Characterizing The Parent Role in School-Based Interventions For Autism: A Systematic Literature Review

School Psychology
© 2019 American Psychological Association 2019, Vol. 34, No. 4, 444 – 457
2578-4218/19/$12.00 http://dx.doi.org/10.1037/spq0000283
Characterizing the Parent Role in School-Based Interventions for Autism:

A Systematic Literature Review
Kristin M. Rispoli, Nicole E. Mathes, and Allura L. Malcolm
Michigan State University
Parent-focused intervention for children with autism spectrum disorder (ASD) has garnered considerable
evidence of effectiveness for treating core symptoms of the disorder. However, these programs often
teach parents discrete skills that may or may not align with school-based interventions. Family–school
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
partnerships (FSPs) are essential for children with ASD given the complex presentation of symptoms
This document is copyrighted by the American Psychological Association or one of its allied publishers.
characteristic of this disorder. It is unclear how and to what degree current school-based interventions for
children with ASD include parents and whether their inclusion is consistent with definitions of parent
involvement or FSPs established in the literature. A systematic review of the school-based intervention
literature for children with ASD was conducted on studies published between 2002 and 2017. Thirty-six
articles met inclusion criteria. Results indicated interventions included parents in ways consistent with
both parent involvement and FSPs, though the former model was more common. Findings suggest a need
for greater focus on measuring parent behavioral outcomes when evaluating intervention effectiveness
and developing or refining interventions to include meaningful family–school partnering.
Impact and Implications

