A Longitudinal Analysis of Parent Responsiveness Following Intervention

Background:  Replicated findings demonstrate that parent responsiveness (PR) is associated with later child outcomes, and that PR in parents of children at-risk for ASD can be increased by intervention. Further, child behaviors, including sensory hypo-reactivity and social communication, predict later PR, emphasizing the transactional nature of PR. The current study follows up on infants at-risk for ASD participating in an RCT that demonstrated a positive treatment effect on PR at posttest.

Objectives:  (1) Determine if there was a continuing treatment effect on PR at preschool follow-up. (2) Examine the longitudinal trajectory of PR by group. (3) Determine if post-test hypo-responsiveness and/or social communication skills predicted PR at follow-up.

Methods:  Parents and community-identified infants at-risk for ASD aged 13-15 months (n=87) participated in a RCT of a parent-mediated intervention, Adapted Responsive Teaching (ART). All families received information about community services and monthly monitoring phone calls, while those randomized to ART were coached using a manualized intervention designed to promote using responsive strategies while targeting social communication and sensory regulation. Measures of social communication (Communication & Symbolic Behavior Scales, Social Composite), sensory regulation (hypo-reactivity, measured by the Sensory Experiences Questionnaire and Sensory Processing Assessment), and PR (proportion of 5-second intervals with parent responses, using partial interval coding of 10-minute parent-child videos) were completed at pre- and post-test. When children were 3-5 years old, a subset (n=47) were re-recruited for follow-up assessments, including a third measurement of PR.

Results: Preliminary analyses used coded data from 28 children at follow-up. Although ART parents in the preliminary analyses were not significantly different in PR than comparison group parents at post-test, they reflected the trend of higher PR found in the full sample. At follow-up, however, they were significantly lower in PR than the comparison group, t = -3.02, p < .01 (Figure 1). Posttest social communication, t = -2.24, p = .04, and hypo-reactivity, t = -2.07, p = .05, predicted follow-up PR. Also, an interaction between posttest social communication and group, t = 2.93, p < .01, reflected that higher post-test social communication was associated with lower follow-up parent responsiveness in the comparison group (Figure 2). Overall, findings were significant only in a model incorporating parent report measures of child predictors, but not in a model using observational measures. Models will be examined further with the larger sample when coding is completed.

Conclusions:  These preliminary results may be unstable due to the small subsample. We anticipate that full sample results will show that ART group PR was higher than the comparison group at post-test but that this difference was not maintained at follow-up. Reductions in PR in the ART group at follow-up could be concerning, given the theoretical importance of PR for child outcomes. Such a finding may suggest the need to provide ongoing support/coaching to families of children at risk for ASD beyond a 6-month intervention. Possibly strategies parents learned to apply with infants are harder to apply or less developmentally appropriate as children mature and gain new abilities or manifest new symptoms.