New research shows acceptance and commitment training cuts stress in parents of children with autism, with flow-on gains for child behaviour.
A structured parenting program grounded in acceptance and commitment therapy (ACT) has been shown to significantly reduce stress among parents of children with autism spectrum disorder (ASD).
The benefits lasted at least six months and extended to improvements in children’s emotional and behavioural problems, the researchers also found.
The randomised clinical trial, conducted across seven government-designated rehabilitation centres in Shenzhen, China, enrolled 154 parents who were the primary caregivers of children aged three to nine years with ASD.
Results have been published in JAMA Network Open.
“Parents of children with ASD often experience heavy psychological and caregiving burdens, with cross-sectional studies reporting parental stress prevalence rates ranging from 37% to 80% across various countries,” the researchers wrote.
“Without adequate resources and social support, parental stress can escalate into severe psychological distress [i.e., anxiety and depressive symptoms], further impairing parents’ ability to effectively support their children with ASD and attend to their own self-care needs.”
Participants were randomly assigned to receive either usual care alone or usual care plus an eight-week, group-based ACT–informed parenting program.
The program combined core ACT principles, such as acceptance of difficult emotions, mindfulness, values clarification and committed action, with practical parenting skills and autism-specific education adapted from the World Health Organization’s Caregiver Skills Training framework.
Sessions were delivered in small groups using a hybrid model, with some face-to-face sessions followed by online delivery – a format likely to resonate with time-poor families and clinicians alike.
Most participants were mothers in their mid-30s. While this limited generalisability, the authors said the findings reinforced what many GPs observe in practice: parental stress is both common and consequential in families affected by autism and addressing it could have downstream benefits for children.
Parents who took part in the ACT-based program reported substantially greater reductions in parenting stress than those receiving usual care alone, both immediately after the intervention and at six-month follow-up.
The effect sizes ranged from medium to large, suggesting clinically meaningful change rather than short-lived improvement. Gains were also seen in parents’ psychological flexibility and sense of parenting competence, outcomes that are increasingly recognised as central to coping with the long-term demands of autism care.
“In this RCT, an ACT-based parenting program was effective in improving parental stress, parents’ psychological flexibility, parenting competence, and the emotional and behavioural problems of their children with ASD at the six-month follow-up, as well as reducing parental depressive symptoms and anxiety only immediately after the intervention,” the researchers wrote.
“To our knowledge, this is the first study to develop a hybrid-modality, group-based program integrating ACT with parenting skills training to provide multifaceted support for parents of children with ASD.
“These findings contribute to the understanding of autism management and caregiver support and facilitate the evidence-based development of similar psychotherapy-based interventions in future health care practice and research.”
Importantly, the intervention’s impact was not limited to parental wellbeing. Parents in the ACT group also reported significant reductions in their children’s emotional and behavioural difficulties, with benefits maintained at six months.
This supports the idea that improving caregiver coping and responsiveness can translate into better day-to-day functioning for children with autism, even without direct child-focused therapy.
While symptoms of parental depression and anxiety also improved in addition to stress, this was only in the short term, the researchers found.
Parents in the ACT group showed lower depressive and anxiety symptoms immediately after the program, however these differences were no longer evident at six months.
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The authors suggest this may reflect the absence of booster sessions or ongoing psychological support, pointing to a potential role for follow-up or stepped-care approaches in primary care and community settings.
The researchers said their study added weight to the importance of earlier identification of caregiver stress and more proactive referral to evidence-based parent support programs. While ACT-based parenting interventions are not yet routine in primary care, the results suggest they could be a valuable adjunct to usual autism management, particularly if integrated with community or allied health services.
“Future studies are recommended to include longer-term follow-ups to assess sustained effects, incorporate booster sessions to enhance ongoing support, include diverse participants and their children with ASD to improve generalisability, implement an active control group to enable blinding, use objective measures alongside self-reports to strengthen the robustness of the findings, and systematically explore how ACT components can be integrated into the WHO-CST framework to enhance its effectiveness across diverse cultural and contextual settings,” the authors concluded.
