþSD2
B

=2
q
where MIis the mean score for the intervention, and MBis the mean score for
baseline. The effect size values and magnitudes for each participant are reported
in Table 5. Across both the OQ45.2 and the KMSS, effect size magnitudes were
Large or Medium for a total of ten (50%) of the dependent measures.
Family therapist skill level
The Family Therapist Rating Scale (Piercy et al., 1983) was administered to
address the potentially confounding variable of therapist skill level. A final
skill level rating was determined by adding each questions numerical score (1
to 6, as described in more detail earlier), with a total possible score ranging
from 0 to 300. The average score for therapist 1 was 170 and for therapist 2
was 160.5. The mean total scores of each treatment group were compared to
see if there was a significant difference between means. After performing an
Table 5. Effect Size.
KMSS OQ 45.2
C1F 4.64 3.03
C1M 3.44 4.79
C2F 0 0.48
C2M 0.27 0.97
C3F 1.05 1.53
C3M 1.90 3.43
C4F 3.38 0.22
C4M 0.45 6.42
C5F 0.15 0.15
C5M 1.04 0.5
Group F 1.36 1.02
Group M 1 0.07
Overall 1.18 0.55
Note: C¼couple; F ¼female; M ¼male.
Table 4. tTests Comparing Therapists on the Therapist Rating Scale.
Mean Std. Deviation tdfSig.
Therapist 1 170 24.0 .450 2 .70
Therapist 2 160.5 17.7
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 15
independent samples ttest, there was no significant difference between the
therapists. In addition, the interrater reliability for this scale was .995. These
results indicate that the therapistsskill level was comparable (Table 4).
Therapist adherence to SFBCT
The second potential confounding variable was therapists adherence to
SFBCT, which indicates fidelity of treatment implementation. The therapist
raters randomly selected and rated three recorded sessions of each therapists
assigned couples, equaling three scores per rater, per couple. The scores for
each couple were averaged. Scores above 4 indicated therapist adherence to
the model in the delivery of therapy for each couple. The range of scores was
4.00 to 4.66. Based on all of the mean scores, both therapists adhered to SFBT
with all couples and implemented the intervention as prescribed.
Social validation
An important component of the effectiveness of any evidence-based or emerg-
ing intervention is social validity (Callahan et al., 2017). Social validity refers to
the acceptability of the goals, procedures, and outcomes of programs and inter-
ventions by their consumers (Kazdin, 1977;Wolf,1978). Thus, social validation
includes the satisfaction of treatments by those who receive, implement, and
oversee them (Alberto & Troutman, 2006). Social validity is a key factor in the
effective implementation of interventions for individuals with autism and their
families (Callahan, Henson, & Cowan, 2008). In this study, evidence of social
validity may be found in the post-therapy structured interview questions that
were asked by the primary researcher. Participants were asked after the first,
third, and sixth therapy session How satisfied were you with the therapy?
Nine of 10 participants gave positive feedback. For example, one couple stated
that they enjoyed it very much,while another stated that every con-
versationhad been useful to either their family or their marriage.
Discussion
The purpose of this pilot study was to assess the effectiveness of a brief thera-
peutic treatment on the quality of life and marital satisfaction of parents raising a
child with autism. Using a novel research design in the field of marriage and
family therapy, SFBCT was delivered once per week for a total of 6 weeks for all
participants in the study. SFBCT was generally supported as an effective treat-
ment for parents of children with autism, especially for the mothers.
Nevertheless, there are several patterns to note. First, some participants (couple 1
and couple 3 father) appeared to show an improvement in their scores immedi-
ately after beginning treatment. These results concur with previous research by
16 B. TURNS ET AL.
Blackledge and Hayes (2006), who found improvements in parentsoverall well-
being after attending a 2-day group workshop format. Other participants (moth-
ers in couples 2, 3, and 4) showed a decline or no change in scores for approxi-
mately three sessions, after which they showed improvement during the
remaining sessions. Previous researchers have found a similar trend for individu-
als receiving therapy; some decline before they get better(Lambert & Ogles,
2004). This may occur because attending therapy gives couples the opportunity
to begin discussing stressors that were previously being dismissed in their rela-
tionship. It is also important to note that each of these participants were females.
