The aim of this research was to study the effects of the intervention Dialogical Family Guidance aimed for target group families, using the FAFHES and DFG-questionnaires. These randomised families were also compared between Intervention group I (onset immediately) and II (onset after three months) and surprisingly, there were no major differences between group I and II. The main finding in this study was that DFG improved family health and family support in both groups. All participants reported being satisfied with the help they received and especially family support increased by parents reports between baseline and after DFG.
Families in both intervention groups gained an increasing experience of family support. Nearly all families would recommend DFG to other families. Their experience was that they got practical guidance, they had good discussions and they were listened to during the DFG sessions. The first impression is, that DFG targets the needs of families with a child with NDD. This result is encouraging and DFG intervention seems to be feasible. Therefore, it is justified to continue delivering DFG intervention to families with a child with NDD as an additional type of support.
Surprisingly, families in this study group reported family functionality, family health and family support as moderate or good at every measure point. According to previous studies [13, 15, 17], it was unexpected to get these relatively good values already from baseline. This can be associated to the fact that the children with NDD in these families` were university hospital ordinary treatment patients during this study. It can be assumed that families taking part of this study were at the same time getting ongoing care for their child and this could explain the proportional good baseline reports.
Although families expressed moderate or good values already at baseline, there were still some positive changes concerning the experience of family health and family support in both groups (Intervention group I and II) after DFG, compared to baseline. On the other hand, family functionality did not change as much as expected. According to a review made by Johnston and Mash  there are many factors in family environment, family relationship and family psychology/dynamics influencing these target families. Accordingly, it is difficult to find one specific reason to the minimal change concerning family functionality in this study and it can be assumed that several different factors are influencing. Yet, the quality of relationship between parents was connected to family functionality and family health. Those families with excellent or good parental relationships between parents, also had better family functionality and family health. This is in line with several studies[15-18, 47] reporting that the nature of NDD symptoms reflect and influence the whole family, including marital problems. Naturally, stressful and demanding nature of NDD symptoms may elicit marital miscommunication and inconsistencies in parenting or low frustration tolerance between parents. Marital dysfunction was not studied in this study profoundly, but according to Hartley et al. (2010) the risk of divorce is significantly high in parents of children with autism and reminds us about the need to pay attention to the relationship of the parents during family interventions.
Obviously, families in this study have children with different range of NDD disorders. Child`s characteristics can evoke negative reactions between family members, and result in dysfunctional parenting practices. Craig et al  compared the relations between certain kind of common characteristics of children with NDD and parenting stress. Parents of children with ASD and ADHD report the highest scores of parenting stress. Difficulties in family interactions, child`s behavior, social and emotional problems may more easily increase levels of stress in parents and bring tension in the parent-child relationship [15-17]. Repetitive unsuccessful parental efforts to control child behavior can decrease parent self-esteem, emotional well-being and affect negatively on their parenting identity. Parents in this study expressed that positive feedback about their own parenthood was important and that DFG was rewarding experience as a parent. As caregivers are often included in different interventions, it seems to have a strengthening impact on parenthood identity when getting positive feedback concerning their parenthood and parental skills from professionals.
The background variables in both intervention groups show that daily life parenting was statistically significant connected to family functionality and family health. Parents` in this study experienced that they received advice and practical guidance to help their daily life. This helped them to manage better with their child with NDD. This is in line with the study by Craig et al which indicated that increasing parents` knowledge and skills can reduce stress and offer parents empowerment. Having enough knowledge as parent, can foster a sense of independence and give confidence in managing something that they previously found difficult.
Based on several studies[6-9] there is due to high heritability rate increased prevalence of same kind of symptoms or even diagnosis in parents and siblings of children with NDD. In this study approximately one third of parents agreed that there were more than one family member with neurodevelopmental disorders. To the question concerning parents having long-term illness or neuropsychiatric disorder themselves, also several parents answered “yes”. According to Rucklidge et al  men and women with ADHD, regardless of gender, are struggling significantly with their own psychosocial functioning. It can be assumed that also in this study, the dynamics between family members has negative effect, not only caused by the child with NDD, but also by genetic characteristics of the parent. As mentioned before, this can cause impairments in parental functioning according to Johnston & Mash .
Apparently, that the role of parental attributions in children’s responses to treatment is essential. When collaborating with families in this target group all family members need to be involved. In this study, nearly all the parents reported that all family members were taken into consideration, and a family systems perspective was put into practice, and this was significant to parents. Also, the study by Caicedo  claims that families need interventions to improve health and functioning for both parents and the children. Ansari et al  confirm that relationships among individuals within the family are known to have a unique influence on the overall family system, and that professionals can help parents in establishing positive thinking towards the child. Our evaluation about DFG effects conclude same kind of findings.
