Comparing the Effectiveness of the Incredible Years Program and the Hanen Parent Training Program on Internalized Stigma Among Mothers of Children with Autism Spectrum Disorder

Niloufar Sadat Bashiri; Seyyedeh Olia Emadian; Seyyedeh Hamideh   Salim Bahrami

Authors

Niloufar Sadat Bashiri Ph.D. student in Educational Psychology, Sar.C., Islamic Azad University, Sari, Iran Author https://orcid.org/0009-0008-1896-8796
Seyyedeh Olia Emadian Assistant Professor, Department of Psychology, Sar.C., Islamic Azad University, Sari, Iran Corresponding author https://orcid.org/0000-0003-4227-9823
Seyyedeh Hamideh Salim Bahrami Assistant Professor, Department of Psychology, Sar.C., Islamic Azad University, Sari, Iran Author https://orcid.org/0009-0008-1026-0646

Keywords:

Incredible Years Program, Hanen Parent Training Program, Internalized Stigma, Mothers, Autism Spectrum Disorder

Abstract

Purpose: The present study aimed to compare the effectiveness of the Incredible Years Program and the Hanen Parent Training Program in reducing internalized stigma among mothers of children with autism spectrum disorder (ASD).

Methods and Materials: This quasi-experimental study employed a pretest–posttest design with a control group and follow-up assessment. The statistical population consisted of all mothers of children diagnosed with ASD who attended an autism center in Gorgan, Iran. Using G*Power software, the required sample size was estimated based on a statistical power of 0.80, an effect size of 0.50, and a significance level of 0.05. Accordingly, 45 eligible mothers were selected through purposive sampling and assigned non-randomly to three groups of 15 participants: the Incredible Years intervention group, the Hanen Parent Training intervention group, and the control group. Internalized stigma was assessed using the Internalized Stigma Questionnaire developed by Ritsher et al. Data collected across the pretest, posttest, and follow-up stages were analyzed using SPSS version 24. A two-way repeated-measures analysis of variance was employed to examine changes over time, between-group differences, and the interaction between time and intervention condition.

Findings: The inferential analyses indicated a statistically significant effect of time and a significant time-by-group interaction on internalized stigma (p < 0.05), demonstrating that changes in stigma differed significantly across the three study groups. Both the Incredible Years Program and the Hanen Parent Training Program produced significant reductions in internalized stigma from pretest to posttest, and these improvements were maintained at follow-up. Comparative analyses further indicated significant differences between the intervention groups and the control group, confirming the effectiveness of both parent-focused interventions in reducing internalized stigma among mothers of children with ASD.

Conclusion: The findings suggest that both the Incredible Years Program and the Hanen Parent Training Program can effectively reduce internalized stigma among mothers of children with ASD. By strengthening parenting competencies, enhancing understanding of the child’s developmental characteristics, and improving parents’ coping and interactional skills, these interventions may help mothers develop more adaptive perceptions of themselves and their parenting experiences. Accordingly, these structured parent-training programs may be incorporated into psychological and family-centered services provided to families of children with ASD.

Downloads

Download data is not yet available.

References

Bekhet, A. K., Johnson, N. L., & Zauszniewski, J. A. (2012). Effects of Resilience on the Relationship Between Stress and Quality of Life in Parents of Children with Autism Spectrum Disorder. Journal of the American Psychiatric Nurses Association, 18(6), 337-345.

Bitsika, V., & Sharpley, C. F. (2004). Stress, Anxiety and Depression Among Parents of Children with Autism Spectrum Disorder. Australian Journal of Guidance and Counselling, 14(2), 151-161. https://doi.org/10.1375/ajgc.14.2.151

Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A Randomized Controlled Trial of Hanen's More Than Words Intervention for Parents of Toddlers with Autism Spectrum Disorder. Journal of Child Psychology and Psychiatry, 52(7), 741-752. https://doi.org/10.1111/j.1469-7610.2011.02395.x

Corrigan, P. W., Larson, J. E., & Rüsch, N. (2014). Self-Stigma and the "Why Try" Effect: Impact on Life Goals and Evidence-Based Practices. World Psychiatry, 13(2), 119-120. https://doi.org/10.1002/wps.20054

Dalbert, C. (2009). Belief in a Just World. In Handbook of Individual Differences in Social Behavior (pp. 288-297). Guilford Press.

