# EMDR Therapy for Child-Related PTSD in Parents of Adolescents with Autism Spectrum Disorder and Severe Emotional Dysregulation: A Multiple Baseline Evaluation

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# EMDR Therapy for Child-Related PTSD in Parents of Adolescents with Autism Spectrum Disorder and Severe Emotional Dysregulation: A Multiple Baseline Evaluation

October 9, 2025Recent Articles

**EMDR Therapy for Child-Related PTSD in Parents of Adolescents with Autism Spectrum Disorder and Severe Emotional Dysregulation: A Multiple Baseline Evaluation***(EMDR-therapy for child-related PTSD in parents of adolescents with autism spectrum disorder and severe emotional dysregulation: a multiple baseline evaluation)*

EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY2025, VOL. 16, NO. 1, 2555792
[https://doi.org/10.1080/20008066.2025.2555792](https://doi.org/10.1080/20008066.2025.2555792)

**Authors:**Anne Stekkinger-de Vries (a-b), Elisa van Ee (c-d), Rianne Verschuur (e) and Liesbeth Mevissen (f)

A- Jeugd ggz, Institute for Specialised Child Mental Health Care, Apeldoorn, The Netherlands

B- Dimence, Institute for Specialised MentalHealth Care, Specialised Center for Developmental Disorders (SCOS), Deventer, The Netherlands

C- Psychotraumacentrum Zuid Nederland,Reinier van Arkel Group, Den Bosch, The Netherlands

D- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands

E- Leo Kannerhuis (specialised in ASD), Oosterbeek, The Netherlands

F- Liesbeth Mevissen Psychotrauma Practice, Rha, The Netherlands

**Translated by:** Specialist Psychologist Elena Gizem Pozam

**ABSTRACT**

**Background:**Parents of adolescents with autism spectrum disorder (ASD) and severe emotional dysregulation (ED) experience trauma symptoms related to their children's behaviors, such as aggression, self-harm, and suicide attempts. These traumatic experiences can lead to post-traumatic stress symptoms (PTSD) in parents, resulting in increased parenting stress, reduced mentalizing capacity, and difficulties with co-regulation with their children. These difficulties can exacerbate existing emotional regulation problems and reduce the effectiveness of the adolescent's treatment. However, child-related PTSD is rarely addressed in mental health services. This study aims to address this gap and examine the effects of trauma-focused treatment in these parents.

**Method:**This single-subject study included seven parents—five mothers and two fathers—of six adolescents (aged 16–21) diagnosed with ASD and emotional dysregulation. Parents received EMDR therapy and were assessed weekly during a randomly assigned baseline period (3–5 weeks), treatment period (4–6 weeks), post-intervention period (3 weeks), and follow-up periods at 6 weeks and 3 months.

**Results:**All parents showed a reduction in PTSD symptoms following EMDR therapy, and none met the diagnostic criteria for PTSD after treatment or at follow-up. All parents reported a significant reduction in parenting stress after treatment and during follow-up. In addition, five of the seven parents reported a reduction in their children's emotional dysregulation after treatment; this effect persisted at follow-up in three cases.

**Conclusions:**This study demonstrates the value of trauma-focused treatment for parents experiencing PTSD following exposure to child-related traumatic events. The findings provide important insights into the possible nature of parenting stress in parents of adolescents with severe ED and how it can be addressed effectively. The results support the hypothesis that parents who feel emotionally regulated can participate more actively in and provide greater support for their adolescents' treatment, potentially improving treatment outcomes.

**HIGHLIGHTS**

- Child-related traumatic events are common among parents of adolescents with ASD and emotional dysregulation.
- Time-limited EMDR therapy reduces not only parents' PTSD symptoms but also parenting stress and adolescents' emotional dysregulation.

