**3. Results**

Data analysis revealed that after the intervention parents of children with autism spectrum disorders were more satisfied with their cooperation with mental health professionals. Fol‐ lowing the implementation of the partnership protocol mental health professionals tended to blame parents less for their children's problems, gave them more information about their children's situation and directions on how they should behave, while they also recognized more their parental status.

#### **3.1. Parents of children with autism spectrum disorders**

#### *3.1.1. Baseline data*

The characteristics of a satisfactory cooperative relationship between parents and mental health professionals according to parents were: honesty, mutual briefing, mutual trust and setting common goals. Parents believed that cooperative mental health professionals pro‐ vide constant briefing on the child's progress (90%); implement the therapy with consistency (68%); are honest with parents (49%); recognize parental skills (40%); understand parental wishes and problems (35%); and really want to help (10%). Uncooperative mental health professionals, on the other hand, do not brief parents about their child's progress (88%); do not implement the therapy consistently (73%); are dishonest with parents (50%); do not un‐ derstand parental wishes and aspirations (43%); withhold information related to the therapy (23%); and are not knowledgeable about autism spectrum disorders (20%).

The vast majority of the parents (88%) thought that it is essential to cooperate with mental health professionals in order for the therapy to succeed and approximately 75% reported that they should actively participate in their child's therapy. The rest of the parents consid‐ ered that nothing can be done to alter the predetermined course that their children with au‐ tism spectrum disorders will follow. When a disagreement occurred with mental health professionals, most parents insisted and discussed with them when they believe that they were right, while they backed down when they were not certain. Parents defined negotia‐ tion as: clear expression of views from both sides; understanding with the child's progress as a common goal; arrangement of a time frame for the accomplishment of some results; and expression of realistic expectation from both parties. Indeed, almost 2/3 of parents (68%) re‐ ported that negotiation is essential for a successful therapeutic relationship. The advantages and the disadvantages that parents identified in their relationships with mental health pro‐ fessionals are presented in Tables 1 and 2 respectively.

Collaboration Between Parents of Children with Autism Spectrum Disorders and Mental Health Professionals http://dx.doi.org/10.5772/53966 539


**Table 1.** Advantages of Working with Mental Health Professionals According to the Parents of Children with Autism Spectrum Disorders


**Table 2.** Disadvantages of Working with Mental Health Professionals According to the Parents of Children with Autism Spectrum Disorders

#### *3.1.2. Post-intervention data*

answer some additional questions about the protocol. The answers of the participants in the open-ended questions were explored with thematic analysis, which led to the categories that are presented. A second rater with experience with this type of analysis looked at approxi‐ mately half of the data and the interrater reliability was extremely satisfactory (95.7%).

Data analysis revealed that after the intervention parents of children with autism spectrum disorders were more satisfied with their cooperation with mental health professionals. Fol‐ lowing the implementation of the partnership protocol mental health professionals tended to blame parents less for their children's problems, gave them more information about their children's situation and directions on how they should behave, while they also recognized

The characteristics of a satisfactory cooperative relationship between parents and mental health professionals according to parents were: honesty, mutual briefing, mutual trust and setting common goals. Parents believed that cooperative mental health professionals pro‐ vide constant briefing on the child's progress (90%); implement the therapy with consistency (68%); are honest with parents (49%); recognize parental skills (40%); understand parental wishes and problems (35%); and really want to help (10%). Uncooperative mental health professionals, on the other hand, do not brief parents about their child's progress (88%); do not implement the therapy consistently (73%); are dishonest with parents (50%); do not un‐ derstand parental wishes and aspirations (43%); withhold information related to the therapy

The vast majority of the parents (88%) thought that it is essential to cooperate with mental health professionals in order for the therapy to succeed and approximately 75% reported that they should actively participate in their child's therapy. The rest of the parents consid‐ ered that nothing can be done to alter the predetermined course that their children with au‐ tism spectrum disorders will follow. When a disagreement occurred with mental health professionals, most parents insisted and discussed with them when they believe that they were right, while they backed down when they were not certain. Parents defined negotia‐ tion as: clear expression of views from both sides; understanding with the child's progress as a common goal; arrangement of a time frame for the accomplishment of some results; and expression of realistic expectation from both parties. Indeed, almost 2/3 of parents (68%) re‐ ported that negotiation is essential for a successful therapeutic relationship. The advantages and the disadvantages that parents identified in their relationships with mental health pro‐

(23%); and are not knowledgeable about autism spectrum disorders (20%).

**3. Results**

more their parental status.

