Parent Stress in a Randomized Clinical Trial of Atomoxetine and Parent Training for Children with Autism Spectrum Disorder.
Luc Lecavalier, Xueliang Pan, Tristram Smith and 6 others
PMID 29022125WHAT IT FOUND
Parent stress dropped in all four groups, whether they got medication, parent training, both, or placebo.
Treatment type did not determine the amount of stress reduction. Parents whose children improved clinically reported the largest decreases in their own stress.
Key findings
01Total parent stress scores declined significantly from baseline to endpoint, but there was no significant difference in these changes among the four treatment groups.
02Neither atomoxetine nor parent training had a statistically significant effect on parent stress scores when compared to placebo or no training.
03Parents who were classified as clinical responders for their child's ADHD or noncompliance symptoms showed significant reductions in stress, unlike non-responders.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study duration was only 10 weeks, which may have been too brief to allow significant changes in parent stress to manifest, particularly for parent training which requires time to become habitual. Attrition was noted, with 14 families dropping out before week 6, and only 99 participants having end-of-study stress data collected. The sample size per group was small (32 children per condition), which may have undermined the statistical power to detect treatment effects on parent stress. The study used a narrow definition of stress, relying solely on the Parenting Stress Index-SF, which measures only one aspect of parental well-being.
Declared interests
Several authors reported extensive conflicts of interest, including research support, consulting fees, and advisory board roles from numerous pharmaceutical companies such as Forest, Novartis, Supernus, and others. Dr. Aman, Dr. Handen, Dr. Arnold, and Dr. Hollway disclosed these relationships. Drs. Lecavalier, Pan, Smith, Tumuluru, and Silverman reported no conflicts.
The easy way to misread this
Do not conclude that parent training or atomoxetine are ineffective for reducing parent stress based on this null finding. The lack of difference between groups may be due to the short 10-week duration, small sample size, or a strong placebo effect from the regular contact with study staff, rather than a true absence of treatment benefit.