EFFECTIVENESS OF PARENT-MEDIATED BEHAVIOURAL INTERVENTION FOR AGGRESSION IN CHILDREN WITH AUTISM SPECTRUM DISORDER IN LAGOS NIGERIA

Abstract

Background: Autism Spectrum Disorders (ASD) is a disabling and lifelong neurodevelopmental disorder identified as an important cause of the global burden of disease in children. Research findings indicate aggression to be common in ASD. Aggression in ASD impacts negatively on the mental health of both the affected child and the family caregiver. Though research has shown effective behavioural interventions exist and can be delivered by parents of children with ASD, there is no published research on the feasibility and implementation of such an intervention in Nigeria. Objective: This study aimed to assess the feasibility and effectiveness of parent-mediated behavioural intervention for aggressive behaviour in children with ASD. A comparison of the pre and post maternal knowledge on behavioural intervention for aggression and the effect of an intervention on the level of stress of the mothers were also examined. Methodology: In a quasi-experimental study, twenty (20) mothers of and their children with a diagnosis of ASD were recruited from a developmental clinic of a Child and Adolescent Mental Health Service Unit. Diagnosis of ASD was based on Diagnostic and Statistical Manual (DSM-V) criteria. Instruments used for data collection were socio-demographic the questionnaire, Aggression and Self Injury Questionnaire (ASIQ), the 12-item General Health Questionnaire (GHQ-12), Burden Interview (BI), Knowledge on Behavioural Management of Aggression Questionnaire (KBMAQ) and Client Satisfaction Questionnaire. Mothers received a weekly group session for a duration of 5 weeks. The intervention Manual was used for training. Responses to the questionnaire were scored on a scale. Rater of aggression outcome measure was blinded to the objective of the study. Assessments were conducted on outcome measures at baseline and after the intervention. Results: The age of children with ASD ranged from 3-17 years with a mean age of 10.7±4.6. The age range of mothers was 32-52 years with a mean age of 42.8±6.4. Score on aggression towards a person or property category of ASIQ ranged from 1-10 with a mean of 4.3±2.5. Score on the self-injurious category of ASIQ ranged from 0-5 with a mean of 2.8±1.8. The score on the knowledge instrument ranged from 3-12 with a mean score of 7.9±2.6. GHQ-12 score ranged from 0-7 with a mean of 3.0±2.3. The significance of differences in the mean scores of the outcome measures was determined with paired t-tests. Compared to pre-intervention Aggression towards a person or property (APP) item mean score of 4.3±2.4 and APP total mean score of 36.0±20.2, showed a statistically significant reduction post-intervention with mean scores of 3.9±2.5 (p=0.008) and 29.1±18.2 (p<0.001) respectively. There was a statistically significant increase in the mother's knowledge on behavioural management of aggression from a pre-intervention mean score of 7.9±2.6 to a post-intervention mean score of11.8±0.4 (p<0.001). Pre-intervention GHQ-12 mean score of 3.0±2.2 and BI Score of 26.5±14.1 decreased significantly to mean scores of 1.6±1.5 (p<0.001) and 24.5±13.4 (p=0.009), respectively. Post-intervention knowledge score was negatively correlated with post-intervention aggression outcome measures, GHQ-12, and BI but results were not statistically significant (p>0.05). Overall, 25.0% of mothers were mostly and 75.0% very satisfied with the intervention programme. Conclusions: Parent-mediated behavioural intervention is a feasible and promising treatment for aggression in ASD and improved maternal mental well-being in Nigeria. The role of mothers as active partners with formal care providers in the management of children with ASD is emphasised. Behavioural intervention in the context of parent education should be an integral component in scaling up services for children with ASD in Nigeria