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Problem solving may aid mothers of kids with autism

By Andrew M. Seaman

NEW YORK (Reuters Health) - Soon after children are diagnosed with autism, their mothers may benefit from learning problem-solving skills to cope with the challenges to come, researchers say.

In a small U.S. trial, mothers who took part in the therapy were less likely to have symptoms of stress after three months, compared to parents who only got information on how to handle their children's diagnosis.

"I think what this offers is an evidence-based intervention that really focuses on skill building and that does not seem to be widely available at this point," Emily Feinberg said. She is the study's lead author from Boston University.

Previous studies have found that mothers of children with autism report high levels of psychological stress, symptoms of depression and isolation, Feinberg and her colleagues write in JAMA Pediatrics.

Typically, children diagnosed with autism get a tailored plan for services, such as speech and language therapy or social skills training. But the help offered to families rarely includes mental health services for parents, the researchers point out.

To see whether a skills therapy could help mothers stave off stress and depression, Feinberg's team recruited mothers and their newly diagnosed children from an autism clinic and six other community programs that serve low-income families in and around Boston.

Of the 122 mothers included in the trial, 59 were randomly assigned to receive the problem-solving skills therapy and the other 63 got the usual care prescribed in their child's individualized treatment plan.

The skills therapy consisted of six sessions doing workbook-guided exercises with an educator. The workbook activities helped the mothers identify problems and work toward resolutions.

For example, a mother who said she felt lonely would be guided to identify an objective, solvable problem - such as wanting to spend time with friends, but not having anyone to watch her child while she goes out.

She would then set goals to resolve that problem, such as asking her sister to watch her child while she has an evening out.

The hope, according to Feinberg, is that mothers could take the problem-solving skills they gain to overcome future obstacles that could cause stress.

About 80 percent of mothers in the therapy group completed all six sessions over two months.

Three months after enrolling in the study, about 29 percent of mothers in the usual-care group reported a concerning level of stress symptoms, according to the researchers. That compared to 4 percent in the therapy group.

The researchers also found a small reduction in worse-than-normal symptoms of depression among mothers in the therapy group. A larger study, however, might have been able to detect a significant difference, Feinberg said.

She also said that another, forthcoming analysis of her group's study will look at whether the skills mothers learned have a lasting effect by reevaluating the women nine months after they first enrolled in the study.

Annette Estes, director of the University of Washington Autism Center in Seattle, said the new study's findings are consistent with a paper she and her colleagues recently published.

"Obviously, the child with autism should be the primary focus, but family has to be part of the interventions as well," she said. "The impact on them really needs to be addressed."

Feinberg said the therapy tested in the new study is not currently available, but there may be support groups or traditional mental health programs available.

"The struggle is having access to those types of programs in communities that are in lower resource areas or areas that don't have academic centers," Estes, who was not involved in the new study, said.

Feinberg also said people should keep in mind that the therapy tested in the new study is not meant to directly improve outcomes for children with autism.

"It's important to know that this is not a substitute in any way for treatment for the child," she said.

Instead, the hope would be that the therapy could lead to fewer stressed parents who are better prepared to engage and follow the recommended care for their children.

SOURCE: http://bit.ly/16Z0Y3S JAMA Pediatrics, online November 11, 2013.

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