### **1. Introduction**

Children and adolescents with autism spectrum disorder (ASD) frequently experience co-occurring emotional and behavioral difficulties (Bougeard et al., 2021). Research shows that among children with ASD aged 5–16 without intellectual disability, 85% exhibit clinically significant hyperactivity, 74% emotional problems, and 64% behavioral problems (Weiss, 2014). Adolescents with ASD are also at increased risk of suicide attempts and suicide (Chen et al., 2017; Jokiranta-Olkoniemi et al., 2021; Zahid & Upthegrove, 2017), deliberate self-harm (Minshawi et al., 2014), psychotic symptoms (Larson et al., 2018), depression (Matson & Williams, 2014), and post-traumatic stress disorder (Haruvi-Lamdan et al., 2020).

A common theme across these comorbid problems is emotional dysregulation (ED), defined as difficulty controlling or regulating one's emotional responses (Restoy et al., 2024). Recent studies show that ED is more prevalent in children and adolescents with ASD. Young people with ASD show particularly elevated levels of emotional reactivity (for example, experiencing intense and rapidly escalating negative emotions) compared with their peers without ASD (Northrup et al., 2021). A review by Dell’Osso et al. (2023) found that young adults with ASD exhibit reduced adaptive behavior, difficulties recognizing and expressing emotions, and increased levels of anger, rumination, depression, and anxiety. Furthermore, individuals with both ASD and ED have been reported to have more frequent histories of psychiatric hospitalization, emergency department use, and psychotropic medication prescriptions (Conner et al., 2021). These findings highlight the central role of ED in the challenges faced by young people with ASD.

These challenges place a significant burden on families of adolescents and young adults with ASD. Studies show higher rates of parenting stress, family conflict, divorce, substance use, and even domestic violence and abuse in families of children with ASD (Berg et al., 2016; Enav et al., 2019; Enea & Rusu, 2020; Shawler & Sullivan, 2017). Although parenting stress is recognized as a key factor in these family problems, most studies do not provide information about the source and nature of the stress experienced by parents. Understanding the nature of parenting stress is important, however, because increased stress directly affects not only parents but also the child's well-being (Yesilkaya & Magallón-Neri, 2024). Addressing the root causes of parenting stress may therefore contribute to the development of more effective treatments for these families.

Nevertheless, post-traumatic stress disorder (PTSD) has not been adequately investigated as a potential source of elevated stress in parents of children with ASD and ED, even though many behaviors associated with ED may meet the DSM-5-TR (APA, 2025) definition of a “Criterion A” traumatic event. This definition includes exposure to actual or threatened death, serious injury, or sexual violence, directly witnessing a traumatic event, or learning about traumatic events involving close others (family/friends). Thus, a child's suicide attempts, self-harming behaviors, or aggressive, threatening behaviors toward siblings or parents may qualify as “Criterion A” traumatic events. One of the few studies on this topic was conducted by Stewart et al. (2016); in that study, parents of children with ASD experienced PTSD symptoms, including avoidance of hospitals, guilt, sleep disturbances, and hypervigilance. These findings suggest that parents of adolescents with ASD may be at risk of developing PTSD because of their children's severe behavioral and emotional problems.

PTSD symptoms are associated with parenting difficulties such as reduced emotional availability and more negative perceptions of the child. This may lead to increased emotional and behavioral problems in the child (Van Ee et al., 2016) and create a vicious cycle, particularly in families of children with ASD and ED. PTSD is also associated with impaired mentalizing skills—that is, the ability to recognize and understand one's own mental states and those of others (Janssen et al., 2021). Parental mentalizing and reflective functioning have been associated with fewer behavioral and emotional symptoms in children with ASD and greater parental self-efficacy (Enav et al., 2019). Addressing parents' PTSD symptoms may therefore improve the feasibility and effectiveness of child- and family-based treatments. Researchers have proposed a theoretical framework that considers mentalizing and emotion regulation processes as shared transdiagnostic mechanisms linking PTSD and parenting (Meijer et al., 2023). Given the relationship between parental PTSD and parenting difficulties, treating PTSD in parents of adolescents with ASD and ED may reduce parental distress, improve mentalizing skills, and consequently support better treatment outcomes for the child. The present study therefore aims to examine the effects of treatment for parental PTSD on PTSD symptoms, parental distress, mentalizing, and adolescent ED. In this study, Eye Movement Desensitization and Reprocessing (EMDR) therapy, a leading treatment option for PTSD in accordance with international evidence-based treatment guidelines (NICE, 2018), was administered alongside Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

