Understanding the Parental Interactive Behaviours of at-Risk Infants: What We Have Learned from Basis and Ibasis

Background: How parents interact with infants who are at risk of developing autism spectrum disorder (ASD) is thought to be important because perturbations in the early social environment, combined with existing neurological vulnerabilities, may have a cascading effect on the infant’s social development. The logical deduction therefore is to introduce early interventions that focus on optimising parenting behaviours in at-risk infants to promote more positive social and communicative development. However, there has been little discussion about what precise parental behaviours may be affected and how, and which others tend to remain intact and contribute positively to developmental outcomes.

Objectives: Synthesising our parent-infant interaction data from the British Autism Study of Infant Siblings (BASIS) and our early parenting intervention trial (iBASIS), we attempt to address: (1) What aspects of parental interaction are positive in parents of at-risk infants? (2) How might parents adapt to their high risk child and can this have positive and/or negative consequences for development?

Methods: The validated global Manchester Assessment of Caregiver-Infant Interaction (MACI) was used to evaluate seven areas of interaction at 7 and 13 months in infants at familial risk of ASD compared with typically developing controls, as well as our parent-mediated intervention, iBASIS. We also explored a subsample of videotaped interactions taken during home intervention sessions at 5 time points using the MACI.

Results: Overall parental sensitivity remained relatively intact; in particular, those parents of at-risk infants who did not go on to develop ASD showed similar degrees of sensitivity at 13 months. However, low-sensitive parents who participated in a parent-mediated (modified VIPP) intervention, on average, showed a time course of steady improvement in their sensitive responding through the programme, which was partially reflected in the post-intervention lab assessment. Parental directiveness, however, was higher in at-risk infants than in typically developing infants from 7 months, but the lack of mutuality effect at 7 months which is then apparent at 13 months, may suggest that this directiveness is an adaptive strategy that may 'work' in the short-term, but may be unhelpful to the infant in the longer term. The parent-mediated intervention reduced parent directiveness and slightly improved infant affect, which were highly correlated in the intervention arm and not among controls.

Conclusions: Combining our published results with new analysis as well as recent data from iBASIS lab and home visit observations, a complex picture is emerging of the interactive behavioural tendencies of parents with at-risk infants, how they may impact both positively and negatively to infant development, and how they may respond to a modified parenting intervention. The findings provide a number of discussion points, such as the possible impact of parental behaviours on infant affective tendencies and language development.