ACT Online: Stress Reduction for Parents who have Children with DD

描述(由申请人提供)：养育孩子可能是一项压力很大的工作。其中一个群体是相当多研究的焦点，由发育障碍儿童的父母组成，特别是自闭症儿童。这些父母报告说，他们比非残疾儿童的父母有更多的育儿压力。患有自闭症和其他类型发育迟缓儿童的家庭经历了过度的照顾需求、经济负担、对休闲和社会活动的限制以及家庭计划的中断。这些父母经历的压力增加往往是慢性的，并会持续很长一段时间。最近的压力管理方法是基于正念的概念--意识到并不加评判地接受一个人正在进行的经历。基于正念的干预措施最近得到了经验支持，有可能帮助父母更多地意识到与照顾者负担增加相关的负面想法和感受，同时支持改变他们与残疾儿童的关系的方法。一个重要的、经过充分研究的正念干预将作为这个项目的框架，那就是接受和承诺疗法-ACT。这一项目的总体目标是：接受和承诺在线培训：减轻有发育迟缓儿童的父母的压力，将证明干预措施在减少与养育残疾儿童有关的父母压力方面是有效的。在第一阶段，研究小组将通过测试模块1来确定在线ACT的可行性。测试将与40名患有发育迟缓儿童的父母进行(20名自闭症儿童的父母和20名其他发育障碍儿童的父母)。计划的可行性将通过实现以下基准来证明：(A)程序的高水平使用；(B)消费者的高度满意；以及(C)在知识、自我效能、状态焦虑和父母痛苦方面具有临床意义的变化。在第二阶段将进行大规模的随机试验，以评估九个模块压力管理计划的效果。第二阶段试验将有足够的统计能力来测试潜在的缓和效果(例如，儿童残疾的严重程度、适应功能的水平)和假定的调解机制(例如，应对和压力管理技能的增加)。结果评估将扩大到包括全球功能和适应的有效测量(例如，社会适应量表)、抑郁症状(例如，流行病学研究中心-抑郁量表)和紧张的日常麻烦(例如，令人不快的事件时间表)。此外，疗效试验将包括一段相当长的随访期(例如，三个月)，以检查计划效果的维持情况。公共卫生相关性：有自闭症和其他发育障碍(DD)儿童的父母面临巨大的心理挑战，但对这些需求关注较少。患有自闭症和其他痴呆症儿童的父母承受着高度的长期压力，往往会感到对孩子的病情负有责任和责备。这项拟议的研究将通过开发基于接受和承诺培训(ACT)的压力缓解计划来解决这一主要问题。

DESCRIPTION (provided by applicant): Parenting a child can be a stressful undertaking. One group that is the focus of considerable study consists of parents of children with developmental disabilities (DD) especially autism. These parents report more parenting stress than do parents of children without disabilities. Families of children with autism and other types of DD experience excessive caretaking demands, financial burden, restrictions on leisure and social activities, and disruptions of family plans. The increased stress experienced by these parents tends to be chronic and last over significant periods of time. Recent approaches to the management of stress have been based on the concept of mindfulness - the awareness and nonjudgmental acceptance of one's ongoing experiences. Mindfulness-based interventions have received recent empirical support and have the potential to help parents become more aware of their negative thoughts and feelings associated with increased caregiver burden while at the same time supporting ways to change how they relate to their child with a disability. One prominent and well researched mindfulness intervention that will serve as the framework for this project is Acceptance and Commitment Therapy-ACT. The overall aim of this project, Acceptance and Commitment Training Online: Stress Reduction for Parents who have Children with DD, will be to demonstrate that the intervention is effective in reducing parental stress associated with raising a child with disabilities. In Phase I, the research team will determine the feasibility of ACT Online by testing Module 1. The test will be conducted with 40 parents who have children with DD (20 parents of children with autism and 20 parents of children with other developmental disabilities). Program feasibility will be demonstrated by the achievement of the following benchmarks: (a) a high level of program usage; (b) a high degree of consumer satisfaction; and (c) clinically meaningful changes in knowledge, self-efficacy, state anxiety, and parental distress. A large scale randomized trial will be conducted in Phase II to evaluate the efficacy of the nine module stress management program. The Phase II trial will have sufficient statistical power to test for potential moderating effects (e.g., severity of child disability, level of adaptive functioning) and putative mediating mechanisms (e.g., increases in coping and stress management skills). The outcome assessment will be expanded to include validated measures of global functioning and adjustment (e.g., the Social Adjustment Scale), depressive symptomatology (e.g., the Center for Epidemiologic Studies-Depression scale), and stressful daily hassles (e.g., the Unpleasant Events Schedule). In addition, the efficacy trial will include a substantial follow-up period (e.g., three months) in order to examine the maintenance of program effects. PUBLIC HEALTH RELEVANCE: Parents with who have children with autism and other developmental disabilities (DD) face enormous psychological challenges, however little attention has been paid to these needs. Parents of children with autism and other DD experience high levels of chronic stress and tend to feel responsible and blamed for their children's conditions. The proposed research will address this major problem by developing a stress reduction program based on Acceptance and Commitment Training (ACT).