Document Type : Research Paper
Authors
1 Professor, Department of Psychology, University of Tabriz, Tabriz, Iran.
2 PhD Student, Department of Psychology, University of Tabriz, Tabriz, Iran.
3 Assistant Professor, Department of Psychology, University of Zanjan, Zanjan, Iran.
4 Professor, Department of Psychology, psychology and educational science faculty. University of Tabriz - Tabriz – Iran.
Abstract
Abstract
The present study aimed to evaluate the effectiveness of an integrated intervention program—comprising parent-child interaction, parent training, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism spectrum disorder (ASD). This research utilized a quasi-experimental pre-test/post-test design with a control group. The statistical population included high-functioning children with ASD (aged 5 to 8 years) residing in Tehran in 2024, from which 30 participants were selected via convenience sampling and randomly assigned to either an experimental or a control group (n = 15 per group). For the pre-test, participants completed the Challenging Behavior Questionnaire (CBQ) and the Short Sensory Profile (Dunn, 1999). The experimental group and their parents participated in an 8-session program over two months, consisting of one hour for the child and 30 minutes for the family, while the control group received no intervention. Data analyzed through multivariate analysis of covariance (MANCOVA) revealed that the mean scores for challenging behavior control significantly increased in the experimental group, while sensory processing problems significantly decreased. In conclusion, the integrated program of parent-child interaction, parent education, and family resilience is an effective approach for enhancing behavioral regulation and mitigating sensory processing challenges in children with high-functioning autism.
Keywords: High-functioning Autism Spectrum Disorder; Challenging Behaviors; Sensory Processing, Parent-Child Interaction; Family Resilience.
Extended Abstract
Introduction
"Autism spectrum disorder (ASD) is defined as a neurodevelopmental condition arising from dysregulation in brain development, characterized by deficits in social interaction alongside restrictive, repetitive, and inflexible behavioral patterns. These patterns often include rigid routines, rituals, intensely focused interests, sensory sensitivities, and motor stereotypies (Skoz et al., 2024). Recent evidence indicates a significant positive correlation between ASD severity, the emergence of challenging behaviors, and deficits in sensory processing integration (Costescu et al., 2024). Furthermore, sensory processing abilities exhibit high variability among individuals across the autism spectrum (Shearer et al., 2024). Imbalances in sensory processing can lead to secondary complications, including anxiety, depression, and compromised physical health, while sensory disintegration interferes with psycho-emotional development and shapes the broader ASD phenotype (Machado et al., 2024). Despite these challenges, autistic children often struggle to generalize skills learned in clinical settings to real-world environments. Moreover, the prolonged nature of recovery means that many families do not receive adequate psychological training regarding their child's rehabilitation or the continuous support needed to enhance family resilience. Consequently, the Integrated Parent-Child Interaction, Parent Education, and Family Resilience Program has been developed as a holistic child-and-family treatment approach. The present study, therefore, aims to investigate the effectiveness of this combined intervention on challenging behaviors and sensory processing in children with high-functioning ASD."
Research Question
The primary objective of this study is to determine the effectiveness of an integrated program—combining parent-child interaction therapy, parent education, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism.
Methodology
The intervention program was developed using a systematic thematic analysis approach. To design the curriculum, an initial pool of 140 articles—published within the last five years in peer-reviewed, high-impact journals—focusing on parent-child interaction, parent education, and family resilience was reviewed. Following a rigorous screening process based on relevance and methodological quality, 73 articles were selected for thematic synthesis. The extracted data were categorized into two primary domains: child-centered and family-centered interventions, resulting in the identification of 12 sub-components.
To ensure the technical robustness of the program, its content validity was evaluated by a panel of experts and professors. The Content Validity Ratio (CVR) was assessed using a three-point scale, while the Content Validity Index (CVI) was measured on a four-point Likert scale. The analysis yielded a CVR of 0.91 and a CVI of 0.96, both of which exceed the minimum acceptable thresholds. These results confirm that the integrated treatment program, encompassing parent-child interaction, parent education, and family resilience, possesses high content validity and is professionally suitable for clinical application.
Research Design: This study was an applied research project employing a quasi-experimental pre-test/post-test design with a control group.
Participants and Sampling: The target population consisted of children aged 5 to 8 years diagnosed with high-functioning autism spectrum disorder (ASD) by a psychiatrist, residing in Tehran in 2024 (1403 SH). Participants were recruited through an online call offering eight complimentary training sessions for high-functioning autistic children. From the pool of volunteers, 30 participants who met the inclusion criteria (including verbal communication skills and specific age range) were selected via convenience sampling and randomly assigned to either the experimental group (n = 15) or the control group (n = 15).