Someparticipants(couple2;couple5,fatheroffourchildren)didnotindicatea
change at all, or declined in their scores and did not improve before the end of
the study. Although there can be numerous explanations for the observed lack of
progress, past researchers have shown that some individuals simply may not
benefit from therapy (Lambert & Ogles, 2004). In addition, six therapy sessions
is a relatively short treatment period. It is possible further and more robust
improvements may have occurred if the treatment was extended.
The results of this study support the conclusion that SFBCT is an appro-
priate and potentially effective therapeutic option for couples raising a child
with ASD. Because the MB design demonstrates changes in the dependent
measures only when the treatment is introduced and a corresponding repli-
cation of effect across the participants is observed, it is likely that any posi-
tive changes were the result of the SFBCT intervention.
Results from the KMSS indicate similar trends to the overall well-being. Some
participants (couple 1; mother couple 4) reported immediate improvements in
scores. Based on the visual analysis used when assessing MB designs, immediate
changes in scores from baseline indicate that the intervention is the likely reason
for the observed improvement (Kazdin, 1982). While other participants (father
couple 4, mother couple 2, father couple 3) showed no immediate change or a
decline in scores after one or two sessions, followed by an improvement after a few
sessions. This may be similar to the trend that occurred with the OQ-45.2, where
an initial decline in scores occurs before improving (Lambert & Ogles, 2004).
Others decreased in their scores (father couple 2, mom couple 3) and did not
improve throughout the remainder of treatment. Although the majority of clients
did improve in their marital satisfaction, not all did. Again, it is possible that some
may have improved with more treatment. Previous research studies have indicated
similarresults.Thecurrentstudys results indicate that SFBCT was effective for
improving couples marital satisfaction and could be used for couples.
Implications
There is a need for increased research studies that assess the effectiveness of
systemic models of therapy for couples raising a child with ASD. The results
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 17
of this pilot study provide initial and encouraging evidence that SFBCT is a
useful model for helping this underserved population, and it would be helpful
to apply and adapt some of its techniques with couples in similar circumstan-
ces. For example, couples in this study were encouraged to set realistic,
observable, and measurable goals consistent with SFBTs goal setting criteria.
However, couples that would like to curetheir childs ASD will likely not
experience clinical improvements. Similarly, the Miracle Questionmay also
need to be slightly reworded to display sensitivity to the unique circumstances
of ASD. Also, in this study at least one partner of each couple reported to
either the therapist or interviewer their strong desire for change and seeking
professional help. It is likely that clients who have a strong desire to improve;
they may experience better outcomes than clients who are less motivated.
Finally and significantly, SFBCT is an attractive option when working with
couples raising a child with ASD. There are many factors of a childs life that
can be challenging for a parent to manage, such as symptomatic behaviors,
lack of support from clinicians, and increased marital problems. SFBCT
allows parents to focus on their strengths and resources rather than the prob-
lems that brought them to therapy. SFBCT is also one of the only therapeutic
approaches to emphasize goal-setting within the model, as well as encourage
a focus on exceptions. Such an approach may provide parents with an alterna-
tive for the problem-focused interventions that can be prominent given the
nature of problematic ASD-related behavioral patterns.
An additional implication to discuss is the how clinicians should be
trained to work with couples raising a child with ASD. Currently, many
training programs do not include specific education on families raising
children with special needs, let alone ASD. This study has shown that if a
clinician is well-trained in SFBT, they should be able to effectively treat
and help couples raising a child with ASD.
Limitations and future research
Although the number of participants in this study met the sample require-
ments for a MB design (a minimum of three to five participants), it remains a
small sample. Future research studies should enhance the sample size to fur-
ther the external validity of the study. Recruitment for the current study was
limited due to the location of the university and locating parents. Future stud-
ies should use more diverse recruitment procedures and reach out to entities
primarily working with children with ASD. Next, the current pilot study did
not assess the childs symptomology or their behaviors. Finally, many of the
couples sought involvement in the study for various reasons. These present-
ing problems could have impacted the effectiveness SFBCT had on each indi-
vidual participant. For example, it may be that these participants had more
18 B. TURNS ET AL.
severe symptoms in their child than do some children with ASD. Or, it may
be that their marriages were less healthy than other families dealing with
ASD. Future studies should consider controlling for the presenting problem
in order to further identify if SFBCT is an effective treatment for couples. For
example, recruiting couples who, specifically, would like to work on enhanc-
ing their marital satisfaction.
