Efficacy of Adapted Responsive Teaching in a Community Sample of One-Year-Olds at-Risk for ASD

Background:   Contemporary theories emphasize the transactional influences of biology and environment on neurodevelopment (Beauchaine et al. 2008). Infants at-risk for ASD are vulnerable to disrupted neural connectivity (e.g., Dinstein et al., 2011; Righi et al., 2014); thus, introducing behavioral intervention soon after the first birthday, when neural shaping processes become prevalent (Webb et al., 2001), may be key timing to promote more typical neural development and, subsequently, more typical child-environment transactions.  The efficacy of interventions for infants at-risk for ASD before all ASD diagnostic symptoms emerge has been examined previously only in small samples. 

Objectives:   To determine whether (1) a parent-mediated intervention, Adapted Responsive Teaching (ART; adapted from Mahoney & MacDonald 2007) impacts expressive communication (ExpCom) outcomes of one-year-olds at-risk for ASD; (2) ART is differentially efficacious as a function of parental stress or infant nonverbal cognitive skills at pretest; (3) ART impacts caregiver interaction styles. 

Methods:   87 infants scoring at-risk for ASD on the First Year Inventory (Baranek et al., 2003) were enrolled in a randomized controlled trial at 13 to 15 months, along with a primary caregiver of each. Staff provided all families with information about community early intervention services, and monitored participants through monthly phone calls. Families randomized to the control group received no further services from project staff. Families randomized to ART participated in a manualized intervention entailing ~30 one-hour home sessions over 6 to 8 months. ART uses a variety of responsive strategies to promote pivotal behaviors in the social-communication and sensory-regulatory domains, with planned individualization. The interventionist provides caregivers with a rationale for each session’s focus, demonstrates and coaches new responsive strategies, and discusses caregivers’ observations of their infants’ behaviors and responses. Assessors, blind to group assignment, completed assessments with the infants and caregivers immediately before and after the intervention phase. 

Results:   Analyses are preliminary. All models covaried for child gender and caregiver education, as well as the pretest scores corresponding to posttest outcomes. There were no significant group differences on posttest ExpCom. Parental Stress Scale (Berry & Jones, 1995) scores did not moderate the effects of ART. However, pretest Visual Reception (VR) T-scores (Mullen, 1995) interacted with treatment group in that infants with low VR scores assigned to ART showed fewer gains on ExpCom than infants in the control group, whereas infants with high VR scores assigned to ART showed greater gains, t = 2.57, p = .012 (Figure 1). No group effect was apparent on the Maternal Behavior Responsiveness Scale (Mahoney et al. 1986) for Responsiveness, Achievement or Directiveness, but parents in the ART group had higher posttest ratings on Affect, Cohen’s d = .71, p < .01. 

Conclusions: The moderating effect of VR on ExpCom outcomes of infants assigned to ART reinforces the importance of determining how to best fit interventions to child and family characteristics. The impact of ART on parent affect raises the possibility of more distal effects on child outcomes due to changes in parent interaction style. Future research should be directed at both issues.