Types of Parent Responsiveness: Longitudinal Changes Associated with a Parent-Mediated Intervention for Children at-Risk for ASD

Background:

Early interventions have effectively increased parent responsiveness (PR) to children at-risk for ASD. Few studies have examined these effects longitudinally, and little is known about the impact of interventions targeting PR on changes in parental nonverbal and verbal responses.

Objectives:

Examine longitudinal effects of a PR intervention, Adaptive Responsive Teaching (ART), on PR in parents of young children at-risk for ASD.

Methods:

Two groups of community-recruited infants at-risk of ASD and their parents were randomized to ART or to “referral to early intervention and monitoring” (REIM). Data were collected at pre-treatment (mean age:13.8 months, ART [n=45], REIM [n=42]), post-treatment (mean age: 22.5 months, ART [n=44], REIM [n= 39]), and follow-up (mean age: 53.91 months, ART [n=27], REIM [n=18]). The Parent Responsiveness Coding System measured PR using 5-second intervals in a 10-minute video of unstructured play. General linear mixed models examined a range of PR behaviors. Due to variance in children’s chronological age (CA) at follow-up, CA was used as the metric of time for estimating outcome trajectories.

Results:

Significant group by time interaction for total responses, F(1, 203.097) = 5.717, p = .018, and total nonverbal responses, F(1, 205) = 4.373, p = .038, indicated more responses in ART compared to REIM at post-treatment, p = <.001, but not follow-up, p = >.05. For nonverbal expansion responses, the interaction was nonsignificant, but comparisons of predicted values suggested a similar marginal linear trend in both groups F (1, 207) = 3.521, p = .062. A marginal group by time interaction emerged for nonverbal non-expansions, F (1, 205) = 3.314, p = .070, and simple comparisons showed more ART group responses at post-treatment, p = <.001, but more REIM group responses at follow-up, p = <.001. The total follow-in verbalizations interaction was nonsignificant, but there was an effect of time F(1, 137.013) = 45.365, p = <.001. Similarly, only a significant effect of time was found in follow-in directive verbalizations F(1, 142.641) = 27.187, p = < .001, suggesting an increase of follow-in directive verbalizations in both groups over time. The follow-in non-directive verbalizations interaction was significant, F(1, 200.945) = 5.744, p = .017, and simple comparisons showed more ART responses only at post-treatment.

Conclusions:

ART was effective in increasing overall PR, nonverbal responses, and non-directive verbalizations at post-treatment, but these effects were not maintained at follow-up. Because our measure of PR heavily focused on contingency, it might not have tapped into other important aspects of PR for preschoolers. That is, contingency in PR is associated with positive outcomes for infants and toddlers, but may be less important for preschoolers, who have attained greater cognitive and linguistic competency. Future longitudinal research should examine broader dimensions of PR to determine if parents who increase their contingent responses to at-risk infants/toddlers differ in other dimensions of PR with their preschool children, such as the syntactic complexity and semantic richness of verbal responses.