Experience and outcomes of stepping stones triple P for families of children with autism Sandra Hodgetts *, Amber Savage, David McConnell Department of Occupational Therapy, University of Alberta, 2-64 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4 1. Introduction Autism spectrum disorders (hereafter referred to as ‘autism’) represents a heterogeneous group of disorders characterized by impairments in communication and social interaction, and the presence of restricted and repetitive behaviours (APA, 2000). Additionally, children with autism exhibit challenging and disruptive behaviours at higher rates than their typically developing peers or peers with intellectual disability (Brereton, Tonge, & Einfeld, 2006). These challenging and disruptive behaviours place high demands on their parents and families, and many parents perceive that their adaptive resources, including but not limited to their energy, knowledge and skills, are insufficient to meet these demands (Dunlop & Fox, 1999; Stein, Foran, & Cermak, 2011). This can contribute to high levels of stress, anxiety and depression, which are prevalent among parents of children with autism (Lecavalier, Leone, & Wiltz, 2006). Stressed parents are, in turn, more likely to respond to their children in ways that exacerbate or reinforce problem behaviours (Hastings, 2002). To offset demands and increase their resources, parents of children with autism are turning to professionals for assistance with their child’s disruptive behaviours. Professional services in autism have historically been delivered to the child, and focused on child behaviour (e.g., Applied Behaviour Analysis; Lovaas, Koegel, Simmons, & Long, 1973). Although these Research in Developmental Disabilities 34 (2013) 2572–2585 ARTICLE INFO Article history: Received 5 March 2013 Received in revised form 23 April 2013 Accepted 2 May 2013 Available online Keywords: Autism spectrum disorder Parent training Parenting efficacy Service needs Psychological well-being Stepping stones triple P ABSTRACT This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the ‘‘attribution of cause’’ of misbehaviour, (2) ‘‘Who’s the boss?’’ reflecting a change to parents feeling more in charge of their child’s behaviour, daily routines and choices, and (3) ‘‘Rewarding is rewarding!’’ reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed. ß 2013 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +1 780 492 0899. E-mail addresses: sandra.hodgetts@ualberta.ca (S. Hodgetts), amsavage@ualberta.ca (A. Savage), david.mcconnell@ualberta.ca (D. McConnell). Contents lists available at SciVerse ScienceDirect Research in Developmental Disabilities 0891-4222/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ridd.2013.05.005