View in EDS HTML Full Text PDF Full Text

Comparative Effects of Mindfulness-Based Stress Reduction and Psychoeducational Support on Parenting Stress in Families of Autistic Preschoolers

Saved in:
Bibliographic Details
Title: Comparative Effects of Mindfulness-Based Stress Reduction and Psychoeducational Support on Parenting Stress in Families of Autistic Preschoolers
Language: English
Authors: Cameron L Neece (ORCID 0000-0003-1778-3497), Rachel M Fenning, Holly ER Morrell, Laurel R Benjamin (ORCID 0000-0003-4353-219X)
Source: Autism: The International Journal of Research and Practice. 2024 28(4):985-998.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 14
Publication Date: 2024
Sponsoring Agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)
Contract Number: R15HD09172601A1
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Preschool Children, Parents, Stress Management, Minority Groups, Intervention, Metacognition, Psychoeducational Methods, Parenthood Education, Stress Variables
Geographic Terms: California
DOI: 10.1177/13623613231191558
ISSN: 1362-3613
1461-7005
Abstract: Relative to parents of children with neurotypical development and other developmental disabilities, parents of autistic children experience higher levels of parenting stress, which are associated with deleterious consequences for parents' mental and physical health and child functioning. Despite urgent calls to action, parenting stress is rarely addressed directly in interventions for families of autistic children, and less so in underserved and racial/ethnic minority populations where clinical needs are greater. This study tested the efficacy of mindfulness-based stress reduction, compared to a psychoeducation and support intervention, in reducing parenting stress among diverse families of autistic preschoolers. Participants (N = 117) were randomly assigned to the mindfulness-based stress reduction or psychoeducation and support groups; assessments were conducted at baseline, immediately postintervention, and 6 and 12 months postintervention. Results indicated significant reductions in parenting stress across both the mindfulness-based stress reduction and psychoeducation and support intervention conditions; however, reductions in parenting stress were greater for parents in mindfulness-based stress reduction than in psychoeducation and support. Furthermore, the benefit of mindfulness-based stress reduction relative to psychoeducation and support increased over time, with significant group differences in parenting stress detected at 12-month follow-up.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1418623
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEf9WkkAFnO9rWC5lNskjdgAAAA4TCB3gYJKoZIhvcNAQcGoIHQMIHNAgEAMIHHBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDLQkmy0xLFk-wqvbyAIBEICBmfHl7Iw9IOnaVf-ZiZ8mlnx_VSvfnzV3zAHSUQP3oV8_okzaaNoeZu7s5DPyxBUfklCo60rKypMktOk4FRoj_arD7pre5j6SNAhgmh7E20oYHj4NPyetKe0iL0j5h7154CZ1HAYXAjS9hpib2e3nPlAS1QST39Gw7OAURXdNSjdGHeQMbkIvFtT8vMQYx20iLo_V1bWrkID5Sg==
Text:
  Availability: 1
  Value: <anid>AN0176331450;f9d01apr.24;2024Apr02.06:55;v2.2.500</anid> <title id="AN0176331450-1">Comparative effects of mindfulness-based stress reduction and psychoeducational support on parenting stress in families of autistic preschoolers </title> <p>Relative to parents of children with neurotypical development and other developmental disabilities, parents of autistic children experience higher levels of parenting stress, which are associated with deleterious consequences for parents' mental and physical health and child functioning. Despite urgent calls to action, parenting stress is rarely addressed directly in interventions for families of autistic children, and less so in underserved and racial/ethnic minority populations where clinical needs are greater. This study tested the efficacy of mindfulness-based stress reduction, compared to a psychoeducation and support intervention, in reducing parenting stress among diverse families of autistic preschoolers. Participants (N = 117) were randomly assigned to the mindfulness-based stress reduction or psychoeducation and support groups; assessments were conducted at baseline, immediately postintervention, and 6 and 12 months postintervention. Results indicated significant reductions in parenting stress across both the mindfulness-based stress reduction and psychoeducation and support intervention conditions; however, reductions in parenting stress were greater for parents in mindfulness-based stress reduction than in psychoeducation and support. Furthermore, the benefit of mindfulness-based stress reduction relative to psychoeducation and support increased over time, with significant group differences in parenting stress detected at 12-month follow-up. Parents of autistic children often experience high levels of parenting stress, which can have negative mental and physical effects on both the parent and child. This study tested the efficacy of mindfulness-based stress reduction in reducing parenting stress in parents of preschool-aged autistic children compared to a psychoeducation and support intervention. We assessed parenting stress before and after the interventions and at 6- and 12-month follow-up. Both interventions significantly decreased parenting stress, but mindfulness-based stress reduction reduced stress more than did psychoeducation and support, with the strongest effect observed 1 year later. This suggests that the stress-reducing benefits of mindfulness-based stress reduction persist and may increase over time.</p> <p>Keywords: autism spectrum disorder; mindfulness; parenting stress; preschoolers</p> <p>Parents of autistic children report higher levels of stress on average relative to parents of children with neurotypical development, genetic disorders, chronic illnesses, and other intellectual and developmental disabilities (IDD; [<reflink idref="bib6" id="ref1">6</reflink>]; [<reflink idref="bib7" id="ref2">7</reflink>]; [<reflink idref="bib16" id="ref3">16</reflink>]; [<reflink idref="bib25" id="ref4">25</reflink>]; for a review, see [<reflink idref="bib39" id="ref5">39</reflink>]). Approximately one-third of parents of autistic children report clinically elevated stress levels, suggesting a high need for intervention ([<reflink idref="bib18" id="ref6">18</reflink>]). Despite urgent calls to action ([<reflink idref="bib8" id="ref7">8</reflink>]; [<reflink idref="bib58" id="ref8">58</reflink>]), parenting stress has rarely been addressed directly in interventions for families of autistic children, and even less so in underserved and racial/ethnic minority populations where clinical needs are greater ([<reflink idref="bib53" id="ref9">53</reflink>]). Recent investigations have drawn upon approaches such as mindfulness-based stress reduction (MBSR; [<reflink idref="bib44" id="ref10">44</reflink>]) to address parental well-being in families of children with unspecified or heterogeneous diagnoses (e.g. [<reflink idref="bib55" id="ref11">55</reflink>]). Although early efforts are promising, a more rigorous evaluation of MBSR involving active comparison conditions, longitudinal assessment, and inclusion of diverse well-characterized samples is needed. Moreover, the efficacy of MBSR has not been rigorously tested among families of autistic children.</p> <p>Parenting stress is common in families of autistic children, and may be tied to a variety of factors, including children's core symptoms and co-occurring conditions, parents' own mental health and related processes, as well as external stressors (e.g. [<reflink idref="bib9" id="ref12">9</reflink>]; [<reflink idref="bib45" id="ref13">45</reflink>]). High levels of parenting stress have been associated with deleterious consequences for parents' mental, physical, and relational health as well as parenting behaviors, intervention uptake, and broader family well-being in families of autistic children ([<reflink idref="bib4" id="ref14">4</reflink>]; [<reflink idref="bib59" id="ref15">59</reflink>]; [<reflink idref="bib61" id="ref16">61</reflink>]). Parenting stress also predicts subsequent child externalizing behavior problems, with longitudinal studies suggesting a mutually escalating transactional relationship in which parenting stress and child behavior problems exacerbate one another over time ([<reflink idref="bib48" id="ref17">48</reflink>]; [<reflink idref="bib60" id="ref18">60</reflink>]). Although findings remain mixed regarding the directionality of effects, several studies suggest the potential for parent-driven processes in early development wherein parenting stress predicts future child behavior problems more strongly than child behavior problems predict parenting stress in families of autistic children, indicating that parenting stress represents a primary predictor of child and family functioning in this population and an important target for early intervention ([<reflink idref="bib49" id="ref19">49</reflink>]; [<reflink idref="bib60" id="ref20">60</reflink>]; [<reflink idref="bib80" id="ref21">80</reflink>]).</p> <p>Parents of preschool-aged (i.e. 3- to 5-year-old) autistic children may face unique risks for clinically elevated parenting stress. During this period in which developmental difficulties are often first recognized and early identification of ASD takes place ([<reflink idref="bib20" id="ref22">20</reflink>]), parents may experience numerous stressors related to the timely acquisition of diagnostic and intervention services ([<reflink idref="bib73" id="ref23">73</reflink>]), including personal and emotional adjustments (e.g. reactions to diagnosis, recalibrating expectations and parenting; [<reflink idref="bib78" id="ref24">78</reflink>]), as well as a host of practical, logistical, financial, and related challenges (e.g. [<reflink idref="bib34" id="ref25">34</reflink>]). Parents from underserved and racial/ethnic minority backgrounds face additional barriers to accessing and utilizing quality diagnostic and treatment services that may further compound parental strain ([<reflink idref="bib64" id="ref26">64</reflink>]; [<reflink idref="bib75" id="ref27">75</reflink>]). Interventions that focus on reducing parenting stress in these diverse, high-need populations are crucial.