Procedure: Both groups underwent a pre-test assessment. The experimental group then participated in an integrated intervention program—combining parent-child interaction, parent education, and family resilience—consisting of eight sessions over a two-month period. During this interval, the control group received no intervention. Following the completion of the program, a post-test was administered to both groups to evaluate the changes.
Instruments: Data were collected using the Challenging Behavior Questionnaire (CBQ) and the Short Sensory Profile (SSP; Dunn, 1999).
Results
Table 1. Results of univariate analysis of covariance to investigate the effectiveness of the treatment program on research variables.
Variable
Sum of squares
Degree of freedom
Mean squares
F
Significance level
Effect size
Challenging behaviors
50/763
1
50/763
54/108
001/0>
83/0
Sensitivity
03/320
1
03/320
08/47
001/0>
67/0
Sensory avoidance
62/1123
1
62/1123
71/96
001/0>
81/0
Sensory sensitivity
05/446
1
05/446
73/69
001/0>
75/0
Sensory registration
27/902
1
27/902
79/117
001/0>
84/0
As presented in Table 4, the multivariate analysis of covariance (MANCOVA) revealed a significant difference between the experimental and control groups in the post-test phase regarding the mean scores of challenging behaviors and sensory processing subscales, including sensation seeking, sensory avoidance, sensory sensitivity, and sensory registration. An examination of the adjusted post-test means indicated that the experimental group demonstrated a significant improvement in challenging behavior control compared to the control group. Furthermore, children in the experimental group exhibited a significant reduction in sensory processing problems across all subscales relative to the control group. Consequently, these findings suggest that the integrated intervention program—incorporating parent-child interaction, parent education, and family resilience—is an effective approach for enhancing mothers' ability to manage challenging behaviors and mitigating sensory processing difficulties in children with high-functioning autism.
5. Discussion
In the current therapeutic landscape of Iran, families of children with autism often face a significant lack of comprehensive support, typically receiving only limited social welfare assistance. Furthermore, a substantial gap exists in clinical practice: parents are frequently excluded from the specifics of their child’s therapeutic sessions and often do not receive the specialized psychological training required to implement rehabilitation exercises at home. This lack of involvement hinders the generalization of learned skills from clinical settings to real-world environments. Additionally, while the child receives treatment, the psychological needs of the family—particularly the development of resilience—are often overlooked in continuous care models. Addressing these systemic gaps, the present study sought to evaluate the effectiveness of an integrated intervention program—combining parent-child interaction, parent training, and family resilience—on challenging behaviors and sensory processing in children with high-functioning autism.
Conclusion
The findings of this study demonstrate that integrated parent-child interaction significantly improves challenging behaviors in children with autism, aligning with recent evidence suggesting that parent-focused counseling is a robust strategy for behavioral reduction (Fatima et al., 2025). Regarding sensory processing, our results corroborate the work of Krupa-Kutara et al. (2023), who posited that enhancing parents' sensory cognition enables them to decode the underlying causes of their child's behaviors, thereby fostering a more supportive environment.
Furthermore, the effectiveness of the parent training component in our program is consistent with the seminal work of Scahill et al. (2016), which highlighted that because parents spend the most time with their children, their behavioral training is more effective in fostering adaptive skills. Similarly, Miller-Kuhaneck and Watling (2018) emphasized that family-centered coaching and training are highly effective for children with sensory integration challenges.
Finally, the role of family resilience in our intervention was pivotal. As noted by Sun and Hong (2024), while raising a child with autism presents immense challenges, professional support and increased resilience empower parents to create a nurturing family ecosystem. Moreover, the link between resilience and sensory processing observed in our study is supported by Rizk-Mohammad Abolanan (2024), who found that parental resilience is intrinsically tied to their specialized knowledge of autism. Collectively, these results suggest that addressing the family unit as a whole—rather than focusing solely on the child—creates a synergistic effect that improves both behavioral and sensory outcomes.
7.Acknowledgments
This article is derived from the first author’s PhD dissertation in Clinical Psychology at the University of Tabriz. The authors would like to thank the University of Tabriz for its support. This research was registered and approved by the Ethics Committee under the code: IR.TABRIZU.REC.1404.057.
Keywords
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