A Review of Early Parent Training and Coaching Models in Autism: Parent and Family Functioning in the First Year After Autism Diagnosis

Background: There is substantial empirical support for the efficacy of parent training in autism (Educating Young Children with Autism, NRC, 2001). This literature demonstrates that when parents develop a sense of self-efficacy by learning effective strategies to work with their child with autism, they experience a reduction in parental stress. We will present a review of this literature to delineate models for service delivery shown to best accomplish this.  We have specifically hypothesized that parental stress reduction will translate into better family functioning, especially if parents are taught to crate and find ‘teachable moments’ in everyday activities.  Specifically, we will examine a parent training method where these skills are ‘front-loaded’ (taught early after the diagnosis) before parents fall prey to the pull of non-evidence-based treatments, instead learning to be discriminating consumers of autism services.   To test whether we could accomplish this, we developed JumpStart Learning-to-Learn (JSLTL), a one-week-long ‘front-end’ training program of full-time services (9am-3pm, Monday-Friday) for parents and their newly-diagnosed child delivered in the first month after diagnosis and before initiation of any intensive treatment.
 

Objectives: The goal of this research is to validate an evidenced-based model for autism training by demonstrating that, in comparison with families not having received JSLTL, JSLTL families will show more positive change on 1) the Beck Depression Inventory (BDI), 2) the Dyadic Adjustment Scale (DAS), and 3) the Family Empowerment Scale (FES).

Methods:  We delivered  JSLTL and then evaluated parent and family outcomes 6-12 months later in families who did and did not receive it.   JSLTL trained parents in a four-pronged approach: 1) teaching behavioral management and daily living skills with an emphasis on pivotal responding, 2) communication training emphasizing a developmental-behavioral model emphasizing non-verbal communication as integral to semantics (VIA, Siegel & Ficcaglia, 2005), and a play component emphasizing child-centric interactional approaches to enhance the quality of family social interactions integrating methods of RDI and Floor-time (Siegel & Bernard, 2008).

Over the past 5 years, intervention procedures have been refined and manualized. Families were either self-referred or recruited through the Autism Clinic at UCSF.  All participating children were assessed for autism prior to starting the program.  Before beginning JSLTL, and 6 to 12 months after completing the program, parents were asked to complete the pre- and post-test measures. Comparison follow-up data were collected at 6-12 months after diagnosis in families not receiving JumpStart. 

Results:   We have visually examined pre-post data for JumpStart families and found trends supporting our hypotheses.  We are now collecting comparison data, and both sets of these analyses (JSLTL pre- to post and JSLTL vs comparisons at 6-12 months post diagnosis) will be presented for the three measures (BDI and DAS, parent; and FES, family). 

Conclusions: Earlier reported data suggested parents are benefiting from and satisfied with the program (Siegel, 2009).   We expect empirical data analysis to support preliminary inspection of the data and parent subjective reports of better personal functioning.