Parents reported in their DFG-questionnaire, that DFG should be delivered to families very quickly after the child`s first visit to the clinic. Nearly all parents in both groups experienced that the time they were delivered DFG intervention for their family was well-timed. This finding was unexpected, because it seems that three months waiting time for the onset of DFG did not cause much difference to parents. Maybe this is due to the fact, that families have already struggled several years with neuropsychiatric and psychiatric problems in their family and three months waiting for DFG, is not causing much difference. According to Moen, Hedelin & Hall-Lord  social support and the support from the community health services are strongly positively associated to family functioning. The knowledge of upcoming DFG can probably provide families comfort and alleviate their feeling of stress to some degree. Families attending this study followed the study protocol and time schedule, and the selection of families did proceed randomly contrary to ordinary clinical work, where DFG is targeting primary families with an actual need for it.
It is well-known that the family environment is an important factor in the development of every child, and family dysfunction may serve as a risk factor that poses a bad influence for the child`s development and on presentations of NDD symptoms. It seems that collaborative approach with parents offer help to parents to identify what aspects of parenting are demanding in their daily life. The use of open dialogue presented by Seikkula & Trimble throughout the DFG intervention process allow professionals to confirm families` emotions, expectations and disappointments. With the help of dialogue, family members get a possibility to process and share their experiences combined with the psychoeducation and guidance in practical issues from the professionals. This study supports Evans et al findings demonstrating parents need for space to discuss their worries and reflect thoughts and feelings. This needs to be considered as an important factor in family interventions.
In the future, DFG needs to be tested with families with children with NDD in this target group having already basic health care contact for their child. At present, there is need to have knowledge about DFG`s effectivity in families having low family functionality and family health at baseline. Studies to gain more accurate information how DFG helps parents to develop a more positive relationship with their children, are needed. At this moment we do not know what effects DFG has on the child with NDD with various age range. Research performed with larger number of families within different levels and settings of healthcare will widen our understanding and knowledge concerning DFG. It would give us information whether this treatment can be used in other diagnostic or disease groups with long term and various difficult problems, eg families with mentally retarded children or other neuropediatric disorders.
The FAFHES questionnaire has been tested since 2002  and ever since used in several clinical contexts, e.g. pediatric intensive care, and child maltreatment in families expecting a baby [44, 45]. The questionnaire was modified for and tested in a pilot study and seemed to be applicable for families of children with NDD . It needs to be noticed, that this modified FAFHES questionnaire has not yet been used in other studies.
Another limitation is the small sample size of families who completed all the phases (thirty-four families completed the whole protocol). The results should be followed by further research evaluating DFG with a larger sample size. However, it can be assumed that DFG has desired intervention effects, because all families reported being satisfied with the help they received. This gives some evidence that tailored DFG intervention can benefit families in this cohort group.
All families included were from the same neuropsychiatric outpatient clinic at the university hospital, and therefore the results do not include any comparison between other outpatient clinics or hospitals. Parents in this study are representative concerning the focus group, because they all have a child with at least one NDD diagnosis. The child started as university hospital ordinary treatment patient during this study and the families were at baseline measure involved in the child`s assessment and treatment plan. Families from several different clinics would offer wider knowledge about families having various baseline experiences.
Several studies reveal that families to children with NDD experience multiple challenges causing stress, burden, exhaustion and emotional problems. However, these study group families are untypical related to their own sample, because all these families surprisingly reported family functionality, family health and family support as moderate already at baseline. Hospital involvement can explain why the parents reported their families as well-functioning already at baseline. This is a limitation and needs to be taken into consideration when reading the results. These relatively good baseline values most likely affect also the three and six-months follow up values. This study is limited to give knowledge about DFG`s effects only concerning families with relatively good baseline values for family functionality and family health.
The result of this study is limited concerning the effects of DFG and further research is required. A longer follow up is needed to receive knowledge about the long-term effects of DFG.
Although the children were taking part of the DFG sessions, they did not fill in their own questionnaires and the children`s opinions are not part of the result in this study. The results in this study involve only the parents` opinions and the children`s voice is not appearing true themselves.
The professionals worked in pairs when delivering the intervention and a check-list manual was used. In this way the DFG interventions implemented to families was apparently homogeneous in quality and delivered in-line with laid out the DFG intervention structure. The professionals received their DFG education from the same educator. In this way, the DFG implementers got equally their training. The researcher was not involved in any way with the families and did not deliver DFG to families taking part of this study.
It is important for families to get information in forward concerning accurate timing for upcoming family intervention. This already can affect positively families` experience of family support.
Varying degree disturbances in families with a child with NDD can affect health of all family members. Systems perspective and family interventions involving the entire family are needed.
Practical guidance and psychoeducation offered thru dialogue with family members allow families targeted support.
Knowledge presented in this study may be useful and should be noticed when planning family interventions and support for this target group families.