</p> <p>To date, parent support groups remain one of the most commonly used interventions for parents of autistic children, as they are relatively cost-effective and easily implemented ([<reflink idref="bib12" id="ref28">12</reflink>]). However, strong evaluation data are lacking and few studies have examined the effects of support groups on parenting stress (for a review, see [<reflink idref="bib68" id="ref29">68</reflink>]). Other studies have used cognitive behavioral techniques to reduce stress in parents of autistic children and those with IDD. Although findings are promising, these studies have predominantly used no-treatment, treatment-as-usual, or waitlist-control comparisons, which often do not account for nonspecific effects of provider contact (e.g. [<reflink idref="bib30" id="ref30">30</reflink>]; [<reflink idref="bib42" id="ref31">42</reflink>]; [<reflink idref="bib54" id="ref32">54</reflink>] for reviews, see [<reflink idref="bib17" id="ref33">17</reflink>]; [<reflink idref="bib38" id="ref34">38</reflink>]). In addition, several investigations have examined whether parent-mediated interventions, wherein the parent serves as the principal change agent for the autistic child, can alter parent outcomes as well. Unfortunately, effects on parents, including parenting stress, appear inconsistent across studies (see [<reflink idref="bib47" id="ref35">47</reflink>]; [<reflink idref="bib58" id="ref36">58</reflink>] for reviews). Moreover, emerging evidence suggests that parenting stress may attenuate the efficacy of behavioral interventions for autistic children ([<reflink idref="bib59" id="ref37">59</reflink>]), highlighting the importance of addressing parenting stress directly to sustain intervention gains.</p> <p>Recently, parent stress-reduction interventions have drawn on mindfulness-based approaches to improve parental well-being in families of autistic children (for reviews, see [<reflink idref="bib11" id="ref38">11</reflink>]; [<reflink idref="bib28" id="ref39">28</reflink>]; [<reflink idref="bib37" id="ref40">37</reflink>]). Given the severity and chronicity of daily stressors experienced by these families, mindfulness-based interventions, which focus on managing rather than eliminating stress, may be particularly valuable. Research in this area has largely examined the utility of mindfulness-hybrids using quasi-experimental designs (e.g. [<reflink idref="bib19" id="ref41">19</reflink>]; [<reflink idref="bib41" id="ref42">41</reflink>]; [<reflink idref="bib43" id="ref43">43</reflink>]; [<reflink idref="bib51" id="ref44">51</reflink>]; [<reflink idref="bib62" id="ref45">62</reflink>]; [<reflink idref="bib63" id="ref46">63</reflink>]; [<reflink idref="bib67" id="ref47">67</reflink>]; [<reflink idref="bib71" id="ref48">71</reflink>]), although some randomized trials have been conducted ([<reflink idref="bib28" id="ref49">28</reflink>]; [<reflink idref="bib52" id="ref50">52</reflink>]). For example, mindfulness-based cognitive therapy (MBCT; [<reflink idref="bib72" id="ref51">72</reflink>]) has been found to enhance quality of life and positive stress reappraisal ([<reflink idref="bib62" id="ref52">62</reflink>]), improve parent mental health and related symptoms ([<reflink idref="bib52" id="ref53">52</reflink>]; [<reflink idref="bib63" id="ref54">63</reflink>]; [<reflink idref="bib71" id="ref55">71</reflink>]), and reduce parenting stress in parents of autistic children and adolescents ([<reflink idref="bib28" id="ref56">28</reflink>]; [<reflink idref="bib43" id="ref57">43</reflink>]). The related mindful parenting intervention ([<reflink idref="bib10" id="ref58">10</reflink>]) has similarly been found to decrease stress in parents of autistic adolescents ([<reflink idref="bib19" id="ref59">19</reflink>]). Effects of mindfulness-hybrids for parents of autistic children and adolescents have been maintained over 2 ([<reflink idref="bib63" id="ref60">63</reflink>]; [<reflink idref="bib71" id="ref61">71</reflink>]), 3 ([<reflink idref="bib28" id="ref62">28</reflink>]), and 5 months postintervention ([<reflink idref="bib52" id="ref63">52</reflink>]).</p> <p>Interestingly, somewhat less attention has been devoted to the applicability of traditional mindfulness-based stress reduction (MBSR; [<reflink idref="bib44" id="ref64">44</reflink>]) to families of autistic children. MBSR is the most empirically-supported stress-reduction intervention to date, with over three decades of extensive research demonstrating efficacy in reducing stress, anxiety, and depression, and promoting overall well-being across a variety of clinical and nonclinical populations ([<reflink idref="bib35" id="ref65">35</reflink>]). MBSR targets stress reduction by fostering nonreactivity and nonjudgment of internal experiences, which promotes acknowledgment of the experience of stress while reducing the emotional impact ([<reflink idref="bib36" id="ref66">36</reflink>]).</p> <p>Utilizing waitlist-control designs (e.g. [<reflink idref="bib55" id="ref67">55</reflink>]; [<reflink idref="bib56" id="ref68">56</reflink>]) and active comparators (e.g. [<reflink idref="bib23" id="ref69">23</reflink>]), several studies have demonstrated the efficacy of [<reflink idref="bib44" id="ref70">44</reflink>] manualized MBSR for improving parenting stress in families of children with heterogeneous IDD diagnoses and chronic conditions. Although these samples have sometimes included autistic children (e.g. [<reflink idref="bib23" id="ref71">23</reflink>]; [<reflink idref="bib56" id="ref72">56</reflink>]), few studies have tested MBSR in families of autistic children specifically. Moreover, existing studies that have examined MBSR in parents of autistic children have combined MBSR with other interventions such as the parent-implemented early start Denver model ([<reflink idref="bib79" id="ref73">79</reflink>]) or self-compassion interventions ([<reflink idref="bib66" id="ref74">66</reflink>]). Thus, the unique effects of MBSR on families of young autistic children remain unknown.</p> <p>Mindfulness interventions, and MBSR in particular, hold promise for reducing stress in parents of young autistic children. However, rigorous testing using a randomized design with an active comparator, a large, well-characterized, and diverse sample, and long-term follow-up is needed to further establish efficacy and support generalizability. The current study addressed these aims by: (<reflink idref="bib1" id="ref75">1</reflink>) conducting a population-specific randomized controlled trial of [<reflink idref="bib44" id="ref76">44</reflink>] manualized MBSR intervention involving an active comparison of psychoeducational support (PE) condition, (<reflink idref="bib2" id="ref77">2</reflink>) recruiting a sample composed of racially and ethnically diverse families of preschool-aged children with a well-characterized ASD diagnosis, and (<reflink idref="bib3" id="ref78">3</reflink>) performing a longitudinal assessment of intervention effects up to 12 months postintervention. We also employed methodologically stringent measurement of parenting stress to enable the use of a latent variable approach, thereby enhancing internal validity and interpretability. We hypothesized that MBSR would be more efficacious in reducing parenting stress than PE as indexed by reductions in parenting stress immediately post-intervention and at 6- and 12-month follow-up.</p> <hd id="AN0176331450-2">Method</hd> <p></p> <hd id="AN0176331450-3">Participants</hd> <p>Participants included 117 families of autistic children aged 3 to 5 years who participated in the Stress-reduction Techniques for Enhancing Parenting Skills (STEPS) Project. Families were recruited through the community from September 2018 to March 2021. Families were primarily recruited from the Inland Empire Regional Center, which is a government agency that contracts services for individuals with developmental disabilities. Additional recruitment was completed through participating universities, community disability groups, local agencies that provide services for autistic children, local preschools, and community events for families of children with developmental disabilities.</p> <p>Data were gathered across three separate cohorts, with assessments at baseline, immediate postintervention, and at 6 and 12 months postintervention. Procedures were primarily in person for the first two cohorts. However, due to the COVID-19 pandemic and prohibitions against in-person activities, the 6- and 12-month follow-up assessments for cohort 2 (<emph>n</emph><emph>=</emph> 36) were conducted virtually. All procedures for cohort 3 (<emph>n</emph> = 51) were also completed virtually, with the exception of direct assessments of intellectual functioning and receptive language, which were completed once in-person activities resumed postintervention.</p> <p>Study inclusion criteria were: (a) child community ASD diagnosis—or waitlisted for a community ASD assessment—with diagnostic symptoms verified by study-administered assessments, (b) child age 3 to 5 years, and (c) parent ability to complete study procedures in English. Exclusionary criteria included: (a) positive screen for active parental psychosis, substance abuse, or suicidality according to the associated modules of the Structured Clinical Interview for <emph>DSM</emph> Disorders, Research Version Non-Patient Edition ([<reflink idref="bib29" id="ref79">29</reflink>]); (b) parent participation in an auxiliary mental health treatment or support group at the time of randomization; and (c) child motor impairment that would prevent participation in the parent–child interaction tasks that were part of the larger assessment protocol (e.g. difficulty sitting independently). Families not meeting study eligibility were provided with appropriate community referrals. Table 1 presents sample demographic and clinical information. Most primary caregivers were mothers with relatively diverse racial/ethnical and socioeconomic backgrounds. Over half of the primary caregivers endorsed clinically significant parenting stress at baseline (>85th percentile, Parenting Stress Inventory-Parental Distress scale). Most children were boys; the majority met <emph>DSM</emph> 5: <emph>Diagnostic and Statistical Manual of Mental Disorders</emph> (5th ed.; <emph>DSM</emph>-5) (American Psychiatric Association, <emph>DSM</emph>-5 Task Force, [<reflink idref="bib5" id="ref80">5</reflink>]) criteria for co-occurring ID according to study-administered assessments (IQ and adaptive behavior < 76), and exhibited clinically elevated parent-reported behavior problems (Child Behavior Checklist; [<reflink idref="bib2" id="ref81">2</reflink>]).</p> <p>Graph</p> <p>Table 1. Demographic and clinical characteristics of participants.