This study found that parents are sometimes included in school interventions for children with autism
spectrum disorder (ASD). This participation is less often focused on creating partnerships between
parents and school providers, and more often on training parents to implement specific interventions.
Results can help educators adapt interventions for children with ASD to foster meaningful FSPs.
Keywords: autism, parents, intervention, school, systematic review
Autism spectrum disorder (ASD) is characterized by persistent other individuals in intervention delivery. Including parents in
deficits in social communication and interactions, and the presence intervention can increase the intensity of intervention and gener-
of restricted repetitive patterns of behavior, interests, and activities alizability of skills outside of the school setting (Burrell & Bor-
(American Psychiatric Association, 2013). Approximately one in rego, 2012).
59 children is diagnosed with ASD (Baio et al., 2018). Over The vital role that family–school connections play in children’s
500,000 students (ages 6 –21) receive special education services learning and development is supported by a large body of research
under the classification of autism. Of those students, an estimated (e.g., Cox, 2005; Henderson & Mapp, 2002). The term family–
40% participate in general education classrooms for 80% or more school partnerships (FSPs) describes a child-centered approach in
of the school day (Snyder, de Brey, & Dillow, 2016). It is essential which families and schools cooperate, coordinate, and collaborate
that schools are well equipped to meet the needs of this growing to produce positive student outcomes across social, emotional,
student population and their families. behavioral, and academic domains (Christenson, 1995; Christen-
Given the complex presentation of symptoms and varied skill
son & Sheridan, 2001; Garbacz, Swanger-Gagné, & Sheridan,
profiles of students with ASD, specialized intervention services are
2015; Sheridan & Kim, 2015). FSPs recognize shared roles and
often necessary to facilitate their participation in the general edu-
responsibilities among schools and families and involve schools
cation curriculum (Snyder et al., 2016). However, the demand for
partnering with families to enhance student outcomes (Christenson
specialized service providers far outweighs the number of such
& Sheridan, 2001; Garbacz et al., 2015). Components of a FSP
providers (Murphy & Ruble, 2012), resulting in a need to involve
framework include (a) shared roles and responsibilities between
families and educators, (b) active collaboration, (c) the targeting of
both home and school contexts in intervention activities, and (d)
Kristin M. Rispoli, Nicole E. Mathes, and Allura L. Malcolm, Depart- multidirectional flow of communication (Garbacz et al., 2015).
ment of Counseling, Educational Psychology, and Special Education,
The active engagement of parents in education and intervention
Michigan State University.
Correspondence concerning this article should be addressed to Kristin
is a primary focus of FSP and is a significant contributor to a
M. Rispoli, Department of Counseling, Educational Psychology, and Spe- child’s learning and development. Parent engagement is associated
cial Education, Michigan State University, 441 Erickson Hall, 620 Farm with children’s improved cognitive and language skills (Hirsh-
Lane, East Lansing, MI 48824. E-mail: rispolik@msu.edu Pasek & Burchinal, 2006), increased engagement in school and
444
PARENT ROLE IN SCHOOL AUTISM INTERVENTION 445
academic performance (Downer & Pianta, 2006; Senechal, 2006), pation in meetings with the child’s school team (Benson, Karlof, &
and improved child problem-solving skills (Webster-Stratton & Siperstein, 2008). Still, parents of both preschool and school-age
Herman, 2008). Additionally, parent engagement is correlated with children with disabilities, especially ASD, are often called upon to
positive social-emotional outcomes including prosocial behavior deliver all or part of an intervention (e.g., Ingersoll & Wainer,
(McWayne, Hampton, Fantuzzo, Cohen, & Sekino, 2004; Ment- 2013; Jones & Feeley, 2009). Involvement as children reach later
ing, Orobio de Castro, & Matthys, 2013), improved child–peer grades may be even more distal, for instance, through discussing
interactions, and self-regulation skills (Neitzel & Stright, 2003). school or school activities with high schoolers (Keith et al., 1998).
The importance of fostering FSP through interventions for chil- A large body of research demonstrates benefits for children
dren with autism has been recognized (National Research Council, when parents are involved in their education, including gains in
2001), yet the degree to which partnerships are the focus of language and reading (Hammer, Farkas, & Maczuga, 2010;
school-based intervention for ASD is not well understood. There Schick, 2014), as well as math skills (Ramani, Rowe, Eason, &
are some examples of school-based ASD research in which parents Leech, 2015). In children with ASD, interventions with PI are
were involved as collaborators, and interventions aimed to foster associated with improved social communication and decreased
relationships between parents and school professionals. For exam- restricted and repetitive behaviors (Matson et al., 2009; Mc-
ple, Blair, Lee, Cho, and Dunlap (2011) implemented individual- Conachie & Diggle, 2007; Odom et al., 2010; Wong et al., 2015).
ized behavioral support plans for three young children with autism, However, limitations of PI include its temporal and singular qual-
developed through collaborations between mothers and teachers. ities. Parents’ long-term engagement in their child’s learning is
Improvements in children’s behavior and both mother– child and limited if parents are instructed on how to perform a specific skill
teacher– child interactions were noted following intervention im- or take part in an activity. Focusing on static or short-term objec-
plementation. Garbacz and McIntyre (2016) implemented conjoint tives does not foster growth of the interactional processes through
behavioral consultation with the parents and teacher of three which parents can continuously support the learning of their child,
school-age children with ASD to address each child’s behavior at such as developing positive working relationships with the child’s
home and in the classroom. The consultant, teacher, and parents school team, which can enhance child outcomes (Kim & Sheridan,
worked collaboratively to design and establish a behavior support 2015; Sheridan et al., 2012).
plan, which was implemented at home and in school and resulted Given the established benefits of FSP, benefits and limitations
in improvements in the behavior of all three children. It is not clear of PI, and the large number of children with ASD enrolled in