The study hypothesized that EMDR therapy for child-related PTSD would (1) reduce parental trauma symptoms, (2) reduce parenting stress, (3) reduce adolescents' emotional regulation and behavioral problems, and (4) significantly improve parents' mentalizing skills. This study is particularly important because, although parents are often involved in adolescent treatment through family therapy or counseling, evidence-based treatment for parental PTSD symptoms is rarely provided. In addition, while child–parent attachment is emphasized in early childhood, this relationship receives less attention in adolescent mental health services, even though child–parent attachment remains critical to emotional development during adolescence (Zayde et al., 2023). By considering parents as co-regulators in the emotional lives of adolescents with ASD and ED, this study therefore offers important insights that could improve treatment effectiveness.

**2.Method**

### **2.1. Setting**

The adolescents participating in this study had been admitted to inpatient units at a center specializing in developmental disorders in the Netherlands. All adolescents maintained regular contact with their parents through face-to-face visits, telephone calls, and online communication. Both adolescents and parents participated in treatment as usual (TAU). For five of the six adolescents, treatment as usual included psychotherapy and music therapy for the adolescent and support sessions for the parents. For one adolescent, treatment as usual consisted of dialectical behavior therapy (DBT), music therapy, psychomotor therapy, trauma-focused therapy, and DBT-based training for the parents and close others caring for the adolescent receiving inpatient treatment.

### **2.2. Procedure**

Parents of adolescents admitted to inpatient units at a center specializing in developmental disorders were sent an information letter in two versions, one for parents and one for the adolescent. When both parties agreed to participate, parents were contacted by telephone or Microsoft Teams. After written consent was obtained, parents were screened using two brief questionnaires: the **PTSD Checklist for DSM-5 (PCL-5)** and the **Strengths and Difficulties Questionnaire (SDQ)**. A standardized interview (the **Clinician-Administered PTSD Scale for DSM-5; CAPS-5**) was then conducted to determine whether the traumatic experiences met PTSD criteria. Adolescents were assessed using only the SDQ.

In this study, the term “adolescent” describes the developmental period between childhood and adulthood. Although early puberty brings forward the onset of adolescence, delays in transitions to adult roles, such as education, marriage, and parenthood, can extend this period into the mid-twenties (Sawyer et al., 2018).

The inclusion criteria for parents were as follows:

1. The child was aged 14–23 and diagnosed with ASD and ED (SDQ cutoff score of 11),
2. The adolescent was receiving treatment in an inpatient facility,
3. At least one parent met the criteria for PTSD related to child-related experiences (PCL-5 cutoff score of 31),
4. Both the adolescent and the parent had an estimated IQ above 80 based on their educational background.

All parents agreed to receive **EMDR therapy specifically targeting child-related experiences**. They also consented to video recording of the EMDR sessions for treatment integrity assessment and supervision.

Assessments were conducted during the following periods:

- **Baseline period:** 3–5 weeks before treatment,
- **Intervention period,**
- **Post-intervention:** 3 weeks,
- **Follow-up:** At 6 weeks and 3 months.

A core principle of the study was to use the same questionnaires at each phase. The measures used were:

- PTSD Checklist for DSM-5 (PCL-5),
- Strengths and Difficulties Questionnaire (SDQ),
- Dutch Parenting Distress and Problems Questionnaire (OBVL),
- Parental Reflective Functioning Questionnaire (PRFQ).

Two follow-up periods were planned:

- **Short-term follow-up:** 6 weeks after the final EMDR therapy session,
- **Long-term follow-up:** 3 months after the final session.

