DISCLOSURE The speaker has no conflicts of interest LEARNING - PDF document

APNA 29th Annual Conference Session 3043: October 30, 2015 EVALUATING THE EFFECTIVENESS OF MULTIPLE FAMILY GROUP THERAPY IN REDUCING STRESS AMONG FAMILIES COPING WITH AUTISM DR. Claudia Mitzeliotis DNP PMHNP,BC PMHCNS,BC DISCLOSURE • The speaker has no conflicts of interest LEARNING OBJECTIVES Objective 1* • Upon completion of this presentation, participants will be able to define the impact of Autism Spectrum Disorder on couples Objective 2* • Upon completion of this presentation, participants will be able to discuss the DSM ‐ 5 classification of Autism Spectrum Disorder Objective 3* • Upon completion of this presentation, participants will be able to identify the effectiveness of Multiple Family Group Therapy with couples living with Autism Spectrum Disorder. Objective 4* • Upon completion of this presentation participants will discuss the benefit and challenges of applying Multiple Family Group Therapy with couples living with Autism Spectrum Disorder Mitzeliotis 1

APNA 29th Annual Conference Session 3043: October 30, 2015 INTRODUCTION  Illness has an impact on all family members.  Parents raising a child with Autism Spectrum Disorder (ASD) have higher levels of stress than other disabilities. (Estes,Munson,Dawson, Koehler, Zhou & Abbott 2009; Davis & Carter 2008 ; Brost, Clopton, Hendrick .2009)  Mothers raising a child with ASD reported less parenting competence, decrease in marital satisfaction difficulty adapting compared to mothers of children coping with Down’s Syndrome . (Dunn, Burbine, Bowers .& Dunn ‐ Tantleff 2001 .  Parents tend to isolate themselves avoiding social contact with the outside world. There are limited services available for parents . (Grey 1993) BACKGROUND  Autism Spectrum Disorder (ASD) has been on the rise and current statistics estimate that males are four times more likely to have ASD than females (Duchan 2012).  Duchan (2012) surveyed the epidemiology of ASD and the number has soared to 60 per 10,000 individuals.  The National Health Statistics Report, which was based on parent reporting, found a significant increase in ASD of 2.00% as of 2011 ‐ 2012. This was compared to 2007 where the rate was reported to be 1.16%.  CDC has reported that 1 in 68 children have been identified with ASD  The ratio of boys 5x more likely to have ASD compared to girls.  CDC report indicated diagnose delay may be related to validated tools to assess symptom severity lack of early assessment AUTISM SPECTRUM DISORDER  Autism Spectrum Disorder – Merges Autism, Asperger’s disorder, and Pervasive Developmental Disorder–Not Otherwise Specified (PDD ‐ NOS) (Skuse 2012)  Diagnostic Criteria has 2 components social communication deficits and repetitive behaviors and fixed interests (DSM ‐ 5, 2013)  3 levels of severity level 1 ‐ requiring support 2 ‐ requiring substantial support 3 ‐ requiring very substantial support (DSM ‐ 5, 2013) Mitzeliotis 2

APNA 29th Annual Conference Session 3043: October 30, 2015 AUTISM SPECTRUM DISORDER Severity Level Social Communication Restricted, Repetitive Behavior Level 3 Severe deficits verbal and non ‐ verbal Inflexible behavior extreme difficulty Requiring very communication coping with change/ restricted or Substantial Severe impairment in ability to initiation repetitive behavior markedly Support social interactions interferes with functioning or to respond to social interactions Severe distress unable to change focus Level 2 Marled deficits in verbal, non ‐ verbal Inflexibility of behavior difficulty Requiring communication and social impairment coping with change Substantial even with support in place. /restricted or repetitive appear Support frequently enough to be obvious to observer. Distress unable to change focus Level 1 Without support in place deficits in social Problems organizing and planning Requiring communication cause noticeable Inflexible behavior interferes with Support impairments functioning . (DSM ‐ 5,2013) IMPACT OF ASD ON PARENTS  Parental stress has been identified as a significant component related to raising a child with ( Bilgin & Kucuk2010; Dabrowska & Pisula 2010; Davis & Carter 2008; Dunn, Burbine, Bowers & Tantleff 2001).  Parental stress has been correlated with many factors ranging from marital discord, child’s behavior, social support, ineffective coping and poor self ‐ efficacy (Davis & Carter 2008; Neely, Eschevarria & Tannen 2012; Osborne, McHugh, Saunders, & Reed, 2008).  Lack of psychoeducation programs focusing on stress and emotions to assist parents to coping with ASD ( Cappe, Wolff, Bobet & Adren 2011).  Parents reported feeling supported when they had the opportunity to meet with other parents coping with ASD (Phelps 2009)  Families expressed an interested in attending support groups for autism (Luther 2005). STATEMENT OF PROBLEM • There is lack of psychoeducation programs focusing on stress and emotions to assist parents raising a child with ASD (Capote Wolff, Bobet & Adren 2011). • Inquiry Question: What impact will a 4 ‐ week Multiple Family Group Therapy intervention have on stress levels of parents raising a child with ASD? Mitzeliotis 3

