2024 Grant Recipient:
Sini LI, PhD Candidate of the The Chinese University of Hong Kong, and her co-investigators; Dr. Waitong Chien and Dr. Kamki LAM (The Chinese University of Hong Kong) are proud to be the recipients of the 2024 ACBS Foundation Grant for Sini LI's randomized controlled trial of an ACT-based parenting program for parents and autistic children.
Parents of children with a diagnosis of autism spectrum disorder (ASD) often experience significant stress and emotional difficulties due to the demands of caregiving and the complex nature of their children's condition. This research proposal aims to evaluate the effectiveness of an acceptance and commitment therapy (ACT)-based parenting program in improving parental stress, depressive symptoms, anxiety symptoms, psychological flexibility, self-efficacy, as well as children’s emotional and behavioral problems, when compared with the usual-care-only. By helping parents develop acceptance, psychological flexibility, and strategies to break free from unhelpful patterns of thinking and behavior, this program can empower them to effectively manage their psychological experiences and flexibly respond to their children’s needs and conditions.
The study will be conducted as a randomized controlled trial, with participants randomly assigned in 1:1 ratio to either the intervention group or the control group. Participants in control group will receive routine services from their children’s special education school as usual-care. Participants in the intervention group, in addition to usual-care, will receive a group-based, blended format (using both face-to-face and online modalities), and eight-weekly-session ACT-based parenting program and a workbook to facilitate recap and home practice. The data will be collected after recruitment (T0), immediate post-intervention (T1), and three-month post-intervention (T2).
This trial fills a crucial evidence gap by evaluating a new intervention program for parents of autistic children, addressing their diverse informational, emotional, and relational needs within the care pathway. By providing targeted and holistic support, parents, autistic children, and family members can benefit in the short and long term. This study would be the first to examine the effectiveness of an ACT-based parental training program for Chinese parents of autistic children. If this program is shown to be helpful, it will fill an important evidence gap in existing care pathways in China and worldwide.
Results of Sini LI's research -
Outputs and Deliverables:
The project produced two manuscripts based on the trial, both currently under journal peer review. The main randomized controlled trial (N = 154) found that an ACT-based parenting program plus usual care significantly reduced parenting stress at both T1 and T2 (medium-to-large effects), increased psychological flexibility and parenting competence at T1 and T2 (medium-to-large effects), and reduced children’s emotional and behavioral problems at T1 and T2 (medium effects). Reductions in parental depressive and anxiety symptoms were evident at T1 (small effects) but were not sustained at T2. The secondary analysis, using cross-lagged panel models, showed that improvements in psychological flexibility or parenting competence at T1 mediated the intervention’s effects on lower parenting stress and fewer child emotional/behavioral problems at T2. Psychological flexibility also partially mediated pathways from parenting stress to child problems across all time points, whereas parenting competence mediated this pathway at baseline only. Beyond publications, we developed a complete, shareable intervention package (session plans, slides, metaphor/role-play scripts, experiential mindfulness exercises, and a parent workbook with homework and QR-linked audio/video resources) and established a fidelity monitoring procedure using an ACT Fidelity Checklist with session audio review. We also compiled cleaned, de-identified datasets with R and Mplus analysis scripts (available on reasonable request under ethics approval) and produced implementation briefs, conference abstracts, and slide decks to support dissemination and scale-up.
Impact and benefits to the researchers, CBS, and society at large
For researchers, this project strengthened trial conduct and analytic capabilities (multi-site RCT, ITT with GEE, missing-data handling, longitudinal mechanism testing via cross-lagged models), established a reproducible ACT-based parenting protocol with fidelity infrastructure, and built durable partnerships with rehabilitation institutions and an interdisciplinary advisory network—foundations for future multi-region trials and adaptation studies. For ACBS/contextual behavioral science, the project delivers high-quality, mechanism-informed evidence that an ACT-based parenting approach improves parent and child outcomes in ASD, with sustained gains plausibly carried by increases in psychological flexibility and parenting competence. It advances process-based therapy by mapping temporal mediation pathways in a non-Western setting and contributes practical know-how for hybrid delivery in community services. For society and service systems, the program offers a feasible, group-based, cost-conscious option that alleviates caregiver burden and improves child behavioral outcomes, with potential downstream reductions in demand on educational and rehabilitation services. The model is exportable to low-resource and technology-assisted settings and provides policy-relevant evidence to embed caregiver mental health support within ASD care pathways in China and beyond.