Plain English Summary
Background and study aims
Treating children with Autism Spectrum Disorder (ASD) usually includes using parent training programs and others to facilitate behavioral treatments. A lot of research shows training parents as co-therapists or parent education programs improved outcomes for children with ASD. Although the clinical effectiveness of these specific parenting training programs in treating children with ASD has been well documented, little research has been investigated on the experiences of children with ASD and their parents in a standard parenting programs that designed in vivo (real life) environments. The Strategies and Skills Learning and Development (SSLD) System is an intervention system for bringing about change in human life, including our thinking, action, motivation, emotion, body, as well as our environment and it is also an action-oriented model for enabling clients in social work, health, mental health, and human services settings to address their needs and life goals. SSLD Parent Capacity Building Program for Parents of Children with ASD is designed to equip and empower parents is grounded in real life, involving people in the child's life world (parents, siblings, peers). Through SSLD systematic learning, the child does not only learn specific skills (e.g., eye contact, verbal requests) but also learns how to learn - imitation, observation learning, and symbolically mediated learning. Moreover, the child can master effective agentive, interpersonal and social strategies and skills. These will lead the child to need gratification, displacing the original symptoms (stereotypic repetitive behavior, withdrawal, isolation). The aim of this study is that participants in the SSLD parent capacity building program can lower parenting stress and high parent sense of competence, report less frequent use of dysfunctional discipline strategies, lower child behavior problem and be beneficial.
Who can participate?
Children aged up to six with ASD and their parents or carers.
What does the study involve?
Participants are randomly allocated to either being treated or to the waiting list for treatment. Participants undergo the SSLD parent capacity building program which includes eight weekly two hour sessions that includes understanding children with ASD from a SSLD perspective, observing and making sense of their needs, circumstances, characteristics and capacity, engaging with the children, parent’s personal development and self-care and preparing children for active learning and enhancing the children’s learning and development. Parenting stress, satisfaction and style is measured after four months.
What are the possible benefits and risks of participating?
The participants are able to know the reasons (needs) behind the problematic behaviors of the children. They can develop tailor-made strategies and skills, in a team, to meet the needs of the children. In the process, participants work with the children in real life environment and they can master the strategies and skills easily. Besides, parents participants can examine their own needs as the role of parents. They can then choose appropriate strategies and skills to meet their own needs. Parenting stress decreases and Parent sense of competence increases. The intervention is regarded safe and no side effect has been reported. However, if there is emotional upset or any other adverse reaction, the intervention will be stopped and referred the participant to the social worker for follow-up. The participant may choose to continue or withdraw form the next intervention session. The questions being asked during data collection are neutral and should not arouse any negative feeling. However, if emotional upset is observed, the researcher will try to comfort the participant and refer to the social worker immediately.
Where is the study run from?
This study is being run by the Hong Kong Christian Service (China) and takes place in Early Education and Training Centre in China.
When is the study starting and how long is it expected to run for?
June 2017 to June 2019
Who is funding the study?
Hong Kong Christian Service (China)
Who is the main contact?
Mr Hin Ching Hung (Public)
wteetc-suh@hkcs-sys.org
Trial website
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
HSEARS20171023003
Study information
Scientific title
A randomized controlled trial evaluating SSLD parent capacity building program for parents of children with Autism Spectrum Disorder
Acronym
Study hypothesis
1. Participants the SSLD Parent Capacity Building Program would report lower parenting stress and higher parent sense of competence at post-intervention as the parents acquired positive parenting skills, compared with the control group.
2. Participants in SSLD Parent Capacity Building Program would report less frequent use of dysfunctional discipline strategies at post-intervention, compared with the control group.
3. Participants in the SSLD Parent Capacity Building Program would report lower child behavior problems at post-intervention, compared with the control group.