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">MBSR</th><th align="left">PE</th><th align="left" rowspan="2">Significance test</th></tr><tr><th /><th align="left">(<italic>n</italic> = 59)</th><th align="left">(<italic>n</italic> = 58)</th></tr></thead><tbody><tr><td colspan="4">Child characteristics</td></tr><tr><td> Male (%)</td><td>78</td><td>82.8</td><td><italic>χ</italic>2(1) = 0.425, <italic>p</italic> = 0.514</td></tr><tr><td> Mean age (<italic>SD</italic>)</td><td>4.370 (0.878)</td><td>4.375 (0.968)</td><td><italic>t</italic>(115) = 0.029, <italic>p</italic> = 0.977</td></tr><tr><td colspan="4">Race/ethnicity (%)</td></tr><tr><td> White</td><td>22</td><td>17.2</td><td><italic>χ</italic>2(1) = 0.425, <italic>p</italic> = 0.514</td></tr><tr><td> Latinx</td><td>40.7</td><td>48.3</td><td><italic>χ</italic>2(1) = 0.684, <italic>p</italic> = 0.983</td></tr><tr><td> Black</td><td>5.1</td><td>5.2</td><td><italic>χ</italic>2(1) = 0.000, <italic>p</italic> = 0.408</td></tr><tr><td> Asian</td><td>3.4</td><td>8.6</td><td><italic>χ</italic>2(1) = 1.423, <italic>p</italic> = 0.233</td></tr><tr><td> Native American</td><td>0</td><td>0</td><td>—</td></tr><tr><td> Pacific Islander</td><td>0</td><td>1.7</td><td><italic>χ</italic>2(1) = 1.026, <italic>p</italic> = 0.311</td></tr><tr><td> Other</td><td>6.8</td><td>1.7</td><td><italic>χ</italic>2(1) = 1.827, <italic>p</italic> = 0.176</td></tr><tr><td>Multiracial</td><td>22</td><td>17.2</td><td><italic>χ</italic>2(1) = 0.425, <italic>p</italic> = 0.514</td></tr><tr><td>Mean IQ (<italic>SD</italic>)</td><td>68.595 (21.588)</td><td>66.750 (18.737)</td><td><italic>t</italic>(80) = –0.412, <italic>p</italic> = 0.681</td></tr><tr><td>Mean adaptive behavior (<italic>SD</italic>)</td><td>68.234 (10.104)</td><td>69.365 (8.843)</td><td><italic>t</italic>(97) = 0.594, <italic>p</italic> = 0.554</td></tr><tr><td>Intellectual disability (%)</td><td>69.1</td><td>66</td><td><italic>χ</italic>2(1) = 0.115, <italic>p</italic> = 0.735</td></tr><tr><td>Mean ASD symptom level (<italic>SD</italic>)</td><td>7.281 (1.611)</td><td>7.471 (1.813)</td><td><italic>t</italic>(64) = 0.447, <italic>p</italic> = 0.656</td></tr><tr><td>Mean SCQ total score (<italic>SD</italic>)</td><td>21.745 (5.376)</td><td>20.339 (5.593)</td><td><italic>t</italic>(109) = –1.350, <italic>p</italic> = 0.180</td></tr><tr><td>Mean receptive vocabulary score (<italic>SD</italic>)</td><td>72.455 (28.166)</td><td>64.125 (30.550)</td><td><italic>t</italic>(63) = –1.143, <italic>p</italic> = 0.257</td></tr><tr><td>CBCL externalizing problems (<italic>SD</italic>)</td><td>68.396 (11.335)</td><td>66.491 (11.393)</td><td><italic>t</italic>(104) = –0.863, <italic>p</italic> = 0.390</td></tr><tr><td>Clinically elevated CBCL externalizing problems (<italic>T</italic> > 63; %)</td><td>67.9</td><td>67.9</td><td><italic>χ</italic>2(1) = 0.000, <italic>p</italic> = 1.000</td></tr><tr><td colspan="4">Primary caregiver characteristics</td></tr><tr><td> Mean primary caregiver age (<italic>SD</italic>)</td><td>34.559 (7.541)</td><td>34.672 (7.529)</td><td><italic>t</italic>(115) = 0.081, <italic>p</italic> = 0.935</td></tr><tr><td> Primary caregiver female (%)</td><td>93.2</td><td>87.9</td><td><italic>χ</italic>2(1) = 0.961, <italic>p</italic> = 0.327</td></tr><tr><td colspan="4">Primary caregiver race/ethnicity (%)</td></tr><tr><td> White</td><td>20.3</td><td>22.4</td><td><italic>χ</italic>2(1) = 0.075, <italic>p</italic> = 0.784</td></tr><tr><td> Latinx</td><td>54.2</td><td>48.3</td><td><italic>χ</italic>2(1) = 0.416, <italic>p</italic> = 0.519</td></tr><tr><td> Black</td><td>5.1</td><td>6.9</td><td><italic>χ</italic>2(1) = 0.171, <italic>p</italic> = 0.680</td></tr><tr><td> Asian</td><td>3.4</td><td>8.6</td><td><italic>χ</italic>2(1) = 1.423, <italic>p</italic> = 0.233</td></tr><tr><td> Native American</td><td>0</td><td>0</td><td>—</td></tr><tr><td> Pacific Islander</td><td>0</td><td>1.7</td><td><italic>χ</italic>2(1) = 1.026, <italic>p</italic> = 0.311</td></tr><tr><td> Other</td><td>3.4</td><td>1.7</td><td><italic>χ</italic>2(1) = 0.325, <italic>p</italic> = 0.569</td></tr><tr><td> Multiracial</td><td>13.6</td><td>10.3</td><td><italic>χ</italic>2(1) = 0.287, <italic>p</italic> = 0.592</td></tr><tr><td>Primary caregiver education (%)</td><td /><td /><td><italic>χ</italic>2(4) = 5.064, <italic>p</italic> = 0.281</td></tr><tr><td> High school or less</td><td>31</td><td>17.2</td><td /></tr><tr><td> Some college</td><td>22.4</td><td>20.7</td><td /></tr><tr><td> Technical degree/AA</td><td>19</td><td>34.5</td><td /></tr><tr><td> Bachelor's degree</td><td>13.8</td><td>15.5</td><td /></tr><tr><td> Graduate degree</td><td>13.8</td><td>12.1</td><td /></tr><tr><td>Primary caregiver marital status (%)</td><td /><td /><td><italic>χ</italic>2(5) = 7.935, <italic>p</italic> = 0.160</td></tr><tr><td> Married</td><td>55.9</td><td>67.2</td><td /></tr><tr><td> Living together</td><td>15.3</td><td>13.8</td><td /></tr><tr><td> Separated</td><td>3.4</td><td>8.6</td><td /></tr><tr><td> Divorced</td><td>1.7</td><td>0</td><td /></tr><tr><td> Widowed</td><td>1.7</td><td>3.4</td><td /></tr><tr><td> Single</td><td>22</td><td>6.9</td><td /></tr><tr><td>Mean primary caregiver mainstream acculturation status (VIA) score (<italic>SD</italic>)</td><td>67.660 (16.529)</td><td>67.210 (15.126)</td><td><italic>t</italic>(100) = −0.144, <italic>p</italic> = 0.886</td></tr><tr><td>Parental depression (CES-D) score (<italic>SD</italic>)</td><td>19.481 (12.690)</td><td>16.962 (9.715)</td><td><italic>t</italic>(103) = −1.140, <italic>p</italic> = 0.257</td></tr><tr><td colspan="4"><italic>Primary Caregiver Stress</italic></td></tr><tr><td> Mean parental stress index-short form parental distress subscale (<italic>SD</italic>)</td><td>37.472 (9.192)</td><td>37.434 (8.354)</td><td><italic>t</italic>(104) = −0.022, <italic>p</italic> = 0.982</td></tr><tr><td> Mean family impact questionnaire, negative impact subscale (<italic>SD</italic>)</td><td>37.170 (13.964)</td><td>36.423 (12.632)</td><td><italic>t</italic>(104) = −0.289, <italic>p</italic> = 0.773</td></tr><tr><td> Mean parenting daily hassles, intensity subscale (<italic>SD</italic>)</td><td>59.660 (17.402)</td><td>58.152 (19.428)</td><td><italic>t</italic>(104) = −0.421, <italic>p</italic> = 0.675</td></tr><tr><td colspan="4">Family characteristics</td></tr><tr><td>Annual gross family income (%)</td><td /><td /><td><italic>χ</italic>2(4) = 2.607, <italic>p</italic> = 0.626</td></tr><tr><td> <$30,000</td><td>25.4</td><td>28.3</td><td /></tr><tr><td> $30,000–<$50,000</td><td>18.6</td><td>15.1</td><td /></tr><tr><td> $50,000–<$70,000</td><td>15.3</td><td>22.6</td><td /></tr><tr><td> $70,000–<$90,000</td><td>13.6</td><td>17</td><td /></tr><tr><td> >$90,000</td><td>27.1</td><td>17</td><td /></tr><tr><td>Primary home language (%)</td><td /><td /><td><italic>χ</italic>2(2) = 5.698, <italic>p</italic> = 0.058</td></tr><tr><td> English</td><td>91.5</td><td>80.7</td><td /></tr><tr><td> Spanish</td><td>0</td><td>8.8</td><td /></tr><tr><td> Other</td><td>8.5</td><td>10.5</td><td /></tr><tr><td colspan="4">Services in past 6 months</td></tr><tr><td> Primary caregiver mental health services (Yes; %)</td><td>34.5</td><td>31.6</td><td><italic>χ</italic>2(1) = 0.110, <italic>p</italic> = 0.741</td></tr><tr><td> Primary caregiver parenting classes (Yes; %)</td><td>15.5</td><td>13.8</td><td><italic>χ</italic>2(1) = 0.069, <italic>p</italic> = 0.793</td></tr><tr><td> Any target child services (Yes; %)</td><td>87.9</td><td>91.4</td><td><italic>χ</italic>2(1) = 0.372, <italic>p</italic> = 0.542</td></tr><tr><td> Any target child ABA (Yes; %)</td><td>56.1</td><td>53.4</td><td><italic>χ</italic>2(1) = 0.084, <italic>p</italic> = 0.772</td></tr><tr><td> Mean number of months of target child ABA (<italic>SD</italic>)</td><td>4.695 (8.105)</td><td>4.966 (8.792)</td><td><italic>t</italic>(115) = −0.563, <italic>p</italic> = 0.886</td></tr><tr><td> Mean number of sessions of target child ABA (<italic>SD</italic>)</td><td>11.271 (16.329)</td><td>9.810 (11.254)</td><td><italic>t</italic>(115) = 0.173, <italic>p</italic> = 0.575</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> ABA: applied behavior analysis therapy; CBCL: Child Behavior Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; MBSR: Group receiving mindfulness-based stress reduction; PE: group receiving psychoeducational support; SCQ: Social Communication Questionnaire; VIA = Vancouver Index of Acculturation.</p> <hd id="AN0176331450-4">Procedure</hd> <p>Procedures were approved by the Institutional Review Board of participating universities, with data collection centered at a single site. Interested parents contacted the research team by phone, postcard, or the study website. Following an initial phone screening, eligible families were scheduled for a baseline laboratory assessment and provided informed consent.</p> <hd id="AN0176331450-5">Baseline assessment</hd> <p>A battery of standardized psychological assessments were administered to assess child cognitive functioning (Stanford-Binet-5 ABIQ; [<reflink idref="bib65" id="ref82">65</reflink>]), child receptive language (Peabody Picture Vocabulary Test-4; [<reflink idref="bib22" id="ref83">22</reflink>]), and ASD diagnostic status. Parents also participated in an interview to collect information on family demographics and service utilization, and to evaluate the child's adaptive behavior (Vineland Adaptive Behavior Scales-3; [<reflink idref="bib76" id="ref84">76</reflink>]). In addition to laboratory assessments, parents completed a packet of questionnaires.</p> <p>For Cohorts 1 and 2, ASD diagnostic confirmation was completed through a multimethod assessment involving the administration of a standardized parent-report form, the Social Communication Questionnaire (SCQ; [<reflink idref="bib69" id="ref85">69</reflink>]), and direct testing with Autism Diagnostic Observation Schedule-2 (ADOS-2; [<reflink idref="bib50" id="ref86">50</reflink>]). One child did not meet the ADOS-2 criterion for ASD classification but was retained following completion of an in-depth clinical best estimate. This child had an existing community diagnosis of ASD and met the age-adjusted clinical criterion on the SCQ ([<reflink idref="bib14" id="ref87">14</reflink>]). Due to COVID-19 prohibitions on in-person activities, Cohort 3 diagnostic status was ascertained using a battery of parent-report measures involving two standardized questionnaires—the SCQ and the Social Responsiveness Scale-2 (SRS-2; [<reflink idref="bib13" id="ref88">13</reflink>])—administration of a comprehensive semistructured interview, the Autism Diagnostic Interview-Revised (ADI-R; [<reflink idref="bib70" id="ref89">70</reflink>]). Nine children did not meet the diagnostic threshold on the ADI-R. Six of these children were retained in the sample following completion of clinical best estimate procedures. All six of these children had an existing community diagnosis of ASD and met the age-adjusted clinical threshold on the SCQ ([<reflink idref="bib14" id="ref90">14</reflink>]). Five of the six children also met clinical criteria on the SRS-2.