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Original Investigation |

Improving Maternal Mental Health After a Child’s Diagnosis of Autism Spectrum Disorder:  Results From a Randomized Clinical Trial

Emily Feinberg, CPNP, ScD1,2; Marilyn Augustyn, MD1,3; Elaine Fitzgerald, DrPH2,4; Jenna Sandler, MPH3; Zhandra Ferreira-Cesar Suarez, MPH2; Ning Chen, MSc1,3; Howard Cabral, PhD5; William Beardslee, MD6; Michael Silverstein, MD, MPH1,3
[+] Author Affiliations
1Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
2Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
4National Initiative for Children’s Healthcare Quality, Boston, Massachusetts
5Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
6Department of Psychiatry, Children’s Hospital Boston, Boston, Massachusetts
JAMA Pediatr. 2014;168(1):40-46. doi:10.1001/jamapediatrics.2013.3445.
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Importance  The prevalence of psychological distress among mothers of children with autism spectrum disorder (ASD) suggests a need for interventions that address parental mental health during the critical period after the child’s autism diagnosis when parents are learning to navigate the complex system of autism services.

Objective  To investigate whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child’s diagnosis of ASD.

Design, Setting, and Participants  A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs that primarily serve low-income families. Participants were mothers of 122 young children (mean age, 34 months) who recently received a diagnosis of ASD. Among mothers assessed for eligibility, 17.0% declined participation. We report outcomes after 3 months of follow-up (immediate postdiagnosis period).

Interventions  Problem-solving education is a brief, cognitive intervention delivered in six 30-minute individualized sessions by existing staff (early intervention programs) or research staff without formal mental health training (autism clinic).

Main Outcomes and Measures  Primary outcomes were parental stress and maternal depressive symptoms.

Results  Fifty-nine mothers were randomized to receive PSE and 63 to receive usual care. The follow-up rate was 91.0%. Most intervention mothers (78.0%) received the full PSE course. At the 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%; adjusted relative risk [aRR], 0.17; 95% CI, 0.04 to 0.65). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance (5.7% vs 22.4%; aRR, 0.33; 95% CI, 0.10 to 1.08); however, the reduction in mean depressive symptoms was statistically significant (Quick Inventory of Depressive Symptomatology score, 4.6 with PSE vs 6.9 with usual care; adjusted mean difference, −1.67; 95% CI, −3.17 to −0.18).

Conclusions and Relevance  The positive effects of PSE in reducing parenting stress and depressive symptoms during the critical postdiagnosis period, when parents are asked to navigate a complex service delivery system, suggest that it may have a place in clinical practice. Further work will monitor these families for a total of 9 months to determine the trajectory of outcomes.

Trial Registration  clinicaltrials.gov Identifier: NCT01021384

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