to what extent the FSP models demonstrated by Blair and col- regular education, there is a need to better understand the role of
leagues (2011) and Garbacz and McIntyre (2016) are representa- parents in school-based interventions for this population. As more
tive of the larger body of school-based intervention research for and more children with the disorder reach adolescence, it is par-
children with ASD. Moreover, it is not known whether existing ticularly necessary to understand methods that may serve to mean-
interventions for older students with ASD aim to foster FSP, and ingfully engage parents in the later grades. This need is under-
how these efforts may differ to accommodate changing expecta- scored by concern raised by both high school teachers and parents
tions for parental engagement as children age. regarding lack of available interventions for adolescents with
Historically, much of the focus on including parents in educa- ASD, limited feasibility and relevance of existing interventions,
tion and treatment for ASD has centered on parent training or and the need for parental input to tailor interventions and maxi-
parent-implemented intervention. Parent-implemented interven- mize acceptability (Kucharczyk et al., 2015). To address these
tion refers to interventions in which parents are trained to imple- needs, the researchers conducted a systematic review of the current
ment techniques with their children aimed at building skills and/or literature on school-based interventions for children and adoles-
reducing disruptive behaviors (Wong et al., 2015). This approach cents with ASD enrolled in prekindergarten (pre-K) through 12th
to intervention is recognized as an evidence-based practice in grade, with a focus on defining how parents were included in these
addressing the core features of ASD as well as behavioral concerns interventions and how the parental role varied within the context of
(Matson, Mahan, & Matson, 2009; McConachie & Diggle, 2007; developmental stages.
Odom, Collet-Klingenberg, Rogers, & Hatton, 2010; Wong et al.,
2015). Method
Traditional parent training or parent-implemented intervention
for children with ASD is aligned with the definition of parent Literature Search and Eligibility Criteria
involvement (PI) in general education. This term refers to parental
actions that are taken at home and in school to intentionally The literature published in peer-reviewed journals from January
support the education of children (Hoover-Dempsey & Sandler, 2002 to July 2017 was searched using the following databases:
1997). Unlike FSP, PI refers to structural or process-oriented PsycINFO, PsycARTICLES, ERIC, ProQuest, and PubMed. Four
activities, often separate from other aspects of the children’s edu- sets of search terms were combined: (a) autisⴱ, Asperger, or
cational experience. For instance, PI for preschool children might PDD-NOS (i.e., Pervasive Developmental Disorder Not Otherwise
include reading to their child (Cline & Edwards, 2013) or prompt- Specified); (b) parentⴱ, mother, or father; (c) intervenⴱ, familⴱ,
ing social communication skills in everyday routines (Ingersoll & parent involvement, parent engagement, treatment, intervention,
Wainer, 2013). As children age, increased expectations for inde- protocol, therapⴱ, or procedure; and (d) school or preschoolⴱ. All
pendence give way to more indirect forms of PI that place greater possible search terms combinations were generated, with each
emphasis on the child’s own efforts to increase their learning combination including one term from each of the four sets. This
and/or participate in school activities. For instance, parents may be resulted in a total of 117 search term combinations. A secondary
involved in the education of school-age children through partici- search was conducted of online prepublication articles in promi-
446 RISPOLI, MATHES, AND MALCOLM
nent autism journals: The Journal of Autism and Developmental Article Coding Procedure
Disorders, Autism, Research on Autism Spectrum Disorders, and
Articles that met the eligibility criteria described above were
Research in Developmental Disabilities. Finally, reference sec-
retained. The full text of retained articles was independently coded
tions of retained articles were searched to identify any outstanding
by two researchers to identify data relevant to the research ques-
articles that met eligibility criteria.
tions. Specifically, articles were coded for information related to
Due to the large number of results using the research terms, the demographics of children and parents, intervention (i.e., set-
articles were retained from the initial search if they appeared to ting, agent, recipient, parent role), and parent and child outcomes.
describe empirical findings from intervention studies focused on The researchers responsible for coding were doctoral students in
children/adolescents with ASD, based on a title review and ab- school psychology, trained by the first author. Coders double
stract screening by three independent researchers. coded all codes. For quantitative codes, such as number of child
Following the initial screening, abstracts of retained articles participants, intercoder agreement was calculated by dividing the
were reviewed by the same group of three researchers to deter- number of agreements by the number of codes for a given cate-
mine if they met a comprehensive set of eligibility criteria: (a) gory. Interrater agreement ranged from 83% to 95% for quantita-
targeted students in preschool/pre-K to 12th grade with a ver- tive codes. For qualitative codes, such as identifying the interven-
ified medical or educational diagnosis of ASD, autistic disor- tion agent, a third researcher (first author) met with the coders and
der, Asperger’s disorder, Pervasive Developmental Disorder the team reviewed all codes to determine consistency between the
Not Otherwise Specified (all per Diagnostic and Statistical descriptions provided by each coder. All qualitative codes were
Manual of Mental Disorders criteria), or Autism (per Individ- discussed until all three researchers agreed that all pertinent infor-
uals with Disabilities Education Act criteria); (b) included mation was included and consensus was established.
quantitative, qualitative, or mixed methods; (c) was imple-
mented at least partially in schools or involved a school pro- Results
vider in some aspect of the intervention (i.e., not simply pro-
The Figure 1 displays the process by which eligible articles were
viding data on the target child[ren]); and (d) included parents.
identified and included in the systematic review. A total of 36
If this information could not be ascertained from the abstract,
articles were included in the final review. Children included in the
the method section of the article was reviewed.
reviewed studies ranged in age from 1 to 19 years. Fourteen studies
Figure 1. Article identification process.

