Using the Language Environmental Analysis System (LENA) to Evaluate a Community Based Pivotal Response Treatment (PRT) Parent Coaching Model for Autism Spectrum Disorder

Background: Though evidence-based practices (EBP) for autism spectrum disorder (ASD) intervention exist, adoption is low in community practice (Dingfelder & Mandell, 2011). There is a need to partner with service providers and evaluate community based interventions as there is often a loss of quality when EBP is disseminated into real world settings. Additionally, there is a need to evaluate new technologies, such as the Language Environmental Analysis System (LENA), to determine if they may expedite efficient, reliable and valid embedded program evaluation, as a means of providing feedback on program effectiveness.

Objectives:

1. To provide a comprehensive description of a community based Pivotal Response Training (PRT) parent coaching model including teaching topics and format.

2. To evaluate the effectiveness of the model on child, parent and parent-child interactional communication patterns using the LENA.

3. To evaluate the use of LENA as a new technology to measure program effectiveness in a real world setting.

Methods:  Using a single-subject research design matched with new digital language processor technology (i.e., LENA) and through partnership with a large accredited autism service provider in Western Canada, a community based PRT parent coaching model was evaluated. Eighteen independent video and audio recordings of baseline, intervention and follow-up data were evaluated on child, adult, conversational turns, and ratio of child initiated conversational turns for one parent-child dyad over a 16 week period. Detailed descriptive information, fidelity of PRT implementation, PRT content validity, and hypothesized relationships between coaching condition and communication patterns are appraised.

Results: Good content validity and program description of the coaching model was obtained. A functional relationship between adult language and coaching condition was identified. Hypothesized relationships between conversational turns and coaching condition could not be evaluated due to high variability in child vocalizations across conditions. PRT fidelity improved though was not fully achieved. Advanced LENA analysis of 29,469 communication blocks suggest balanced child and adult initiations also improved as a result of the coaching, though did not sustain once the coach was no longer present.

Conclusions: The PRT parent coaching model is an EBP that holds promise for community based implementation and the LENA is a useful adjunct evaluation measure, allowing for more in depth analysis of longitudinal communication patterns. However, given PRT fidelity was not achieved by the parent and child vocalization data was variable, interpretation of results is limited. Further research on this coaching model is needed. Positively, a clear description of the model in community practice was obtained including teaching format, topics and procedures. Additionally, parent-child ASD communication patterns were identified in a reliable, valid and user friendly manner over time, using new technologies, as they participated in this EBP coaching model. This study demonstrates the importance of evaluating EBP in community settings and how new technologies, such as LENA, can support this objective.