title: Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial.
abstract: OBJECTIVE
  Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials.
  
  
  OBJECTIVE
  To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior.
  
  
  METHODS
  This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.
  
  
  METHODS
  Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies.
  
  
  METHODS
  Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3.
  
  
  RESULTS
  At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001).
  
  
  CONCLUSIONS
  For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01233414.
authors.affiliation: Department of Pediatrics, Marcus Autism Center, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia.
authors.forename: Karen
authors.initials: K
authors.lastname: Bearss
authors.affiliation: Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania13Dr Johnson is now with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Johnson
authors.affiliation: Department of Pediatrics, University of Rochester, Rochester, New York.
authors.forename: Tristram
authors.initials: T
authors.lastname: Smith
authors.affiliation: Departments of Psychology and Psychiatry, Nisonger Center, UCEDD, Ohio State University, Columbus.
authors.forename: Luc
authors.initials: L
authors.lastname: Lecavalier
authors.affiliation: Department of Psychiatry, Indiana University, Indianapolis.
authors.forename: Naomi
authors.initials: N
authors.lastname: Swiezy
authors.affiliation: Departments of Psychology and Psychiatry, Nisonger Center, UCEDD, Ohio State University, Columbus.
authors.forename: Michael
authors.initials: M
authors.lastname: Aman
authors.affiliation: Department of Pediatrics, University of Rochester, Rochester, New York.
authors.forename: David B
authors.initials: DB
authors.lastname: McAdam
authors.affiliation: Department of Pediatrics, Ohio State University and Nationwide Children's Hospital, Columbus.
authors.forename: Eric
authors.initials: E
authors.lastname: Butter
authors.affiliation: Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Charmaine
authors.initials: C
authors.lastname: Stillitano
authors.affiliation: Department of Psychiatry, Indiana University, Indianapolis.
authors.forename: Noha
authors.initials: N
authors.lastname: Minshawi
authors.affiliation: Child Study Center, Yale University, New Haven, Connecticut.
authors.forename: Denis G
authors.initials: DG
authors.lastname: Sukhodolsky
authors.affiliation: Department of Pediatrics, University of Rochester, Rochester, New York.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Mruzek
authors.affiliation: Division of Education Leadership and Innovation, Mary Lou Fulton Teachers College, Arizona State University, Tempe.
authors.forename: Kylan
authors.initials: K
authors.lastname: Turner
authors.affiliation: Department of Psychiatry, Indiana University, Indianapolis.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Neal
authors.affiliation: Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Department of Psychology, London, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hallett
authors.affiliation: Department of Pediatrics, Ohio State University and Nationwide Children's Hospital, Columbus.
authors.forename: James A
authors.initials: JA
authors.lastname: Mulick
authors.affiliation: Department of Pediatrics, Marcus Autism Center, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia.
authors.forename: Bryson
authors.initials: B
authors.lastname: Green
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Handen
authors.affiliation: School of Public Health, Yale University, New Haven, Connecticut.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Deng
authors.affiliation: Department of Emergency Medicine, Yale University, New Haven, Connecticut.
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.affiliation: Department of Pediatrics, Marcus Autism Center, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Scahill
mesh_terms: D001521:Behavior Therapy; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology / Q000628:therapy*; D002659:Child Development Disorders, Pervasive / Q000150:complications / Q000628:therapy*; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education*; D016037:Single-Blind Method