focused specifically on students in early childhood settings (12 intervention development. When the parent role did not include
months through 5 years [5-year-olds in pre-K]), 11 studies in- collaboration (i.e., agent, recipient, or both), the study was cate-
cluded students in elementary grades (ages 5 [5-year-olds in kin- gorized as a PI intervention, consistent with definitions from
dergarten] to 11 years), and seven studies involved children of general and special education (Hoover-Dempsey & Sandler, 1997;
middle and high school ages (12–19 years) or Grades 6 –12 if only Wong et al., 2015). Parent as intervention agent was defined as the
grades were reported. The remaining studies (n ⫽ 4) spanned parent delivering some or all intervention components. Parent as
elementary and middle/high school-age children and adolescents. recipient of the intervention indicated the parent received some
See Table 1 for detailed demographic information. component(s) of the intervention (e.g., parent education) or was
First, studies were categorized according to whether the parent the direct recipient of the intervention (e.g., parent-implemented
(a) had multiple roles, (b) was an intervention collaborator, (c) was intervention). See Table 2 for study descriptions.
an agent of the intervention, or (d) was a recipient of the inter-
vention. Second, studies were grouped as reflecting either an FSP
Parent Role in Intervention
or PI approach (see Table 2). Interventions that included parent–
school collaboration were reflective of an FSP approach, given the Parents held diverse roles across the reviewed articles. In more
emphasis on “co-determined structural activities” (Kim & Sheri- than half (n ⫽ 22) of the articles, parents fulfilled a combination
dan, 2015, p. 9) or, in other words, active collaboration (Garbacz of roles (see Table 2). Among FSP interventions, the parent role
et al., 2015) by experts in the field as a hallmark of FSP, and the included the combinations of collaborator, agent, and recipient
recognition that few extant interventions contain all FSP compo- (n ⫽ 6) and agent and collaborator (n ⫽ 1). In two other studies,
nents identified by Garbacz and colleagues (2015). Parent as parents were solely collaborators and not responsible for receiving
collaborator was defined as the parent assuming an active role in or delivering any part of the intervention. In studies categorized as
Table 1
Demographic Characteristics of Study Participants
Participants
Study N Age (% male) Diagnoses
Arvans and LeBlanc (2009) 1 14 years (100%) Asperger’s syndrome, depression, anxiety
Au et al. (2015) 33 5–15 years (85%) ASD, 1 diagnosis of epidermolysis bullosa
Axelrod, Tornehl, and Fontanini-Axelrod (2006) 2 13 and 14 years (100%) ASD and intellectual disabilities
Baker-Ericzén, Brookman-Frazee, and Stahmer (2005) 60 18–36 months (78%) 37 participants with ASD, 23 without
Bauminger (2002) 15 8–17 years (73%) Autism
Blair, Lee, Cho, and Dunlap (2011) 3 4.5–5.5 years, (67%) Autism
Deckers, Muris, Roelofs, and Arntz (2016) 52 8–12 years (90%) PDD-NOS, Asperger’s syndrome, or autism
Dekker, Nauta, Mulder, Timmerman, and de Bildt (2014) 120 10–12 years (NR) ASD
Devlin and Harber (2004) 1 5 years (100%) Autism
Drmic, Aljunied, and Reaven (2017) 44 13–15 years (86%) ASD
Edgington, Hill, and Pellicano (2016) 7 11–16 years (100%) ASD or Asperger’s syndrome
Eikeseth, Smith, Jahr, and Eldevik (2002) 25 4–7 years (76%) Autism
Ergüner-Tekinalp and Akkök (2004) 10 12–19 years (100%) Autism
Freitag, Feineis-Matthews, Valerian, Teufel, and Wilker (2012) 13 47.5–91.6 months (77%) Autism, Asperger’s syndrome, or atypical autism
Garbacz and McIntyre (2016) 3 6–8 years (67%) ASD
Hampshire, Butera, and Bellini (2016) 5 Grades 6–8 (80%) ASD
Ingersoll and Wainer (2013) 24 26–70 months (87.5%) ASD and developmental delay
Jones and Feeley (2009) 3 3–4 years (67%) Autism or PDD-NOS
Kaale, Smith, and Sponheim (2012) 61 29–60 months (76.5%) Autism
Karaaslan, Diken, and Mahoney (2013) 19 3–6 years (52.6%) Down syndrome, autism, or intellectual disabilities
Kenworthy et al. (2014) 67 Grades 3–5 (NR) ASD
LeBlanc, Carr, Crosset, Bennett, and Detweiler (2005) 3 4 years (67%) Autism
Lopata et al. (2012) 12 6–9 years (83.3%) ASD
Mahoney and Perales (2003) 20 3–5 years (60%) Autism or PDD-NOS
Marshall et al. (2016) 50 5–15 years (74%) ASD
Oosterling et al. (2010) 67 12–42 months (77.8%) Autism or PDD-NOS
Ratcliffe, Wong, Dossetor, and Hayes (2014) 217 7–13 years (89.6%) ASD
Retherford and Schreiber (2015) NR Grades 11–12 (NR) Autism or Asperger’s syndrome
Schwartz, Sandall, McBride, and Boulware (2004) 48 3–6 years (77%) Autism
Solomon et al. (2014) 128 2:8–5:11 years (82.1%) Autism or PDD-NOS
Strain and Bovey (2011) 294 M ⫽ 50 months (NR) Autism
Thomeer (2012) 7 7–8 years (85.7%) HFASDs
Wilkinson (2005) 1 9 years (100%) Asperger’s syndrome
Wood et al. (2009) 19 7–11 years (84%) ASD and an anxiety disorder
Wood, Fujii, Renno, and Van Dyke (2014) 13 7–11 years (71%) ASD
Young, Falco, and Hanita (2016) 302 3–5 years (82%) ASD
Note. ASD ⫽ Autism Spectrum Disorder; PDD-NOS ⫽ Pervasive Developmental Disorder Not Otherwise Specified; NR ⫽ not reported; HFASDs ⫽
children with high-functioning autism spectrum disorder.
Table 2
Summary of the Reviewed Studies’ Characteristics
Study Methodology Intervention; setting Child outcomes Parent outcomes
Family–school partnership interventions

