Purpose:
Children with autism spectrum disorder (ASD) are at high risk for challenging behaviors, and their parents need effective interventions to manage these behaviors. Stepping Stones Triple P (SSTP) is an evidence-based parent-mediated intervention designed for parents of children with developmental disabilities. This narrative review aimed to evaluate the evidence on the effectiveness of SSTP on child outcomes in children with ASD and examine implementation and acceptability indicators.
Methods:
This study is a narrative review. A comprehensive search was conducted in PubMed, Scopus, Web of Science, PsycInfo, and Google Scholar using relevant keywords. Of 714 identified articles, 11 studies met the inclusion criteria and were included in the narrative synthesis. Findings were analyzed using a narrative synthesis approach.
Results:
The seven quantitative studies reported significant reductions in challenging behaviors with effect sizes ranging from moderate to large (d = 0.78-1.24, η² = 0.16-0.26). Evidence for the program's effect on core autism symptoms was extremely limited and inconclusive. In the domain of social skills, two of three studies showed small to moderate improvements. The strongest effects were observed in the brief (4-session) and group versions.
Conclusion:
SSTP is a promising intervention for addressing challenging behaviors in children with ASD. Its adaptation for use in Iran requires cultural modifications to disciplinary strategies (e.g., Time-Out), implementation of the brief version due to resource constraints, and screening to identify families at risk of dropout. Further comparative research and high-quality randomized controlled trials (RCTs) are recommended to confirm its effectiveness and inform health policy in Iran