Test of an Innovative, Scalable Support Program for Parents with a Young Child Recently Diagnosed with Autism Spectrum Disorder

摘要 改善儿童的家庭环境、服务获取和行为调整 自闭症谱系障碍（ASD）与儿童及其家庭都有很高的相关性 以及医疗保健和服务支付者。家庭环境对ASD的发生有重要影响 儿童的适应：父母的适应不良会增加ASD儿童的行为问题， 降低了父母获得和坚持关键服务的能力， 早期干预的好处。然而，由于导航ASD相关的压力源， 医疗服务，以及管理儿童行为挑战，ASD儿童的父母 报告个人和夫妇适应水平较低。父母们报告说他们的抑郁程度很高 和焦虑，以及低水平的父母效能和夫妻关系质量相比， 典型发育儿童的父母。为了满足父母对支持的双重需求， 导航ASD服务和保持积极的家庭功能，我们建议测试自闭症 家长导航器（APN），一个创新的家庭，同伴支持模式的父母与年轻的 最近被诊断为ASD的孩子。APN的设计是可行的和可扩展的， 家长同侪导师进行课程。过去三年的广泛试点工作 产生了可行性、可接受性和影响的证据。这项试点工作使我们能够 微调家长辅导员培训、参与者招募、交付和忠诚度监测 程序. 目标1。在一项包含180个家庭的随机试验中评估APN的疗效。目标二。测试 APN影响结果的中介途径：我们将测试APN是否影响 近端目标（ASD相关评估;共同养育;父母自我效能感 服务;和同伴导师支持）影响父母的心理健康，养育和治疗 这反过来又会影响孩子的成长。目标3：评估基线是否 父母特征（经济压力，心理健康，关系冲突），孩子特征， 或程序过程（忠诚度，父母参与）的结果。

Abstract Improving the family environment, service access, and behavioral adjustment of children with Autism Spectrum Disorder (ASD) has high relevance both for the children and their families as well as for health care and service payors. Family environment is a critical influence on ASD children’s adjustment: Poor parent adjustment increases behavior problems in ASD children, reduces parents’ capacity to access and adhere to critical services, and dampens or eliminates the benefits of early intervention. However, due to the stressors of navigating ASD-related and medical services, as well as managing child behavior challenges, parents of children with ASD report low levels of individual and couple adjustment. Parents report high levels of depression and anxiety, and low levels of parental efficacy and couple relationship quality compared to parents of typically developing children. To address the dual needs of parents for support in navigating ASD services and maintaining positive family functioning, we propose to test Autism Parent Navigators (APN), an innovative in-home, peer support model for parents with a young child recently diagnosed with ASD. APN was designed to be feasible and scalable by relying on parent peer mentors to conduct sessions. Extensive pilot work over the past 3 years has generated evidence of feasibility, acceptability, and impact. This pilot work has allowed us to fine-tune the parent mentor training, participant recruitment, delivery, and fidelity monitoring procedures. Aim 1. To assess the efficacy of APN in a randomized trial with 180 families. Aim 2. To test the mediating pathways through which APN impacts outcomes: We will test whether impact on proximal targets (ASD-related appraisals; coparenting; parent self-efficacy about accessing services; and peer mentor support) influence parent mental health, parenting, and treatment engagement, and if these in turn influence child outcomes. Aim 3. To assess whether baseline parent characteristics (financial stress, mental health, relationship conflict), child characteristics, or program processes (fidelity, parent engagement) moderate outcomes.