When you look around your office waiting room, how often do you see fathers there with their children? All too many of us are likely to say, “not very often except for diagnostic evaluations or intakes.” What about meetings to discuss early intervention Individual Family Service Plans (IFSPs) or school Individual Education Plans (IEPs)? Again the answer is most commonly, “not very often.” Mothers generally appear to be more engaged in services for their child with autism spectrum disorder (ASD) than fathers. In this article we will begin to look at possible reasons for this, whether engaging fathers is important, and how we can work to better engage both parents.
First, it is important to determine if there is true value in engaging fathers. While nothing could be found in the literature specifically addressing this question for children with ASD, there has been some work around the importance of parent engagement in other behavioral health services to be considered. One attempt at looking at parent engagement found significant improvements in child outcomes when a parent was engaged in the process, although there appeared to be little difference between engagement of the father or the mother. Another study suggested that there was some additional improvement in the child when both parents were engaged as opposed to a single parent. Overall, these studies highlight the importance of parental involvement, but do not seem to make a strong case for actively striving to involve both parents – at least in terms of the short-term benefit to the child.
Are these findings appropriately generalizable to children with ASD? Quite possibly not! Behavioral interventions require consistent response to a child’s behavior for an extended period of time. If there are two parents, there will be times when each parent will be faced with the need to respond. In addition, children with ASD tend to have a greater need for stability and consistency than neurotypical children. Thus, it is important that both parents respond in the same way to the same behavior consistently. This is not likely to occur reliably if the clinician is teaching interventions to only one parent and that parent then either teaches them to the other or is responsible for always being present with the child and managing the response. Behavioral interventions with children really do require consistent responses by all caretakers (and especially by both parents), and this is more likely achieved when both parents are engaged in the child’s services and receive training directly from the provider.
Ensuring consistency in behavioral responses is not the only reason to strive for engaging both parents in services, however. Parents of a special needs child (whether the child’s needs are medical, developmental, or behavioral) face increased stress in the parenting role. They can frequently find their actions or parenting ability questioned by other family members, friends, and strangers and this all too often causes them to isolate their child and themselves in the home. The engagement of both parents provides an opportunity for each parent to support the other, and for each parent to give the other a break to maintain connections with family, friends, and community. This can help decrease parental stress and isolation, helping parents remain “in the game” for the long run – especially important when the child is likely to need care or supervision by the parents well past adolescence.
And there is yet another reason to work to engage both parents. While early intensive behavioral intervention- Applied Behavioral Analysis (ABA)- remains the evidence- based practice of choice for children with ASD, it is expensive and rarely adequately covered by insurance. The Autism Speaks Toddler Treatment Network (ASTTN) has been looking at parent-mediated behavioral interventions for several years, and clinicians have found that trained parents can continue a number of ABA-like interventions in the home, effectively increasing the number of hours of intervention available for each child. At a roundtable discussion in Seattle in April, 2013 members of the ASTTN highlighted the benefit of having both parents involved in parent-facilitated behavioral intervention noting that it is not uncommon for one parent to find it easier to use structured behavioral interventions while the other may find this challenging, and find other important interventions more comfortable. When both parents are engaged in treatment, these complementary strengths serve to provide a full range of supports and interventions to the child.
In the next issue of TAPPED In, we will explore some of the reasons both parents may not be equally engaged in services for their child with ASD, and ways to address some of these barriers.
Russell Bonanno- Program Manager for The Autism Program of Illinois (TAP)