Shiri E, Pouratemad H, Fathabadi J, Narimani M. Parent-mediated Behavioral Intervention for Treatment Behavioral Excesses in Children With Autism Spectrum Disorder. J Arak Uni Med Sci. 2020; 23 (4) :422-437
xtra-role behaviors are the problems of children with Autism Spectrum Disorder (ASD). They are behaviors that are resistant to many educational-rehabilitation programs. These behaviors have significant adverse effects on the performance of the child’s orthodoxy and his educational environment  and the psychological health of parents [12, 13].
Some pharmacological and non-pharmacological therapies are applied to manage these behaviors [17, 18]. Among these therapies, it seems that parents play an essential role in treating children with autism. The child spends most of his time with his parents, which can be an excellent opportunity to teach appropriate behavior to children and manage extra-role behaviors in them . Therefore, parent-mediated behavioral intervention seems to be an effective way to overcome these problems. However, these methods have not been adequately introduced yet. This study aims to systematically review these studies and their primary and secondary outcomes, analyze the components of parent-mediated behavioral therapy, and examine the need to expand these Iranian families’ programs.
Materials and Methods
The current study is a systematic review; the statistical population includes useful articles of national databases including Sid and Magiran in 2006-2007 and international databases including Medline, PubMed, Springer, Science Direct, Online library, PsycINFOT in 2000-2017 to review studies of parent-mediated behavioral interventions on autism-related behaviors. At the first stage, to achieve tasks related to the subject, the researchers selected the related keywords in internal databases. Next, the researchers examined the external databases, including Medline, PubMed, Springer, Science Direct, Online Library, and PsycINFOT.
We obtained 3557 articles at this stage. Next, we deleted duplicate studies and retrieved 2705 papers from foreign databases; no documents were obtained from Persian databases. In the second stage, unrelated items were removed, and 84 articles remained. Then, according to the including and excluding criteria, the abstract and the quality of the articles’ methodology (based on the exact definition of the target group, type of study, sampling method, sample size, and validity and reliability of data collection tools) were reviewed. Finally, 9 articles with inclusion criteria were selected.
Based on the study methodology results, 7 studies were randomized experimental studies, and 2 were quasi-experimental studies. All treatment programs were based on a behavioral approach. Three studies used the structure of group meetings, 5 studies used the design of individual sessions, and 1 study used a combination of group and individual sessions. The studies’ results showed a positive effect of parent-mediated behavioral therapy on extra-role behavior such as repetitive behaviors, habituation (mood swings, aggression, self-harm), echo, and destructive behaviors (preliminary results).
Regarding parents’ psychological functions, these interventions have increased parental self-efficacy, increased positive parenting style, increased parental knowledge about managing aggressive behaviors, and reduced psychological problems (anxiety and depression). In addition, consequently, the reduction of extra-role behaviors has led to an increase in adaptive behaviors [33, 34] and social skills  in children with autism (secondary results).
The conceptual and practical basis of all parent education programs is behavioral management education. Components of treatment plans included a variety of outcome-oriented interventions (such as stopping response and re-guidance), earlier interventions A (such as daily program design), and earlier interventions B (such as enriching the game environment). Four studies reported the results of treatment loyalty assessment, and six studies reported treatment follow-up. Three studies had moderate evidence of certainty, and six studies had strong evidence of confidence.
Discussion and Conclusion
The results of this study showed that parent-mediated behavioral intervention is effective in extra-role behaviors. In general, according to the results of this study, it seems that in many countries, parent-centered therapies, especially those focusing on addictive behaviors, are gaining more and more attention, and efforts have begun to adapt autism treatment to the family system [50, 51].
The importance of this change can be seen in the high cost of treatment  and parents’ efforts in learning the behavior of children with autism and generalizing the better effects of treatment  because parents are always with children and can cause fundamental changes in the autistic syndrome by fundamentally changing the child’s lifestyle. Therefore, it seems that such a move (changing tissue therapy from clinic to home) should be made in different countries, especially in Iran. Of course, the critical point when designing programs based on empirical evidence is to pay attention to culture. These programs should be in harmony with the culture of families in each country. The values and beliefs of the family should be considered in the treatment program.
It seems that to increase the effectiveness of parent-mediated behavioral intervention, it is necessary to use a variety of outcome-based and antecedent-based interventions so that with integrated therapy, these interventions can be more effective in reducing extra-role behaviors in children with autism. Since the children with autism have different severity of symptoms and also due to the lack of therapists and autism centers and the increasing prevalence of this disorder, it is necessary to change the treatment of ASD from center- mediated to family-mediated; this highlights the importance of developing family-mediated treatment programs in the country.