</p> <p>At the conclusion of the baseline visit, families were randomly assigned to MBSR (<emph>n</emph> = 59) or PE (n = 58). Group size ranged from 14 to 26 for MBSR, and 16 to 21 for PE, <emph>χ</emph><sups>2</sups>(<reflink idref="bib2" id="ref91">2</reflink>) = 0.757, <emph>p</emph> = 0.685. Figure 1 depicts the CONSORT diagram and flow through the study.</p> <p>Graph: Figure 1. CONSORT diagram.</p> <hd id="AN0176331450-6">Participation enhancement</hd> <p>Following intervention assignment, we deployed an adapted version of [<reflink idref="bib57" id="ref92">57</reflink>]<emph>Participation Enhancement Intervention</emph> (PEI) at the conclusion of the baseline visit (see also [<reflink idref="bib26" id="ref93">26</reflink>]; [<reflink idref="bib27" id="ref94">27</reflink>]). Our adapted PEI represented a brief motivational interviewing module designed to optimize intervention engagement and reduce anticipated barriers. We worked individually with parents for 10 to 30 min to develop a collaborative plan to promote parent-identified intervention goals and to proactively address potential barriers to intervention engagement. PEI sessions were also deployed as needed to support engagement throughout the intervention. Planned boosters were delivered after session 6 and postintervention to promote follow-up.</p> <hd id="AN0176331450-7">MBSR intervention</hd> <p>The MBSR intervention followed the established MBSR manual ([<reflink idref="bib44" id="ref95">44</reflink>]) and included eight weekly 2-h group sessions, a 6-h meditation retreat on the weekend after session 6, 30–45 min of daily home practice guided by instructional audio, and an MBSR parent workbook. Formal mindfulness exercises aimed to increase the capacity for mindfulness and included body scans, mindful yoga, and sitting meditation. Participants were also taught to practice mindfulness informally in everyday activities. In addition, during groups, participants broke into dyads to discuss daily homework practice and met as a large group to discuss mindfulness practice in everyday life. The MBSR intervention was delivered by a certified MBSR instructor with over 20 years of experience and was co-led by a clinical psychology doctoral student who had experience with MBSR and received weekly supervision from the certified instructor.</p> <hd id="AN0176331450-8">Psychoeducational support</hd> <p>In order to provide a rigorous test of the efficacy of MBSR in reducing parenting stress, we employed an active comparator matched for contact. The PE group ran concurrently with the MBSR group, and was conducted at the same time and location, but on different weekdays in order to avoid intervention contamination. The PE condition consisted of 8 weekly 2-h sessions; a 6-h family resource fair after session 6; daily homework that included monitoring progress on goals identified at the end of each session; and a parent workbook that provided information regarding their child's development, disability, and associated considerations. To enhance external validity, the PE group was modeled after the support groups offered to parents of autistic children in the local community. Each session had a general topic for discussion (e.g. Preparing for Individualized Education Plan meetings, Parent Advocacy, Sibling Issues). At the start of each session, group leaders provided didactic instruction on the topic, then facilitated small- and large-group discussion. PE group sessions were led by parents of children with developmental disabilities who were identified as local community leaders working in the field. The PE groups were also co-led by clinical psychology doctoral students who received weekly supervision with a clinical psychologist and parent group leader.</p> <hd id="AN0176331450-9">Intervention adaptations for COVID-19</hd> <p>Interventions for Cohort 3 were delivered virtually due to pandemic-related restrictions on in-person activities. Families were provided with a tablet and/or an Internet hotspot as needed to facilitate intervention participation. Virtual session duration and format were consistent with in-person groups, with virtual groups using online breakout rooms to facilitate dyadic and small group discussions. The 6-h meditation retreat (MBSR) and the resource fair (PE) were also conducted online.</p> <hd id="AN0176331450-10">Childcare</hd> <p>Childcare was provided for parents during all in-person MBSR and PE sessions. Given the virtual format, Cohort 3 did not receive childcare support, although we did troubleshoot barriers to participation associated with childcare needs.</p> <hd id="AN0176331450-11">Postintervention assessment</hd> <p>After completion of the intervention, parents participated in postintervention assessments as well as 6- and 12-month follow-up assessments. Assessments followed baseline procedures with the exception of child testing and the Vineland, which were not conducted. Study staff collected updated demographic and service information and parents completed the questionnaire packets again.</p> <hd id="AN0176331450-12">Community involvement statement</hd> <p>Family members of autistic individuals have been involved in all aspects of this study. Recruitment was conducted in partnership with community programs, and family members and community partners were involved in the development and implementation of PE intervention.</p> <hd id="AN0176331450-13">Measures</hd> <p></p> <hd id="AN0176331450-14">Demographic information</hd> <p>Child and parent ages, races, ethnicities, family income, child diagnoses, and services received were collected via parent interviews.</p> <hd id="AN0176331450-15">Parenting stress measures</hd> <p>To comprehensively examine parenting stress, we assessed: general distress, stress specific to the child's condition, and daily parenting hassles. The <emph>Parental Distress</emph> subscale of the <emph>Parenting Stress Index-4, Short Form</emph> (PSI4-SF-PD; [<reflink idref="bib1" id="ref96">1</reflink>]) was used to assess parents' perceived general distress in the parenting role (study alphas 0.83–0.88). The <emph>Negative Impact</emph> scale of the <emph>Family Impact Questionnaire</emph> (FIQ-NI; [<reflink idref="bib21" id="ref97">21</reflink>]), which asks about the child's impact on the family relative to the impact of other children his or her age, was used to assess stress specific to the autistic child (study alphas 0.87–0.92). Finally, the <emph>Intensity</emph> subscale of the <emph>Parenting Daily Hassles</emph> questionnaire (PDH-I; [<reflink idref="bib15" id="ref98">15</reflink>]) was used to assess parents' perceived intensity of daily stressors related to caregiving demands and responsibilities (study alphas 0.90–0.94).</p> <hd id="AN0176331450-16">Statistical analysis</hd> <p>We performed intention-to-treat analyses using a series of two-level linear growth curve models to examine the outcome variable of parenting stress. Repeated measures across time at Level 1 were nested within individuals (primary caregivers) at Level 2. Time was defined according to study time points (baseline, postintervention, 6-month and 12-month follow-up), and was centered at baseline for purposes of improved interpretability. Parenting stress was a latent variable defined by three indicator variables: PSI-4-SF-PD, FIQ-NI, and PDH-I. The FIQ-NI had the strongest overall reliability (α = 0.92), and was therefore used to set the metric for the parenting stress factor. The data were evaluated for and met the assumptions of multilevel modeling (e.g. [<reflink idref="bib74" id="ref99">74</reflink>]).</p> <p>Preliminary analyses were conducted using SPSS 28 to identify potential covariates to include in the main analyses. We examined associations between each of the variables listed in Table 1 and all outcome indicator variables at each study time point. The following Level-2 variables were then selected as covariates due to having significant relationships with our outcome indicator variables: whether or not anyone in the family had received any type of mental health services in the 6 months prior to the baseline assessment (0 = No, 1 = Yes) and the number of months that the target child had received applied behavior analysis services at baseline; these two variables were centered to improve interpretability, <emph>p</emph>s < 0.05.</p> <p>We also tested rates of attrition between the intervention groups. Individuals who were randomized but did not complete a post-intervention or follow-up assessment were defined as study dropouts There were no significant differences in attrition between the MBSR and PE groups, between intervention modalities (in-person vs virtual), or across the three study cohorts. In addition, we tested for differences between intervention completers and dropouts based on variables in Table 1. Intervention completers differed from those who dropped out in that they were more likely to have received mental health services for their child's primary/secondary diagnosis and the target child was less likely to be Latinx. Mental health services were included as a covariate in our statistical models due to associations with all three outcome variables at multiple time points. Child ethnicity was not included as a covariate because it was not consistently associated with any of our outcome variables over time.</p> <p>Finally, we tested for differences between the study cohort affected by COVID (Cohort 3) and cohorts not affected by COVID (Cohorts 1 and 2) on all variables listed in Table 1 and all variables included in the multilevel models. There were few differences between the groups, and none of these differences were statistically significant after correcting for elevated familywise Type I error due to conducting so many analyses.</p> <p>Multilevel models were tested in the following order: (<reflink idref="bib1" id="ref100">1</reflink>) the unconditional means model, (<reflink idref="bib2" id="ref101">2</reflink>) the unconditional growth model, (<reflink idref="bib3" id="ref102">3</reflink>) a model in which intervention group (0 = PE, 1 = MBSR) was allowed to predict baseline parenting stress, (<reflink idref="bib4" id="ref103">4</reflink>) a model in which Level 2 covariates (described above) were allowed to predict baseline parenting stress in addition to intervention group, and (<reflink idref="bib5" id="ref104">5</reflink>) a model in which intervention group was allowed to predict change in parenting stress over time. Each model was tested to determine if it fit the data significantly better than the previous model.