28 Psychoeducation group for parents who raise a child with autism spectrum

e-mail: desvi.ym@gmail.com Abstract The aim of the research is to know how the impact of psychoeducation group to the level of parenting stress of parents who raise a child with autism spectrum disorder. This research used quasi experimental method with the design of the untreated control group with dependent pretest and posttest samples. This research involved 25 parents (20 mothers and 5 fathers) who raise a child with autism spectrum disorder divided into two groups, experimental group and the control group. The experimental group has received psychoeducation treatment with ecological approach for two months (8 meetings, conducted once a week). This research used Scale of Parenting Stress, observation, test of knowledge about parenting of children with autism spectrum disorder, and sheet of evaluation of psychoeducationactivities in collecting the data. The result of the analysis with mixed anovahave shown that psychoeducation group has no effect to the level of parenting stress (F = 0,697 p > 0,05). The result of check manipulation have shown that the knowledge of subject on parenting of children with autism increase after join in the


Introduction
Parenting is a difficult and complex task, especially if the child is a child with special needs (Berns, 2007). On the parents who raise children with autism spectrum disorders, Lee et al (2008) found that childrearing is considered more difficult and lead to a heavy burden for parents and family. Reviewing base on ecological approach, parents experience difficulties in all existing subsystem. At the level of microsystem, parents experience difficulties encountering children with autism spectrum disorders directly, such as overcoming behavioral problems experienced by children (Brobst et al., 2009). At the level of mesosystem and exosystem, the difficulties experienced by parents such as having to face the jealousy of siblings of autistic children and often having conflict with spouses or other family members such as grandmother and grandfather (Mukhtar et al., 2016), job disruption (Scott, 2010;Stoner & Stoner, 2014;Syeda, Weiss, &Lunsky, 2011), and limited interaction with the surrounding due to need more time to spend in parenting (Lee et al., 2008;Mukhtar, 2014;Sander & Morgan, 1997). At the level of macrosystem, parents often get stigma or negative response from common people because less of information about autism spectrum disorder so parents feel isolated (Ha et al., 2014;Hoogsteen&Woodgate, 2013). Various difficulties that faced by parents in raising a child with autism cause stress of parenting, which is negative reaction that experienced by parents as an effort to adapt to the demands of roles and responsibilities as parents (Deater-Deckard, 2004). Many studies show that parents who raise a child with autism spectrum disorders experience higher levels of stress than parents with normal child or child with other developmental disorders (ex. Hayes & Watson, 2013;McConnell, Savage, &Breitkreuz, 2014;Samadi, McConkey, & Bunting, 2014;Serrata, 2012;Wang, Michaels, & Day, 2011).
As the main factor that determines function of family, parents that experience stress need to be supported in order to increase resource they have (Swick& Williams, 2006). According to Perry (2004), resources that owned by individual, both of personal and from family, are important factors that determine their psychological condition as parents of child with autism. Patterson (2002) emphasizes that resources owned by that parents would help them to adapt positively with the condition they face as parents.
One of ways that can be used to increase resource in order to be able to adapt positively is establishing psychoeducation group. By giving intervention in group setting, there will be benefits rather than individual setting. According to the professionals, the application of group setting is more efficient, both of time and material (Masson et al., 2012;Nichols &Jenkinson, 2006;Schultz et al., 2011). In the case of parents, group approach has some therapeutic factors, for instance chance to be open and learn, establish cohesiveness and universal feeling (Corey et al., 2014);Forsyth, 2014. Those things can decrease isolated feeling that experienced by parents and find hope in order to solve their problems so they will be happy psychologically (Corey et al. 2014;Forsyth, 2014;Nichols &Jenkinson, 2006).

Method
This research used a quasi experimental method with the design of the untreated control group with dependent pretest and posttest samples (Shadish, Cook, & Campbell, 2002). Subjects that involved in this research were 25 parents who cared for children with autism spectrum disorders. Subjects were divided into two groups, 14 parents (11 mothers, 3 fathers) were in the experimental group and 11 parents (9 mothers, 2 fathers) were in the control group.
Experimental group received treatment in the form of psychoeducation for two months conducted in eight meetings (once a week). Each meeting lasts for two hours (120 minutes). The material coveredare organized by using an ecological approach and adjusted with the results of the need assessment of the problems faced by parents which have done before. There were eight topics discussed: introduction to autism spectrum disorders, strengthening the parents personally strengthening family, obstacles of social communication in child with autism spectrum disorder, emotional and behavior problem in child with autism spectrum disorder, train independency in daily activities, the handling of children with autism spectrum disorder, and advocacy for children. Psychoeducation implementation used several variations of methods: lectures, discussions, watching the short videos, role playing, and doing the exercises. The control group did not receive any treatment during the study and only received psychoeducation after the follow-up measurements were completed.
Data collection in this research has been done by using scale, observation of the process in the group, test of knowledge about parenting of children with autism spectrum disorder, and the sheet of evaluation of psychoeducationactivities . The scale used is the Scale of Parenting Stress, given three times, before treatment, after treatment, and at follow-up (two months after treatment). This scale is prepared by the researchers based on the theory presented by Deater-Deckard (2004). The Scale of Parenting Stress consists of 35 items and has a Cronbach Alpha coefficient of 0.930 and the item-total correlation coefficient ranges from 0.327 to 0.669. There are two aspects that are revealed in the Scale of Parenting Stress, physiological aspects and psychological aspects. The psychological aspect is broken down into three sub-aspects: cognitive, behavioral, and emotional. Observation of the process in the group and the test of knowledge about parenting of children with autism spectrum disorder are used as a tool to check the manipulation of the treatment given.The sheet of evaluation of psychoeducationactivities is used to evaluate the activity of psychoeducation and to know the subject's opinion about the process of the psychoeducation group that have been done.