Conclusion
This clinical outcome study investigated the effectiveness of SFBCT for
couples raising a child with ASD. With the use of a MB design, it was
established that SFBCT is an effective treatment option for couples. The
majority of participants in this study increased in their overall well-being
and marital satisfaction assessment scores. Although there are several limi-
tations in this study, we have identified the first couples therapy treatment
to help the stressful experiences couples face while raising a child with an
autism spectrum disorder.
Compliance with ethical standards
This study was funded by the Solution-Focused Brief Therapy Association
and by the Texas Tech College of Human Sciences.
Conflict of interest
Authors declare no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in
accordance with the ethical standards of Texas Tech University and/or
national research committee and with the 1964 Helsinki declaration and its
later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all participants included in the study.
GrantFunding
Student Research Award from Solution Focused Brief Therapy Association,
Nova Scotia, Canada. Doctoral Dissertation Completion Fellowship,
Graduate School, Texas Tech University.
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 19
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Appendix A
SFBT session formats
First Session Format:
This table gives key interventions that will be used in the first session and examples of
how the therapist can conduct the intervention.
22 B. TURNS ET AL.
Second to Sixth Session Format:
The left column is key interventions that will be conducted in the second through sixth
therapy session and example questions for how the therapist can ask them.
Key Interventions Example Questions/Description of Intervention
Having the client identify their problem So, how can I be helpful to you today?
Asking goal-formulating questions What do you want to see changed as a result of
coming here today?
Asking the Miracle question (see Berg &
Dolan, 2001)
Highlighting exceptions Are there times when the problem is not as bad?
Asking scaling questions - Coping - Confidence On a scale from 1 to 10, how well are you coping
with your daughters outbursts?
On a scale from 1 to 10, how confident are you
that thing will improve at home?
Take a break and develop compliments for the client The therapist can leave the room or take a break
in their chair, gathering their thoughts and devel-
oping compliments
Compliments Compliments are based on what the client(s)
reported that they 1) like about themselves, 2) are
proud of, 3) things they are doing well
Homework Homework should come from what the client has
mentioned that would be helpful/useful.
These techniques were adapted from (De Jong & Berg, 2013 and Baveles et al., 2013).
Key Interventions Example Questions/Description of Intervention
Whats better
Start Again
Note: If nothing better is reported
-So what has been better since the last time we met? Whats
going on thats better? -So how did you do that? -What
difference did you notice since you have been taking more time
for yourself ? -So what else is better? -How are you keeping
things from getting worse?
Doing More -So what will it take to keep this going?
Scaling Progress Current Future -On a scale of 1 to 10, where 10 is [their goal], where are you
this week? -When you move up one point on the scale of
[define goal], what will that look like?
Take a break and develop
compliments for the client
-The therapist can leave the room or take a break in their chair,
gathering their thoughts and developing compliments
Compliments -Compliments are based on what the client(s) reported that
they 1) like about themselves, 2) are proud of, 3) things
they are doing well
Homework -Homework should come from what the client has mentioned
that would be helpful/useful.
These techniques were adapted from De Jong & Berg, 2013, and Baveles et al., 2013.
JOURNAL OF COUPLE & RELATIONSHIP THERAPY 23
Article
The aim of this qualitative case study is to understand the experiences of receiving solution-focused brief therapy for couples raising a child with Autism Spectrum Disorder. Five couples received six sessions of solution-focused brief couples therapy (SFBT) and were interviewed after the first, third, and last therapy sessions. Couples engaged in a semi-structured interview and were asked about their experiences in therapy. After using descriptive and in vivo coding to analyze the fifteen transcripts, the codes were placed into major themes. The six themes include: (a) therapy as a “blessing”; (b) positive experiences with the therapist; (c) helpful conversations; (d) reactions to the miracle question; (e) clarifying the couple and co-parent identity; and (f) the growth of the parent-child relationship. The current study is the first to identify parents’ experiences of treatment, while raising a child with ASD.
