Autism spectrum disorder (ASD) is recognized the world over as a major public health issue. Autism is highly prevalent, persists across the lifespan, and is characterized by behaviors that can profoundly impair typical functioning. Interventions based on behavioral strategies have proven effective, but there are significant barriers to care, including cost, intensity of treatment, and access to qualified practitioners. The impact of ASD and obstacles to appropriate care are magnified by systemic limitations in developing countries. Parent training holds promise as a method of disseminating therapy to underserved areas. This study investigated the effectiveness of a pyramidal parent training intervention in Macedonia. Fifteen parents of children with ASD were trained in three specific strategies for promoting prosocial skills: eye contact, compliance, reducing restricted repetitive behaviors (RRB). Parents reported daily ratings of these skills and their own confidence, action or engagement, and family distress. Participants were ethnic Macedonians from the capital of Skopje with at least one child with ASD between the ages of 2 and 13 years. This study utilized a single case research design. Data were collected per and post intervention using an interrupted time series design. Individual response was analyzed visually and Tau U effect sizes were calculated. Moderator and mediator effect was considered following the method initially established by Gaynor and Harris (2008). Effect sizes were small but significant for the group overall for all variables except restricted repetitive behaviors (RRB). The program was especially effective for younger children, those with comorbid hyperactivity, those with low to moderate symptomology, and those with no prior special education services.



College and Department

David O. McKay School of Education; Counseling Psychology and Special Education



Date Submitted


Document Type





autism spectrum disorder, pervasive developmental disorders, behavior modification, developing nations, interpersonal competence, parent workshops, family environment