Results and Discussion
The results of descriptive analysis as shown in Table 2,show that at the time of pre-test, the mean score of parenting stress on group psychoeducation is lower than the control group but the standard deviation is higher. This suggests that the level of parenting stress of subject in the psychoeducation group is lower but has greater variation than the control group. At post-test, the mean score of parenting stress in both groups was similar, but the standard deviation in the control group was greater. At follow-up, the mean score of parenting stress in the psychoeducation group was also lower than the control group but the standard deviation in both groups was relatively similar. The results of data analysis by using mixed anova shows that there is no interaction between the time of measurement of parenting stress with groups (F = 0,697 p > 0.05). Its means that the psychoeducation group has no affect or can not decrease the level of parenting stress. The result of this research is different with meta-analysis result to 48 researches on parents group training that conducted by Barlow et al. (2012), but in the same line with research that conducted by Farrar (2005) and Gattuso (2013). Possibly some factors cause the failure of psychoeducation group in decreasing level of parenting stress. Firstly, possibly individual from psychoeducation group also needs help and emotional support so need chance to tell more in order to decrease psychological stress they feel. According to Yoak et al. (1985), parents who need help and emotional support like this will not feel satisfied when join a group that focus on education and sharing information.
Second factor is the involvement in psychoeducation group possibly increases personal stress among individual. Krauss, Upshur, Shonkoff, and Hauser-Cram (1993) assert that the involvement in parents group has positive yet negative influence to the parents psychological function and their perception to social support. Participation in a group relate to the increase of perception to social support acceptance from friend who has the same age can be classified as positive influence. In contrast, negative influence of this thing is the involvement in parents group relates to the increase of personal stress and it can create conflict in family or social relationship.
Through observation, there are some conditions that relate to the increase of individual stress during process of psychoeducation. Firstly, there is duty and requirement to practice material that has been discussed. Secondly, during process of psychoeducation, group leader mostly shares information. That can help parents to get proper information, but on the other hand that information or material becomes a burden for parents. Research conducted by Jones and Passey (2004) also shows that interaction with professional is one of sources of stress for parents who has child with development disorder. This condition is not the same with condition in parents support group. Subjects get more suggestion or information that told by other participants and information from group leader is merely additional information. Based on research conducted by Solomon, Pistrang, and Barker (2011), information from other participants is easier to understood because based on personal experience (Solomon et al., 2001) and consists of practical advice (Mueller, Milian, and Lopez, 2010).
Although the group psychoeducationcan notreduced the level of parenting stress, the result of manipulation check shows that the subjects in psychoeducation group have increased knowledge about parenting a child with autism spectrum disorder. This is confirmed by the results of subject evaluation which stated that the main benefits they experienced from participation in a group psychoeducation was increasing knowledge about the parenting of children with autism spectrum disorder.
The second benefit is making friend, especially between parents who has child with autism spectrum disorder. Other benefits are feeling peace, increasing confidence in parenting, more patience, instance optimism and excitement in parenting and facing the future, be grateful for the condition of the children, realize role and responsibility in parenting child with autism and feel get support from professionals, especially psychologist. The results of the observation indicate that the subject actually has a fairly high openness, but the opportunity to talk openly is not much because the time allocation is more used for lectures and role-playing or exercises.
These findings are in the same line with some researches on group for parents who has child with special need. Thurston (2007) finds that support program for parents can increase confidence and decrease worry, Barlow et al. (2008) and Keen et al. (2010) find that training for parent can increase self-efficacy and Gattuso (2013) find that psychoeducation for parent can increase ability to problem solving.

Conclusion
Psychoeducation group does not have any influence to the level of parenting stress. The failure of psychoeducation group in decreasing the level of parenting stress can be caused by some factors, for instance the low chance to be open and the risk to experience personal conflict due to group process. Although it does not decrease the level of parenting stress, but group of psychoeducationis considered able to give benefits, for instance the increaseof knowledge about parenting of child with autism spectrum disorder, make friend, be optimistic for the future of the child, be grateful with the condition of the child, realize the role and responsibility of parents, and get support from professional, especially psychologist.