4. The aforementioned short term benefits would be maintained in the longer term (4 month follow-up).
Ethics approval
Departmental Research Committe, Department of Applied Social Sciences, The Hong Kong Polytechnic University, 23/10/2017, ref: HSEARS20171023003
Study design
Randomised controlled trial design employing a mixed within-between-subjects design and a wait-list control group
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Community
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Condition
Autistic Spectrum Disorder and Development Delay
Intervention
SSLD Parent Capacity Building Program: Parents/Caregivers in the treatment group are provided with eight weekly sessions of training. Each session lasts approximately two hours. The detailed agenda of each session are given as follows. This intervention programme has five key components:
1. Understanding children with ASD from an SSLD perspective
2. Observing and making sense through assessment of needs, circumstances, characteristics, and capacity (N3C)
3. Engaging with the children in real life practice by applying the principles and methods learned
4. Parents’ personal development and self-care (e.g. parent support; respite; self-care, personal growth, and quality of life enhancement; specialized counseling programs if indicated)
5. Preparing the child for active learning and enhancing the child’s learning and development of strategies and skills.
Simple randomisation is achieved by assigning the random numbers from random number tables to the treatment (odd number) and wait-list groups (even number).
Session Objectives & Content
Session 1:
1. Individual pre-group session
2. Individualized goal setting and learning and development plan for each parent-child dyad or group (when both parents are participating)
Session 2:
1. Introduction to the Strategies and skills learning and development (SSLD) System and Conceptualization with Problem Translation
2. Understanding the relationship between child’s problem and parents’ need
3. Problems understood in terms of unmet needs, as well as the circumstances, characteristics, and capacity (N3C) of the child
Session 3:
1. Conceptualization (Problem Translation):
2. Understanding the parents’ need
3. Problems understood in terms of unmet needs, as well as the circumstances, characteristics, and capacity (N3C) of the parents
Session 4:
1. Learning respectful listening
2. Consolidation of strategies and skills learning
3. 1.5-2 hour real life practice
4. Learning specific skills to bring about desired change through:
4.1. Actual hands-on practice learning with own child and/or other people’s children;
4.2. Coaching by professional trainers;
4.3. Audio-visual recording and feedback;
4.4. Peer learning support,
4.5. Homework exercises and real-life learning;
Session 5:
1. Learning strategies to increase positive behaviors: praise and rewards
2. Consolidation of strategies and skills learning
Session 6:
1. Learning communication skills and giving effective instructions (eye contact, distance and emotion)
2. Consolidation of strategies and skills learning
3. 1.5-2 hour real life practice
4. Learning specific skills to bring about desired change through
4.1. Actual hands-on practice learning with own child and/or other people’s children
4.2. Coaching by professional trainers
4.3. Audio-visual recording and feedback
4.4. Peer learning support
4.5. Homework exercises and real-life learning;
Session 7:
1. Personal development and self-care
2. Consolidation of strategies and skills learning
3. Ongoing review and monitoring
Session 8:
1. Closure: Synthesis of skills and strategies
2. Skill integration and self-reflection sharing
SSLD:
The Strategies and Skills Learning and Development (SSLD) System is an intervention system for bringing about change in human life, including our thinking, action, motivation, emotion, body, as well as our environment and it is also an action-oriented model for enabling clients in social work, health, mental health, and human services settings to address their needs and life goals. It is developed by Professor Ka Tat Tsang of the University of Toronto, and first named in 2005, based on over three decades of research and practice experience in social work, clinical psychology, and different areas of human services. SSLD as a comprehensive model for practice in psychosocial service has been successfully applied in many domains, such as senior service, immigrants and refugees, settlement practice, sexuality and intimacy. SSLD Parent Capacity Building Program for Parents of Children with ASD designed to equip and empower parents is grounded in real life, involving people in the child's life world (parents, siblings, peers). From the SSLD perspective, the child with ASD is unable to process information effectively due to neurological impairment, especially complex and multi-modal interpersonal signals (biology and cognition). The autistic child’s inability to decipher and process information leads to feelings of being overwhelmed, perplexed, confused, and anxious (emotion). The child with ASD will adopt withdrawal or disengagement as strategies for avoiding negative emotional experience (motivation and behavior). While other children can gratify various needs through social interaction, children with ASD have to use other means such as auto-stimulation, control and manipulating objects, maintaining rigid order/pattern (motivation, behavior, environment). Through SSLD systematic learning, the child does not only learn specific skills (e.g., eye contact, verbal requests) but also learns how to learn - imitation, observation learning, and symbolically mediated learning. Moreover, the child can master effective agentive, interpersonal and social strategies and skills. These will lead the child to need gratification, displacing the original symptoms (stereotypic repetitive behavior, withdrawal, isolation).