</p> <p>A missing values analysis indicated rates of missingness that varied from 0% to 35.7% (PDH-I), and missingness exceeded the traditionally recommended cutoff of 5% for our three outcome indicator variables ([<reflink idref="bib33" id="ref105">33</reflink>]). Therefore, we imputed missing data using Blimp 3 ([<reflink idref="bib46" id="ref106">46</reflink>]), which utilizes Bayesian imputation and an iterative Markov chain Monte Carlo (MCMC) algorithm, and assumes that the data are missing at random. This imputation method is preferable to more commonly used modern approaches such as multiple imputation and full information maximum likelihood estimation because it accounts for the multilevel structure of the data ([<reflink idref="bib24" id="ref107">24</reflink>]). We assessed convergence using potential scale reduction factor diagnostics and trace plots, and assessed whether the number of estimates for each parameter was sufficient by examining a number of effective sample sizes ([<reflink idref="bib31" id="ref108">31</reflink>]; [<reflink idref="bib32" id="ref109">32</reflink>]). Based on these metrics, we specified two MCMC chains with between 5000 and 150,000 burn-in iterations and post burn-in iterations, depending on the model. Twenty multiply imputed data sets per model were then saved and imported into RStudio 2022.07.0 for multilevel analysis.</p> <p>Blimp 3 was used for main effects and simple slopes analyses following significant cross-level interactions. Blimp provides the results of Bayesian estimation, which include posterior median estimates of parameters and their associated 95% credible intervals (95% CrIs). A Bayesian CrI is interpreted as the probability that the true effect lies within a specified interval, given the evidence provided by the observed data ([<reflink idref="bib40" id="ref110">40</reflink>]). The values of Bayesian credible intervals and traditional frequentist confidence intervals are often nearly identical in practice ([<reflink idref="bib3" id="ref111">3</reflink>]), and therefore we interpret a 95% CrI that does not include one as representing a statistically significant effect at <emph>p</emph> < 0.05.</p> <hd id="AN0176331450-17">Results</hd> <p></p> <hd id="AN0176331450-18">Intervention fidelity</hd> <p>Both groups were monitored for adherence to intervention targets. Independent research assistants observed each intervention session and completed intervention fidelity checklists. Interventionist fidelity scores were calculated according to the percentage of intervention components completed as outlined in the MBSR and PE group manuals. Collapsing across modalities and cohorts, the MBSR interventionists completed 98.03% of the possible fidelity items and the PE interventionists completed 97.89% of the possible fidelity items, <emph>t</emph>(<reflink idref="bib4" id="ref112">4</reflink>) = −0.112, <emph>p</emph> > 0.05, 95% CI (−3.51, 3.23). Overall total contact time for the MBSR group across cohorts was 1247.00 min (<emph>SD</emph> = 58.39) and 1107.67 min (<emph>SD</emph> = 161.33) in the PE group, which was not significantly different, <emph>t</emph>(<reflink idref="bib4" id="ref113">4</reflink>) = −1.41, <emph>p</emph> > 0.05, 95% CI (−414.35, 135.69).</p> <hd id="AN0176331450-19">Parenting stress</hd> <p>The fifth and final model, in which the intervention group was allowed to predict change in parenting stress over time, fit the data best (see Table 2). In that model, there were no differences in parenting stress at baseline between MBSR and PE (<emph>b</emph> = 0.194, <emph>p</emph> > 0.05). Parenting stress significantly decreased over time in both groups (<emph>b</emph> = −2.647, <emph>p</emph> < 0.0001), but that relationship was significantly stronger for participants in MBSR than for participants in PE (<emph>b</emph> = −1.970, <emph>p</emph> < 0.05). On average, parental distress decreased by 4.694 points at each time point for participants in MBSR (95% CrI (−6.055, −3.417)), and by 2.620 points at each time point for participants in PE (95% CrI (−4.018, −1.286)). Simple slopes analyses indicated that there was a significant difference in parental distress between the MBSR and PE groups at 12-month follow-up, such that the median estimate of the latent parental distress score was 5.906 points lower for the MBSR group than the PE group at that time point (95% CrI (−11.145, −0.720), respectively). There were no significant differences in parenting stress between the groups at baseline, immediate postintervention, or 6-month follow-up (95% CrI −3.674, 4.153), 95% CrI (−5.292, 1.701), and 95% CrI (−7.897, 0.161), respectively; see Figure 2). Our model explained approximately 46.0% of the variance in parental distress at Level 1, 22.8% of the variance in the intercept (average baseline parental distress score) at Level 2, and 29.3% of the variance in the slope (change in parental distress over time) at Level 2.</p> <p>Graph</p> <p>Table 2. Results of multilevel models predicting initial status and change in parenting stress over time.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th /><th align="left">Parenting stress</th></tr></thead><tbody><tr><td colspan="3">Fixed effects</td></tr><tr><td rowspan="4"> Initial status (π<sub>0i</sub>)</td><td>Intercept (γ<sub>00</sub>)</td><td>−0.217</td></tr><tr><td>Intervention Group (γ<sub>01</sub>)</td><td>0.194</td></tr><tr><td>Mental Health Services (γ<sub>02</sub>)</td><td>4.653<xref ref-type="table-fn" rid="tfn3">*</xref></td></tr><tr><td>Months of ABA (γ<sub>03</sub>)</td><td>0.365<xref ref-type="table-fn" rid="tfn3">**</xref></td></tr><tr><td rowspan="2"> Rate of change(π<sub>1i</sub>)</td><td>Intercept (γ<sub>10</sub>)</td><td>−2.647<xref ref-type="table-fn" rid="tfn3">***</xref></td></tr><tr><td>Intervention Group (γ<sub>11</sub>)</td><td>−1.970<xref ref-type="table-fn" rid="tfn3">*</xref></td></tr><tr><td colspan="3">Random effects</td></tr><tr><td> Level 1</td><td>Within-Person (σ2<sub>e</sub>)</td><td>36.968</td></tr><tr><td> Level 2</td><td>Initial Status (σ2<sub>ζ0</sub>)</td><td>52.94</td></tr><tr><td /><td>Rate of Change (σ2<sub>ζ1</sub>)</td><td>3.919</td></tr><tr><td><italic>R</italic>2</td><td><italic>R</italic>2<sub><italic>e</italic></sub></td><td>0.460</td></tr><tr><td /><td><italic>R</italic>2<sub><italic>0</italic></sub></td><td>0.228</td></tr><tr><td /><td><italic>R</italic>2<sub><italic>1</italic></sub></td><td>0.293</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 <emph>Note.</emph> ABA: applied behavior analysis therapy.</item> <item>3 <emph>p</emph> < 0.05. **<emph>p</emph> < 0.01. ***<emph>p</emph> < 0.001.</item> </ulist> <p>Graph: Figure 2. Change in parenting stress over time by intervention group. Note. MBSR: mindfulness-based stressed reduction group; PE: psychoeducation group. Graph is adjusted for family mental health services in the 6 months prior to baseline and number of months of ABA at baseline. Parenting stress latent variable scores are reported.</p> <hd id="AN0176331450-20">Discussion</hd> <p>The current study stringently tested MBSR ([<reflink idref="bib44" id="ref114">44</reflink>]) efficacy in reducing parenting stress for parents of preschool-aged autistic children. Utilizing a racially/ethnically and socioeconomically diverse sample, we employed a methodologically rigorous design involving an active comparator, multiple measures of parenting stress, and long-term follow-up. All parents reported reduced parenting stress over time. However, MBSR reduced parenting stress more than did PE, and the benefit of MBSR increased over time, with significant differences emerging between groups at the final 12-month follow-up.</p> <p>Although MBSR outperformed PE in reducing parenting stress over time (i.e. at 12-month follow-up), comparable improvements in parenting stress among parents in PE up to 6 months postintervention suggest the efficacy of both stress-reduction interventions for parents of young autistic children. Findings may also point to the benefit of PE in directly addressing the social support, informational, and services navigation needs of this population, particularly during a sensitive period for early intervention. Nonetheless, the informational and supportive benefits of PE may reach a ceiling. On the other hand, the steeper improvements found among the MBSR group (versus PE) at 12 months postintervention may reflect parents' sustained use—and continued benefit from—stress-reduction techniques taught in MBSR. Evidence of steady improvements in parenting stress up to 12 months postintervention contrasts with existing literature which has assessed outcomes up to 6 months postintervention at most and has largely found intervention effects to taper over time (e.g. [<reflink idref="bib79" id="ref115">79</reflink>]).</p> <p>A key contribution of the current study is the inclusion of an active comparator involving a manualized psychoeducation and support intervention, a service which is commonly offered to parents of children with developmental disabilities ([<reflink idref="bib38" id="ref116">38</reflink>]) but lacks sufficient efficacy data. Our trial thus provides foundational evidence of the stress-reduction benefits of PE for underserved families. Although MBSR produced greater and more prolonged stress amelioration, evidence that both approaches confer benefit provides compelling options for supporting parents of young autistic children. Future research would benefit from examining potential moderators of intervention outcomes to further refine and individualize clinical decision-making.</p> <p>This study possesses several strengths and addresses important gaps in the current literature. First, we utilized a well-characterized and racially, ethnically, and socioeconomically diverse sample. We assessed three different types of parenting stress that have been investigated in families of autistic children (general distress, stress specific to the child's condition, and daily parenting hassles) to comprehensively examine this construct. In addition, we employed a longer follow-up period than existing literature, which enhances the external validity of our findings. Taken together, this study provides the most rigorous test of the efficacy of MBSR for parents of autistic children to date.</p> <p>Findings from this study must also be considered in the context of several limitations. The onset of the COVID-19 pandemic and associated restrictions on in-person activities changed our procedures mid-study and likely impacted parents' stress levels and experiences in the interventions. In addition, while the use of an active comparator was a significant strength of the study's design, we did not have a no-intervention control group and therefore we cannot evaluate the benefit of the MSBR of PE interventions relative to normative changes in parenting stress over time. However, a recent waitlist-control mindfulness intervention for parents of autistic children found that control participants significantly increased parenting stress over the course of 2 months without treatment ([<reflink idref="bib71" id="ref117">71</reflink>]). We speculate that our underserved parents would have followed a similar or exacerbated trajectory in a no-intervention control group. Given the risks of untreated stress in this population and our focus on families experiencing high levels of strain, we opted for a stringent active comparison condition.