Maternal mental health after a child's diagnosis of autism spectrum disorder.

Abstract

Clinical Review & Education From The JAMA Network Maternal Mental Health After a Child’s Diagnosis of Autism Spectrum Disorder Elizabeth A. Karp, BA; Alice A. Kuo, MD, PhD JAMA PEDIATRICS Improving Maternal Mental Health After a Child’s Diagnosis of Autism Spectrum Disorder: Results From a Randomized Clinical Trial 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). Emily Feinberg, CPNP, ScD; Marilyn Augustyn, MD; Elaine Fitzgerald, DrPH; Jenna Sandler, MPH; Zhandra Ferreira-Cesar Suarez, MPH; Ning Chen, MSc; Howard Cabral, PhD; William Beardslee, MD; MAIN OUTCOMES AND MEASURES Primary outcomes were parental stress and maternal depressive symptoms. Michael Silverstein, MD, MPH IMPORTANCE The prevalence of psychological distress among mothers of children with autism spectrum disorder (ASD) sug- gests 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 inter- vention 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). From the moment a developmental concern is suspected, either by a child’s parent or a clinician, a family embarks on a lifelong jour- ney of diagnosis and treatment. Receiving a formal diagnosis of autism spectrum disorder (ASD) initiates the journey into the world of ASD. Establishment of an ASD diagnosis determines eligibility for services, including but not limited to behavioral, speech, and occu- pational therapies. Most parents develop a sense of urgency that early intervention services should be implemented immediately once their child is suspected of having ASD, potentially resulting in parental stress as the diagnostic process unfolds. Parents may feel they have not adequately supported their child if they cannot acquire intervention services in a timely fashion. While an ASD 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. JAMA Pediatr. 2014;168(1):40-46. doi:10.1001/jamapediatrics.2013.3445. diagnosis is established and treatment is initiated, parents may experience their own sense of grief as they cope with having a child with a potential ASD. After the diagnosis is established and treatment initiated, par- ents are often educated about becoming active participants in de- livering therapy to their child. They must learn a new vocabulary and parenting approach that are often very different from their original view of parenting. Being engaged in delivering therapy changes the nature of the parents’ relationship with their child. Many early in- tervention strategies rely on mothers (or other primary caregivers) to continue to use the behavioral, social, and cognitive interven- tion strategies in the home, in part because it is cost-effective to have jama.com JAMA January 6, 2015 Volume 313, Number 1 Copyright 2015 American Medical Association. All rights reserved. Downloaded From: http://jama.jamanetwork.com/ by a University of California - Los Angeles User on 01/07/2015