The Role of Parents in a Social Communication Intervention for Children Who Are Minimally Verbal

Background:  The success of an intervention hinges on its capacity for sustainability and generalizability. Consequently, parent training has become a crucial element of many early intervention programs, as parents’ uptake of treatment strategies is ideal for implementation across contexts. Parents’ level of buy-in (i.e., expectations about treatment) can affect strategy uptake, ultimately affecting treatment outcomes in children (Nock & Kazdin, 2001). This process may elucidate why some children acquire spoken language during the course of intervention while others do not.

Objectives:  To examine: 1) the relationship between parent buy-in and parent uptake of intervention strategies, and 2) how changes in parent behavior are consequently related to changes in child language outcomes.

Methods:  Preschoolers (n=23) who were low-rate communicators (approx. <30 words) received JASPER, a naturalistic developmental social communication intervention (Kasari et al., 2006, 2008), for 6 months. Parents received weekly 2-month individualized training in JASPER strategies, including matching child’s language (# words, # utterances) and JA gesture use.

Parents completed a questionnaire that assessed the broad range of pre-treatment buy-in. Each parent-child dyad completed a videotaped 10-minute free play assessment (PCX) pre- and post-intervention.

Children’s minimally verbal designation at both entry and exit was determined if they used <5 words on the ADOS, <5 words on the PCX, and <8 words on the MSEL. This formed three groups of children: 1) those who remained minimally verbal over the course of intervention (MV), 2) those who acquired language during the course of intervention, i.e., were speech-emergent (SE; met MV criteria at entry, but not at exit), and 3) those who were early communicators (EC; never met MV criteria).

PCX’s were transcribed, coded, and analyzed for language and gesture use (pointing, showing, giving). Composites and change scores were calculated and analyzed using linear regression and ANOVA.

Results: Parents’ level of buy-in, particularly their belief in child improvement, was associated with change in parents’ total utterances during the PCX (b=-.64, p=.001, R²=.41), but not with gesture use. Change in parent utterances was significantly related with MV status at the end of intervention (b=.58, p=0.023, R²=.38).

There were significant differences in parent language change between the three groups of children (F(2,20)=7.12, p=.005, η²=.42). Post-hoc tests indicated significant differences between MV and EC groups (p<.05, d=2.26) as well as between MV and SE groups (p<.10, d=1.41).

Conclusions:  Results point to potential factors contributing to treatment effectiveness in a population that is not particularly well-researched. Parent buy-in is related to measurable change in parent behavior in the context of intervention. These changes are also related to measureable and significant gains in children’s language outcomes, such that children who were potentially MV pre-intervention no longer met this criteria post-intervention.

Parents who bought into treatment decreased their utterance use, providing more opportunity for their children to verbally communicate. However, while this study highlights the relationship between parent buy-in, strategy uptake, and child outcomes, it does not propose a causal model. As such, future research should examine a cross-lagged model to determine directionality and causality of this relationship.