Parent role: Collaborator, agent, and recipient
Arvans and LeBlanc AB design Token economy for migraine Increase in prosocial behavior Satisfaction with the program
(2009) reports and school and school attendance;
absences; home and decreased migraine reports
school
Garbacz and McIntyre Multiple baseline across CBC; home and school Improvements in classroom Improved parent–teacher
(2016) participants social behavior relationship for 2 of 3 parent–
teacher dyads; Increased
parental problem-solving and
high rates of intervention
acceptability and fidelity

Hampshire et al. Multiple baseline across Homework self-management Increased task independence High fidelity of intervention
(2016) participants program; home and school implementation
Schwartz et al. (2004) Pre–post Inclusive preschool program Gains in speech, following Satisfaction with program
including extended directions, motor imitation, content and progress
instruction time family toilet training, symbolic
support, service and cooperative play
coordination, and
transition support;
preschool and home
Strain and Bovey RCT Inclusive preschool program Significantly greater None
(2011) targeting social skills and improvement than
skills training for families; comparison group in
preschool cognitive, language, social
and behavioral skills;
decreased autism
symptomology
Wilkinson (2005) Case study CBC self-management Improved behavioral control, High fidelity of intervention
intervention; school and decreased behavioral issues implementation; evidence of
home at home and school intervention acceptability and
effectiveness
Parent role: Collaborator and agent
Blair et al. (2011) Multiple baseline across Behavior plan designed and Problem behavior decreased High fidelity of intervention
participants implemented by parents and appropriate behavior implementation; Positive
and teachers; home and increased interactions with child
school increased and negative
interactions decreased
Parent role: Collaborator
Marshall et al. (2016) RCT Social story intervention; None High intervention acceptability
school
Thomeer (2012) Qualitative feasibility CSBI; school None High intervention acceptability
study and feasibility
Parent involvement interventions

Parent role: Agent and recipient
Au et al. (2015) Pre–post Multiple behavioral Aggressive behaviors Satisfaction with the program,
interventions integrated decreased for all children; children’s progress, and
throughout the school day some children increased children’s teachers
and at home social behaviors and
independence with daily
living tasks
Baker-Ericzén et al. Quasi-experimental Inclusive classroom focused Not reported Significant reduction in child-
(2005) on language, social and but not parent-related stress
self-help skills paired with for mothers; no significant
home visits; home and reduction in stress for fathers
school
Deckers et al. (2016) Between- and within- Group SST sessions in Greater social skills at None
subjects pre–post addition to parent posttest compared to
sessions; clinic and home controls; no change in
loneliness
Table 2 (continued)

Dekker et al. (2014) RCT SST and SST with parent– Not reported Not reported
teacher involvement group
interventions; mental
health center; school and
home
Freitag et al. (2012) Pre–post Early intervention targeting Improved mental age and None
language, social socialization abilities
interactions, motivation,
stereotyped/ repetitive
behaviors and interests
with parent and teacher
training included; school
Ingersoll and Wainer Pre-post Project ImPACT; school and Increased language and Improved fidelity of intervention
(2013)
home social-communication implementation; high

skills, decreased social intervention acceptability
impairment ratings; significant decrease in
parenting stress
Jones and Feeley Multiple probe across DTT and PRT for joint Mastery and generalization of High fidelity of intervention
(2009) participants attention; home and initiating joint attention implementation
preschool
Karaaslan et al. (2013) RCT Parent-mediated responsive Greater gains in engagement, Greater gains in responsiveness
teaching intervention; pivotal behavior, and and affect, but not in
home and special personal–social, language, directiveness and achievement
education center and cognitive skills than orientation compared to
controls controls
Kenworthy et al. Quasi-experimental CBT-based executive Significantly greater None
(2014) function intervention; improvements in rule
home and school following, transitions, and
flexibility than comparison
group; both conditions
showed equal
improvements in social
skills
Lopata et al. (2012) Pre–post Summer and school program Significant improvement in High ratings of intervention
targeting social and knowledge of target social satisfaction and acceptability
emotion skills with parent skills, emotion recognition
training; summer camp skills, and social
and school performance
Mahoney and Perales Pre–post Responsive teaching Significant improvements in Significant improvements in
(2003) intervention for parents; social–emotional responsiveness and affect; no
home or early intervention functioning changes in achievement and
center directiveness.
Oosterling et al. RCT Parents trained on behavior No intervention effects on No significant effects on
(2010) management, play, language development, parental skills in promoting
language elicitation, and engagement, social children’s joint attention,
visual supports; daycare communication, or global engagement, and language
and home improvement
Solomon et al. (2014) RCT Coaching to support Large treatment effects for Decreased depressive
caregiver–child parent and child symptomology; no change in
interaction, speech- interactional behaviors; stress
language and occupational significant improvement in
therapy; home functional development and
improvement in
symptomology as measured
by ADOS; language and
development did not differ
over time by group
Wood et al. (2009) RCT CBT program for anxiety Greater improvements in None
with parent training and social communication and
school consultation; home, anxiety symptoms
school, and clinic compared to controls
(table continues)
Table 2 (continued)

