Effect of Occupational Therapy with Mindfulness Training on the Mental Health of Parents of Children with Autism Spectrum Disorder: A Quasi-Experimental Study

DISCUSSION

This study looked at how occupational therapy with mindfulness training affects the health of parents of children with autism spectrum disorder. Both groups of parents got better over the eight weeks of therapy, and the group that received mindfulness training along with therapy did even better than the group that received only occupational therapy. The parents who received mindfulness training showed greater psychological well-being and were more mindful in their daily lives.

A. Sample Characteristics

Most of the parents in this study were mothers, which was expected, since mothers usually take on more of the caregiving and can feel more stressed and tired as a result. More than half of the children in this study had moderate autism, meaning their parents had substantial caregiving demands. Most of the families in this study were nuclear, so parents often carried out caregiving with less extended-family support. In most families the father was recorded as the head of the household, which is common in this setting; this pattern can still leave mothers with most of the day-to-day caregiving. Some parents in this study had a family history of illness or had received treatment before, which can make them more vulnerable to caregiving-related difficulties. Autism spectrum disorder and the mental health of parents of children with autism spectrum disorder are both important considerations in this study of occupational therapy with mindfulness training.

B. Effect of Occupational Therapy with Mindfulness Training

The experimental group demonstrated large, statistically significant improvements on both the GHQ-28 and FFMQ-39 following the combined intervention, supporting the alternative hypothesis. This finding aligns with previous work showing that structured mindfulness programmes integrated with occupational therapy reduce stress, anxiety, and depression while enhancing psychological well-being in parents of children with developmental disabilities (Ridderinkhof et al., 2018; Sarang & Telles, 2020). Mindfulness-based practices such as breath awareness, meditation, and body scanning are thought to enhance interoceptive awareness, helping parents recognise and regulate somatic markers of chronic stress (Grossman et al., 2004; Kabat-Zinn, 1990). These behavioural gains are consistent with neuroscientific accounts of mindfulness training, which describe increased prefrontal cortical engagement and reduced amygdala reactivity, together with structural changes in the hippocampus and insula that support emotional regulation and bodily awareness (Brewer et al., 2011; Farb et al., 2007; Hölzel et al., 2011; Tang et al., 2015). It is plausible that the mindfulness component of the experimental protocol contributed to the larger post-intervention gains observed in this study through these same mechanisms, although this study did not directly assess neurophysiological outcomes.

C. Effect of Conventional Occupational Therapy

The control group received training in coping strategies, parent training, relaxation techniques, group therapy and social skills training, without any mindfulness component. This group also showed improvement on the outcome measures. Coping-strategy training is beneficial because it helps people manage their emotions and problems, building resilience and reducing anxiety and depression (Aldao et al., 2010; Folkman & Moskowitz, 2004), including among parents of children with autism (Lin et al., 2023). Parent training supports emotional and behavioural regulation (Bearss et al., 2015; Rutherford et al., 2015). Relaxation techniques help reduce stress (Zeidan et al., 2010), and social-skills training helps people become more empathetic and get along better with others (Iacoboni, 2009; Laugeson et al., 2012; Lindenberg et al., 2011). These components, which are all normally part of occupational therapy practice, likely accounted for the improvement observed in the control group even without any mindfulness training.

D. Between-Group Comparison

Baseline GHQ-28 and FFMQ-39 scores did not differ significantly between groups, indicating that allocation to experimental and control conditions produced comparable groups prior to intervention. At post-test, the experimental group showed significantly greater improvement than the control group across all GHQ-28 and FFMQ-39 domains, indicating that the addition of structured mindfulness training conferred an incremental benefit over conventional occupational therapy alone. This pattern is consistent with prior findings that an eight-week mindfulness-based stress reduction programme integrated with occupational therapy produces greater gains in grey matter density, connectivity, and cortical thickness, alongside reduced amygdala activity, than standard care (Sarang & Telles, 2020). Within occupational therapy practice, cultivating present-moment, non-judgemental awareness may complement standard strategies that promote engagement in meaningful roles and routines, offering a combined behavioural and attentional pathway to improved emotional regulation and resilience in parents caring for a child with autism.

E. Limitations

This study has several limitations. The sample was drawn predominantly from mothers, limiting representation of fathers and other caregivers. Convenience sampling from two centres may limit generalisability of the findings to the wider population of parents of children with autism. Reliance on self-report outcome measures introduces potential response bias. Finally, the study assessed only parental outcomes and did not examine corresponding changes in child behaviour or family functioning.

CONCLUSION

Occupational therapy with mindfulness training produced significantly greater improvements in psychological well-being and dispositional mindfulness than conventional occupational therapy alone among parents of children with autism spectrum disorder. Both interventions were associated with meaningful within-group improvement, but the addition of structured mindfulness training conferred a clear incremental benefit. Given its low cost, minimal equipment requirements, and suitability for delivery in both clinical and home settings, occupational therapy with mindfulness training merits consideration as an adjunct intervention to support the mental health of parents caring for children with autism, in both resource-limited and well-resourced settings.

Recommendations for Future Research

Future studies would benefit from incorporating objective physiological markers alongside self-report measures, examining gender differences in caregiver response to intervention, extending recruitment to caregivers beyond parents, and assessing child behavioural outcomes following parent-directed intervention.

DECLARATIONS

Ethical Approval: This study was approved by the Institutional Ethics Committee of SRM Medical College Hospital and Research Centre (SRMIEC-ST0424-1316). Written informed consent was obtained from all participants.

Conflict of Interest: The authors declare no conflict of interest.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Acknowledgements: The authors thank the participants and the staff of SRM College of Occupational Therapy for their support during this study.

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