Parenting disabled children & young people

There is strong evidence that evidence-based parent-mediated programmes can reduce behaviours that challenge and promote social skills and interaction in autistic children aged 0 to 15 years old. This includes children without a formal diagnosis but are showing potentially similar characteristics of autism.

What?

• Programmes that empower parent carers with skills to build positive relationships and communication with their children can significantly improve children’s social engagement.
• Practitioners should focus on supporting parent carers to enhance their child’s social responsivity, functional communication and positive social interaction.

Programmes that empower parent carers with skills to build positive relationships and communication with their children can significantly improve children’s social engagement.

Practice supervisors and practitioners should deliver programmes that are focused on supporting parent carers to improve the child’s:

1. Social responsivity: encouraging children to engage in shared interactions and respond to social cues.
2. Functional communication: supporting children to use communication methods such as vocalisation to express their needs and desires.
3. Positive social interaction: promoting positive moments between parent carers and their children.

How?

To improve social and emotional skills in autistic children, practice supervisors and practitioners should train and support parent carers to deliver evidence-based programmes that promote skill generalisation across various contexts, using tools like structured television series, computer games, and visual support cards – typically implemented at home under practitioner supervision.

One such proven programme, The Transporters animated and translated television series, includes key components such as:

• Voice tone recognition
• Facial expression and body posture identification
• Understanding and detecting strengths of emotions
• Integrating multiple social cues
• Teaching relaxation strategies like slow breathing and helpful thinking.

Other proven evidence-based programmes include:

• The Social ABCs
• Primary Care Stepping Stones Triple P
• Pre-school Autism Communication Trial
• Parent–Child Interaction therapy
• The Transporters animated and translated television series.

There is strong evidence that evidence-based parent-mediated programmes can improve language and communication in autistic children and children with primary and secondary language impairment aged 1 to 6 years old. This also includes children who have not been formally diagnosed but are showing potentially similar characteristics of autism or language impairment.

What?

• For these children, evidence shows that parent-mediated programmes such as Parent-mediated Early Start Denver Model, Social ABCs, The Pre-school Autism Communication Trial, and Parent–Child Interaction therapy
• are effective in improving language and communication outcomes. Practice supervisors and practitioners should support parent carers to use conversational, child-directed speech – characterised by simple words, dynamic verbs, concrete nouns, and slowed speech with longer pauses
• Evidence shows that following the child’s lead and using non-directed play can lead to improvement in communication and language skills among autistic children or children with language impairment
• Parent-mediated activities such as book reading and storytelling are effective in improving children’s language and communication skills.

How?

When sharing a book with the child, Practice supervisors and practitioners should encourage parent carers to undertake reading behaviours that increase a child’s verbal participation in telling the story. This includes avoiding book reading behaviours such as reading without the child’s participation and asking the child ‘yes/no’ or pointing questions. Practice supervisors and practitioners should encourage parent carers to use the following strategies when sharing a book with their child:

• Use of ‘what?’ questions, questions about attributes and function, repetition and praise
• Use of verbal expansion of the child’s speech and open-ended questions to support children to develop more sophisticated sentence-level skills.

There is strong evidence that evidence-based parent-mediated programmes are effective in improving parent–child interaction among families of autistic children, and children with brain injury, ADHD, hearing loss, or intellectual disability.

There is also strong evidence that these programmes are effective in improving outcomes for children without a formal diagnosis but are showing potentially similar characteristics of autism, ADHD, hearing loss, or intellectual disability.

What?

The evidence demonstrates that for children and young people aged 1 to 15 years, parent-mediated programmes such as Parent–Child Interaction Therapy, the New Forest Parenting Programme, Incredible Years Pre-school, and Primary Care Stepping Stone Triple P have proven effective.

How?

• These programmes focus on educating parent carers about their child’s disability and its impact on behaviour and the parent–child relationship – an approach that should be adopted by practice supervisors and practitioners
• Additionally, practitioners should support parent carers in learning strategies to manage attention-related difficulties, impulse control, and behaviours that challenge caregivers
• Key elements of effective programmes include supporting parent carers to:
• • Set limits
  • Establish routines
  • Communicate clearly
  • Avoid confrontations
  • Use quiet time, time-out, firm limits, and distraction techniques appropriately to manage behaviours that challenge the caregiver.

There is strong evidence that evidence-based parent-mediated programmes can reduce parenting stress in parent carers of autistic children and children with language impairment, or intellectual disability.

What?

• Evidence shows that for children aged 1 to 13 years old, programmes including The Pre-school Autism Communication Trial, Parent–Child Interaction Therapy, the Social ABCs, Parent-mediated Early Start Denver Model, and the Parent Plus Early Years programme have proven effective.

How?

• These programmes are designed to support parent carers to implement effective parenting strategies at home, enhance parental confidence, and reduce parental stress.
• Practice supervisors and practitioners should support parent carers to learn:
  • Strategies for establishing predictable family routines
  • Strategies for reinforcing positive child behaviours
  • Strategies for discouraging behaviours that challenge the caregiver through age-appropriate discipline.