Article
Raising a child with an Autism Spectrum Disorder (ASD) can have negative effects on the parents’ emotional wellbeing, along with their marital relationship. Although there is some information on the treatment of parents, there is a lack of research investigating how the process of change occurs during couples therapy. The current study interviewed five couples, raising a child with ASD, who received Solution-Focused Brief Couples Therapy (SFBCT). A grounded theory approach was used to understand the process of change for couples receiving six sessions of SFBCT. Through the use of constructivist-grounded theory methodology (GTM), a theory was constructed on the experience of change perceived by participants. The results indicate the importance of both the therapists’ and clients’ process of change during therapy.
Article
Attachment injury resolution model (AIRM) is a structured approach for treatment and improves the distressed relationship that focuses on stable interactive negative cycles which caused by deep emotional vulnerability. The current study was administered aimed to investigate the effectiveness of emotionally-focused couple therapy based on attachment injury resolution model on increase forgiveness among the injured women with marital infidelity. In this research, a single-case experimental design, type of non-concurrent multiple baseline designs was used. The statistical population consisted of 53 injured women with marital infidelity who referred to Bushehr counseling centers. The sample research consisted of 3 couples (6 individuals) among couples referred to these counseling centers that were selected by considering the inclusion and exclusion criteria and according to the results of the forgiveness scale (Rye et al., 2001) with purposeful sampling method. The protocol of emotionally focused couple therapy based on attachment injury resolution model was carried out in three phases of basic lines, intervention and follow-up. Data analysis were conducted by visual analysis, reliable change index and percentage improvement formula. The findings indicated that attachment injury resolution model had significant effect in increasing of forgiveness among injured women with marital infidelity during the therapy (%35.26 improvement) and follow-up (%45.93 improvement). Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries caused by marital infidelity.
Article
Attachment injury resolution model (AIRM) is a structured approach for treatment and improves the distressed relationship that focuses on stable interactive negative cycles which caused by deep emotional vulnerability. The current study was administered aimed to investigate the effectiveness of emotionally-focused couple therapy based on attachment injury resolution model on increase forgiveness among the injured women with marital infidelity. In this research, a single-case experimental design, type of non-concurrent multiple baseline designs was used. The statistical population consisted of 53 injured women with marital infidelity who referred to Bushehr counseling centers. The sample research consisted of 3 couples (6 individuals) among couples referred to these counseling centers that were selected by considering the inclusion and exclusion criteria and according to the results of the forgiveness scale (Rye et al., 2001) with purposeful sampling method. The protocol of emotionally focused couple therapy based on attachment injury resolution model was carried out in three phases of basic lines, intervention and follow-up. Data analysis were conducted by visual analysis, reliable change index and percentage improvement formula. The findings indicated that attachment injury resolution model had significant effect in increasing of forgiveness among injured women with marital infidelity during the therapy (%35.26 improvement) and follow-up (%45.93 improvement). Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries caused by marital infidelity.
Article
Attachment injury resolution model (AIRM) is a structured approach for treatment and improves the distressed relationship that focuses on stable interactive negative cycles which caused by deep emotional vulnerability. The current study was administered aimed to investigate the effectiveness of emotionally-focused couple therapy based on attachment injury resolution model on increase forgiveness among the injured women with marital infidelity. In this research, a single-case experimental design, type of non-concurrent multiple baseline designs was used. The statistical population consisted of 53 injured women with marital infidelity who referred to Bushehr counseling centers. The sample research consisted of 3 couples (6 individuals) among couples referred to these counseling centers that were selected by considering the inclusion and exclusion criteria and according to the results of the forgiveness scale (Rye et al., 2001) with purposeful sampling method. The protocol of emotionally focused couple therapy based on attachment injury resolution model was carried out in three phases of basic lines, intervention and follow-up. Data analysis were conducted by visual analysis, reliable change index and percentage improvement formula. The findings indicated that attachment injury resolution model had significant effect in increasing of forgiveness among injured women with marital infidelity during the therapy (%35.26 improvement) and follow-up (%45.93 improvement). Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries caused by marital infidelity.
