Clinical evaluation of SSLD parent capacity building program for parents of children with Autism Spectrum Disorder

ISRCTN ISRCTN36895493
DOI https://doi.org/10.1186/ISRCTN36895493
Secondary identifying numbers HSEARS20171023003
Submission date
05/01/2018
Registration date
29/01/2018
Last edited
27/02/2024
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Mental and Behavioural Disorders
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

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 December 2020

Who is funding the study?
Hong Kong Christian Service (China)

Who is the main contact?
Mr Hin Ching Hung (Public)
hunghinching@hkcs.email

Contact information

Mr Hin Ching Hung
Public

Hong Kong Christian Service
102-107, G/F, Fook Tsui House
Wan Tsui Estate
Chai Wan
Hong Kong
NIL
China

Study information

Study designRandomised controlled trial design employing a mixed within-between-subjects design and a wait-list control group
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Community
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleA randomized controlled trial evaluating SSLD parent capacity building program for parents of children with Autism Spectrum Disorder
Study objectives1. 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(s)Departmental Research Committe, Department of Applied Social Sciences, The Hong Kong Polytechnic University, 23/10/2017, ref: HSEARS20171023003
Health condition(s) or problem(s) studiedAutistic Spectrum Disorder and Development Delay
InterventionSSLD 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 typeBehavioural
Primary outcome measure1. 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 measures1. 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 study start date01/06/2017
Completion date31/12/2020

Eligibility

Participant type(s)Mixed
Age groupMixed
SexBoth
Target number of participants50 for Control Group and 50 for Intervention Group
Total final enrolment115
Key inclusion criteria1. 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).
Key exclusion criteriaParents/carers who have joined the SSLD related program.
Date of first enrolment20/11/2017
Date of final enrolment09/12/2017

Locations

Countries of recruitment

  • China
  • Hong Kong

Study participating centres

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
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
Tuen Mun Early Education and Training Centre
Hong Kong Christian Service
1/F., 201 Castle Peak Road, Tuen Mun
Hong Kong
NIL
China
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
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
Cheung Wah Child Care Centre
Hong Kong Christian Service
Wing A, G/F, Cheung Chi House
Cheung Wah Estate
Fanling
Hong Kong
NIL
China
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

University of Toronto
University/education

Factor-Inwentash Faculty of Social Work
246 Bloor Street West, Suite # 250
Toronto
M5S 1V4
Canada

Website http://www.utoronto.ca/
ROR logo "ROR" https://ror.org/03dbr7087
The Hong Kong Polytechnic University
University/education

Department of Applied Social Sciences
Hung Hom
Kowloon
-
Hong Kong

Funders

Funder type

Charity

Hong Kong Christian Service

No information available

Results and Publications

Intention to publish date30/06/2024
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot expected to be made available
Publication and dissemination planPlanned publication in a high-impact peer reviewed journal.
IPD sharing planCurrent IPD sharing statement as of 14/02/2023:
The datasets generated during and/or analysed during the current study are not expected to be made available due to ethical considerations.

Previous 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

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol file 14/02/2023 No No
Statistical Analysis Plan 20/02/2023 No No

Additional files

ISRCTN36895493_PROTOCOL.pdf
ISRCTN36895493_SAP.pdf

Editorial Notes

27/02/2024: The intention to publish date has been changed from 31/12/2023 to 30/06/2024.
20/02/2023: The statistical analysis plan was uploaded and the total final enrolment was added.
14/02/2023: The following changes were made to the trial record:
1. Protocol uploaded (not peer reviewed).
2. The intention to publish date has been changed from 30/06/2022 to 31/12/2023.
3. The IPD sharing statement was updated.
01/07/2022: The contact email was updated.
02/06/2021: The following changes have been made:
1. The overall trial end date has been changed from 30/06/2019 to 31/12/2020 and the plain English summary has been updated to reflect this change.
2. The intention to publish date has been changed from 30/06/2020 to 30/06/2022.
19/04/2021: The public contact has been updated and the plain English summary has been updated accordingly.