Parent-Mediated Intervention Increasing Parent-Child Engagement and Improving Cognitive and Behavioural Outcomes of Toddlers with Autism Spectrum Disorder

Background:

Now that it is possible to identify a child with autism spectrum disorder (ASD) in the first two years of life, efforts are being made to develop early effective interventions for toddlers at high risk of ASD. Thus, age-specific strategies have to be used to offer effective early intervention to these toddlers with a diagnosis or a suspicion of ASD (Rogers & Wallace, 2011) including parent involvement. By participating in parent-mediated interventions, parents develop skills to promote their toddler’s development. Parent-mediated interventions that focus on joint attention, imitation and play can capitalize on teachable moments as they occur, provide learning opportunities during daily routines, and facilitate the generalization of learned skills across environments.

Objectives: this study aims to evaluate the effects of parent-mediated intervention for toddlers with a suspicion or a diagnosis of ASD on quality of parent-child interactions and children developmental outcomes using a crossover randomized controlled trial.

Methods: The 12-week parent-mediated intervention was an adaptation of the parent delivery of the Early Start Denver Model (P-ESDM, Rogers, Dawson, & Vismara, 2012) and the Social Communication Emotion Regulation Transaction Support (SCERTS, Prizant, Wetherby, Rubin, & Laurent, 2003) Model. The intervention was delivered in the family’s home (60 to 90 minutes). The 19 parent-child dyads were randomized either in the Intervention group or the Waitlist group (participants in this group had to wait three months before getting access to the intervention). The primary outcome was the quality of dyadic engagement between the child and his parent as measured by the total score of the Engagement state, Child and Caregiver Behavior, and Shared Topic (Adamson, Bakeman, Deckner, & Nelson, 2013). Based on Adamson’s and colleagues protocol (Adamson et al., 2013), four cluster scores were also analyzed, which are 1) Child Joint Engagement, 2) Child Behavior, 3) Caregiver Behavior, and 4) Shared Topic. Secondary outcomes were related to children's development. These outcomes include cognitive abilities, motor skills, and adaptive behaviors all assessed via the Bayley Scales of Infant Development – 3^rd edition (Bayley, 2006), a widely used tool for early childhood assessment

Results: This crossover randomized trial highlights the positive effect of the parent-mediated intervention on parent-child dyadic engagement (p=.012; effect size=.51). Also, the participation to the intervention stimulates the child development that is manifested by a mild-to-moderate normalization of toddlers’ cognitive abilities (p=.010; effect size=.57) and motor skills (p=.071; effect size=.38) compared to typically developing peers.

Conclusions: Very promising effect sizes underline trends toward moderate-to-large improvement in parent-child dyadic engagement and a mild-to-moderate normalization of children's developmental outcomes after a 12-week parent-mediated intervention. These results also highlight greater benefits on proximal outcomes, specifically the way parent and child interact with one another in play compared to more distal child-related outcomes (Helm & Kozloff, 1986; Mahoney & Perales, 2003; Mahoney & Perales, 2005; Oono et al., 2013).