Parenting a child with autism: Support for early parent-child interaction

The greater part of this thesis concerns the development and testing of an interaction-focused intervention: ‘Video feedback Intervention to promote Positive Parenting adapted to Autism’ (VIPP-AUTI). VIPP-AUTI is a manualised program of a five-session home training, using video-taped fragments of the individual parent-child dyad during play and mealtime interactions. The video feedback has been provided to the primary caregiver of the child (mother or father) and targeted at enhancing parental sensitivity to their child’s signals, taken its ASD-characteristics into account. The interveners were trained professionals with bachelor or master degree. In a randomized controlled trial we tested effectiveness of VIPP-AUTI with primary caregivers of 78 children with ASD. In comparison with treatment as usual at the university hospital, parents in the VIPP-AUTI group demonstrated increased sensitivity toward their child, as apparent from lower levels of intrusiveness in the interaction with their child. Parental intrusiveness refers to a form of overstimulation and interrupting child behavior in abrupt ways and has previously been found overrepresented in families with infants at risk for developing ASD. Furthermore, post intervention, parents in the VIPP-AUTI group showed increased feelings of efficacy in child rearing. At follow up (three months post intervention), results of VIPP-AUTI demonstrated an increase of children’s initiating joint attention skills. No intervention effects were found on children’s responsiveness and involvement during interaction, responding to joint attention and play behavior. The VIPP-AUTI program turned out to be feasible implementable in clinical practice because the training of professionals is relatively brief, the manual is detailed and the programming is short-term. All parents completed the VIPP-AUTI program and reported treatment satisfaction. The intervention effectiveness, feasibility and client satisfaction supports implementation of the VIPP-AUTI program in clinical practice. Alongside the studies concerning VIPP-AUTI, we explored coping-related competences of parents with respect to their child’s ASD diagnosis, using a brief, semi-structured interview. Results demonstrated that the majority of 77 parents adapted well to the circumstances and the care for their child. This parental coping style does not depend on experienced levels of parental stress or the presence of depressive moods. Factors of influence were autism severety and parents’ nationality. Parents of children with more severe autism characteristics or non-Dutch nationality were more likely to be classified with unresolved reactions to the child’s diagnosis. Sub-sample analysis revealed stability of reaction to ASD diagnosis after seven months. In order to tailor family support and intervention programming with respect to parent’s needs, we recommend the identification of parental reactions to their child’s diagnosis. We also focused on neurobiological mechanisms related to early parent-child interactions. In a placebo-controlled, double-blind, within-subject experiment, we investigated the influence of oxytocin, a neuropeptide and attachment-related hormone, on father-child play-interaction. After intranasally oxytocin administration, 32 fathers of children with and without ASD, demonstrated improvements in their stimulation skills directed at exploration activities of the child. This finding suggests that increased paternal sensitivity through oxytocin administration could advance the effectiveness of treatment to promote adequate parent-child interactions.