Article
Attachment injury resolution model (AIRM) is a structured approach for treatment and improves the distressed relationship that focuses on stable interactive negative cycles which caused by deep emotional vulnerability. The current study was administered aimed to investigate the effectiveness of emotionally-focused couple therapy based on attachment injury resolution model on increase forgiveness among the injured women with marital infidelity. In this research, a single-case experimental design, type of non-concurrent multiple baseline designs was used. The statistical population consisted of 53 injured women with marital infidelity who referred to Bushehr counseling centers. The sample research consisted of 3 couples (6 individuals) among couples referred to these counseling centers that were selected by considering the inclusion and exclusion criteria and according to the results of the forgiveness scale (Rye et al., 2001) with purposeful sampling method. The protocol of emotionally focused couple therapy based on attachment injury resolution model was carried out in three phases of basic lines, intervention and follow-up. Data analysis were conducted by visual analysis, reliable change index and percentage improvement formula. The findings indicated that attachment injury resolution model had significant effect in increasing of forgiveness among injured women with marital infidelity during the therapy (%35.26 improvement) and follow-up (%45.93 improvement). Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries caused by marital infidelity.
Article
Attachment injury resolution model (AIRM) is a structured approach for treatment and improves the distressed relationship that focuses on stable interactive negative cycles which caused by deep emotional vulnerability. The current study was administered aimed to investigate the effectiveness of emotionally-focused couple therapy based on attachment injury resolution model on increase forgiveness among the injured women with marital infidelity. In this research, a single-case experimental design, type of non-concurrent multiple baseline designs was used. The statistical population consisted of 53 injured women with marital infidelity who referred to Bushehr counseling centers. The sample research consisted of 3 couples (6 individuals) among couples referred to these counseling centers that were selected by considering the inclusion and exclusion criteria and according to the results of the forgiveness scale (Rye et al., 2001) with purposeful sampling method. The protocol of emotionally focused couple therapy based on attachment injury resolution model was carried out in three phases of basic lines, intervention and follow-up. Data analysis were conducted by visual analysis, reliable change index and percentage improvement formula. The findings indicated that attachment injury resolution model had significant effect in increasing of forgiveness among injured women with marital infidelity during the therapy (%35.26 improvement) and follow-up (%45.93 improvement). Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries caused by marital infidelity.
Article
Natural disasters can greatly impact the physical and psychological well-being of individuals, families, and communities. Experiencing the event is only the beginning of negative outcomes endured by families. The loss of a home, livelihood, possessions, and a sense of safety can cause depression, anxiety, posttraumatic stress disorder, and a vast array of other psychological challenges. This article proposes the use of the Miracle Question (MQ), an intervention from Solution focused Brief Therapy, for individuals and families recovering from a natural disaster. A case study example will also be provided to demonstrate the empathetic and effective use of the intervention.
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Objective: The present study aimed at determining the effectiveness of emotionally-focused couple therapy, based on attachment injury resolution model (AIRM) on increasing trust among the injured women with marital infidelity. Method: The present study was a single case experiment of the multiple baseline design type. The population included all injured women with marital infidelity, referring to Bushehr family therapy clinics, among whom three women were selected and participated in the intervention through purposive sampling method, based on the desired recall, By considering the inclusion and exclusion criteria and answering the trust scale. Data analysis was conducted by visual analysis, clinically meaningful (reliable change index and normative comparison) and percentage improvement formula. Results: The percentage obtained from the overall increase of trust among the injured women during the therapy was 38.76 and follow-up was 48.58. In addition, the reliable change index during the therapy and a follow-up was 2.77 and 3.49 in the first couple, 3.10 and 3.62 in the second couple, 2.66 and 3.67 in the third couple indicating that these values were significant and higher than z = 1.96 during the therapy and follow-up (p = 0.05). Conclusion: Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries by marital infidelity.