All parents were also invited to a brief interview. The purpose of this interview was to evaluate their overall treatment experience, potential benefits, session duration, the number of sessions attended, and the questionnaires completed. Information from the interviews was used to supplement data not captured by the questionnaires. Parents were asked to share their insights into the effects of treatment on their daily lives. These responses were used as supporting information, illustrated by examples from parents' experiences.

### **2.3. Participants**

The study included seven parents and six adolescents—five female and one male—aged 16–21 (mean age = 18.9). All adolescents had been diagnosed with ASD according to the DSM-5-TR before admission to the center and had at least one additional diagnosis (for example, depression, an anxiety disorder, or PTSD) (see Table 1). Participants were receiving treatment in one of three inpatient units at a center specializing in developmental disorders.

The participating parents consisted of two fathers and five mothers (age range 44–52, mean = 48), including one couple and two single parents. All parents met the DSM-5-TR criteria for PTSD, as established by the CAPS-5 interview. **Criterion A events** were directly related to child-specific traumatic experiences (see Table 2). Most parents reported exposure to their children's suicide attempts or severe self-harming behaviors. Most parents had also experienced child-related traumatic events that did not meet Criterion A, such as emergency calls or involuntary hospitalizations.

One parent had a history of an ASD diagnosis and another of attention-deficit/hyperactivity disorder (ADHD), but neither had received treatment for these conditions. Two parents had previously received trauma-focused treatment. One parent had undergone a single EMDR session for a child-related experience two years earlier. The other parent had received EMDR therapy for childhood trauma several years before this study.

**2.4. EMDR Therapy**Eye Movement Desensitization and Reprocessing (EMDR) therapy is an evidence-based treatment for post-traumatic stress disorder (PTSD) (Shapiro & Maxfield, 2002; World Health Organization, 2013). The intervention phase lasted three to five weeks and included weekly 90-minute EMDR sessions. Before treatment began, all parents received written psychoeducation about PTSD and EMDR therapy. In the first session, therapists developed a case formulation based on the child's life history (see De Jongh et al., 2010). All significant child-related events contributing to the onset and escalation of parenting stress were placed on this timeline. The three most distressing memories were selected as targets. Given the number of reported child-related traumatic experiences and the finding by Conijn et al. (2022) that four EMDR sessions effectively reduced trauma-related symptoms in parents of children with life-limiting illnesses, three to five EMDR sessions were expected to be sufficient to address these traumatic experiences. If necessary, other distressing memories remaining on the timeline were addressed after the study.

**2.5. Treatment Adherence / Integrity**EMDR therapy was delivered by four therapists registered with the EMDR Europe Association. To ensure adherence to the treatment protocol, therapists were supervised by an EMDR consultant throughout the study. Supervision focused on case formulation and implementation of the standard EMDR protocol, using video or audio recordings of therapy sessions.
To assess treatment integrity, a total of 12 video recordings, representing 33% of EMDR sessions, were randomly selected, stratified by therapist and session number, and evaluated by two independent EMDR Europe practitioners using a dedicated checklist based on the most recent EMDR protocol. Interobserver agreement was calculated as the average percentage agreement across videos. The overall mean agreement was 92.14% (SD = 7.15, range 70–100), indicating good interobserver agreement (Leaf et al., 2017). Treatment adherence was also high (89.15%, SD = 9.18, range 68.75–100).

**2.6. Measures**

**2.6.1. Parental PTSD Symptoms**Parents' post-traumatic stress symptoms were assessed using the **PTSD Checklist for DSM-5 (PCL-5)** (Weathers et al., 2013). The PCL-5 consists of 20 items rated on a five-point Likert scale ranging from 1 (not at all) to 5 (extremely). The PCL-5 demonstrates high internal consistency (α = .94), test–retest reliability (r = .82), high convergent validity (rs = .74–.85), and discriminant validity (rs = .31–.60) (Blevins et al., 2015). A recent validation study confirmed that the PCL-5 is valid and reliable for measuring PTSD symptoms in Dutch adults (Hoeboer et al., 2024). Hoeboer et al. recommended slightly lower cutoff scores than previous studies (22 for screening and 29 for estimating prevalence). The PCL-5 also has excellent diagnostic accuracy.