Intervention type
Behavioural
Phase
Drug names
Primary outcome measure
1. Parenting stress is measured using the Parenting Stress Index/Short Form (PSI/SF) at baseline, post treatment and four month follow up
2. Parental satisfaction is measured using parenting sense of competence (PSOC) at baseline, post treatment and four months follow up
3. Parenting style is measured using the parenting scale (PS) at baseline, post-treatment and four months follow up
Secondary outcome measures
1. Parent-child interaction is measured using video coding at baseline and post-treatment:
1.1. Communication acts: verbal and non-verbal behaviours that have communicative intent or form part of a communication act
1.2. Asynchronous parental communication: responses aimed at redirecting, controlling or making demands on the child to respond
1.3. Synchronous parental communication: comments, statements, acknowledgments or social interaction, which maintained the child’s responses
1.4. Semantic contingency: verbal responses related in meaning to the child’s previous verbal or non-verbal topic
1.5. Shared attention: episodes in which the parent and child shared attentional focus
2. Child social cognition is measured using the Hong Kong Comprehensive Assessment Scales for Preschool Children (HKCAS-P) Social Cognition Scale-validated for Hong Kong Chinese) at baseline, post-treatment and four months
Overall trial start date
01/06/2017
Overall trial end date
30/06/2019
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Parents/carers of Children with ASD/Developmental Delay under the program
2. Children from birth to 6 years of (1) above and diagnosed with ASD/Developmental Delay (All cases are from Subsystem for Disabled Pre-schoolers, Central Referral System for Rehabilitation Services, Social Welfare Department of Hong Kong Special Administrative Region Government).
Participant type
Mixed
Age group
Mixed
Gender
Both
Target number of participants
50 for Control Group and 50 for Intervention Group
Participant exclusion criteria
Parents/carers who have joined the SSLD related program.
Recruitment start date
20/11/2017
Recruitment end date
09/12/2017
Locations
Countries of recruitment
Hong Kong
Trial participating centre
Wan Tsui Early Education and Training Centre
Hong Kong Christian Service
102-107, G/F
Fook Tsui House
Wan Tsui Estate
Chai Wan
Hong Kong
NIL
China
Trial participating centre
Choi Wan Early Education and Training Centre,
Hong Kong Christian Service
G/F., Choi Wan Community Center
Choi Wan Estate
38 Choi Fung Path
Kowloon
Hong Kong
NIL
China
Trial participating centre
Tuen Mun Early Education and Training Centre
Hong Kong Christian Service
1/F., 201 Castle Peak Road, Tuen Mun
Hong Kong
NIL
China
Trial participating centre
Yuen Long Early Education and Training Centre
Hong Kong Christian Service
207-210 Pik Shui House
Shui Bin Wai Estate
Yuen Long
Hong Kong
NIL
China
Trial participating centre
Kwai Hing Early Education and Training Centre
Hong Kong Christian Service
G/F., Hing Fok House
Kwai Hing Estate
Kwai Chung
Hong Kong
NIL
China
Trial participating centre
Cheung Wah Child Care Centre
Hong Kong Christian Service
Wing A, G/F, Cheung Chi House
Cheung Wah Estate
Fanling
Hong Kong
NIL
China
Trial participating centre
Morrison Hill Child Development Centre
Hong Kong Christian Service
1/F., Community Ambulatory Care Centre
Tang Shiu Kin Hospital
282 Queen's Road East
Wan Chai
Hong Kong
NIL
China
Sponsor information
Organisation
University of Toronto
Sponsor details
Factor-Inwentash Faculty of Social Work
246 Bloor Street West
Suite # 250
Toronto
M5S 1V4
Canada
Sponsor type
University/education
Website
Organisation
The Hong Kong Polytechnic University
Sponsor details
Department of Applied Social Sciences
Hung Hom
Kowloon
-
Hong Kong
Sponsor type
University/education
Website
Funders
Funder type
Charity
Funder name
Hong Kong Christian Service
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer reviewed journal.
IPD Sharing statement:
The datasets generated during and/or analysed during the current study are/will be available upon request from Joseph HUNG H C at wteetc-suh@hkcs-sys.org
Intention to publish date
30/06/2020
Participant level data
Available on request
Basic results (scientific)
Publication list