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Problem/condition: Autism spectrum disorder (ASD). Period covered: 2014. Description of system: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence of autism spectrum disorder (ASD) among children aged 8 years whose parents or guardians reside within 11 ADDM sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). ADDM surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by professional service providers in the community. Staff completing record review and abstraction receive extensive training and supervision and are evaluated according to strict reliability standards to certify effective initial training, identify ongoing training needs, and ensure adherence to the prescribed methodology. Record review and abstraction occurs in a variety of data sources ranging from general pediatric health clinics to specialized programs serving children with developmental disabilities. In addition, most of the ADDM sites also review records for children who have received special education services in public schools. In the second phase of the study, all abstracted information is reviewed systematically by experienced clinicians to determine ASD case status. A child is considered to meet the surveillance case definition for ASD if he or she displays behaviors, as described on one or more comprehensive evaluations completed by community-based professional providers, consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for autistic disorder; pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism); or Asperger disorder. This report provides updated ASD prevalence estimates for children aged 8 years during the 2014 surveillance year, on the basis of DSM-IV-TR criteria, and describes characteristics of the population of children with ASD. In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which made considerable changes to ASD diagnostic criteria. The change in ASD diagnostic criteria might influence ADDM ASD prevalence estimates; therefore, most (85%) of the records used to determine prevalence estimates based on DSM-IV-TR criteria underwent additional review under a newly operationalized surveillance case definition for ASD consistent with the DSM-5 diagnostic criteria. Children meeting this new surveillance case definition could qualify on the basis of one or both of the following criteria, as documented in abstracted comprehensive evaluations: 1) behaviors consistent with the DSM-5 diagnostic features; and/or 2) an ASD diagnosis, whether based on DSM-IV-TR or DSM-5 diagnostic criteria. Stratified comparisons of the number of children meeting either of these two case definitions also are reported. Results: For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. Overall ASD prevalence estimates varied among sites, from 13.1-29.3 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and race/ethnicity. Males were four times more likely than females to be identified with ASD. Prevalence estimates were higher for non-Hispanic white (henceforth, white) children compared with non-Hispanic black (henceforth, black) children, and both groups were more likely to be identified with ASD compared with Hispanic children. Among the nine sites with sufficient data on intellectual ability, 31% of children with ASD were classified in the range of intellectual disability (intelligence quotient [IQ] <70), 25% were in the borderline range (IQ 71-85), and 44% had IQ scores in the average to above average range (i.e., IQ >85). The distribution of intellectual ability varied by sex and race/ethnicity. Although mention of developmental concerns by age 36 months was documented for 85% of children with ASD, only 42% had a comprehensive evaluation on record by age 36 months. The median age of earliest known ASD diagnosis was 52 months and did not differ significantly by sex or race/ethnicity. For the targeted comparison of DSM-IV-TR and DSM-5 results, the number and characteristics of children meeting the newly operationalized DSM-5 case definition for ASD were similar to those meeting the DSM-IV-TR case definition, with DSM-IV-TR case counts exceeding DSM-5 counts by less than 5% and approximately 86% overlap between the two case definitions (kappa = 0.85). Interpretation: Findings from the ADDM Network, on the basis of 2014 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD among children aged 8 years in multiple communities in the United States. The overall ASD prevalence estimate of 16.8 per 1,000 children aged 8 years in 2014 is higher than previously reported estimates from the ADDM Network. Because the ADDM sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States. Consistent with reports from previous ADDM surveillance years, findings from 2014 were marked by variation in ASD prevalence when stratified by geographic area, sex, and level of intellectual ability. Differences in prevalence estimates between black and white children have diminished in most sites, but remained notable for Hispanic children. For 2014, results from application of the DSM-IV-TR and DSM-5 case definitions were similar, overall and when stratified by sex, race/ethnicity, DSM-IV-TR diagnostic subtype, or level of intellectual ability. Public health action: Beginning with surveillance year 2016, the DSM-5 case definition will serve as the basis for ADDM estimates of ASD prevalence in future surveillance reports. Although the DSM-IV-TR case definition will eventually be phased out, it will be applied in a limited geographic area to offer additional data for comparison. Future analyses will examine trends in the continued use of DSM-IV-TR diagnoses, such as autistic disorder, PDD-NOS, and Asperger disorder in health and education records, documentation of symptoms consistent with DSM-5 terminology, and how these trends might influence estimates of ASD prevalence over time. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.