**2.6.2. Parenting Stress**Parenting stress was assessed using the **Dutch Parenting Distress and Problems Questionnaire (OBVL)** (Veerman et al., 2014). This questionnaire consists of 34 items rated on a four-point scale ranging from 1 (not at all true) to 4 (completely true). Research has shown that the OBVL has high reliability (α = .90) and good validity (Veerman et al., 2014).

**2.6.3. Parental Reflective Functioning and Mentalizing**Parents' mentalizing capacity was measured using the **Parental Reflective Functioning Questionnaire (PRFQ)** (Fonagy et al., 2016). The PRFQ consists of 18 items rated on a seven-point scale ranging from 1 (not true) to 7 (true). The PRFQ is a brief, multidimensional measure of parental reflective functioning or mentalizing. Research has shown that its subscales have good internal consistency and are only weakly to moderately associated with demographic characteristics and symptomatic distress (Luyten et al., 2017). In this study, the **Pre-mentalizing** subscale was used as an indicator of the parent's pre-mentalizing mode.

**2.6.4. Emotional Regulation and Behavioral Problems in Adolescents**Adolescents' emotional regulation and behavioral problems were assessed using the **Strengths and Difficulties Questionnaire – Informant Report (SDQ-IR)** (Goedhart et al., 2003). The SDQ-IR consists of 25 items rated on a three-point scale ranging from 1 (not true) to 3 (true). Both parent and teacher versions have demonstrated good validity in distinguishing child psychiatric patients from community samples and identifying different diagnostic categories within clinical samples (Becker et al., 2004). The adolescent self-report version of the SDQ was used to measure emotional regulation and behavioral difficulties.

Although the OBVL, SDQ, and PRFQ have been validated for children up to age 18, equivalent measures are not available for adolescents aged 18–23. Therefore, the same measures were also administered to participating adolescents over 18. This decision was based on two considerations:

1. In clinical practice, adolescents with ASD are often assumed to have a developmental age lower than their chronological age (Shan et al., 2022).
2. In single-subject research, questionnaires are used to assess individual change over time rather than age differences, so revalidation for each age group is not required.

**2.7. Research Design**Data were collected using a **single-case series design**, a method frequently used to bridge the gap between research and clinical practice (Kazdin, 2016; Maric, 2020). Given the exploratory nature of the study, this design was selected to provide detailed, in-depth information about cases and enable an understanding of similarities and differences between them (Gustafsson, 2017).
This study used a **nonconcurrent multiple baseline single-case design**. Participants were randomly assigned to different baseline durations (three, four, or five weeks, with weekly measurements). The intervention phase lasted three to five weeks, with weekly measurements. The post-intervention period lasted three weeks, with one measurement per week. Follow-up assessments were conducted at six weeks and three months, each over a three-week period with weekly measurements. The same questionnaires were used at all time points. Data were analyzed both within and between phases.

This study was reviewed by the research committee of the mental health organization where it was conducted and by the Faculty Ethics Review Committee (FETC) (file number: 2022-13510).

**2.8. Data Analysis**Data analysis consisted of both visual and statistical analyses. Following the guidelines of Lane and Gast (2014), visual analysis involved systematically analyzing trends and levels between consecutive phases for each participant. The baseline trend was calculated using the **split-middle trend estimation method**. Level was analyzed by comparing median values across phases (baseline, intervention, post-intervention, and follow-up). Visual analysis was also used to assess clinical improvement based on cutoff scores and to examine trend lines.

