A Randomized Controlled Trial of a Group Parent-Training Program in a Joint Attention Intervention

Background: Interventions designed to facilitate increased joint attention skills in young children with autism have been found to be effective in addressing core autism symptoms. Furthermore, parents have been successfully trained to deliver these interventions effectively at home. However, parent-mediated joint attention interventions for young children with autism have yet to be widely adopted in community settings despite their promise for delivering effective early intervention at a lower cost than therapist-implemented models. Lack of widespead disemination may be, in part, due to the fact that most the published efficacy studies of parent-mediated, joint attention interventions have used a one-on-one parent-coaching model to train parents. This is not easily adapted to community-based settings with limited resources. Additionally, most of these interventions have been tested with predominantly White, middle-class Americans without testing the efficacy with families from low-income or minority cultural backgrounds bringing into question the applicability of these interventions to diverse populations.

Objectives: This randomized controlled trial is a pilot study of a parent-training program designed to teach parents from low-income and minority backgrounds to implement a joint attention intervention with their young children with autism.  

Methods:  Participants were parents of children 5 years and under diagnosed with autism spectrum disorder with an expressive language level of less than 32 months. The participants were predominantly from low-income households and were all from minority racial/ethnic groups. Children were assessed at intake with the ADOS, Mullen Scales of Early Learning, Vineland SEEC, McArthur Bates CDI and parents completed the Parenting Stress Index. Additionally, a 15 minutes parent-child free play video sample was coded for periods of joint engagement and joint attention skills. Parents were randomly allocated into two groups, 1) the treatment group received 12 hours of instruction in six 2-hour sessions over six consecutive weeks and 2) the delayed treatment group who received the same training at a later time. The parent-training program was designed to be highly interactive and require no more than an 8^th grade reading level in English. Transportation costs to the training program were covered and child care was provided during training sessions. The McArthur Bates, PSI and parent-child free play measures were repeated immediately after parent training and at 3-month follow-up. All children maintained their regular schedule of state provided early intervention and preschool services throughout the study period.

Results: Changes in measures of child social-communication development, parent stress and the interactive states of the dyad were analyzed for between-groups differences.

Conclusions: Parents from diverse backgrounds were trained in a low-cost group settings to implement joint attention interventions at home with their young children with autism.