Do Caregiving-Related Stress and Emotion Regulation Impact Treatment Adherence to a Caregiver-Mediated Intervention for Toddlers at Risk for ASD?

• Main Author: Karp, Elizabeth A
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2019
• Subjects: Clinical psychology; Disability studies
• ISBN: 1088334237; 9781088334232

Caregivers of toddlers with autism spectrum disorder (ASD) experience increased levels of caregiving-related stress, which can impede gains their toddlers make from participating in interventions. Treatment adherence (i.e., the degree to which caregivers implement interventions in the manner intended) predicts improvements in toddlers’ gains from treatment. In addition, caregivers’ emotion regulation (ER) strategies predicts treatment adherence, suggesting that this may be a primary way in which caregiving-related stress is managed.The current study examines the extent to which caregiving-related stress and ER strategies are associated with caregivers’ treatment adherence to Project ImPACT while delivering it to their toddlers at familial risk for ASD. It was expected that: 1) high levels of caregiving-related stress would predict low levels of treatment adherence; 2) high levels of adaptive ER strategies would predict high levels of treatment adherence; and 3) ER strategies would moderate the relation between caregiving-related stress and treatment adherence, such that the relation between caregiving-related stress and treatment adherence would be stronger in caregivers with less optimal ER strategies than in caregivers with more optimal ER strategies.Participants were thirty-eight caregivers who had a child with ASD and a later-born toddler between 11 and 18 months and were assigned to the treatment condition of a randomized controlled trial at the University of Washington and Vanderbilt University. Caregiving-related stress and ER strategies (i.e., reappraisal, suppression, and rumination) were measured via self-report surveys at Baseline (i.e., prior to beginning Project ImPACT training). Treatment adherence was measured via video coding of caregivers’ use of modeling and expanding their toddler’s language at Baseline and T2 (after completing Project ImPACT training).Descriptive analyses indicated that caregivers demonstrated low levels of caregiving-related stress and that treatment adherence increased significantly from Baseline to T2. Reappraisal and suppression were negatively correlated with caregiving-related stress, indicating that higher stress was associated with less optimal use of these two ER strategies. Linear regressions indicated that neither caregiving-related stress nor ER strategies predicted treatment adherence. Reappraisal was the only ER strategy that moderated the relation between caregiving-related stress and treatment adherence. The association between caregiving-related stress and treatment adherence was stronger in caregivers with high levels of reappraisal than caregivers with low levels of reappraisal. This pattern of results was in the opposite direction than predicted; however, this result should be interpreted with caution, as the region of significance represented only a small number of participants (n = 3). In sum, results suggest that caregiving-related stress and emotion regulation strategies did not affect caregivers’ treatment adherence in implementing Project ImPACT in this sample. It is likely that low levels of caregiving-related stress and normative use of ER strategies underlie the null findings in this sample. Future studies should consider the ways in which high levels of caregiving-related stress affect caregivers’ treatment adherence and ER strategies in other samples.