**Effect sizes** were calculated using **Tau-U** to analyze differences between the intervention, baseline, and post-intervention periods (Parker et al., 2011). Tau-U is a single-subject research method used to examine the proportion of nonoverlapping data between two phases while controlling for undesirable positive baseline trends. Because one parent (P4) showed a positive baseline trend in PTSD symptoms, parenting stress, and reflective functioning, these data were excluded from subsequent statistical analyses. For participants without a positive baseline trend, **taunovlap** was calculated.

All Tau calculations were performed using **Single Case Research**, a web-based tool for analyzing single-subject data. Tau values range from −1 to 1, with −1 indicating that all data points are lower than baseline and 1 indicating that they are higher, with no overlap between phases. Combined effect sizes for all participants were also calculated using **SCR**. Analyses were two-tailed, with the p-value threshold set at .05. Following the guidelines of Vannest and Ninci (2015), overall effect sizes were interpreted as follows: small (≤0.20), moderate (0.21–0.60), large (0.61–0.80), and very large (>0.80) (Figure 1).

**3. Results**

### **3.1. Parental PTSD Symptoms**

Figure 2 presents data on parents' PTSD symptoms across all phases. Visual analysis for six parents revealed no positive baseline trend, allowing statistical analysis using Taunovlap. Comparison of baseline and post-intervention median scores showed a significant reduction in PTSD symptoms in all participants. All participants had a Taunovlap value of −1, indicating no overlap between baseline and post-intervention data. In addition, all participants' post-intervention scores remained below the cutoff score of 31 (median range: 3–23). The combined Tau value between baseline and post-intervention was −0.92 (p = .00), indicating a very large effect.

Median scores at baseline and short-term follow-up were also compared, yielding the same results: all parents maintained a significant reduction in PTSD symptoms six weeks after treatment. All scores remained below the cutoff. The combined Tau-U value between baseline and short-term follow-up was −0.92 (p = .00), again indicating a very large effect. Data from one parent (P2) who completed the long-term follow-up assessment showed that this large effect was sustained.

### **3.2. Parenting Stress**

Figure 3 presents parenting stress data across all phases of the study. Comparison of baseline and post-intervention median scores showed a significant reduction in parenting stress in all participants. Because no positive baseline trend was present, Taunovlap was used for the analysis. Each participant had a Taunovlap value of −1, indicating no overlap between baseline and post-intervention data. The combined Taunovlap value between baseline and post-intervention was −0.92 (p = .00), indicating a very large effect. Three participants had post-intervention median scores below the cutoff (60) (P1, P2, P7).

Comparison of baseline and short-term follow-up median scores showed that parenting stress remained significantly lower in all participants six weeks after treatment. The combined Tau value was −0.92 (p = .00), also indicating a very large effect. At short-term follow-up, three of the six parents still had median scores below the cutoff (median range 44–80) (P1, P2, P7). This very large effect was also maintained for the parent (P2) who completed the long-term follow-up assessment.

### **3.3. Parental Reflective Functioning and Mentalizing**

Figure 4 presents data on parents' reflective functioning and mentalizing across all phases of the study. Although there is no established cutoff score for the PRFQ, visual analysis showed that some parents had quite low baseline scores on the pre-mentalizing scale. Comparison of baseline and post-intervention median scores showed a significant reduction in pre-mentalizing mode in one of the six participants. This participant (P3) had a Taunovlap value of −1 (p = .03). The combined Tau value between baseline and post-intervention was −0.55 (p = .00), reflecting a moderate, significant effect.

Comparison of baseline and short-term follow-up median scores yielded similar results: one of the six parents still had a significantly lower pre-mentalizing score six weeks after treatment (Taunovlap −1, p = .03). The combined Tau value for all participants was −0.34 (p = .06), indicating a moderate but nonsignificant effect.

### **3.4. Emotional Regulation and Behavioral Problems in Adolescents**

Parent-reported data on adolescents' emotional regulation and behavioral problems are presented in Figure 5, and adolescent self-report data are presented in Figure 6. Two of the six adolescents were excluded from the analysis because too much of their data was missing.