538 Recent Advances in Autism Spectrum Disorders - Volume I

*3.1.1. Baseline data*

**3.1. Parents of children with autism spectrum disorders**

fessionals are presented in Tables 1 and 2 respectively.

Most parents (87%) stated that the partnership protocol was useful, because it provides a clear context for the relationships between parents and mental health professionals, it de‐ fines the roles of both parties, it promotes the positive cooperation that contributes to the child's progress and it familiarizes parents with their rights. The remaining 13% claimed that the protocol is not useful because it is binding and difficult to adhere to. Some parents said that the protocol should also clarify which qualifications mental health professionals should hold in order to work with children with autism spectrum disorders and what pa‐ rents can do if mental health professionals do not follow the protocol.

The most important points of the partnership protocol were: ensured cooperation, honest re‐ lationships, understanding of parental limitations, parental participation in decision-mak‐ ing, and recognition of parental needs and emotions. Parents referred to the protocol every time that something changed in their child's therapy or a problem came up, as well as in case of disagreement with mental health professionals. The changes that parents observed in their relationship with mental health professionals after the implementation of the protocol were: parents and mental health professionals cooperated more effectively (32%); mental health professionals offered psychological support to parents (25%); mental health profes‐ sionals took parental needs and expectations into account (19%); parents learned how to act as therapists for their children at home (13%); a time frame was set for the therapy (9%); and mental health professionals did not treat parents just as an income source (3%).

the therapy, setting mutual goals, discussing new possibilities, and compromising, if neces‐ sary. The advantages and the disadvantages that mental health professionals identified in

Collaboration Between Parents of Children with Autism Spectrum Disorders and Mental Health Professionals

1. Interest in their child's therapy 38 95 2. Willing to devote time to their child 35 88 3. Realistic expectations about their child's progress 27 68 4. Active participation in their child's therapy at home 22 55 5. Source of important information for the child 19 48 6. Willing to cooperate with mental health professionals 14 35 7. Trust mental health professionals 10 25 8. Wish a better future for their child 9 23 9. Encourage other family members to participate in therapy 6 15

**Table 3.** Advantages of Working with Parents of Children with Autism Spectrum Disorders According to Mental

1. No understanding of the child's condition 33 83 2. Emotional overload 30 75 3. Provision of inaccurate information 29 73 4. Refusal to engage actively in therapy 25 63 5. Exaggerated and unrealistic expectations 25 63 6. Unwillingness to cooperate 20 50 7. Lack of trust in mental health professionals 18 45 8. Feelings of parenting inadequacy 16 40 9. Insecurity for their child's future 15 38 10. Parental disagreements about their child 13 33 11. Rejection of the diagnosis of autism spectrum disorders 10 25 12. Experience of guilt over the child's condition 8 20 13. Crossing the boundaries (e.g., calling in the middle of the night) 6 15 14. Insisting on their views, even when they are wrong 10 4

**Table 4.** Disadvantages of Working with Parents of Children with Autism Spectrum Disorders According to Mental

Most mental health professionals (80%) claimed that the partnership was useful, because it sets the boundaries of the cooperation, it promotes negotiation, it emphasizes mutual re‐ spect, it clarifies the need for parental involvement in the therapeutic process and mental health professionals have a reference point in case of disagreement. The remaining 20% stat‐

Health Professionals

Health Professionals

*3.2.2. Post-intervention data*

**Ν %**

541

http://dx.doi.org/10.5772/53966

**Ν %**

their relationships with parents are presented in Tables 3 and 4 respectively.

#### *3.1.3. The attitudes of parents of children with autism spectrum disorders towards mental health professionals*

Paired-samples t-test was use to compare differences in parental attitudes towards mental health professionals before and after the implementation of the partnership protocol. Before the intervention (Μ = 31.95, SD = 8.64) parents expressed statistically significant less positive attitudes towards mental health professionals (*t(1, 39)* = 107.25, *p* < 0.001, *η<sup>2</sup>* = 0.73) than after the intervention (Μ = 28.65, SD = 7.67).

#### **3.2. Mental health professionals**

#### *3.2.1. Baseline data*

The characteristics of a satisfactory cooperative relationship between parents and mental health professionals according to mental health professionals were: the exchange of ideas about the child, shared decision-making, mutual trust and respect, will to negotiate, and fre‐ quent contact. Mental health professionals believed that cooperative parents provide accu‐ rate information about their children (78%); follow their advise (68%); are honest about their child's condition (50%); are interested to learn more about their child (43%); do not have un‐ reasonable expectations for their child's progress (42%); and actively participate in their child's treatment. Uncooperative parents, on the other hand, provide inaccurate information about their children (80%); question the mental health professional (60%); do not understand their child's condition (53%); do not keep certain agreements (45%); have irrational demands for their child's progress (38%); do not participate in their child's therapy (25%); and do not behave consistently (20%).

