Effects of a Parent Mediated Intervention on Positive Social Behavior of Toddlers with Autism: A Randomized Controlled Trial

Background: The purpose of this presentation is to report the results of a randomized controlled trial in which we examined the effects of a parent mediated intervention on the social behavior of toddlers with autism spectrum disorder (ASD). The Joint Attention Mediated Learning (JAML) program is a parent-mediated, relationship-based, developmentally oriented intervention focused primarily on supporting joint attention learning. While prior research has demonstrated large effects of the JAML intervention on the important targeted outcome of child joint attention, no published studies have examined potential effects of the JAML program on child social behavior, in general, or on parent positive support behaviors as potential mediators of child change.

Objectives: Research objectives include (a) examination of JAML effects on toddler positive social behavior directed toward their parents and (b) exploratory examination of the effects of JAML on parent positive support behavior and its relationship to child positive social behavior.

Methods: Twenty-three toddlers with Autism Spectrum Disorder, age 15 to 30 months, and their parents in Colorado, Kansas, Missouri, and Indiana were randomized to the JAML intervention group or a control group. Eligibility screening with the Autism Diagnostic Observation Schedule (ADOS-2) was conducted to establish ASD for inclusion. Parent-child free-play interactions at home were video recorded at pre- and post-assessment. Trained observers, naïve to group assignment and time point, completed the Indicator of Parent-Child Interaction (IPCI-2) based on direct observation of parent-child interaction videos. Mean interobserver agreement for child and parent behaviors was .86 and .85 (R= .74-.98 and .76-.96), respectively.

Results: While there were no significant differences in observed child behaviors or parent positive support behaviors between the intervention and control group at pre-assessment, toddlers in the intervention group, in contrast to the control group, demonstrated significant pre-post gains in positive social behavior toward their parents (t(10) = -4.05, p < .01) and follow through behavior (t(10) = -2.50, p < .05) with large to medium effects (d=1.29, d=.72, respectively). Exploratory analysis revealed a medium effect (d=.58) on parent following child’s lead from pre- to post-assessment for parents in the JAML intervention group as compared to parents in the control group. Parent following child’s lead was positively correlated with child positive social behavior (r=.38) and child follow through (r=.60), p<.05.

Conclusions: These pilot and exploratory results build on prior published work and provide preliminary evidence of JAML effects beyond the primary targeted child outcome of joint attention. Specifically, effects extended more generally to parent-child interaction, including positive toddler social and engagement behavior toward their parents. The finding of medium effects of the JAML intervention on parent positive support behavior, in particular, following child’s lead, which was significantly correlated with child positive engagement behavior, points to the need for conducting sufficiently powered controlled trials to determine JAML effects on parent positive support behaviors and their potentially mediating effects on child positive social behavior.