Family therapy for autism spectrum disorders

Review question

What is the evidence that family therapy can help to improve communication, strengthen relationships, and enhance coping, mental health and well-being for people who have autism spectrum disorders (ASDs) or their family members, or both?

Background

People with ASD often experience difficulty with knowing how to communicate with others, and with developing and maintaining friendships and relationships. They can also find it difficult to manage changes to their routine. People with ASD tend to rely on family members, including parents and siblings, well into adulthood. Family members of people with ASD sometimes experience stress, anxiety and depression.

Several research studies have investigated the benefits of talking therapies for individuals with ASD or for family members. While study findings suggest that these therapies can improve communication and coping, and mental health and well-being, outcomes are usually reported for the person with ASD or family members, but not both.

Family therapy is designed to help people within the family make sense of difficult situations, and help them work together to develop new ways of thinking about and managing these difficulties. It is important to find out if family therapy can be helpful for people with ASD and their relatives given that the core symptoms of ASD, and additional difficulties people can experience, often impact on the family unit.

We searched for all the available evidence, published or unpublished, up until 16 January 2017, which examined family therapy for ASD.

Study characteristics

While there have been a few studies investigating the benefits of family therapy interventions for ASD, none have compared family therapy with either no treatment, a group of people waiting to start treatment, or another type of psychological therapy. There is one study awaiting classification.

Quality of the evidence

There is limited high-quality evidence available about whether family therapy is helpful for people with ASD or their family members. More research studies are needed to evaluate the effectiveness of family-focused interventions to enhance communication, reduce stress and improve coping.

Authors' conclusions: 

Few studies have examined the effectiveness of family therapy for ASD, and none of these are RCTs. Further research studies employing methodologically robust trial designs are needed to establish whether family therapy interventions are clinically beneficial for enhancing communication, strengthening relationships, augmenting coping and reducing mental health morbidity for individuals with ASD and family members.

Read the full abstract...
Background: 

Autism spectrum disorders (ASDs) are characterised by impairments in communication and reciprocal social interaction. These impairments can impact on relationships with family members, augment stress and frustration, and contribute to behaviours that can be described as challenging. Family members of individuals with ASD can experience high rates of carer stress and burden, and poor parental efficacy. While there is evidence to suggest that individuals with ASD and family members derive benefit from psychological interventions designed to reduce stress and mental health morbidity, and enhance coping, most studies to date have targeted the needs of either individuals with ASD, or family members. We wanted to examine whether family (systemic) therapy, aimed at enhancing communication, relationships or coping, is effective for individuals with ASD and their wider family network.

Objectives: 

To evaluate the clinical effectiveness and acceptability of family therapy as a treatment to enhance communication or coping for individuals with ASD and their family members. If possible, we will also seek to establish the economic costs associated with family therapy for this clinical population.

Search strategy: 

On 16 January 2017 we searched CENTRAL, MEDLINE, Embase, 10 other databases and three trials registers. We also handsearched reference lists of existing systematic reviews and contacted study authors in the field.

Selection criteria: 

Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of family therapy for young people or adults with ASD or family members, or both, delivered via any modality and for an unspecified duration, compared with either standard care, a wait-list control, or an active intervention such as an alternative type of psychological therapy.

Data collection and analysis: 

Two authors independently screened each title and abstract and all full-text reports retrieved. To enhance rigour, 25% of these were independently screened by a third author.

Main results: 

The search yielded 4809 records. Of these, we retrieved 37 full-text reports for further scrutiny, which we subsequently excluded as they did not meet the review inclusion criteria, and identified one study awaiting classification.

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