</p> <p>The present study explicitly focused on parenting stress. Future studies should examine the potential benefits of MBSR and PE for other facets of parental well-being (e.g. anxiety, life satisfaction, self-efficacy), parenting cognitions (e.g. parenting self-efficacy), and parenting behavior. Indeed, evidence suggests that parenting cognitions and behaviors may underlie associations between parenting stress and child externalizing behavior problems and that low resources may intensify these effects ([<reflink idref="bib77" id="ref118">77</reflink>]). Thus, future studies should also examine how changes in parent-level factors following MBSR and PE influence child outcomes in this population. Finally, since MBSR is an intensive intervention that requires a highly trained interventionist that may not be available in most clinical settings, a future dismantling study identifying the key elements, intensity, and training required to enact significant change would facilitate broader dissemination, particularly to underserved communities.</p> <p>MBSR and PE were efficacious in reducing stress for parents of preschool-aged autistic children. Stress amelioration was especially pronounced and lasting for parents receiving MBSR. Our results may inform efforts to disseminate evidence-based interventions that attenuate parenting stress in this population during a critical window for early intervention.</p> <ref id="AN0176331450-21"> <title> References </title> <blist> <bibl id="bib1" idref="ref75" type="bt">1</bibl> <bibtext> Abidin R., Flens J. R., Austin W. G. (2006). The parenting stress index. Lawrence Erlbaum Associates.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref77" type="bt">2</bibl> <bibtext> Achenbach T. M. (2000). Child behavior checklist. Encyclopedia of Psychology, 2, 69–70.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref78" type="bt">3</bibl> <bibtext> Albers C. J., Kiers H. A., van Ravenzwaaij D. (2018). Credible confidence: A pragmatic view on the frequentist vs Bayesian debate. Collabra: Psychology, 4(1), Article 31. https://doi.org/10.1525/collabra.149</bibtext> </blist> <blist> <bibl id="bib4" idref="ref14" type="bt">4</bibl> <bibtext> Allik H., Larsson J. O., Smedje H. (2006). Health-related quality of life in parents of school-age children with Asperger syndrome or high-functioning autism. Health and Quality of Life Outcomes, 4, 1–8. https://doi.org/10.1186/1477-7525-4-1</bibtext> </blist> <blist> <bibl id="bib5" idref="ref80" type="bt">5</bibl> <bibtext> American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical of mental disorders: DSM-5TM (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596</bibtext> </blist> <blist> <bibl id="bib6" idref="ref1" type="bt">6</bibl> <bibtext> Baker-Ericzén M. J., Brookman-Frazee L., Stahmer A. (2005). Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders. Research and Practice for Persons with Severe Disabilities, 30(4), 194–204. https://doi.org/10.2511/rpsd.30.4.194</bibtext> </blist> <blist> <bibl id="bib7" idref="ref2" type="bt">7</bibl> <bibtext> Barroso N. E., Mendez L., Graziano P. A., Bagner D. M. (2018). Parenting stress through the lens of different clinical groups: A systematic review & meta-analysis. Journal of Abnormal Child Psychology, 46(3), 449–461. https://doi.org/10.1007/s10802-017-0313-6</bibtext> </blist> <blist> <bibl id="bib8" idref="ref7" type="bt">8</bibl> <bibtext> Bearss K., Burrell T. L., Stewart L., Scahill L. (2015). Parent training in autism spectrum disorder: What's in a name? Clinical Child and Family Psychology Review, 18(2), 170–182. https://doi.org/10.1007/s10567-015-0179-5</bibtext> </blist> <blist> <bibl id="bib9" idref="ref12" type="bt">9</bibl> <bibtext> Benson P. R. (2006). The impact of child symptom severity on depressed mood among parents of children with ASD: The mediating role of stress proliferation. Journal of Autism and Developmental Disorders, 36(5), 685–695. https://doi.org/10.1007/s10803-006-0112-3</bibtext> </blist> <blist> <bibtext> Bögels S., Restifo K. (2014). Mindful parenting: A guide for mental health practitioners. Springer. https://doi.org/10.1007/978-1-4614-7406-7</bibtext> </blist> <blist> <bibtext> Cachia R. L., Anderson A., Moore D. W. (2016). Mindfulness, stress and well-being in parents of children with autism spectrum disorder: A systematic review. Journal of Child and Family Studies, 25(1), 1–14. https://doi.org/10.1007/s10826-015-0193-8</bibtext> </blist> <blist> <bibtext> Clifford T., Minnes P. (2013). Who participates in support groups for parents of children with autism spectrum disorders? The role of beliefs and coping style. Journal of Autism and Developmental Disorders, 43, 179–187. https://doi.org/10.1007/s10803-012-1561-5</bibtext> </blist> <blist> <bibtext> Constantino J. N., Gruber C. P. (2012). Social Responsiveness Scale: SRS-2. Western Psychological Services.</bibtext> </blist> <blist> <bibtext> Corsello C., Hus V., Pickles A., Risi S., Cook E. H. Jr Leventhal B. L., Lord C. (2007). Between a ROC and a hard place: Decision making and making decisions about using the SCQ. Journal of Child Psychology and Psychiatry, 48(9), 932–940. https://doi.org/10.1111/j.1469-7610.2007.01762</bibtext> </blist> <blist> <bibtext> Crnic K. A., Greenberg M. T. (1990). Minor parenting stresses with young children. Child Development, 61(5), 1628–1637. https://doi.org/10.2307/1130770</bibtext> </blist> <blist> <bibtext> Dabrowska A., Pisula E. (2010). Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome. Journal of Intellectual Disability Research, 54(3), 266–280. https://doi.org/10.1111/j.1365-2788.2010.01258.x</bibtext> </blist> <blist> <bibtext> Da Paz N. S., Wallander J. L. (2017). Interventions that target improvements in mental health for parents of children with autism spectrum disorders: A narrative review. Clinical Psychology Review, 51, 1–14. https://doi.org/10.1016/j.cpr.2016.10.006</bibtext> </blist> <blist> <bibtext> Davis N. O., Carter A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics. Journal of Autism and Developmental Disorders, 38(7), 1278–1291. https://doi.org/10.1007/s10803-007-0512-z</bibtext> </blist> <blist> <bibtext> de Bruin E. I., Blom R., Smit F. M., van Steensel F. J., Bögels S. M. (2015). MYmind: Mindfulness training for youngsters with autism spectrum disorders and their parents. Autism, 19(8), 906–914. https://doi.org/10.1177/1362361314553279</bibtext> </blist> <blist> <bibtext> De Giacomo A., Fombonne E. (1998). Parental recognition of developmental abnormalities in autism. European Child & Adolescent Psychiatry, 7(3), 131–136. https://doi.org/10.1007/s007870050058</bibtext> </blist> <blist> <bibtext> Donenberg G., Baker B. L. (1993). The impact of young children with externalizing behaviors on their families. Journal of Abnormal Child Psychology, 21(2), 179–198. https://doi.org/10.1007/BF00911315</bibtext> </blist> <blist> <bibtext> Dunn L. M., Dunn D. M. (2007). PPVT-4: Peabody Picture Vocabulary Test. Pearson Assessments.</bibtext> </blist> <blist> <bibtext> Dykens E. M., Fisher M. H., Taylor J. L., Lambert W., Miodrag N. (2014). Reducing distress in mothers of children with autism and other disabilities: A randomized trial. Pediatrics, 134(2), e454–e463. https://doi.org/10.1542/peds.2013-3164</bibtext> </blist> <blist> <bibtext> Enders C. K., Du H., Keller B. T. (2020). A model-based imputation procedure for multilevel regression models with random coefficients, interaction effects, and nonlinear terms. Psychological Methods, 25(1), 88–112. https://doi.org/10.1037/met0000228</bibtext> </blist> <blist> <bibtext> Estes A., Munson J., Dawson G., Koehler E., Zhou X. H., Abbott R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism: The International Journal of Research and Practice, 13(4), 375–387. https://doi.org/10.1177/1362361309105658</bibtext> </blist> <blist> <bibtext> Fenning R. M., Butter E. M., Macklin E. A., Norris M., Hammersmith K. J., McKinnon-Bermingham K., Chan J., Stephenson K. G., Albright C., Scherr J., Moffitt J., Lu F., Spaulding R., Guijon J., Hess A., Coury D. L., Kuhlthau K. A., Steinberg-Epstein R. (2022). Parent training for dental care in underserved children with ASD: A randomized controlled trial. Pediatrics, 149(5), Article e050691. https://doi.org/10.1542/peds.2021-050691</bibtext> </blist> <blist> <bibtext> Fenning R. M., Butter E. M., Norris M., Chan J., Macklin E. A., McKinnon-Bermingham Albright C., Stephenson K. G., Scherr J., Moffitt J., Hess A., Steinberg-Epstein R., Kuhlthau K. A. (2022). Optimizing parent training to improve health behaviors and outcomes in underserved children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 1–17. https://doi.org/10.1007/s10803-022-05660-6</bibtext> </blist> <blist> <bibtext> Ferraioli S. J., Harris S. L. (2013). Comparative effects of mindfulness and skills-based parent training programs for parents of children with autism: Feasibility and preliminary outcome data. Mindfulness, 4(2), 89–101. <ulink href="http://dx.doi.org/10.1007/s12671-012-0099-0">http://dx.doi.org/10.1007/s12671-012-0099-0</ulink></bibtext> </blist> <blist> <bibtext> First M. B., Spitzer R. L., Gibbon M., Williams J. B. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. SCID-I/P.</bibtext> </blist> <blist> <bibtext> Gammon E. A., Rose S. D. (1991). The coping skills training program for parents of children with developmental disabilities: An experimental evaluation. Research on Social Work Practice, 1(3), 244–256. https://doi.org/10.1177/104973159100100302</bibtext> </blist> <blist> <bibtext> Gelman A., Carlin J. B., Stern H. S., Dunson D. B., Vehtari A., Rubin D. B. (2014). Bayesian data analysis (3rd ed.). CRC Press.</bibtext> </blist> <blist> <bibtext> Gelman A., Rubin D. B. (1992). Inference from iterative simulation using multiple sequences. Statistical Science, 7, 457–472.