Adaptation of Parent Target Problems for Blinded, Idiographic Outcome Measurement of Caregiver Skills Training Interventions

Abstract Measuring individualised, clinically meaningful developmental outcomes in autistic children remains challenging. The Parent Target Problems (PTP; Arnold et al. 2003) provides a brief, idiographic framework based on parent‑nominated concerns, but its original use is restricted to challenging behaviour and hyperactivity. We adapted the PTP by expanding its scope to encompass a wider range of developmental domains and by introducing a standardized baseline severity rating. We evaluated the feasibility, inter‑rater reliability, and concurrent validity of this revised protocol within a pilot trial of the WHO Caregiver Skills Training (CST). The adapted PTP was applied to a sample of 30 caregivers of autistic children (aged 3 to 8 years) participating in a pilot trial of CST delivered remotely in public clinical centres in Northern Italy. Narratives of parent-nominated problems, elicited without setting restrictions on problem domain, were collected at baseline, 3-month treatment endpoint and 6-months follow-up (n=168). Narratives were rated with good to excellent agreement by four expert judges for vignette quality, baseline problem severity (ICC range: 0.75–0.90) and improvement at endpoint and follow-up (ICC = 0.93). The PTP interviews were feasibly administered as per protocol within 10 minutes. PTP endpoint and follow-up improvement scores were strongly correlated with each other and not associated with baseline problem severity. Improvement scores correlated in the expected direction with caregiver adherence measures and caregiver competency. Findings indicate that PTP narratives may offer a systematic, reliable, and valid way to track meaningful, individualised outcomes in children with developmental disabilities in clinical trials and clinical practice.