Young et al. (2016) RCT Comprehensive program Small positive effects on None
trains teachers and parents receptive language and
to use environmental social skills; no change in
arrangement, visual adaptive behavior,
supports, naturalistic and cognition, expressive
incidental teaching, and language, and social skills
pivotal response therapy;
home and school
Parent role: Agent
Axelrod, Tornehl, and Multiple baseline across Behavioral toilet training and Achievement of full fecal None
Fontanini-Axelrod participants laxative intervention; continence
(2016) home
Bauminger (2002) Pre–post Social skills intervention; Improved social skills and None
school problem solving, positive

interaction initiations,
emotion knowledge
Devlin and Harber Pre–post DTT; home and school Improvements in attending, None
(2004) imitation, language,
preacademic, and self-help
skills
Eikeseth et al. (2002) Quasi-experimental Behavior intervention using Greater IQ, language, and None
Lovaas method; school adaptive behavior scores
compared to controls
LeBlanc, Carr, Multiple baseline across Intensive behavioral toilet All children remained None
Crosset, Bennett, participants training procedure; clinic, continent; 2 of 3 children
and Detweiler home and school initiated most toileting
(2005) events
Parent role: Recipient
Drmic et al. (2017) Pre–post CBT intervention for Significantly fewer anxiety Positive acceptability ratings
anxiety; school symptoms per parent
report; no change in
teacher-reported anxiety or
emotional/behavioral
problems
Edgington et al. Pre–post CBT program targeting No significant changes in Provided suggestions for future
(2016) sensory processing; school sensory processing implementation (e.g.,
difficulties, anxiety, and importance of communication
repetitive behaviors with parents)
Ergüner-Tekinalp and Quasi-experimental Coping skills intervention for None Significantly lower hopelessness
Akkök (2004) mothers; special education and greater use of social
centers support as coping strategy
compared to controls; no
difference in stress,
avoidance, or problem solving
Kaale et al. (2012) RCT Joint attention intervention; Experimental group showed None
preschool increased joint attention
skills during play
Ratcliffe et al. (2014) Quasi-experimental Emotion-based SST; school Teacher-reported emotional None
competence improved, but
no significant parent-
reported effects
Retherford and Survey College exposure program; Improved functional and None
Schreiber (2015) university campus social skills; all involved in
extracurricular activities
and most enrolled in or
graduated from
postsecondary education at
1-year follow-up
Wood et al. (2014) RCT CBT program for anxiety, Outperformed controls on None
clinic and school frequency of self-isolation,
proportion of time spent
with peers, and positive or
appropriate interaction with
peers
Note. RCT ⫽ randomized controlled trial; SST ⫽ social skills training; DTT ⫽ discrete trials training; CBT ⫽ cognitive– behavioral therapy; CBC ⫽
conjoint behavioral consultation; CSBI ⫽ comprehensive school-based intervention; PRT ⫽ pivotal response training; AB design ⫽ baseline-intervention;
ADOS ⫽ Autism Diagnostic Observation Schedule; ImPACT ⫽ Improving Parents As Communication Teachers.
PI interventions, the parent role included both agent and recipient child with autism in school and at home to target language and
(n ⫽ 15), as well as solely agent (n ⫽ 5) and recipient (n ⫽ 7). The conversational skills.
agent-recipient combination occurred most frequently, suggesting Parents were tasked with implementing interventions targeting a
that most school-based interventions for students with ASD that wide range of skills. Many parent-implemented interventions ad-
include parents reflect the PI model (Hoover-Dempsey & Sandler, dressed social and communication skills (e.g., Ingersoll & Wainer,
1997; Wong et al., 2015). In these interventions, parents receive 2013; Lopata et al., 2012) as well as behavior (e.g., Eikeseth,
training/coaching from an expert and were charged with imple- Smith, Jahr, & Eldevik, 2002; Karaaslan, Diken, & Mahoney,
menting all or a portion of the intervention. 2013). Other skills included social skills (Dekker, Nauta, Mulder,
Evidence of FSP: Parents as collaborators. Efforts to foster Timmerman, & de Bildt, 2014), toileting (Axelrod et al., 2016;
FSP were evident in any studies that included parents as collabo- LeBlanc, Carr, Crosset, Bennett, & Detweiler, 2005), and coping
rators with interventionists and/or teachers (n ⫽ 9; alone or in skills for anxiety (Wood et al., 2009).
combination with other roles, including when other roles were Across the studies in which parents received all or a portion of
agent and recipient). Within these studies, the parent role typically an intervention (n ⫽ 27), parents were either the sole intervention
encompassed a combination of collaboration and other functions. recipient, received an intervention concurrently with the child, or
Two studies (Marshall et al., 2016; Thomeer, 2012) reported received training to implement an intervention with their child. In
parental collaboration alone, including parents working with teach- one intervention for which parents were the sole recipient, parents
ers to define and operationalize target behaviors and create social participated in a structured cognitive– behavioral therapy interven-
stories (Marshall et al., 2016) and participating in a focus group tion designed to teach coping skills (Ergüner-Tekinalp & Akkök,
with researchers and teachers to develop a manualized compre- 2004). When parents were trained to implement an intervention
hensive school-based intervention protocol (Thomeer, 2012). In with children, they almost always also served as an intervention
one example of parents in multiple roles (collaborator, agent, and agent in the study (n ⫽ 17). For example, consultants in a study by
recipient), Hampshire, Butera, and Bellini (2016) implemented a Solomon, Van Egeren, Mahoney, Quon Huber, and Zimmerman
homework self-management intervention that included three par- (2014) coached parents on play-based intervention techniques in
ent training sessions followed by collaborative planning between the Play and Language for Autistic Youngsters program and mea-
the researcher, parent, teacher, student, and other relevant school sured improvements in parent– child interactive behaviors.
personnel. Parents oversaw the self-management intervention and There were some exceptions in which parents were encouraged
collected data to determine student mastery. but not required to implement interventions. For instance, Kaale,
Across the ages/grade levels of students included in the re- Smith, and Sponheim (2012) invited parents to observe joint
viewed studies, there were a similar number of studies that re- attention training sessions delivered by preschool teachers to 2- to
flected an FSP approach (n ⫽ 3 early childhood, n ⫽ 3 elementary, 5-year-old children. Parents were not required to attend these
n ⫽ 2 middle/high school). There were far fewer studies that sessions and were not coached to implement the intervention.
reflected this approach compared to PI across all ages/grade levels For all ages/student grade levels, most studies adopted a PI (vs.
studied. FSPs were promoted in two studies of young children as FSP) approach to including parents in intervention. In early child-
part of inclusive preschool programs. Parents were broadly en- hood settings, parents were often trained and responsible for de-
gaged in the efforts of the programs, such as collaborating with livering some or all intervention components. These interventions
school staff to develop individualized goals for children and learn- were behaviorally based and focused on addressing core symptoms
ing how to support development in the context of a wide range of of ASD, including language, social skills, and behavior manage-
daily routines and activities through individualized home visits ment (e.g., Karaaslan et al., 2013). Parents of elementary-aged
(e.g., Schwartz, Sandall, McBride, & Boulware, 2004; Strain & children were similarly trained and implemented behaviorally fo-
