Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent Training Intervention for Children with ASD

Background:  Although there has been growing interest in using telehealth interventions to provide parent training for children with ASD, empirical evaluations of such programs are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions for ASD.  Self-directed programs have far greater dissemination potential as they do not require a trained professional and can typically be administered at a much reduced cost.  At the same time, research on telehealth interventions for other disorders have found that therapist-assisted programs lead to better client outcomes than self-directed programs.

Objectives:  The goal of this pilot RCT was to compare the effect of a self-directed (SD) and therapist-assisted (TA) telehealth intervention program on parent learning and self-efficacy and child language skills.

Methods:  Children were matched with 3 months of expressive language age and then randomly assigned to the SD (n=14) or TA group (n=15).  Parents were given up to 6 months to complete the program.  Parent outcomes included parent intervention knowledge, parent intervention fidelity during a parent-child interaction in the home, and parent self-efficacy.  Child outcomes included parent-report and observational measures of child language skills.  In addition, program engagement data was monitored and treatment acceptability was measured at post-treatment.  

Results:  The program engagement data indicated high rates of program completion and treatment acceptability for both groups.  Parents in both groups demonstrated significant improvements in parent knowledge of the intervention and parent self-efficacy from pre- to post treatment.    Parents in both groups also demonstrated a significant improvement in parent fidelity; however, parents in the TA group made significantly greater gains in fidelity than parents in the SD group.  Children in both groups demonstrated significant gains in expressive vocabulary on the MCDI, communication standard scores on the VABS, and rate of expressive language during a parent-child interaction, with a trend toward greater gains in child expressive language during the parent-child interaction for the TA group.  Change in parent fidelity from pre- to post-treatment was significantly associated with improvements in child language during the parent-child interaction.   

Conclusions:  Both approaches show promise for increasing parents’ use of evidence-based intervention techniques to promote their child’s language skills.  The self-directed program was effective for improving parent knowledge, self-efficacy, and fidelity of implementation.  However, therapist assistance via remote coaching provided an added benefit for improving parent fidelity and child language.  Additional research that can identify parents who are most likely to need remote coaching would assist in the development of a stepped care model that can increase parent access to evidence-based services in underserved communities.