4. Discussion
neurodevelopmental impairments, fatigue, neurodevelopmental disabilities, neurodevelopmental disorders, disability, intellectual disabilities, autism
EVENTS
The ACT-based intervention for parents of children with neurodevelopmental disorders and intellectual disabilities was followed by a significant reduction in perceived stress, thought suppression, and PI. Additionally, changes in the suppression of private events and PF variables were statistically significant at post-intervention and follow-up. Statistical significance was also reached in changes in perceived stress during the follow-up period. The responses to punitive and hostile interactions with children who have intellectual and neurodevelopmental disabilities considerably decreased while responses to supportive and accompanying interactions rose. The effect size was large–medium for all the studied variables. In addition, the application of the intervention programme in the usual care context of the parents supports the ecological validity of the intervention. The results are similar to those found in recent ACT studies on parents of children with autism and neurodevelopmental disorders [The analysis of clinical change, as assessed through the RCI, allowed for us to conduct a more individualised study of behavioural changes. In line with the ACT hypotheses [The findings of this randomised clinical trial give us reason to assume that teaching parents in a group setting can be more efficient and effective because certain parents act as role models for others, forming a network of support among family members, particularly among women [Traditional behaviour modification programmes typically offer specific behavioural management instructions for the child with neurodevelopmental impairments and disabilities. However, ACT interventions focus not only on parents’ public behaviour but also on increasing their psychological well-being, not by promoting the control or reduction of discomfort but by incorporating strategies that allow for them to more flexibly relate to their private events, orienting them towards value-based parenting. Therefore, our intervention is focused at the stress derived from raising a child with neurodevelopmental disorders and intellectual disabilities, so that the improvement in the relationship with the unpleasant private events experienced by the parents may also affect the behaviour of the diagnosed child [However, there are still substantial limitations to this randomised clinical trial. Firstly, there are limitations derived from the small sample size of participants, which were revealed by the power analysis. The vital condition of the family members, the need for care for the diagnosed minors, and the fatigue derived from the journey through the care systems favour low adherence of the participants and the loss of experimental subjects. The results would be more generalisable if they included even more participants. Additionally, the majority of participants were females, in whom, it seems, the training is probably effective. Future research should, however, look at whether the same training is effective in a sample made up primarily of males. The different degrees of disability associated with the diagnosis of autism and the behavioural problems and different levels of punitive/hostile behaviours pre-intervention may be variables that interfere with the results and may affect the analysis of the intervention’s efficacy [This study aims to continue providing scientific evidence from the perspective of functional contextualism on the relevance of PF and its relationship with improvements in the quality of life of families with children with neurodevelopmental disorders and intellectual disabilities. Thus, PF acts as a core variable to facilitate conscious, self-directed and value-based parenting.