Bovey, 2011). In school-age children, FSP interventions indicated cused interventions to address core features of the disorder in some
greater focus on individual skills. Two of these studies used studies (e.g., Devlin & Harber, 2004; Eikeseth et al., 2002). How-
conjoint behavioral consultation, in which teachers and parents ever, in other studies parents were taught to carry out interventions
worked together with a consultant to define a problem, develop focused on emotion management (e.g., Lopata et al., 2012; Wood
and implement an intervention (Garbacz & McIntyre, 2016; et al., 2009; Wood, Fujii, Renno, & Van Dyke, 2014). In four
Wilkinson, 2005). The focus and parent role in FSP interventions studies involving students in middle and high school grades, par-
in middle and high school grades reflected students’ growing ents solely received some form of the intervention, either to
independence; parents worked with school professionals to design support their child with no apparent requirement to implement the
programs focused on homework self-management (Hampshire et techniques taught (Drmic, Aljunied, & Reaven, 2017; Edgington,
al., 2016) and school attendance and work completion (Arvans & Hill, & Pellicano, 2016), to learn stress management and coping
LeBlanc, 2009). skills for themselves (Ergüner-Tekinalp & Akkök, 2004), or to
Evidence of PI: Parents as intervention agents and recipients. gain information related to supporting students’ postsecondary
Parents were intervention agents (either alone or as a recipient) in success (Retherford & Schreiber, 2015). There was one example of
27 reviewed studies. In some studies, parents were the sole party parents being trained and implementing intervention similar to
responsible for intervention delivery, such as implementing an studies of younger children (Axelrod et al., 2016).
in-home toileting intervention (Axelrod, Tornehl, & Fontanini-
Axelrod, 2016). In other studies, interventions were implemented
Parent Outcomes
by multiple individuals. For instance, Devlin and Harber (2004)
trained parents, teachers, and speech-language pathologists to im- While all reviewed articles included parents in the intervention
plement a discrete trial training intervention with a 5-year-old in some way, there were several (n ⫽ 16) articles that did not
report parent outcome data. For all six articles in which the parent & McIntyre, 2016; Ingersoll & Wainer, 2013; Lopata et al., 2012;
was given the role of intervention agent (alone, not in combina- Mahoney & Perales, 2003; Ratcliffe, Wong, Dossetor, & Hayes,
tion), there were no reported parent outcomes. Of the articles that 2014; Solomon et al., 2014; Strain & Bovey, 2011) examined
did report parent outcomes, 10 reported outcomes related to pa- outcomes of parent-implemented interventions on these social
rental satisfaction and/or acceptability of the intervention, and six skills. Results included significant improvements in child social-
reported findings regarding the fidelity of parental intervention emotional functioning, social communication, socialization, emo-
implementation. tion knowledge, and emotion regulation skills. In other studies,
Both quantitative and qualitative measures of intervention fidel- social skill improvements were secondary to target skills or one of
ity were used to monitor parental intervention implementation. For many skills addressed. For instance, Arvans and LeBlanc (2009)
instance, Ingersoll and Wainer (2013) relied on independent ob- reported increases in children’s prosocial behavior following in-
servational ratings to assess fidelity across four domains related to troduction of a token economy system targeting migraine reports
a parent-implemented social communication intervention for young and school absences.
children with ASD. Several studies (Blair et al., 2011; Garbacz & Seven studies examined behavioral interventions, such as token
McIntyre, 2016; Hampshire et al., 2016; Jones & Feeley, 2009) made economy systems, self-monitoring, behavior plans, and nonspeci-
use of a procedural checklist completed by the parent, researcher, or fied classroom behavioral interventions (Arvans & LeBlanc, 2009;
both. Wilkinson (2005) used a semistructured interview to provide Au et al., 2015; Blair et al., 2011; Eikeseth et al., 2002; Garbacz &
feedback and encouragement to parent and teacher consultees on their McIntyre, 2016; Hampshire et al., 2016; Wilkinson, 2005). Student
implementation of a self-monitoring plan for a 9-year-old boy with outcomes included increased prosocial behavior and school atten-
Asperger’s disorder. Booster sessions were used to address low levels dance, improvements in social behavior, increased task depen-
of parental fidelity in Hampshire et al. (2016), while other studies did dence, decreased behavioral issues at home and school, and im-
not specify if and how performance feedback was provided to parents. provements in preacademic skills.
High rates of parent intervention fidelity were reported for all Cognitive, adaptive, and academic child outcomes were reported in
studies in which fidelity data were available; the minimum fidelity eight studies. Child cognition (visual perception, fine motor, expres-
reported was 77% (range ⫽ 77–100%; Jones & Feeley, 2009) sive/receptive language) improved following participation in an in-
while the maximum (100%) was reported by Hampshire et al. clusive preschool program with family skills training (Strain &
(2016; range ⫽ 86 –100%) and Jones and Feeley (2009). Ingersoll Bovey, 2011), early intervention with parent and teacher training
and Wainer (2013) was the only study to report fidelity as an effect (Freitag et al., 2012), behavior intervention jointly delivered by ther-
size and cited a high effect (d ⫽ 1.64) for parents’ overall imple- apists and parents (Eikeseth et al., 2002), and parent-implemented
mentation of intervention strategies. responsive teaching intervention (Karaaslan et al., 2013). Adaptive
For a small subset of articles, specific behavioral outcomes were outcomes included increased independence with tasks of daily living
reported for parents that related to intervention goals. For instance, following multiple behavioral interventions implemented at school
Garbacz and McIntyre (2016) noted improvements in the parent– and at home (Au et al., 2015), improved self-help skills following a
teacher relationship and parental problem solving following im- joint home and school discrete trial training procedure (Devlin &
plementation of conjoint behavioral consultation with parents and Harber, 2004), and better adaptive behavior scores than controls in a
teachers of three school-age children. Another study found im- behavioral intervention (Eikeseth et al., 2002). Academic outcomes
proved positive and decreased negative parent– child interactions included improved preacademic skills (Devlin & Harber, 2004) and
following the introduction of behavior plans jointly developed by enrollment and/or graduation from postsecondary institutions one
parents and teachers and implemented at home and in school (Blair year following a college exposure program for adolescents (Rether-
et al., 2011). ford & Schreiber, 2015).
There were four studies that reported outcomes related to pa- Other studies reported on discrete functional skills, such as recep-
rental well-being, including increased positive affect (Karaaslan et tive and expressive language (Young, Falco, & Hanita, 2016), joint
al., 2013; Mahoney & Perales, 2003), reduced stress (Baker- attention, (Jones & Feeley, 2009; Kaale et al., 2012), direction fol-
Ericzén, Brookman-Frazee, & Stahmer, 2005), reduced depressive lowing (Kenworthy et al., 2014; Schwartz et al., 2004), and motor
symptomology (Ergüner-Tekinalp & Akkök, 2004; Solomon et al., imitation (Schwartz et al., 2004). Three articles focused on the
2014), and increased use of positive coping skills (Ergüner-Tekinalp achievement and maintenance of toileting skills (Axelrod et al., 2016;
& Akkök, 2004). LeBlanc et al., 2005; Schwartz et al., 2004).
Intervention Foci and Child Outcomes Discussion

