Parent, child, and family outcomes following Acceptance and Commitment Therapy for parents of autistic children: A randomized controlled trial

Maughan, A. L., Lunsky, Y., Lake, J., Mills, J. S., Fung, K., Steel, L., & Weiss, J. A. (2024). Parent, child, and family outcomes following Acceptance and Commitment Therapy for parents of autistic children: A randomized controlled trial. Autism: The International Journal of Research and Practice, 28(2), 367–380. https://doi.org/10.1177/13623613231172241

Summary by: Lou Arian Doré

The study at hand aims to test the efficacy of Acceptance and Commitment Therapy (ACT) for reducing depressive symptoms and improving other outcomes in parents of children with autism. ACT is a third-wave cognitive behavioural therapy approach that focuses on enhancing psychological flexibility (Hayes et al., 2006). It has been shown to be effective for caregivers (Han et al., 2021) and has been adapted into a group-based ACT workshop developed by parents of autistic individuals for this specific target group.

Parents of children on the autism spectrum commonly experience higher levels of stress, anxiety, and depression compared to parents of children without disabilities. These challenges may stem from the additional demands of making significant adjustments to care for their children (Meirsschaut et al., 2010). This highlights the need for support that focuses on the parents themselves to help them manage these challenges. Since acceptance may be more appropriate than problem-solving in this context, ACT is a well-suited intervention. Previous studies have demonstrated its effectiveness in similar settings (Blackledge & Hayes, 2006; Poddar et al., 2015; Lunsky et al., 2018), although this is the first randomized controlled trial (RCT) to examine its effects on a large sample.

Fifty-four parents with children aged 3 to 34 years participated in the study. They completed a survey before beginning the treatment and again at 3, 7, and 17 weeks post-randomisation. The program consisted of three sessions: the first introduced ACT processes and mindfulness; the second included various activities to demonstrate ACT concepts; and the third was a refresher session held one month later. The survey assessed symptoms of depression (Depression Anxiety Stress Scale–21; Lovibond & Lovibond, 1995), parent mental health and functioning (Parenting Stress Index–Fourth Edition; Abidin, 2012; Positive and Negative Affect Schedule; Crawford & Henry, 2004), ACT processes (Acceptance and Action Questionnaire-II; Bond et al., 2011; Valued Living Questionnaire; Wilson et al., 2010; Cognitive Fusion Questionnaire; Gillanders et al., 2014; Bangor Mindful Parenting Scale; Jones et al., 2014), as well as youth mental health and family functioning (Strengths and Difficulties Questionnaire; Goodman, 2001; Brief Family Distress Scale; Weiss & Lunsky, 2011; McMaster Family Assessment Device; Epstein et al., 1983). After recruitment and a baseline assessment, participants were randomised into either the treatment or the waitlist group, stratified by gender. Data were analysed using linear mixed-effects regression analyses, examining Time and Group effects on various outcome measures.

Regarding the primary outcome of depression, parents in the treatment group, but not those in the waitlist group, showed reduced depression scores, which were maintained at follow-up four months later. Effects on secondary outcomes were less pronounced, though some improvements were observed in the treatment group but not in the waitlist group. These included lower stress at Time 3 compared to baseline, increased positive affect at Time 2, significantly higher odds of achieving or exceeding one’s goals, improvements in experiential avoidance and cognitive fusion, as well as reductions in family distress. The most robust treatment effects maintained at follow-up were observed for parent depression and family distress. There were no significant improvements in mindful parenting, valued living, overall family functioning, or child mental health.

The discussion highlights that ACT effectively reduced parent depression, consistent with previous research (Blackledge & Hayes, 2006; Joekar et al., 2016; Lunsky et al., 2018; Poddar et al., 2015), though the underlying mechanisms (e.g., cognitive defusion, values-consistent action) were less clear in this sample. While improvements in positive affect and goal attainment were seen shortly after the intervention, these effects diminished over time, possibly due to a lack of sustained engagement or follow-up. Core ACT processes such as valued living and mindful parenting showed minimal change, suggesting that behavioural change may require more time and continued practice. Reductions in family distress may reflect shifts in perception or informal social support during the intervention, although broader measures of family functioning and child mental health remained unaffected. The authors emphasize the need for future research into different delivery formats, group cohesion and social connection, longer-term follow-up, and the inclusion of external outcome measures. Noted limitations include reliance on self-report, a relatively privileged sample, and partial program completion.