). Given the large literature on the importance of these skills as predictors of later development, early interventions have increasingly targeted these skills, especially for very young Lixisenatide web children (Kasari, et al., 2005). The foundational nature of these skills for the ability of children to develop relationships with others leads researchers to consider order C.I. 75535 parents as important mediators of change and potential targets of intervention. However, the current evidence for parent-mediated interventions for children with ASD is mixed. For example, experimental low intensity, three-month, short-term parent-mediated interventions for very young children who are at risk for ASD have not demonstrated significantly greater change in parent and child outcomes relative to community-based, treatment-as-usual interventions (Carter et al., 2011; Rogers et al., 2012). Longer -term interventions of nine months have shown greater effects for children who begin intervention before age two years (Wetherby et al, 2014). However, for older children with confirmed diagnoses of ASD, these same types of interventions of 12?4 sessions over 3 to 6 months have improved parent responsiveness and child outcomes to a significantly greater extent when compared to treatment-as-usual community groups (Green et al., 2010; Kasari, Gulsrud, Wong, Kwon, Locke, 2010) or an alternative treatment (Kasari et al, 2014). What might account for these age-related differences? One notion is that older children display more readily apparent delays relative to other children. Thus, parents are better able to recognize the specific needs of their children. Another speculation is that children who have confirmed diagnoses are often receiving a range of intervention services in the community, thereby increasing the difficulty in identifying the augmenting effects of parentmediated interventions against the background of more intensive treatments. Currently, we are unclear on the absolute dose needed and the best methods for teaching parents to achieve the most optimal child outcomes. Other factors may also affect parent and child outcomes. Increased stress and worry have been well documented for parents of children with ASD and suggest the need for specific interventions to address parental mental health concerns (Schieve, Blumberg, Rice, Visser, Boyle, 2007). The increased stress may result from many sources: distress from the impact of their child’s diagnosis, the strain of additional parenting roles and demands, including expectations that they deliver interventions to their young child, as well as time lost from work, and increased medical costs associated with caring for a child with ASD (Cidav, Marcus, Mandell, 2012). Early interventions that provide parenting strategies through psychoeducational programs have significantly decreased parental stress in these families (Feinberg et al., 2014; Tonge et al., 2006). Although effects of psychoeducationalAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptJ Consult Clin Psychol. Author manuscript; available in PMC 2016 June 01.Kasari et al.Pageapproaches on child outcomes are rarely tested, a recent study found that a parent education and counseling program that included behavior management strategies helped to improve child adaptive behaviors (Tonge, Brereton, Kiomall, Mackinnon, Rinehart, 2014). Thus, the combination of counseling and education for ASD-specific parenting strategies may be effective for improving bo.). Given the large literature on the importance of these skills as predictors of later development, early interventions have increasingly targeted these skills, especially for very young children (Kasari, et al., 2005). The foundational nature of these skills for the ability of children to develop relationships with others leads researchers to consider parents as important mediators of change and potential targets of intervention. However, the current evidence for parent-mediated interventions for children with ASD is mixed. For example, experimental low intensity, three-month, short-term parent-mediated interventions for very young children who are at risk for ASD have not demonstrated significantly greater change in parent and child outcomes relative to community-based, treatment-as-usual interventions (Carter et al., 2011; Rogers et al., 2012). Longer -term interventions of nine months have shown greater effects for children who begin intervention before age two years (Wetherby et al, 2014). However, for older children with confirmed diagnoses of ASD, these same types of interventions of 12?4 sessions over 3 to 6 months have improved parent responsiveness and child outcomes to a significantly greater extent when compared to treatment-as-usual community groups (Green et al., 2010; Kasari, Gulsrud, Wong, Kwon, Locke, 2010) or an alternative treatment (Kasari et al, 2014). What might account for these age-related differences? One notion is that older children display more readily apparent delays relative to other children. Thus, parents are better able to recognize the specific needs of their children. Another speculation is that children who have confirmed diagnoses are often receiving a range of intervention services in the community, thereby increasing the difficulty in identifying the augmenting effects of parentmediated interventions against the background of more intensive treatments. Currently, we are unclear on the absolute dose needed and the best methods for teaching parents to achieve the most optimal child outcomes. Other factors may also affect parent and child outcomes. Increased stress and worry have been well documented for parents of children with ASD and suggest the need for specific interventions to address parental mental health concerns (Schieve, Blumberg, Rice, Visser, Boyle, 2007). The increased stress may result from many sources: distress from the impact of their child’s diagnosis, the strain of additional parenting roles and demands, including expectations that they deliver interventions to their young child, as well as time lost from work, and increased medical costs associated with caring for a child with ASD (Cidav, Marcus, Mandell, 2012). Early interventions that provide parenting strategies through psychoeducational programs have significantly decreased parental stress in these families (Feinberg et al., 2014; Tonge et al., 2006). Although effects of psychoeducationalAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptJ Consult Clin Psychol. Author manuscript; available in PMC 2016 June 01.Kasari et al.Pageapproaches on child outcomes are rarely tested, a recent study found that a parent education and counseling program that included behavior management strategies helped to improve child adaptive behaviors (Tonge, Brereton, Kiomall, Mackinnon, Rinehart, 2014). Thus, the combination of counseling and education for ASD-specific parenting strategies may be effective for improving bo.