</bibtext> </blist> <blist> <bibtext> Graham J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60(1), 549–576. https://doi.org/10.1146/annurev.psych.58.110405.085530</bibtext> </blist> <blist> <bibtext> Grindle C. F., Kovshoff H., Hastings R. P., Remington B. (2009). Parents' experiences of home-based applied behavior analysis programs for young children with autism. Journal of Autism and Developmental Disorders, 39, 42–56. https://doi.org/10.1007/s10803-008-0597-z</bibtext> </blist> <blist> <bibtext> Grossman P., Niemann L., Schmidt S., Walach H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/S0022-3999(03)00573-7</bibtext> </blist> <blist> <bibtext> Gu J., Strauss C., Bond R., Cavanagh K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006</bibtext> </blist> <blist> <bibtext> Hartley M., Dorstyn D., Due C. (2019). Mindfulness for children and adults with autism spectrum disorder and their caregivers: A meta-analysis. Journal of Autism and Developmental Disorders, 49, 4306–4319. https://doi.org/10.1007/s10803-019-04145-3</bibtext> </blist> <blist> <bibtext> Hastings R. P., Beck A. (2004). Practitioner review: Stress intervention for parents of children with intellectual disabilities. Journal of Child Psychology and Psychiatry, 45(8), 1338–1349. https://doi.org/10.1111/j.1469-7610.2004.00841.x</bibtext> </blist> <blist> <bibtext> Hayes S. A., Watson S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. https://doi.org/10.1007/s10803-012-1604-y</bibtext> </blist> <blist> <bibtext> Hespanhol L., Vallio C. S., Costa L. M., Saragiotto B. T. (2019). Understanding and interpreting confidence and credible intervals around effect estimates. Brazilian Journal of Physical Therapy, 23(4), 290–301. https://doi.org/10.1016/j.bjpt.2018.12.006</bibtext> </blist> <blist> <bibtext> Hwang Y. S., Kearney P., Klieve H., Lang W., Roberts J. (2015). Cultivating mind: Mindfulness interventions for children with autism spectrum disorder and problem behaviours, and their mothers. Journal of Child and Family Studies, 24, 3093–3106. https://doi.org/10.1007/s10826-015-0114-x</bibtext> </blist> <blist> <bibtext> Izadi-Mazidi M., Riahi F., Khajeddin N. (2015). Effect of cognitive behavior group therapy on parenting stress in mothers of children with autism. Iranian Journal of Psychiatry and Behavioral Sciences, 9(3), Article e1900. https://doi.org/10.17795/ijpbs-1900</bibtext> </blist> <blist> <bibtext> Jones L., Gold E., Totsika V., Hastings R. P., Jones M., Griffiths A., Silverton S. (2018). A mindfulness parent well-being course: Evaluation of outcomes for parents of children with autism and related disabilities recruited through special schools. European Journal of Special Needs Education, 33(1), 16–30. https://doi.org/10.1080/08856257.2017.1297571</bibtext> </blist> <blist> <bibtext> Kabat-Zinn J. (2013). Full catastrophe living, revised edition: How to cope with stress, pain and illness using mindfulness meditation. Bantam.</bibtext> </blist> <blist> <bibtext> Karst J. S., Van Hecke A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15(3), 247–277. https://doi.org/10.1007/s10567-012-0119-6</bibtext> </blist> <blist> <bibtext> Keller B. T., Enders C. K. (2021). Blimp user's guide (Version 3). https://<ulink href="http://www.appliedmissingdata.com/blimp">www.appliedmissingdata.com/blimp</ulink></bibtext> </blist> <blist> <bibtext> Kulasinghe K., Whittingham K., Mitchell A. E., Boyd R. N. (2023). Psychological interventions targeting mental health and the mother–child relationship in autism: Systematic review and meta-analysis. Developmental Medicine & Child Neurology, 65(3), 329–345. https://doi.org/10.1111/dmcn.15432</bibtext> </blist> <blist> <bibtext> Lecavalier L., Leone S., Wiltz J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50(Pt. 3), 172–183. https://doi.org/10.1111/j.1365-2788.2005.00732.x</bibtext> </blist> <blist> <bibtext> Lin Y. N., Iao L. S., Lee Y. H., Wu C. C. (2021). Parenting stress and child behavior problems in young children with autism spectrum disorder: Transactional relations across time. Journal of Autism and Developmental Disorders, 51(7), 2381–2391. https://doi.org/10.1007/s10803-020-04720-z</bibtext> </blist> <blist> <bibtext> Lord C., Rutter M., DiLavore P., Risi S., Gotham K., Bishop S. (2012). Autism diagnostic observation schedule (ADOS-2) (2nd ed.). Western Psychological Corporation.</bibtext> </blist> <blist> <bibtext> Lunsky Y., Albaum C., Baskin A., Hastings R. P., Hutton S., Steel L., Wang W., Weiss J. (2021). Group virtual mindfulness-based intervention for parents of autistic adolescents and adults. Journal of Autism and Developmental Disorders, 51(11), 3959–3969. https://doi.org/10.1007/s10803-020-04835-3</bibtext> </blist> <blist> <bibtext> Lunsky Y. P., Hastings R., Weiss J. A. M., Palucka A., Hutton S., White K. (2017). Comparative effects of mindfulness and support and information group interventions for parents of adults with autism spectrum disorder and other developmental disabilities. Journal of Autism and Developmental Disorders, 47, 1769–1779. https://doi.org/10.1007/s10803-017-3099-z</bibtext> </blist> <blist> <bibtext> Magaña S., Parish S. L., Rose R. A., Timberlake M., Swaine J. G. (2012). Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities. Intellectual and Developmental Disabilities, 50(4), 287–299. https://doi.org/10.1352/1934-9556-50.4.287</bibtext> </blist> <blist> <bibtext> Mueller R., Moskowitz L. J. (2020). Positive family intervention for children with ASD: Impact on parents' cognitions and stress. Journal of Child and Family Studies, 29(12), 3536–3551. https://doi.org/10.1007/s10826-020-01830-1</bibtext> </blist> <blist> <bibtext> Neece C. L. (2014). Mindfulness-based stress reduction for parents of young children with developmental delays: Implications for parental mental health and child behavior problems. Journal of Applied Research in Intellectual Disabilities, 27(2), 174–186. https://doi.org/10.1111/jar.12064</bibtext> </blist> <blist> <bibtext> Neece C. L., Chan N., Klein K., Roberts L., Fenning R. M. (2019). Mindfulness-based stress reduction for parents of children with developmental delays: Understanding the experiences of Latino families. Mindfulness, 10(6), 1017–1030. https://doi.org/10.1007/s12671-018-1011-3</bibtext> </blist> <blist> <bibtext> Nock M. K., Kazdin A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73(5), 872–879. https://doi.org/10.1037/0022-006X.73.5.872</bibtext> </blist> <blist> <bibtext> Oono I. P., Honey E. J., McConachie H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Evidence-Based Child Health: A Cochrane Review Journal, 8(6), 2380–2479. https://doi.org/10.1002/14651858.CD009774.pub2</bibtext> </blist> <blist> <bibtext> Osborne L. A., McHugh L., Saunders J., Reed P. (2008). Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1092–1103. https://doi.org/10.1007/s10803-007-0497-7</bibtext> </blist> <blist> <bibtext> Osborne L. A., Reed P. (2009). The relationship between parenting stress and behavior problems of children with autistic spectrum disorders. Exceptional Children, 76(1), 54–73. https://doi.org/10.1177/00144029090760010</bibtext> </blist> <blist> <bibtext> Rao P. A., Beidel D. C. (2009). The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning. Behavior Modification, 33(4), 437–451. https://doi.org/10.1177/0145445509336427</bibtext> </blist> <blist> <bibtext> Rayan A., Ahmad M. (2016). Effectiveness of mindfulness-based interventions on quality of life and positive reappraisal coping among parents of children with autism spectrum disorder. Research in Developmental Disabilities, 55, 185–196. https://doi.org/10.1016/j.ridd.2016.04.002</bibtext> </blist> <blist> <bibtext> Ridderinkhof A., de Bruin E. I., Blom R., Bögels S. M. (2018). Mindfulness-based program for children with autism spectrum disorder and their parents: Direct and long-term improvements. Mindfulness, 9(3), 773–791. https://doi.org/10.1007/s12671-017-0815-x</bibtext> </blist> <blist> <bibtext> Rivera-Figueroa K., Marfo N. Y. A., Eigsti I. M. (2022). Parental perceptions of autism spectrum disorder in Latinx and Black sociocultural contexts: A systematic review. American Journal on Intellectual and Developmental Disabilities, 127(1), 42–63. https://doi.org/10.1352/1944-7558-127.1.42</bibtext> </blist> <blist> <bibtext> Roid G. H. (2003). Stanford-Binet Intelligence Scales (5th ed.). Riverside.</bibtext> </blist> <blist> <bibtext> Rojas-Torres L. P., Alonso-Esteban Y., López-Ramón M. F., Alcantud-Marín F. (2021). Mindfulness-Based Stress Reduction (MBSR) and Self Compassion (SC) training for parents of children with autism spectrum disorders: A pilot trial in community services in Spain. Children, 8(5), Article 316. https://doi.org/10.3390/children8050316</bibtext> </blist> <blist> <bibtext> Ruiz-Robledillo N., Sariñana-González P., Pérez-Blasco J., González-Bono E., Moya-Albiol L. (2015). A mindfulness-based program improves health in caregivers of people with autism spectrum disorder: A pilot study. Mindfulness, 6, 767–777. https://doi.org/10.1007/s12671-014-0316-0</bibtext> </blist> <blist> <bibtext> Rutherford M., Singh-Roy A., Rush R., McCartney D., O'Hare A., Forsyth K. (2019). Parent focused interventions for older children or adults with ASD and parent wellbeing outcomes: A systematic review with meta-analysis. Research in Autism Spectrum Disorders, 68, Article 101450. https://doi.org/10.1016/j.rasd.2019.101450</bibtext> </blist> <blist> <bibtext> Rutter M., Bailey A., Lord C. (2003a). The Social Communication Questionnaire. Western Psychological Services.</bibtext> </blist> <blist> <bibtext> Rutter M., Le Couteur A., Lord C. (2003b). ADI-R: Autism Diagnostic Interview-Revised (ADI-R). Western Psychological Services. https://doi.org/10.1007/s12671-014-0316-0</bibtext> </blist> <blist> <bibtext> Schwartzman J. M., Millan M. E., Uljarevic M., Gengoux G. W. (2021). Resilience intervention for parents of children with autism: Findings from a randomized controlled trial of the AMOR method. Journal of Autism and Developmental Disorders, 52, 738–757. https://doi.org/10.1007/s10803-021-04977-y</bibtext> </blist> <blist> <bibtext> Segal Z. V., Williams J. M. G., Teasdale J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press.</bibtext> </blist> <blist> <bibtext> Shattuck P. T., Durkin M., Maenner M., Newschaffer C., Mandell D. S., Wiggins L., Cuniff C. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 474–483. https://doi.org/10.1097/CHI.0b013e31819b3848</bibtext> </blist> <blist> <bibtext> Singer D., Willett B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. Oxford University Press.</bibtext> </blist> <blist> <bibtext> Smith K. A., Gehricke J. G., Iadarola S., Wolfe A., Kuhlthau K. A. (2020). Disparities in service use among children with autism: A systematic review. Pediatrics, 145(1), S35–S46. https://doi.org/10.1542/peds.2019-1895G</bibtext> </blist> <blist> <bibtext> Sparrow S. S., Chicchetti D. V., Saulnier C. A. (2016). Vineland Adaptive Behavior Scales (3rd ed.). Pearson.