Abstract
IMPORTANCE: Parents of children with autism spectrum disorder (ASD) experience significant stress and caregiving burden and urgently require targeted psychological support and parenting guidance. Integrating acceptance and commitment therapy (ACT) into the World Health Organization's caregiver skills training has demonstrated good feasibility, acceptability, and potential benefits in addressing these parents' unmet psychological and informational needs; however, its effectiveness remains unexplored. OBJECTIVE: To evaluate the effectiveness of an evidence-based ACT-based parenting program on parental stress and that of other health outcomes on parents and their children with ASD immediately and 6 months after intervention. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial using the intention-to-treat principle was conducted across 7 government-designated rehabilitation institutions in Shenzhen, China, from February 18, 2024, to January 20, 2025. Participants were adult parents serving as the primary caregivers of their children with ASD (aged 3-9 years). INTERVENTIONS: Participants were randomly allocated in a 1:1 ratio to either an intervention group or a control group using block randomization. Participants in the intervention group received usual care plus an 8-week, group-format ACT-based parenting program, while the control group received usual care only. MAIN OUTCOMES AND MEASURES: Parental stress was the primary outcome, assessed by the Chinese version of the Parenting Stress Index-Short Form. Secondary outcomes included parental depressive symptoms, anxiety, psychological flexibility, and parenting competence and children's emotional and behavioral problems. RESULTS: Among 154 parents (mean [SD] age, 36.55 [4.92] years; 135 [87.66%] mothers) caring for children with ASD (mean [SD] age, 5.69 [1.75] years; 118 [76.62%] boys), 77 participants were randomized to the ACT-based intervention group and 77 were randomized to the control group. Those in the intervention group reported significantly greater improvements in parental stress (group × time effect, β = -2.04 [95% CI, -3.51 to -0.57]; P = .007), psychological flexibility (β = 1.12 [95% CI, 0.29 to 1.95]; P = .008), and parenting competence (β = 2.45 [95% CI, 0.53 to 4.36]; P = .01) and children's emotional and behavioral problems (β = -1.16 [95% CI, -2.26 to -0.05]; P = .04) during the 6-month follow-up. Significant effects on parental depressive symptoms (β = -1.61 [95% CI, -3.12 to -0.10]; P = .04) and anxiety (β = -1.62 [95% CI, -2.81 to -0.44]; P = .007) were observed in the ACT-based intervention group immediately post intervention. CONCLUSION AND RELEVANCE: In this randomized clinical trial of an ACT-based parenting program, the intervention was effective in helping parents manage their stress in caregiving and the emotions and behaviors of their children with ASD, underscoring the need for future studies among more diverse populations globally. TRIAL REGISTRATION: ChiCTR Identifier: 2400080472.