Design and Assessment of a Web-Based Training Tutorial Developed to Empower Parents with the Knowledge and Skills Necessary to Effectively Improve Their Child's Communication and Behavior during Daily Activities

Background:  There is a growing consensus that early intervention strategies can significantly improve long-term outcomes for children with autism and their families.  Due to a critical shortage of trained professionals in this area many children who are eligible for early intervention services do not receive them.  One way to bridge the gap between the need for services and their availability is to provide access to the information parents need to foster their child’s development within daily interactions at home.  More effective interactions would improve long-term outcomes by helping to remediate the core deficits associated with the disorder and reduce caregiver stress. While successful parent training programs have been developed, access to such programs is limited due to the lack of trained clinicians providing such services.  One powerful way to increase the accessibility of this program is through web-based technologies. 

Objectives:  To develop and evaluate the feasibility and efficacy of technology-based, multi-media, interactive tutorial (“Enhancing Interactions”), which utilizes the principles of instructional design to help caregivers identify individual steps in everyday routines that can help to move a child from intolerance of an activity towards independent participation and engagement. 

Methods:  96 parents with a child between 18 months to 6 years of age with autism enrolled in the study.  Mean age of parents was 34 (range 21-52).   The sample was 4% African American, 88% Caucasian, 2% Asian, and 6% other.  30 percent received their child’s diagnosis within the past 6 months.  Participating parents were randomly assigned to either “immediate” participation or “delayed” participation (i.e., completing the program after an eight week waiting period, following post-test measures).  Pre- and post-test scores of parents’ knowledge of the concepts presented in the tutorial were used to evaluate teaching effectiveness.  For parents assigned to the immediate participation group, user satisfaction was gauged with The System Usability Scale (SUS) (for technical aspects) and the User Satisfaction Questionnaire (for tutorial content).  Group comparisons in behavioral change in parenting skills and child behavior over the 8 week period was assessed with the Parent Interview of Autism-Clinical Version (PIA-CV), Parent Efficacy Scale (PES), and parent questionnaires.  Changes in parenting stress were assessed by the Parenting Stress Index/Short Form (PSI/SF). 

Results:  Previous analyses of the Enhancing Interactions content show an increase in the number of correct items on a test of concepts, from 12.6 to 20.4 (t=10.72, p<.001.) and an increase percentage of participants receive passing scores from pre- to post-test (8% compared to 80%).  Survey data collection is ongoing and scheduled to be complete in 8 weeks.  Full analysis of changes in parental stress levels and in child and parenting behaviors will be presented. 

Conclusions:  We have developed a customize approach to teaching parents how to use daily activities as a context for enhancing their child’s interactions and communication skills.  By targeting a child’s daily routines and interactions, the tutorial shows potential to provide a means for caregivers to feel empowered with the knowledge and skills necessary to effectively help soothe the pressures created by autism.