Effects of a Parenting Intervention for Emotional and Behavioral Problems in Young Autistic Children Under Conditions of Enhanced Uncertainty: Two-Year Follow-up of a Pilot Randomized Controlled Trial Cohort (ASTAR) During the United Kingdom COVID-19 Pandemic.

Researchers followed up on families who participated in a parenting program study for autistic children during COVID-19 lockdowns. Two years after the original study, parents who received the 'Predictive Parenting' program reported slightly lower levels of their child's irritability and their own parenting stress compared to the control group. Parents said they continued using the strategies they learned during the pandemic restrictions.

This two-year follow-up study examined the lasting effects of a behavioral parenting intervention (Predictive Parenting) for emotional and behavioral problems in autistic children during COVID-19 lockdowns. The original pilot RCT included 62 children aged 6-11, with 49 participating in follow-up. Small but significant intervention effects were found at the COVID-19 follow-up (2 years post-randomization) for parent-reported child irritability (d=-0.33) and parenting stress (d=-0.31). However, no overall intervention effect was detected across all timepoints using area under curve analysis.

Qualitative interviews revealed parents continued using Predictive Parenting strategies during pandemic restrictions, with positive feedback on both interventions.

Results suggest behavioral parenting interventions may show delayed or context-dependent effects in autistic populations. Clinicians should consider longer follow-up periods and that intervention benefits may become more apparent during times of increased family stress.

Small sample size for follow-up (n=49 from original 62). Opportunistic follow-up design limits generalizability. No significant effects found at primary endpoint, with effects only emerging at 2-year follow-up during pandemic conditions.

Most young autistic children display emotional and behavioral problems (EBPs). There is evidence that behavioral parenting interventions (BPIs) reduce these. The COVID-19 pandemic and associated lockdowns can be seen as a natural experiment to test the longer-term effect of BPIs under conditions of increased uncertainty. Opportunistic follow-up (n = 49) of a pilot randomized controlled trial (RCT) cohort (n = 62 autistic children aged 6-11 years; originally randomized to a 12-week group BPI [Predictive Parenting; n = 31] or an attention control [Psychoeducation; n = 31]) was conducted during COVID-19-related lockdowns.

Measures of parent-reported child irritability and parenting stress were collected at 3 time points (baseline: mean age = 6.7 years; primary endpoint: mean age = 7.1 years, ∼5 months after randomization; and COVID-19 follow-up: mean age = 8.8 years, ∼2 years after randomization). We tested the magnitude of intervention effects using point estimates of differences in child irritability and parenting stress between arms at primary endpoint and COVID-19 follow-up, covarying for baseline scores. We used area under the curve (AUC) analyses to obtain overall estimates of the average intervention effect across all 3 timepoints. Semi-structured qualitative interviews were conducted with a subsample of parents (n = 18).

A small but significant intervention effect was found from baseline to COVID-19 follow-up in favor of Predictive Parenting on parent-reported child irritability (d = -0.33, 95% CI = -0.65, -0.01) and parenting stress (d = -0.31, 95% CI = -0.59, -0.03). No overall mean intervention effect for these measures as estimated by the AUC analyses (which takes into account the nonsignificant effect at primary endpoint) was found. Interview feedback on the both interventions was positive, and parents reported using strategies from Predictive Parenting during COVID-19-related restrictions. This opportunistic follow-up study at a time of stress indicates the need for careful consideration of how and when to measure the effects of BPIs in autistic child populations.

Future trials should consider both the most appropriate endpoint and in what context effects may be more likely to be seen. Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com; 91411078.