APNA 29th Annual Conference Session 3043: October 30, 2015 Aspects of Parental Stress in Families Raising a Child with ASD Theme One: Impact on Parent’s Relationship  Parents coping with a child diagnosed with ASD have lower marital happiness (Higgins, Bailey,& Pearce, 2005).  The demands of coping with with ASD impacts on parents interpersonal relationship (Tunali & Power 2002)  The behavior of the child with ASD impacts on the parents more then the developmental delayed issues (Hartley 2010 ).  Decrease in fathers’ involvement in child life creates greater stress in the relationship (Brobst, Clopton & Hendrick 2013). Aspects of Parental Stress in Families Raising a Child with ASD Theme Two: Parental Stress  There are 3 factors causing parental stress, child’s behavior, lack of professional support and social attitudes directed at the child (Pisula 2011)  The inability to manage the behavior of the child produced parental stress ( Altiere & Von Kluge. 2009; Dabrowska & Pisula . 2010).  Mothers reported that the lack of attachment children show have produced stress this was reinforced in the high scores on the PSI ‐ SF in area of Child Domain (Pisula 2011 ) Aspects of Parental Stress in Families Raising a Child with ASD Theme Three: The Impact Stress Has on Parents Coping  Parents reported withdrawal, helplessness, worrying, and blaming behaviors’ produced a daily negative mood (Pottie and Ingram 2008).  Coping does not improve with time (Hastings et al. (2005),  Parents reported feeling sadness, depression, stress, and exhaustion raising a child with ASD (Phelps, Hodgson, McCammon, & Lamson, 2009). Mitzeliotis 4

APNA 29th Annual Conference Session 3043: October 30, 2015 Aspects of Parental Stress in Families Raising a Child with ASD Theme Four: Social Support  Parents reported parental stress and lower social support and relationship satisfaction compared to parents not experiencing ASD. (Brobst, Clopton, and Hendrick 2008),  The isolation parent’s feel raising a child with ASD is prominent ( Altiere & Von Kluge, 2009; Dunn, Burbine, & Tantleff ‐ Dunn, 2001; Luther, Canham, & Young Cureton, 2005).  Parents reported a decrease in social circles, feeling stigmatized and lack of motivation related to socializing. (Markoulakis, Fletcher, & Bryden, 2012)  Luther et. al. (2005) noted that families were interested in attending support groups for autism.  Parents reported feeling supported when they had the opportunity to meet with other parents coping with ASD (Phelps 2009) APPLICATIONS OF PERRY’S STRESS MODEL  Perry designed model to be applied in research and clinical practice. Designed for families of ASD . (Perry,A.1990).  The theoretical framework has been adopted in a number of studies (Perry, Harris & Flynn 2004;Bluth 2013). THEORETICAL MODEL Perry’s Stress Model Mothers’ Positive Individual Couple Perception of Outcome Child RESOURCES Child SUPPORT Characteristics Negative Fathers' Formal Outcome Informal Perception of Child (Perry 1990) Mitzeliotis 5

APNA 29th Annual Conference Session 3043: October 30, 2015 MULTIPLE FAMILY GROUP THERAPY (MFGT) Historical Background of Multiple Family Group Therapy  Peter Lacquer in 1977 was the first to discuss the importance of providing education to parents on what initial topic  Multiple Family Group Therapy served as the intervention.  McFarlane expanded on his concept framework and designed Multiple Family Group Therapy (MFGT). APPLICATIONS OF MFGT  MFGT is a psychoeducation model, which has been seen as the most effective evidence ‐ based practice in both clinical trials and community settings (Jewel, Downing & McFarlane 2009; McFarlane & Lukens 2004;Fristad,Gavazzi, Soldano1999 ).  The model is flexible, incorporating both illness information and strategies for coping.  McFarlane and Lukens (2004) found the MFGT model to be the most effective of the evidence ‐ based practice models in treating families coping with illnesses ranging from schizophrenia to cancer. TRANSLATIONAL RESEARCH • Translational research involves utilizing or applying basic and clinical research findings to new clinical and research tools, medications, and therapies. Mitzeliotis 6