Effectiveness of parent-focused interventions for improving the mental health of parents and their children with autism spectrum disorder: A systematic review and meta-analysis

Background: Parenting a child with autism spectrum disorder (ASD) is a major life challenge that leads to negative emotional distress and heavy parent duties. Parent-focused interventions have recently been developed to improve parents' psychosocial well-being in caring for their children with ASD. This study aimed to evaluate the effectiveness of parent-focused interventions on improving psychological health in parents of children with ASD, when compared with active/ inactive controls, and investigate the optimal features of the effective interventions found. Methods: Comprehensive and systematic searches of articles was conducted in PubMed, Embase, PsycINFO, CINAHL, Cochrane Central Register, ProQuest, and CNKI, from their inceptions to 31 December 2022. Results: A total of 21 eligible randomized controlled trials (RCTs) were included. The results indicated that the parent-focused intervention group showed reduced stress (Hedge's g=-1.26), depressive symptoms (g=-0.71), and distress (g=-0.44) in parents and problem behaviours in children (g=-0.21) and improved parent-child relationships (g=0.51) compared with the active/inactive control group post-intervention, with moderate to high certainty of evidence. Moreover, subgroup analyses revealed that mindfulness-based interventions/acceptance commitment therapy (ACT) were the optimal intervention approach for reducing parental stress and depressive symptoms. The optimal intervention duration (five to eight weeks) and target participants (involving only parents) were also identified. Conclusion: As mindfulness-based interventions/ACT were identified as the potentially best approach, future well-designed RCTs are recommended to further examine their effects on both parents and their children with ASD and explore the factors and mechanisms of action influencing the effectiveness of these interventions.