Effects of written disclosure on psychophysiological stress among parents of children with autism: A randomized controlled pilot study

Background: In comparison to parents of typically functioning children or parents of children with other developmental disabilities (i.e. Down's syndrome or cerebral palsy), parents or caregivers of children with an autism spectrum disorder (ASD) sustain a greater incidence of depression, anxiety, and emotional distress. It is imperative to identify effective methods that target improvement to caregiver mental health. Method: A randomized controlled pilot study was conducted to investigate the effect of a written disclosure intervention (expressive writing about traumatic events versus neutral events) on the psychophysiological stress of 71 parents (age 23-62) caring for a child with ASD. Self-reported measures of stress (parenting stress, caregiver burden, and global stress) and a stress biomarker (cortisol awakening response) were evaluated at baseline and 6-month follow-up. Adjusting for baseline values, we performed a univariate analysis of covariance to test directional hypotheses that parents in the treatment group would show a reduction in subjective stress and improvement in physiological stress over time. Results: As expected, treatment group parents displayed healthier cortisol activity and reported less global stress compared to controls. Whereas within group analyses indicated all parents experienced improvement in parenting stress and caregiver burden over time, there was no significant treatment effect for these caregiving-specific stress measures. Conclusions: Within this pilot study, written disclosure appeared beneficial to caregiver psychophysiological stress. However, due to the provision of substantial participant adherence support, we refrain from suggesting feasibility. Nonetheless, improvement of mental health pathology in parents of children with ASD is both significant and timely.