Effect of Parent and Teacher Training with Project Impact on the Social Communication of Children with Autism Spectrum Disorder during Play

Background: There is growing consensus that intervention for children with autism spectrum disorder (ASD) should include their natural interaction partners to make the intervention cost-effective and to help children generalize skills to a range of situations. Project ImPACT (Ingersoll & Dvortcsak, 2010) is a social communication intervention originally developed to train parents, which makes use of interactive and more direct behavioural techniques. Since children with ASD spend a large part of their day at school, there could be an additional benefit of training not only parents, but also teachers to stimulate the social-communicative skills of children with ASD during the school day.

Objectives:

1. To study the effect of Project ImPACT on social-communicative skills of children with ASD at home and at school.
2. To assess whether progress in these skills starts already after the introduction of interactive techniques or only after the introduction of behavioral techniques.

Methods: We used a multiple baseline design with four children with ASD between 2.5 and 6 years old. Parents and teachers each received 24 semi-weekly sessions at home and in the school respectively. Teacher training started 5-7 weeks after the start of the parent training. Children were followed-up until 4-6 months after completion of the intervention. Treatment effect was assessed by weekly video-observations of parent-child and teacher-child interaction, in which social engagement, requesting and imitation were coded. The data were analyzed visually and by calculating an effect size d1.

Results: A clear effect was found of the parent training on the duration of social engagement. For two children this effect was clear during the phase where only interactive techniques were used (d1 = 1.6-7.2). For the other two the effect only became clear in the phase where behavioral techniques were introduced (d1 = 1.1-1.7). There was no added effect of the teacher training on social engagement. Three out of four children showed an increase in the number of requests to their parents after the introduction of interactive techniques (d1 = 1.5-2.0). All children showed an increase in the number of requests after the start of the teacher training. For three of them this effect was visible from the beginning of the intervention (d1 = 1.7-4.2). Only one child started to imitate more during parent-child-interaction after the start of the parent training. All children imitated their teachers more after the start of the teacher training. Two children already did this during the interactive teaching phase (d1 = 0.5-0.6), while the other two needed more direct instruction (d1 = 0.5-1.5). Most of these effects were maintained until follow-up.

Conclusions: Project ImPACT had the clearest effect on the requesting skills of the children, since these skills improved with both parents and teachers, soon after the introduction of the intervention in the respective contexts. Social engagement only improved during parent-child interaction, while imitation skills only improved during the teacher-child interaction. For some children these effects were only visible after the introduction of behavioral techniques, providing support for the effect of both types of techniques.