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Although social validation of the goals, methods, and outcomes of evidence-based practices (EBPs) in autism treatment is a significant factor in their selection and effective use, EBPs are typically identified on the basis of the technical soundness of research without consideration of social validity. The authors investigated EBPs and emerging treatments identified by the National Autism Center (NAC) and National Professional Development Center on Autism Spectrum Disorders (NPDC) to determine which interventions have evidence of social validity, and the types of social validation addressed. A review of 828 articles cited by the NAC and NPDC determined that only 221 articles (26.7%) demonstrated direct evidence of the measurement of social validation. Of seven social validity categories analyzed, only consumer satisfaction, clinically significant behavioral change, and socially important dependent variables were consistently reported. A list of EBPs with varying levels of social and empirical validation is presented, and implications for future research are discussed.
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Autism Spectrum Disorder is a growing phenomenon impacting the lives of children and their families. Although resources in the medical community exist for individuals dealing with Autism Spectrum Disorder, systemic psychotherapy resources for families are lacking. This article discusses the challenges that families coping with Autism Spectrum Disorder possess as well as their strengths. Solution-focused brief therapy is offered as a resource-based systemic approach to helping Autism Spectrum Disorder families. This article provides an overview of solution-focused brief therapy approach, a rationale for using it with Autism Spectrum Disorder families, and an example transcript of applying the model.
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Many couples raising children diagnosed with an Autism Spectrum Disorder (ASD) are often resilient in confronting unique parental demands, while others experience greater risk for relational distress. Research has shown that Emotionally Focused Couple Therapy (EFT) is efficacious with couples raising chronically ill children and relevant to the relational demands of parents of children diagnosed with an ASD. This pilot study tested the effectiveness of EFT with seven couples presenting with moderate to severe distress, who were also parents of a child diagnosed with an ASD. Results demonstrated significant decreases in marital distress at posttreatment and 6-month follow-up. The study also identified several unique themes associated with couple distress and the parenting experiences of this population.
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Accumulating research suggests that shame can strongly contribute to the development and maintenance of posttraumatic stress disorder (PTSD). Interventions that promote self-compassion have shown promise for reducing shame related to various clinical problems, but this approach has not been systematically evaluated for traumatized individuals. The aim of this study was to develop a brief compassion-based therapy and assess its efficacy for reducing trauma-related shame and PTSD symptoms. Using a multiple baseline experimental design, the intervention was evaluated in a community sample of trauma-exposed adults (N = 10) with elevated trauma-related shame and PTSD symptoms. Participants completed weekly assessments during a 2-, 4-, or 6-week baseline phase and a 6-week treatment phase, and at 2- and 4-weeks after the intervention. By the end of treatment, 9 of 10 participants demonstrated reliable decreases in PTSD symptom severity, while 8 of 10 participants showed reliable reductions in shame. These improvements were maintained at 2- and 4-week follow-up. The intervention was also associated with improvements in self-compassion and self-blame. Participants reported high levels of satisfaction with the intervention. Results suggest that the intervention may be useful as either a stand-alone treatment or as a supplement to other treatments.
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Autism spectrum disorders (ASDs) have been increasingly diagnosed in recent years and carries with it far reaching social and financial implications. With this in mind, educators, physicians, and parents are searching for the best practices and most effective treatments. But because the symptoms of ASDs span multiple domains (e.g., communication and language, social, behavioral), successfully meeting the needs of a child with autism can be quite challenging. Evidence-Based Practices and Treatments for Children with Autism offers an insightful and balanced perspective on topics ranging from the historical underpinnings of autism treatment to the use of psychopharmacology and the implementation of evidence-based practices (EBPs). An evaluation methodology is also offered to reduce the risks and inconsistencies associated with the varying definitions of key autism terminology. This commitment to clearly addressing the complex issues associated with ASDs continues throughout the volume and provides opportunities for further research. Additional issues addressed include: Behavioral excesses and deficits treatment Communication treatment Social awareness and social skills treatment Dietary, complementary, and alternative treatments Implementation of EBPs in school settings Interventions for sensory dysfunction With its holistic and accessible approach, Evidence-Based Practices and Treatments for Children with Autism is a vital resource for school psychologists and special education professionals as well as allied mental health professionals, including clinical child and developmental psychologists, psychiatrist, pediatricians, primary care and community providers. © Springer Science+Business Media, LLC 2011. All rights reserved.