Divan, G., Vajaratkar, V., Desai, M. U., Strik-Lievers, L., & Patel, V. (2019). The Feasibility and Effectiveness of Parent Training for Autism Spectrum Disorder in Low- and Middle-Income Countries: A Systematic Review. Autism, 23(7), 1656-1670. https://doi.org/10.1177/1362361318803492

Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2014). Long-Term Outcomes of Early Intervention in 6-Year-Old Children with Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(5), 580-587. https://doi.org/10.1016/j.jaac.2014.02.008

Girolametto, L., Weitzman, E., & Greenberg, J. (2007). Changes in Parent-Child Interaction After Hanen Parent Programs for Toddlers with Developmental Delays. Journal of Speech-Language Pathology and Applied Behavior, 40(1), 27-41. https://doi.org/10.1044/1058-0360(2007/004)

Gray, D. E. (2002). "Everybody Just Freezes. Everybody Is Just Embarrassed": Felt and Enacted Stigma Among Parents of Children with High Functioning Autism. Sociology of Health & Illness, 24(6), 734-749. https://doi.org/10.1111/1467-9566.00316

Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., & Pickles, A. (2010). Parent-Mediated Communication-Focused Treatment in Children with Autism (PACT): A Randomized Controlled Trial. The lancet, 375(9732), 2152-2160. https://doi.org/10.1016/S0140-6736(10)60587-9

Hayes, S. A., & Watson, S. L. (2013). The Impact of Parenting Stress: A Meta-Analysis of Studies Comparing the Experience of Parenting Stress in Parents of Children with and Without Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 43(3), 629-642. https://doi.org/10.1007/s10803-012-1604-y

Hutchings, J., Pearson-Blunt, R., Pasteur, M., Fox, E., & Williams, M. E. (2017). The Incredible Years Parent Program with Families of Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 47(9), 2862-2873. https://doi.org/10.1007/s10803-017-3200-6

Kinnear, S. H., Link, B. G., Ballan, M. S., & Fischbach, R. L. (2016). Understanding the Experience of Stigma for Parents of Children with Autism Spectrum Disorder and the Role Stigma Plays in Families' Lives. Journal of Autism and Developmental Disorders, 46(3), 942-953. https://doi.org/10.1007/s10803-015-2637-9

Koohzad, N., Asgari, P., Heidari, A., Esmaeili, S., & Johari Fard, R. (2025). Mitigating Social Stigma and Enhancing Distress Tolerance: A Comparative Analysis of Mindfulness-Based Parenting Training and Transdiagnostic Interventions in Mothers of Autistic Children.

Kuhn, J. C., & Carter, A. S. (2006). Maternal Self-Efficacy and Associated Parenting Cognitions Among Mothers of Children with Autism. American Journal of Orthopsychiatry, 76(4), 564-575. https://doi.org/10.1037/0002-9432.76.4.564

Leijten, P., Melendez-Torres, G. J., Knerr, W., & Gardner, F. (2018). Transported Versus Homegrown Parenting Interventions for Reducing Disruptive Child Behavior: A Multilevel Meta-Regression Study. Journal of the American Academy of Child & Adolescent Psychiatry, 57(7), 530-540. https://doi.org/10.1016/j.jaac.2018.03.016

Leung, C., Sanders, M. R., Leung, S., Mak, R., & Lau, J. (2023). Effectiveness of the Incredible Years Program on Parental Stress and Child Behavior Problems: A Randomized Trial. Prevention Science, 24(5), 879-891. https://doi.org/10.1007/s11121-023-01542-w

Mak, W. W. S., & Cheung, R. Y. M. (2008). Affiliate Stigma Among Caregivers of People with Intellectual Disability or Mental Illness. Journal of Applied Research in Intellectual Disabilities, 21(6), 532-545. https://doi.org/10.1111/j.1468-3148.2008.00426.x

Mak, W. W. S., & Kwok, Y. T. Y. (2010). Internalization of Stigma for Parents of Children with Autism Spectrum Disorder in Hong Kong. Social Science & Medicine, 70(12), 2045-2051. https://doi.org/10.1016/j.socscimed.2010.02.023

McConachie, H., & Diggle, T. (2007). Parent Implemented Early Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review. Journal of Evaluation in Clinical Practice, 13(1), 120-129. https://doi.org/10.1111/j.1365-2753.2006.00674.x

McConachie, H., Parr, J. R., Livingstone, N., Morris, C., Beresford, B., & Couteur, A. L. (2021). Parent-Mediated Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review. Autism, 25(2), 357-372. https://doi.org/10.1177/1362361320951376

McConachie, H., Parr, J. R., & Team, P. (2021). Long-Term Outcomes of Parent-Mediated Interventions in Autism: A Follow-Up of Randomized Trials. Lancet Psychiatry, 8(6), 499-508. https://doi.org/10.1016/S2215-0366(21)00106-3

Morawska, A., & Sanders, M. R. (2009). Parenting Gifted and Talented Children: What Are the Key Parenting Challenges? Australasian Journal of Gifted Education, 18(1), 33-41.

Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent-Mediated Early Intervention for Young Children with Autism Spectrum Disorders (ASD). Cochrane Database of Systematic Reviews, 2013(4), CD009774. https://doi.org/10.1002/14651858.CD009774.pub2

Oppenheim, D., Mottes‐Peleg, M., Dolev, S., & Yirmiya, N. (2025). Play Interactions of Autistic Preschoolers With Their Mothers and Fathers Without Toys Yield More Positive Interactions Than Play With Toys. Autism. https://doi.org/10.1177/13623613251329975

Postorino, V., Sanges, V., Giovagnoli, G., Fatta, L. M., De Peppo, L., & Mazzone, L. (2020). The Incredible Years Parent Training Program in Children with Autism Spectrum Disorder: A Pilot Study. Journal of Autism and Developmental Disorders, 50(7), 2548-2562. https://doi.org/10.1007/s10803-019-03975-z

Postorino, V., Sharp, W. G., McCracken, C. E., Bearss, K., Burrell, T. L., Evans, A. N., & Scahill, L. (2017). A Systematic Review and Meta-Analysis of Parent Training for Disruptive Behavior in Children with Autism Spectrum Disorder. Clinical Child and Family Psychology Review, 20(4), 391-402. https://doi.org/10.1007/s10567-017-0237-2

Ramos-Serrano, L. (2025). “I Am Their Haven”: Mothering Experiences of Spanish Autistic Mothers. Neurodiversity, 3. https://doi.org/10.1177/27546330251349375

Reid, M. J., Webster-Stratton, C., & Hammond, M. (2003). Follow-Up of Children Who Received the Incredible Years Intervention for Oppositional Defiant Disorder: Maintenance and Booster Effects. Journal of Clinical Child and Adolescent Psychology, 32(4), 489-500. https://doi.org/10.1207/S15374424JCCP3204_2

Roberts, J., Williams, K., Carter, M., Evans, D., Parmenter, T., Silove, N., Clark, T., Warren, A., & Warren, S. (2011). A Randomised Controlled Trial of Two Early Intervention Programs for Young Children with Autism: Centre Based with Parent Program and Home Based. Journal of Autism and Developmental Disorders, 41(4), 475-488. https://doi.org/10.1007/s10803-010-1062-9

Rogers, S. J., Estes, A., Vismara, L., Munson, J., Zierhut, C., Greenson, J., & Lord, C. (2019). Enhancing Parent-Child Communication in Autism: A Randomized Controlled Trial of the Early Start Denver Model Parent Coaching Program. Journal of Autism and Developmental Disorders, 49(2), 623-641. https://doi.org/10.1007/s10803-018-3743-1

Tellegen, C. L., & Sanders, M. R. (2013). A Randomized Controlled Trial Evaluating a Brief Parenting Program with Children with Autism Spectrum Disorders. Journal of consulting and clinical psychology, 81(6), 1191-1205. https://doi.org/10.1037/a0034860

Webster-Stratton, C. (2011). The Incredible Years: Parents, Teachers, and Children's Training Series: Program Content, Methods, Research and Dissemination 1980-2011. Incredible Years.

Webster-Stratton, C., & Reid, M. J. (2010). The Incredible Years Parents, Teachers, and Children Training Series: A Multifaceted Treatment Approach for Young Children with Conduct Problems. In Evidence-Based Psychotherapies for Children and Adolescents (2nd ed., pp. 194-210). Guilford Press.

Werner, K., Clifford, J., & O'Hara, M. (2020). Parent-Child Interaction Therapy in Autism Spectrum Disorder: A Systematic Review. Clinical Child and Family Psychology Review, 23(2), 212-239. https://doi.org/10.1007/s10567-019-00299-8

Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Stepping Stones Triple P: A Parenting Program for Families with a Child Diagnosed with an Autism Spectrum Disorder. Journal of abnormal child psychology, 37(4), 469-480.

Xiang, Y., Zhan, X., Li, X., Wang, Y., & Kuang, Z. (2025). A Study of the Effects of Dance/Movement Therapy on Parenting Stress and Emotions in Mothers of Children With Autism Spectrum Disorder. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1465677

Yan, Y., & Abdullah, E. B. (2025). Clinical Interventions for Depression and Anxiety in Mothers of Children With Autism Spectrum Disorder in China. Ls, 1(3), 1-27. https://doi.org/10.71204/srdzv858

Zaidman-Zait, A., Mirenda, P., Duku, E., Vaillancourt, T., Smith, I. M., Segal, O., & Bennett, T. (2017). Impact of Personal and Social Resources on Parenting Stress in Mothers of Children with Autism Spectrum Disorder. Autism, 21(2), 155-166.

Zeng, W., Heyman, M., Jerome, S. J., Davis, M. L., & Akobirshoev, I. (2025). Longitudinal Trajectories of Maternal Stress for Mothers with Intellectual Disabilities and Borderline Intellectual Functioning: Evidence from the Future of Families and Child Wellbeing Study. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-025-06732-z