Child outcomes were reported for 31 of the 36 reviewed This study investigated the degree to which school-based inter-
studies. Among the five remaining studies, two (Marshall et al., ventions for children and adolescents with ASD include parents
2016; Thomeer, 2012) only gathered intervention acceptability and whether parent roles are consistent with definitions of PI and
and feasibility data from parents, two (Baker-Ericzén et al., FSP in the literature (Garbacz et al., 2015; Hoover-Dempsey &
2005; Ergüner-Tekinalp & Akkök, 2004) focused on parent Sandler, 1997; Kim & Sheridan, 2015). A systematic review was
outcomes only, and one (Dekker et al., 2014) indicated data conducted on peer-reviewed literature published between 2002 and
collection was ongoing. 2017. Thirty-six articles were included in the review.
Several studies (n ⫽ 18) targeted child social skills. Ten studies Results of this review indicate that PI models are widely re-
(Bauminger, 2002; Deckers, Muris, Roelofs, & Arntz, 2016; Fre- flected in school-based intervention research for students with
itag, Feineis-Matthews, Valerian, Teufel, & Wilker, 2012; Garbacz ASD. Parents were taught a variety of specific skills and tech-
niques, such as using discrete trial training, a common behavioral geted training concerning discrete skills, versus the broader infor-
intervention technique (Devlin & Harber, 2004), procedures for mation often conveyed to parents in the earlier grades. This trend
increasing toileting behavior (Axelrod et al., 2016), and manage- reflected the changing needs of children and their families with
ment of anxiety (Wood et al., 2009). Consistent with PI models in age; PI in later grades may be best fostered through targeted
general education research (i.e., temporal and singular focus; Kim interventions that address functional skills considered by both
& Sheridan, 2015), these studies focused on teaching parents to parents and educators to be relevant to the individual’s future
use a predetermined set of practices to address a specific skill or success (Kucharczyk et al., 2015).
set of skills relevant to their children at the time the intervention Comparatively, far fewer studies followed the FSP approach
was implemented. Despite their limitations, the importance of across all age ranges/grade levels included in the reviewed studies.
parent training interventions for children with ASD has been under- This finding underscores the need for more research on programs
scored by numerous reviews citing these programs as evidence-based targeting meaningful collaboration and shared implementation of
(Matson et al., 2009; Odom et al., 2010; Wong et al., 2015). Findings techniques to support the education of children evident in the
across the studies included in this review similarly suggest a range of general education literature (Kim & Sheridan, 2015). Among the
positive outcomes for children when parents are trained in the context articles that did adopt an FSP approach, programs in the earlier
of school-based interventions (e.g., reduced behavioral concerns, in- grades were rather broad, focusing on collaborative planning and
creased language, social-emotional functioning, and self-help skills). training of parents across a range of skills to support several home
Compared to PI, there were relatively fewer interventions that routines and activities. With older children, interventions became
reflected the FSP model defined by Garbacz and colleagues (2015) more focused, consistent with trends observed for PI interventions.
as including shared responsibility, collaboration, home and school The long-term effects of these studies are not known, including
intervention activities, and multidirectional communication. In the how FSP versus PI interventions may or may not enhance future
CBC intervention implemented by Garbacz and McIntyre (2016), home-school collaboration around essential skills for older chil-
consultants facilitated joint communication, data collection, inter- dren and adolescents. Supporting successful postsecondary transi-
vention planning and implementation, and decision-making pro- tion is one area in which enhanced working relationships between
cesses for parents and a teacher of three elementary-age students parents and schools may be of particular benefit to the lives of
with ASD. Likewise, Hampshire et al. (2016) examined the effec- individuals with ASD (e.g., White et al., 2017). Complexities are
tiveness of an intervention package that combined teaching self- inherent in the design of interventions that include parents in the
management strategies and training parents as interventionist agents later grades, as interventions must balance the potential contribu-
(i.e., to develop and implement the intervention, collect data, and tion of parent support with the need to foster self-advocacy (Elias
collaborate with school personnel) to address homework challenges & White, 2018), as well as consider the individual’s unique set of
for five middle school students with ASD. strengths and needs. This area is ripe for future study.
There were variations evident in other studies that indicated Interventions in the included studies addressed diverse skills for
only partial adaptation of FSP approaches. For instance, parents the children and adolescents involved, including pro-social behav-
collaborated with teachers and researchers to inform intervention ior, challenging behavior, social skills, cognition, and adaptive
development in research by Marshall et al. (2016) and Thomeer behavior. Interventions targeting social skills were found to be
(2012) but did not participate in implementation nor engage in effective (e.g., Wood et al., 2014), which align with the results of
ongoing communication concerning student progress. Few studies another systematic review conducted on behaviorally based social
described a process for gathering parent feedback regarding the interventions for ASD (Camargo et al., 2014). However, the results
effectiveness of intervention techniques, suggesting limited focus of interventions targeting adaptive behavior and cognition were
on multidirectional communication between parents, teachers and mixed; some articles reported significant gains in adaptive behav-
other interventionists. As highlighted by Garbacz and colleagues ior and cognition (Au et al., 2015; Strain & Bovey, 2011), while
(2015), few interventions in the larger school-based socioemo- one article reported no intervention effects on adaptive behavior or
tional learning literature contain all five components of FSPs. cognition (Young et al., 2016). These findings are consistent with
Because adoption of interventions that contain all five components a review of evidence-based practices for ASD by Wong and
may be unwieldy, particularly for parents and educators of children colleagues (2015), in which there were more identified studies
with ASD, research to determine what components of this model documenting the efficacy of interventions on behavioral and social
result in the greatest benefit to children and families is a worthy skills outcomes than those with adaptive and cognitive outcomes.
avenue for future work. Limitations to the studies reviewed highlight areas in need of
Important trends were noted in how parents were included in attention concerning future adaptation and development of school-
interventions across the ages/grade levels of children studied. As based interventions for children with ASD. Overall, there is a clear
previously noted, most studies adopted a PI approach. For students need for interventions that include parents (i.e., only 36 studies met
in early childhood and elementary grades, parents were often inclusion criteria). While many of the reviewed studies described
trained and subsequently implemented a behaviorally based tech- PI activities, there is a need for more comprehensive, FSP models.
nique to address core symptoms of ASD such as language and These models not only involve parents in the intervention at hand
social skills. However, increased attention to common comorbidi- but foster ongoing engagement in their children’s education
ties, such as anxiety, was evident in interventions targeting ele- through techniques that support the formation of positive parent–
mentary and middle/high school students, consistent with calls teacher relationships and ongoing collaboration to address shared
from researchers for school-based interventions that include par- student goals. Use of these models promotes skill generalization
ents to address internalizing issues in ASD (Lopata & Thomeer, and maintenance over time, a shortcoming recognized in parent-
2014). As children aged, parents received increasingly more tar- focused autism interventions (Matson et al., 2009).
Results of this systematic review highlight methodological short- tion fidelity. Additionally, of the 36 articles reviewed, only two
comings in research on school-based autism interventions involv- reported a parent role in school-based interventions focused on
ing parents. As recognized in other reviews of autism research student academic outcomes (Devlin & Harber, 2004; Retherford &
(i.e., Wong et al., 2015), the studies included in this review were Schreiber, 2015). Parental inclusion in school-based academic
largely focused on preschool and elementary-age students, with intervention for ASD is in need of more attention in the literature
relatively fewer studies targeting adolescents with ASD. Given the given the promising findings from these studies. Importantly,
changing needs of adolescents with ASD and their families (Elias however, increasing parental focus on social and adaptive skills to
& White, 2018) research is needed to identify optimal methods for support postsecondary success (Elias & White, 2018) suggests
including parents in intervention. Samples were also primarily parents may be more amendable to interventions targeting these
male. While gender ratios are reflective of the distribution of the rather than academic skills in the later grades. Finally, information
disorder in the general population, there is a need for more re- on the current ways in which parents are included in school-based
search on girls with the disorder. Recent research underscored intervention across rural, urban, culturally and linguistically di-
meaningful differences in the presentation of the disorder in girls verse, and/or low-income districts is needed to inform future
and boys (Dean, Harwood, & Kasari, 2017), suggesting the need school-based ASD intervention with diverse populations.
for careful analysis of cross-gender treatment response. Specific to

our research questions and focus on parental inclusion in ASD
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School Psychology

Characterizing the Parent Role in School-Based Interventions for Autism:

Impact and Implications

Keywords: autism, parents, intervention, school, systematic review

Figure 1. Article identification process.

Study Methodology Intervention; setting Child outcomes Parent outcomes

Family–school partnership interventions

acceptability and fidelity

Parent involvement interventions

Study Methodology Intervention; setting Child outcomes Parent outcomes

home social-communication implementation; high

Study Methodology Intervention; setting Child outcomes Parent outcomes

school problem solving, positive

Intervention Foci and Child Outcomes Discussion

for careful analysis of cross-gender treatment response. Specific to

spectrum disorders. Topics in Early Childhood Special Education, 23, .1016/j.appdev.2014.05.006

Members of Underrepresented Groups:

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