The vast majority of mental health professionals (93%) claimed that it is necessary to cooper‐ ate with parents for the success of the therapeutic intervention, since parents: possess valua‐ ble knowledge about their child that can be used in therapy, can complement the therapist's work and spend a lot of time with the child. In order to ensure parental cooperation, mental health professionals make parents feel more comfortable; brief them regularly about their child's progress; show sensitivity to the child's problems; express positive attitudes towards the child and the parents; promote parental beliefs that their child can improve with the proper therapy and support; take parental needs and wishes into account; engage parents in decision-making; gain parental trust; and try to specialize in autism spectrum disorders.

When mental health professionals disagree with parents, they tend usually to have an open and honest discussion with them, to engage them in decision-making, to be discrete, and to present their arguments. They may even resort to another mental health professional and in the end they make the final decisions if they cannot reach an agreement with the parents. Mental health professionals defined negotiation as exchange of ideas with the child's inter‐ est in mind, defining the boundaries of the cooperation, determining the expectations from the therapy, setting mutual goals, discussing new possibilities, and compromising, if neces‐ sary. The advantages and the disadvantages that mental health professionals identified in their relationships with parents are presented in Tables 3 and 4 respectively.


**Table 3.** Advantages of Working with Parents of Children with Autism Spectrum Disorders According to Mental Health Professionals


**Table 4.** Disadvantages of Working with Parents of Children with Autism Spectrum Disorders According to Mental Health Professionals

#### *3.2.2. Post-intervention data*

sionals took parental needs and expectations into account (19%); parents learned how to act as therapists for their children at home (13%); a time frame was set for the therapy (9%); and

*3.1.3. The attitudes of parents of children with autism spectrum disorders towards mental health*

Paired-samples t-test was use to compare differences in parental attitudes towards mental health professionals before and after the implementation of the partnership protocol. Before the intervention (Μ = 31.95, SD = 8.64) parents expressed statistically significant less positive attitudes towards mental health professionals (*t(1, 39)* = 107.25, *p* < 0.001, *η<sup>2</sup>* = 0.73) than after

The characteristics of a satisfactory cooperative relationship between parents and mental health professionals according to mental health professionals were: the exchange of ideas about the child, shared decision-making, mutual trust and respect, will to negotiate, and fre‐ quent contact. Mental health professionals believed that cooperative parents provide accu‐ rate information about their children (78%); follow their advise (68%); are honest about their child's condition (50%); are interested to learn more about their child (43%); do not have un‐ reasonable expectations for their child's progress (42%); and actively participate in their child's treatment. Uncooperative parents, on the other hand, provide inaccurate information about their children (80%); question the mental health professional (60%); do not understand their child's condition (53%); do not keep certain agreements (45%); have irrational demands for their child's progress (38%); do not participate in their child's therapy (25%); and do not

The vast majority of mental health professionals (93%) claimed that it is necessary to cooper‐ ate with parents for the success of the therapeutic intervention, since parents: possess valua‐ ble knowledge about their child that can be used in therapy, can complement the therapist's work and spend a lot of time with the child. In order to ensure parental cooperation, mental health professionals make parents feel more comfortable; brief them regularly about their child's progress; show sensitivity to the child's problems; express positive attitudes towards the child and the parents; promote parental beliefs that their child can improve with the proper therapy and support; take parental needs and wishes into account; engage parents in decision-making; gain parental trust; and try to specialize in autism spectrum disorders.

When mental health professionals disagree with parents, they tend usually to have an open and honest discussion with them, to engage them in decision-making, to be discrete, and to present their arguments. They may even resort to another mental health professional and in the end they make the final decisions if they cannot reach an agreement with the parents. Mental health professionals defined negotiation as exchange of ideas with the child's inter‐ est in mind, defining the boundaries of the cooperation, determining the expectations from

mental health professionals did not treat parents just as an income source (3%).

*professionals*

the intervention (Μ = 28.65, SD = 7.67).

540 Recent Advances in Autism Spectrum Disorders - Volume I

**3.2. Mental health professionals**

*3.2.1. Baseline data*

behave consistently (20%).

Most mental health professionals (80%) claimed that the partnership was useful, because it sets the boundaries of the cooperation, it promotes negotiation, it emphasizes mutual re‐ spect, it clarifies the need for parental involvement in the therapeutic process and mental health professionals have a reference point in case of disagreement. The remaining 20% stat‐ ed that the protocol is not useful because it is binding and parents who are not educated cannot understand it. Some mental health professionals said that the protocol should clarify how much time mental health professionals should devote to parents, what happens when parents do not follow the protocol, and for which third parties mental health professionals should get the consent of the parents before they disclose information about their children.