There is strong evidence that evidence-based behavioural and psychosocial parenting programmes can lead to improvement in parenting practices and parental wellbeing among parent carers of autistic children and those with children diagnosed with ADHD.

These programmes can also improve the overall characteristics of autism and ADHD among children with a diagnosis, and those without a formal diagnosis but are showing potentially similar characteristics of autism or ADHD.

What?

• Evidence shows that behavioural parenting programmes with a higher number of sessions on negative consequences, such as ‘planned ignoring’ can significantly reduce behaviours that challenge in autistic children and children with ADHD.
• Strategies such as planned ignoring can help parent carers to avoid reinforcing harmless but challenging behaviours by withholding attention or providing reaction.
• Correction, on the other hand, is used to address and modify behaviours that challenge to prevent recurrence and promote more positive behaviours.
• The evidence suggests that programmes aimed at addressing behaviours that challenge are most effective in improving outcomes when delivered to individual parent carers.
• Programmes targeting behaviours that challenge, especially for children aged 3 to 5, are effective in fostering positive parenting practices. Behavioural parenting programmes with proven effectiveness include the New Forest Parenting Programme, Incredible Years Pre-school, and Parent–Child Interaction Therapy.

Evidence also shows that parent carer-focused psychosocial programmes are effective in reducing parental distress and depressive symptoms, as well as improving parent–child relationships. Examples of proven psychosocial parenting programmes include the Social ABCs, the Parent-mediated Early Start Denver Model, and the The Pre-school Autism Communication Trial.

How?

• Practice supervisors and practitioners should support parent carers in learning to use planned ignoring and correction appropriately to achieve positive behavioural outcomes. This includes:
  • Using planned ignoring only for challenging but harmless behaviours, and not for harmful behaviours like biting or hitting
  • Managing attention-seeking behaviours by withholding responses and avoiding eye contact in response to behaviours that challenge
  • Ensuring that correction is used as a teaching tool and not as punishment, to help children learn alternative behaviours
  • Using calm, supportive, and solution-focused correction strategies
  • Employing verbal (e.g. reminders of expectations) and non-verbal cues (e.g. gestures or eye contact) to interrupt behaviour that challenges
  • Recognising and praising appropriate behaviours to reinforce a child’s positive actions.
• Practice supervisors and practitioners should target programmes at individual parent carers rather than groups of parent carers, to improve children’s attention and reduce hyperactivity-impulsivity
• Practice supervisors and practitioners should deliver evidence-based parenting training to parent carers of children aged 3 and older to promote positive parenting and reduce harsh parenting
• Practice supervisors and practitioners should deliver parent carer-focused psychosocial programmes to parent carers of autistic children and children with ADHD, aged 2 t0 16 years old. Common features of effective programmes which should be adopted by practice supervisors and practitioners in programme design and delivery include mindfulness-based or acceptance commitment therapy, delivered with or without parenting skills training, with a duration of about five to eight weeks.

There is good evidence that parenting programmes targeted at families with autistic children and those with children diagnosed with cerebral palsy or acquired brain injury can improve child development and cognitive skills, and the overall wellbeing of families.

What?

• Evidence shows that family-oriented programmes, like the I-InTERACT and the Counsellor-Assisted Problem-Solving (CAPS) programmes, are particularly effective for supporting families with children diagnosed with acquired brain injury or cerebral palsy.
• I-InTERACT is most effective for supporting families with children aged 3 to 9 years old, while the CAPS programme is effective when delivered to families with children aged 12 to 17 years old.
• Family Oriented programmes can help improve family dynamics, reduce parental stress and ultimately lead to improvement in the child’s development, cognitive skills, and the families’ emotional and psychological wellbeing.
• For families with autistic children aged 0 to 4 years old, the Family-Implemented TEACCH for Toddlers (FITT) programme is an evidence-based programmes with proven effectiveness in improving children’s development and cognitive skills.

How?

For families with children diagnosed with acquired brain injury or cerebral palsy, Practice supervisors and practitioners should deliver programmes that:

• Emphasise positive parenting strategies
• Provide guidelines for behaviour management
• Provide support to families to build responsive and positive relationships to address behaviours that challenge
• Practice supervisors and practitioners should target programmes at all family members involved in the child’s care, including the child with acquired brain injury or cerebral palsy, parent carers, and siblings where available
• Other key features of the I-InTERACT and the CAPS programmes which should be adopted by practice supervisors and practitioners in programme delivery include:
  • Supporting families to learn strategies such as staying positive and coping with stress
  • Supporting families to learn behaviour management and cognitive reframing skills
  • Using positive parenting skills and in setting house rules
  • Supporting families to learn verbal and non-verbal communication and problem-solving skills
  • Handling crises and getting organised
  • Working alongside the child or young person’s school.

• For families with autistic children, practice supervisors and practitioners should deliver proven evidence-based programmes designed to:
  • Support families in better understanding how autism may be impacting their child
  • Support families to better engage with their child throughout the day
  • Support families to implement naturalistic behavioural strategies with their child to improve communication, play, receptive understanding, and engagement.