A Parent-Implemented Autism Intervention Among Underserved Families in Taiwan

Background:  

There is compelling evidence that access to early behavioral intervention is associated with positive cognitive, adaptive, behavior, and language outcomes for children with autism spectrum disorder (ASD).  There is a lack of existing infrastructure and an absence of resources to deliver clinic- or school-based interventions for children with ASD in some regions of southern Taiwan.  Parent-mediated intervention and behavior management are particularly suitable for these families to implement at home.  Pivotal Response Training (PRT) is an evidence-based, naturalistic, behavioral intervention with a clear structure that can be used to target a variety of goals.  These characteristics make PRT a good fit for the target population.

Objectives:  

The objectives are: 1) to develop a culturally sensitive ASD intervention by adapting PRT; 2) to train clinicians to train parents in delivering the program at home; 3) to train parents in implementing the program at home; and 4) to evaluate this program’s efficacy and effectiveness.

Methods:  

A culturally modified version of PRT with emphasis on behavior management and communication was adopted to address concerns of Taiwanese parents.  Local clinicians were trained to fidelity by PRT experts.  Fifteen families who have a child diagnosed with ASD participated in the study, which consists of 20 sessions: 1) 3 group-education sessions (3-5 parents) on ASD, 2) 3 group-education sessions on PRT, 3) 1 group-education session on behavior management, and 4) 13 one-on-one at-home coaching sessions.  Program efficacy and effectiveness were measured by the changes between enrollment (baseline) and the last at-home session (post-intervention) in parental stress on parent-child interaction and child behaviors (measured using Chinese version of Parenting Stress Index), and the child’s problem behaviors (measured using the Chinese version of Child Behavior Checklist).  Parental satisfaction with the program, including training materials, procedures, clinicians’ expertise, was measured post-intervention.  Qualitative information was also obtained throughout study sessions to obtain in-depth input from parents and clinicians.

Results:  

Of 15 enrolled families, 13 completed all study sessions.  All child participants were boys, ages 36-75 months (mean: 57.8, SD: 18.6) at enrollment.  Eleven parents reached fidelity in PRT by the end of study.  Parents rated the intervention highly, with 100% reporting their child made satisfactory or highly satisfactory improvement (rated 4-5 on a 1-5 scale) in getting along with others, language, learning new skills, and attention.  Similarly, 100% of parents  reported their own improvement in understanding their child’s behaviors, communicating with their child, knowing how to handling their child’s problem behaviors, solving problems for their child, and knowing how to use learned skills in daily life.

Conclusions:  

Our preliminary findings are promising and very encouraging.  Beneficial effects of the intervention for the families were observed by our clinicians as well as reported by parents.  The developed program could become a model for efficiently and effectively providing evidence-based behavioral intervention to families with low resources in Taiwan and for populations that share a similar cultural background.  Changes measured between baseline and post-intervention in parental stress and child behaviors will be discussed.