Comparison of baseline and post-intervention median scores showed significant reductions in emotional regulation and behavioral problems in reports from five of the seven parents. The combined Tau value between baseline and post-intervention was −0.82 (p = .00), indicating a very large effect. One parent (P1) had a post-intervention median score below the cutoff score of 11 (median range 10–38).

Comparison of baseline and short-term follow-up median scores showed that one parent (P1) continued to report a significant reduction in the adolescent's emotional regulation and behavioral problems six weeks after treatment. The combined Tau value was −0.71 (p = .00), indicating a large effect. Two participants (P2, P4) who completed the long-term follow-up assessments continued to report significant reductions in the adolescent's emotional regulation and behavioral problems three months after treatment.

For adolescent self-reports, four of the six participants consistently completed the weekly measurements. One adolescent (A4) reported a significant reduction in emotional regulation and behavioral problems during the post-intervention period (Taunovlap = −0.93, p = .04). The combined Tau value between baseline and post-intervention for the four adolescents was −0.08 (p = .73), indicating no significant effect. No significant change was found between baseline and short-term follow-up either.

### **3.5. Parents' Experiences**

All parents reported being satisfied with the number of sessions. However, two of the seven parents found the 90-minute EMDR sessions too intensive and said they would have preferred shorter sessions. All parents were able to give examples of effects they had noticed in daily life. These included positive changes such as being able to go grocery shopping or walk the dog without feeling the need to focus constantly on their phone, sleep without taking sleeping medication, hug their child again without fear of hurting them, leave the adolescent home alone, and regain trust in mental health services.

**4. Discussion**

Parents of adolescents diagnosed with autism spectrum disorder (ASD) and emotional dysregulation (ED) may experience traumatic events related to their children, which can lead to the development of PTSD symptoms. Despite the significant impact of these symptoms on parental functioning, treatment of parental PTSD remains insufficiently addressed in child and adolescent mental health care. This study examined the effectiveness of EMDR therapy in addressing child-related PTSD symptoms in parents of adolescents with ASD and severe ED. Consistent with the hypothesis, reductions were observed in post-traumatic stress symptoms, parenting stress, and parent-reported emotional regulation problems in adolescents.

Parents had been exposed to child-related traumatic experiences, such as aggression, severe self-harm, and suicide attempts, that met DSM-5-TR Criterion A for PTSD. However, they also described other traumatic events, such as calling an ambulance or fearing the worst while searching for a missing child. This suggests that child-related experiences that may be traumatic for parents of children with ASD need to be considered from a much broader perspective. Distressing experiences involving the child profoundly affect parents' well-being. De Vries and Kuiper (2017) also identified an association between unprocessed parenting experiences that did not meet Criterion A and parenting stress. Research shows that the number of unprocessed parenting experiences predicts the level of parenting stress.

The findings of this study show that EMDR therapy targeting child-related traumatic experiences significantly reduces parents' PTSD symptoms and parenting stress. This is particularly meaningful given the well-established effects of parenting stress on children's well-being and development. Conijn et al. (2022) also found similar outcomes from EMDR therapy in parents experiencing PTSD related to their children's rare, life-limiting illnesses and recommended incorporating this time-limited trauma treatment into routine pediatric care. Similarly, Terrell and Resnick (2023) obtained promising results in their study examining the effect of EMDR therapy on parenting stress in parents of children with special needs. In light of the present findings, further research is recommended into how EMDR therapy may contribute to better treatment outcomes for adolescents with ASD and ED and their parents.

Contrary to the hypothesis, no significant effect was found on parental reflective functioning or mentalizing skills. Participating parents appeared to have reflective functioning and mentalizing capacities before treatment, and these skills did not change significantly afterward. Research increasingly suggests that parental reflective functioning may be a context-dependent process rather than a stable trait. A study by Enav et al. (2020) showed that parents of children with ASD (aged 3–18) exhibited higher levels of reflective functioning when interacting with their child with ASD than with their other children. This finding suggests that parents of adolescents with ASD become particularly attuned to their children's internal emotional states.