</bibtext> </blist> <blist> <bibtext> Stephenson K. G., Fenning R. M., Macklin E. A., Lu F., Norris M., Steinberg-Epstein R., Butter E. M. (2022). Child behavior problems and parenting stress in underserved families of children with ASD: Investigation of family resources and parenting self-efficacy. Journal of Autism and Developmental Disorders, 1–12. https://doi.org/10.1007/s10803-022-05681-1</bibtext> </blist> <blist> <bibtext> Wachtel K., Carter A. S. (2008). Reaction to diagnosis and parenting styles among mothers of young children with ASDs. Autism, 12(5), 575–594. https://doi.10.1177/1362361308094505</bibtext> </blist> <blist> <bibtext> Weitlauf A. S., Broderick N., Stainbrook J. A., Taylor J. L., Herrington C. G., Nicholson A. G., Santulli M., Dykens E. M., Juárez A. P., Warren Z. E. (2020). Mindfulness-based stress reduction for parents implementing early intervention for autism: An RCT. Pediatrics, 145(Suppl. 1), S81–S92. https://doi.org/10.1542/peds.2019-1895K</bibtext> </blist> <blist> <bibtext> Zaidman-Zait A., Mirenda P., Duku E., Szatmari P., Georgiades S., Volden J., Zwaigenbaum L., Thompson A., Pathways in, A. S. D., & Study Team. (2014). Exam-ination of bidirectional relationships between parent stress and two types of problem behavior in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1908–1917. https://doi.org/10.1007/s10-803-014-2064-3</bibtext> </blist> </ref> <ref id="AN0176331450-22"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health to the first three authors (R15HD091726-01A1).</bibtext> </blist> <blist> <bibtext> Informed consent was obtained from all individual participants included in the study. Procedures were approved by the Institutional Review Board at Loma Linda University in collaboration with the additional participating universities.</bibtext> </blist> <blist> <bibtext> Cameron L Neece</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0003-1778-3497 Laurel R Benjamin</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0003-4353-219X</bibtext> </blist> </ref> <aug> <p>By Cameron L Neece; Rachel M Fenning; Holly ER Morrell and Laurel R Benjamin</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib16" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib25" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib39" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib18" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib58" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib53" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib44" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib55" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib45" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib59" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib61" firstref="ref16"></nolink> <nolink nlid="nl12" bibid="bib48" firstref="ref17"></nolink> <nolink nlid="nl13" bibid="bib60" firstref="ref18"></nolink> <nolink nlid="nl14" bibid="bib49" firstref="ref19"></nolink> <nolink nlid="nl15" bibid="bib80" firstref="ref21"></nolink> <nolink nlid="nl16" bibid="bib20" firstref="ref22"></nolink> <nolink nlid="nl17" bibid="bib73" firstref="ref23"></nolink> <nolink nlid="nl18" bibid="bib78" firstref="ref24"></nolink> <nolink nlid="nl19" bibid="bib34" firstref="ref25"></nolink> <nolink nlid="nl20" bibid="bib64" firstref="ref26"></nolink> <nolink nlid="nl21" bibid="bib75" firstref="ref27"></nolink> <nolink nlid="nl22" bibid="bib12" firstref="ref28"></nolink> <nolink nlid="nl23" bibid="bib68" firstref="ref29"></nolink> <nolink nlid="nl24" bibid="bib30" firstref="ref30"></nolink> <nolink nlid="nl25" bibid="bib42" firstref="ref31"></nolink> <nolink nlid="nl26" bibid="bib54" firstref="ref32"></nolink> <nolink nlid="nl27" bibid="bib17" firstref="ref33"></nolink> <nolink nlid="nl28" bibid="bib38" firstref="ref34"></nolink> <nolink nlid="nl29" bibid="bib47" firstref="ref35"></nolink> <nolink nlid="nl30" bibid="bib11" firstref="ref38"></nolink> <nolink nlid="nl31" bibid="bib28" firstref="ref39"></nolink> <nolink nlid="nl32" bibid="bib37" firstref="ref40"></nolink> <nolink nlid="nl33" bibid="bib19" firstref="ref41"></nolink> <nolink nlid="nl34" bibid="bib41" firstref="ref42"></nolink> <nolink nlid="nl35" bibid="bib43" firstref="ref43"></nolink> <nolink nlid="nl36" bibid="bib51" firstref="ref44"></nolink> <nolink nlid="nl37" bibid="bib62" firstref="ref45"></nolink> <nolink nlid="nl38" bibid="bib63" firstref="ref46"></nolink> <nolink nlid="nl39" bibid="bib67" firstref="ref47"></nolink> <nolink nlid="nl40" bibid="bib71" firstref="ref48"></nolink> <nolink nlid="nl41" bibid="bib52" firstref="ref50"></nolink> <nolink nlid="nl42" bibid="bib72" firstref="ref51"></nolink> <nolink nlid="nl43" bibid="bib10" firstref="ref58"></nolink> <nolink nlid="nl44" bibid="bib35" firstref="ref65"></nolink> <nolink nlid="nl45" bibid="bib36" firstref="ref66"></nolink> <nolink nlid="nl46" bibid="bib56" firstref="ref68"></nolink> <nolink nlid="nl47" bibid="bib23" firstref="ref69"></nolink> <nolink nlid="nl48" bibid="bib79" firstref="ref73"></nolink> <nolink nlid="nl49" bibid="bib66" firstref="ref74"></nolink> <nolink nlid="nl50" bibid="bib29" firstref="ref79"></nolink> <nolink nlid="nl51" bibid="bib65" firstref="ref82"></nolink> <nolink nlid="nl52" bibid="bib22" firstref="ref83"></nolink> <nolink nlid="nl53" bibid="bib76" firstref="ref84"></nolink> <nolink nlid="nl54" bibid="bib69" firstref="ref85"></nolink> <nolink nlid="nl55" bibid="bib50" firstref="ref86"></nolink> <nolink nlid="nl56" bibid="bib14" firstref="ref87"></nolink> <nolink nlid="nl57" bibid="bib13" firstref="ref88"></nolink> <nolink nlid="nl58" bibid="bib70" firstref="ref89"></nolink> <nolink nlid="nl59" bibid="bib57" firstref="ref92"></nolink> <nolink nlid="nl60" bibid="bib26" firstref="ref93"></nolink> <nolink nlid="nl61" bibid="bib27" firstref="ref94"></nolink> <nolink nlid="nl62" bibid="bib21" firstref="ref97"></nolink> <nolink nlid="nl63" bibid="bib15" firstref="ref98"></nolink> <nolink nlid="nl64" bibid="bib74" firstref="ref99"></nolink> <nolink nlid="nl65" bibid="bib33" firstref="ref105"></nolink> <nolink nlid="nl66" bibid="bib46" firstref="ref106"></nolink> <nolink nlid="nl67" bibid="bib24" firstref="ref107"></nolink> <nolink nlid="nl68" bibid="bib31" firstref="ref108"></nolink> <nolink nlid="nl69" bibid="bib32" firstref="ref109"></nolink> <nolink nlid="nl70" bibid="bib40" firstref="ref110"></nolink> <nolink nlid="nl71" bibid="bib77" firstref="ref118"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1418623
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Comparative Effects of Mindfulness-Based Stress Reduction and Psychoeducational Support on Parenting Stress in Families of Autistic Preschoolers
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Cameron+L+Neece%22">Cameron L Neece</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1778-3497">0000-0003-1778-3497</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rachel+M+Fenning%22">Rachel M Fenning</searchLink><br /><searchLink fieldCode="AR" term="%22Holly+ER+Morrell%22">Holly ER Morrell</searchLink><br /><searchLink fieldCode="AR" term="%22Laurel+R+Benjamin%22">Laurel R Benjamin</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4353-219X">0000-0003-4353-219X</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2024 28(4):985-998.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 14
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: R15HD09172601A1
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Management%22">Stress Management</searchLink><br /><searchLink fieldCode="DE" term="%22Minority+Groups%22">Minority Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink><br /><searchLink fieldCode="DE" term="%22Psychoeducational+Methods%22">Psychoeducational Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Parenthood+Education%22">Parenthood Education</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22California%22">California</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/13623613231191558
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613<br />1461-7005
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Relative to parents of children with neurotypical development and other developmental disabilities, parents of autistic children experience higher levels of parenting stress, which are associated with deleterious consequences for parents' mental and physical health and child functioning. Despite urgent calls to action, parenting stress is rarely addressed directly in interventions for families of autistic children, and less so in underserved and racial/ethnic minority populations where clinical needs are greater. This study tested the efficacy of mindfulness-based stress reduction, compared to a psychoeducation and support intervention, in reducing parenting stress among diverse families of autistic preschoolers. Participants (N = 117) were randomly assigned to the mindfulness-based stress reduction or psychoeducation and support groups; assessments were conducted at baseline, immediately postintervention, and 6 and 12 months postintervention. Results indicated significant reductions in parenting stress across both the mindfulness-based stress reduction and psychoeducation and support intervention conditions; however, reductions in parenting stress were greater for parents in mindfulness-based stress reduction than in psychoeducation and support. Furthermore, the benefit of mindfulness-based stress reduction relative to psychoeducation and support increased over time, with significant group differences in parenting stress detected at 12-month follow-up.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1418623
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1418623
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/13623613231191558
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 985
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Preschool Children
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Stress Management
        Type: general
      – SubjectFull: Minority Groups
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Metacognition
        Type: general
      – SubjectFull: Psychoeducational Methods
        Type: general
      – SubjectFull: Parenthood Education
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: California
        Type: general
    Titles:
      – TitleFull: Comparative Effects of Mindfulness-Based Stress Reduction and Psychoeducational Support on Parenting Stress in Families of Autistic Preschoolers
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Cameron L Neece
      – PersonEntity:
          Name:
            NameFull: Rachel M Fenning
      – PersonEntity:
          Name:
            NameFull: Holly ER Morrell
      – PersonEntity:
          Name:
            NameFull: Laurel R Benjamin
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
            – Type: issn-electronic
              Value: 1461-7005
          Numbering:
            – Type: volume
              Value: 28
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Autism: The International Journal of Research and Practice
              Type: main
ResultId 1