Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, restricted, repetitive patterns of behavior, and clinically significant impairment in functioning. Its prevalence is increasing globally, placing a significant burden on families. Caregivers of children with ASD experience heightened stress compared to those of children with other disabilities, facing challenges related to physical and mental health, parenting, family relationships, and finances. Current clinical recommendations often involve intensive, costly interventions difficult for many families to afford. In China, limited medical support exacerbates these economic burdens. Parent-implemented interventions (PIIs), also known as parent training or parent-mediated interventions, offer a cost-effective alternative, empowering parents to implement interventions in daily life settings. While some studies demonstrate PIIs' positive effects on motor skills, communication, and social behaviors in children with ASD, research specifically focusing on their impact on families in China is limited. Therefore, this study aims to test the effects of PIIs on children with ASD in China and explore their effects on the family quality of life, addressing the following research questions: (i) What are the effects of PIIs on the abilities of children with ASD in China? (ii) Does PIIs affect the family quality of life of families of children with ASD in China? If so, what are the effects?

Existing literature largely focuses on the effects of PIIs on children with ASD, with less attention paid to the impact on their families. Studies have demonstrated positive effects of PIIs on various aspects of children's development, particularly in social communication and adaptive behaviors. However, the benefits for families, particularly family quality of life, have not been extensively explored, especially in the Chinese context. Social support theory suggests that providing support can foster positive, sustainable development for families in distress. Given the lack of research on PIIs' impact on family quality of life and the need for replicable studies to inform policy and practice, this study aims to fill this gap in the Chinese context.

This study employed a randomized controlled trial (RCT) design with 70 children with ASD and their parents recruited from a public hospital specializing in neurodevelopmental disorders in China. Parents were included if they had at least a junior high school education, were biological parents of the child, and had complete parenting experience since diagnosis. Children were diagnosed with ASD and had detailed diagnostic reports. Participants were randomly assigned to either an intervention group (35 parent-child pairs) or a control group (35 parent-child pairs). The intervention group participated in 15 sessions of Caregiver Skills Training (CST), a program designed to enhance caregiver capacity in building their children’s communication, engagement, and daily living skills. Post-training, parents in the intervention group implemented interventions with their children for 5 months (90-120 minutes daily). Both groups received regular hospital-based rehabilitation training as usual. Data was collected using the Childhood Autism Rating Scale, Second Edition (CARS-2) to assess children's abilities and the Beach Center Family Quality of Life Scale (FQOL Scale) to assess family quality of life. Assessments were conducted pre-intervention, post-intervention, and after a 3-month follow-up. Data analysis involved 2 (group) x 3 (time point) repeated measures ANOVAs and paired-samples t-tests.

A total of 140 scales (70 for children, 70 for parents) were administered at each assessment point with 140 valid scales. Repeated measures ANOVAs revealed a significant main effect for time on both CARS-2 (F(2,67)=101.85, p<0.001) and FQOL Scale scores (F(2,67)=91.87, p<0.001). For CARS-2, group effects were non-significant in the pre-test but significant in the post-test and follow-up (p<0.05). The interaction effect between time and group was significant (F(2,67)=49.61, p<0.001). Paired t-tests on the intervention group indicated significant post-intervention improvements in imitation, emotional response, fear/nervousness, and non-verbal communication compared to pre-intervention scores. These improvements were partially maintained at the follow-up. Regarding the FQOL Scale, group effects were significant in the post-test and follow-up phases (p<0.001). Paired t-tests in the intervention group showed significant improvements in all five FQOL dimensions (family interaction, parenting, emotional well-being, physical/material well-being, and disability-related support) at post-intervention and some maintained at follow-up. Table 4 and 5 provides statistical details.

The findings support the effectiveness of PIIs in improving social communication abilities in children with ASD in China, aligning with previous research. The strong parent-child attachment often found in families of children with ASD may enhance the effectiveness of parent-mediated interventions. The structured nature of the CST program, focusing on parent understanding of ASD, parent-child communication, emotional regulation, and behavior management, aligns with the observed improvements. The combination of institutional and family interventions appears more effective than hospital-only interventions, suggesting PIIs offer a cost-effective and beneficial approach. The significant improvement in family quality of life (satisfaction) across multiple dimensions emphasizes PIIs' role in providing emotional, informational, and instrumental support to families.

This study demonstrates the effectiveness of PIIs in enhancing both the social communication skills of children with ASD and the quality of life of their families in China. PIIs are a valuable and cost-effective supplement to professional rehabilitation services. Future research should expand the sample to reflect China's diverse population, delve deeper into the factors influencing family quality of life, explore social policy interventions, and examine PIIs' applicability across different life stages of individuals with ASD.

The study's limitations include a sample drawn from a single source, limiting the generalizability of findings. Future studies should consider a broader, more representative sample across diverse regions and cultural backgrounds. Further research is needed to explore the specific factors affecting family quality of life in Chinese families of children with ASD. Given the lifelong nature of ASD, additional research is needed on the sustainability of PIIs and the need for ongoing support. The study only investigated family quality of life (satisfaction), and further research on the importance dimension could add valuable insights.