In addition to reductions in parents' PTSD symptoms and stress levels, this study found significant reductions in adolescents' emotional regulation and behavioral problems according to parent reports. However, adolescents' self-reports differed in some respects. Adolescents reported no significant changes between baseline, post-intervention, and follow-up measurements. Adolescents' participation in inpatient treatment may be a confounding factor in the reduction in ED observed in parent reports. However, the “sleeper effect,” often seen during the therapeutic process in individuals with ASD, may also explain this finding. This effect relates to limited awareness of one's own behavior and difficulty immediately recognizing behavioral changes (Leuning et al., 2023). It is also possible that parents perceived their children's behaviors and emotions as less severe after EMDR therapy. Although no significant change was observed on reflective functioning measures, reductions in PTSD symptoms and parenting stress may allow parents to feel more regulated and have a more positive mood, enabling them to better co-regulate with and support their children during treatment. This is consistent with the findings of an intensive inpatient trauma-focused program for families with mild intellectual disability conducted by Mevissen et al. (2020). In that program, parents received EMDR therapy first, followed by their children. Five of the participating children had a comorbid ASD diagnosis. Most children no longer met the diagnostic criteria for PTSD before starting their own EMDR treatment, as a result of improvements in their parents' functioning. This suggests that trauma-focused therapy for parents may positively affect not only parents' well-being but also their children with ASD.

One methodological strength of this study is its use of a multiple baseline design and correction for positive baseline trends. However, several limitations should be noted. First, parents received other interventions, such as parenting counseling or family therapy, alongside EMDR therapy. However, because these interventions had begun before the study and remained unchanged throughout it, nonspecific treatment effects are unlikely to have been confounding factors. Second, because the questionnaires used had been validated only up to age 18, they were not fully appropriate for all adolescents and parents. Third, the PCL-5 was used, but this is a screening measure rather than a diagnostic instrument. Fourth, adolescents were receiving inpatient treatment and returned home only on some weekends. Although they were in frequent contact with their parents, the full range of daily parent–child interactions was not observed. Finally, the study had a limited sample size. Nevertheless, single-case design studies can control threats to internal and external validity by using repeated measurements, introducing the intervention sequentially, and replicating effects across participants (Kratochwill & Levin, 2025). Such studies provide detailed case information that can inform future research with larger samples.

The parent interviews conducted to evaluate treatment within the study provided valuable information about changes in quality of life during long-term follow-up. Parents described changes such as going grocery shopping or walking the dog without anxiety about constantly checking their phones, sleeping without taking sleeping medication, hugging their child again without fear that the child would harm themselves, leaving the adolescent home alone, and regaining trust in mental health services (see Results). Considered alongside the data, these examples highlight the importance of time-limited, trauma-focused therapies for parents of children and adolescents with severe emotional dysregulation.

The present study provides a foundation for systematic research on this topic, with many aspects still to be investigated. These include trauma-focused treatments for parents experiencing stressful child-related life events, parents of adolescents with ED without an ASD diagnosis, and parents of adolescents receiving outpatient treatment. It is anticipated that starting parents' treatment before adolescents' treatment may increase parents' capacity to support their adolescents during treatment and thereby reduce confounding variables in research. Further research is also needed into parent-focused approaches to reduce PTSD symptoms and improve quality of life.

In conclusion, this study provides strong evidence supporting the development of family-focused mental health care models that prioritize not only an individual patient but also their family and their experiences. It is essential for clinicians and researchers to recognize how the experiences of adolescents, parents, and siblings affect mental health, parenting, and family functioning. With appropriate support, positive outcomes can be achieved for all family members.

**Artificial Intelligence Tool**An AI-assisted tool was used in this study to improve the quality of the English language.

**Disclosure Statement**No conflict of interest was reported by the author(s).

**Data Availability Statement**The data supporting the findings of this study may be shared upon request to the corresponding author. The data are not publicly available because they contain information that could compromise the privacy of research participants.

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