**4. Discussion**

**health professionals**

they have observed in their interactions.

with other research [24, 28, 117].

The research hypotheses were confirmed, since both parents of children with autism spec‐ trum disorders and mental health professionals expressed more positive attitudes about each other after the implementation of the partnership protocol. Most participants felt that the partnership protocol was particularly useful and they also identified some points that could be further clarified, while they also pointed out the exact nature of the changes that

Collaboration Between Parents of Children with Autism Spectrum Disorders and Mental Health Professionals

http://dx.doi.org/10.5772/53966

543

**4.1. The attitudes of parents of children with autism spectrum disorders towards mental**

Most parents of children with autism spectrum disorders believed from the beginning that it was imperative to work together with mental health professionals in order to enhance their child's progress, while the rest believed that their child's progress was predetermined and there was nothing they could do to change that. Parents define a cooperative relationship as a relationship that is characterized by honesty, mutual briefing, mutual trust, and setting common goals [27]. The information that parents receive from mental health professionals is

Parents describe cooperative mental health professionals as constant providers of update regarding their child's progress, consistent, honest, understanding, willing to help, and aware that parents possess certain skills. So, the parents in this study have identified es‐ sentially the defining characteristics of cooperative relationships [77]. Parents cannot co‐ operate with mental health professionals who do not brief them, are inconsistent and insincere, ignore them, withhold information and are not well trained – in agreement

The implementation of the partnership protocol helped the parents of children with autism spectrum disorders to redefine their cooperative relationship with mental health professio‐ nals. They learned to function as therapists at home, facilitating thus the therapeutic process [25-26]. They received emotional support from mental health professionals and they set a time frame for some therapeutic goals, which could help them feel less stressed [146]. Most parents reported that after the intervention mental health professionals treated them as more equals, briefed them about their child's progress, engaged them more actively in the therapeutic process, and took their feelings and opinions into consideration. This change may be due to the fact that a trusting relationship was created through the protocol, which helped the parents express themselves more freely and become more assertive. Trust is im‐ perative for the creation of a constructive cooperative relationship between mental health professionals and parents of children with disabilities [104]. Many parents actively seek to

An additional change that was reported by the parents of children with autism spectrum disorders was that the mental health professionals started briefing them more about the ways in which the proposed therapy will help their child and encouraged them to get ac‐

more important to them than sympathy or psychological support [144-145].

create this bond of trust, since they feel that it will benefit their child [11, 117].

The most important points of the partnership protocol were: the negotiation of the bounda‐ ries of the relationship between parents and mental health professionals, the clarification of the roles of both sides, and the emphasis placed on active parental involvement in their child's therapy. Mental health professionals referred to the protocol every time there was a disagreement with parents. The changes that mental health professionals observed in their relationship with parents after the implementation of the protocol were: parental expecta‐ tions became more relevant to the child's condition (93%); parents realized that the whole family should be part of the therapy (80%); initial tensions were normalized (75%); parents felt that their expectations and emotions were taken into account (65%); parents were more committed to the therapy (58%); parents were more open to new suggestions and treatments for their child (35%); parents made less calls of hypothetical crises (23%).

#### *3.2.3. The attitudes of mental health professionals towards parents of children with autism spectrum disorders*

Analysis with MANOVA revealed that there was a statistically significant change in four out of the five subscales that measured the attitudes of mental health professionals towards the parents of children with autism spectrum disorders, even after being controlled for age, gender, and years of professional experience. More specifically, there were statistically sig‐ nificant changes in parental incrimination (*F(1, 39)* = 5.56, *p* < 0.05, *η<sup>2</sup>* = 0.12); necessity of in‐ forming parents (*F(1, 39)* = 5.03, *p* < 0.05, *η<sup>2</sup>* = 0.11); recognition of parental status (*F(1, 39)* = 4.83, *p* < 0.05, *η<sup>2</sup>* = 0.10); and providing guidance to parents (*F(1, 39)* = 5.35, *p* < 0.05, *η<sup>2</sup>* = 0.12). There was no statistically significant difference in the attitudes that mental health professionals ex‐ pressed towards drug use before and after the intervention (*F(1, 39)* = 0.96, *p* > 0.05, *η<sup>2</sup>* = 002). Means and standard deviations are presented in Table 5.


**Table 5.** Means and Standard Deviations of the Attitudes of Mental Health Professionals Towards Parents of Children with Autism Spectrum Disorders Before and After the Intervention
