The Social ABCs for Toddlers with Suspected Autism: Pilot Evaluation of a Parent-Mediated Intervention

Background: The Social ABC’s is a parent-mediated intervention based on empirically supported Pivotal Response Treatment (PRT; Koegel & Koegel, 2006). The main goals of our intervention are to increase early communication skills and positive emotion sharing (parent and child smiling together) among toddlers at high risk for ASD. We have developed and refined our manualized intervention model and present data from our completed pilot phase.

Objectives: To examine post-training and follow-up gains in: (1) child early communication skills, (2) positive affect sharing, and (3) child engagement (looking at parent’s face); and (4) to evaluate the feasibility and acceptability of our intervention.

Methods: Intervention included 12 weeks of in-home, live parent coaching, followed by 12 weeks of implementation by parents, and a follow-up assessment (at week 24). Parent satisfaction was measured through a Parent Satisfaction Questionnaire. Positive Emotion Sharing and Engagement were coded in 10-second intervals at Baseline (BL), Post-treatment (PT), and Follow-up (FUp). Communication was measured at all 3 time points using videotape analysis, as well as standardized assessment (at BL and FUp). Paired samples t-tests were used to evaluate change across time points. 

Results: Twenty-three toddlers (mean age @BL = 21.8 mos; FUp = 29.7 mos) with suspected or confirmed ASD were included. Treatment duration varied due to variances related to families’ schedules, illnesses, and competing demands. Communication: Standardized measure of language (Mullen) revealed non-significant T-score gains from BL to FUp for Receptive (M=44.1 vs. 45.4) and Expressive Language (M=44.79 vs. 47.57). However, significant Age Equivalent gains (BL vs. FUp) were obtained for both Receptive (M=18.7mo vs. 25.9mo); p=.001, and Expressive (M=19.1 vs. 27.9mo); p=.006, representing 7-8 months of gain in a mean duration of 8 months. Video analysis of Functional Language revealed statistically significant gains from BL to PT, that remained at FUp, in: Responsivity (.62, .82, .82), Initiations (14, 28, 28), and Total Functional Utterances (46, 77, 75), but no changes in child gesture use or rate of inappropriate responses. Positive Emotion Sharing: Gains in child smiling approached significance from BL (M=27.9%, SD=19.0) to PT (M=36.6, SD=19.8), p = .06. Shared smiling increased from BL (M=16.9, SD=10.8) to PT (M=24.8, SD=14.6), t = -2.6, p = .02, but was attenuated at FUp (M=20.7, SD=11.4; n.s.). Child Engagement increased from BL to PT (26% vs. 36%; p<.05), and this was maintained at FUp (34%). Satisfaction: Parent ratings were extremely positive (mean = 30 out of 35). Correlations between raters for video-coding are very strong (p’s < .001); Kappas will be calculated and reported.

Conclusions: Significant gains were observed in children’s communication on video-coded measures, and standardized measures (age equivalent gains commensurate with typical developmental rates). Gains in shared smiling and engagement were observed post-treatment, but gains in smiling were not consistently maintained at follow-up. The model of training parents as mediators presents an opportunity for the integration of intervention into daily activities, thus allowing for intensive intervention at a very young age. Next steps include a randomized controlled trial (underway), and eventually community translation.