Systematic Review of Web- and Smartphone-Based ASD Parent Trainings: Increasing Access and Improving Outcomes

Background: Parents of children with ASD have difficulty obtaining services triple that of parents of children with other healthcare-related needs, with up to 56% of these parents reporting long wait-lists, local unavailability of services, or financial limitations (Montes, Halterman, Magyar, 2009). Telehealth coaching has begun to address issues of delivery of high-quality, efficacious services to more rural areas, but has not addressed issues of clinician availability, nor treatment costs. Online or app-based parent training have the ability to partially address these issues through providing triage, connecting parents with evidence informed practices and resources, and supplementing ongoing therapy. However, as studies on eLearning are rather nascent in comparison with tele-consultation, systematic reviews have yet to specifically explore the effects of parent eLearning programs on child social, emotional and behavioral outcomes.

Objectives: The aim of this systematic review was to evaluate the impact of web- and app- based parent trainings, not solely reliant on web-based video conferencing, on outcomes for children with ASD.

Methods: Using PRISMA methodology, we searched five different databases (EBSCO, ProQuest, PsychInfo, PubMed, Web of Science) for abstracts containing search terms in each of the following categories: ASD, web/smartphone, intervention, and parenting. The search results identified 1191 articles, with 737 unique articles once duplicates were removed. 40 relevant abstracts and 13 articles for inclusion resulted after screening for articles: 1) in English, 2) in a peer-reviewed journal, 3) included a parent-mediated intervention or training 4) intervention was disseminated at least partially online or in an app, 5) contained an online element besides teleconferencing, 6) reported child outcomes, and 7) were tested with an ASD population. Using the snowball method, we scanned the references of included articles, however failed to find additional articles that met inclusion criteria.

Results: Demographics for these studies largely represented middle class, college-educated, non-minority parents. Out of the 13 studies, 6 were single-subject multiple baseline designs, 5 were RCTs, and 2 consisted of pre- and post- measures with no control group. Interventions targeted child social-communication skills, reciprocal imitation skills, joint attention, as well as secondary conditions such as anxiety. Parent skills targeted were modeling, prompting, reinforcement, creating visual supports, setting up behavior contingencies, and problem solving. Effect sizes for child outcomes ranged from d=0.58-2.2. Twelve studies supplemented online parent training with in-person or web-based coaching sessions. Eleven studies utilized web-based platforms, while 2 were application based. Programs varied in terms of length, online components, attrition, and research quality.

Conclusions: This review suggests that there is a burgeoning literature of promising online parenting programs. Published findings suggest moderate to large effect sizes for improving social-communication skills and reducing anxiety in children with ASD. Most of these studies were a hybrid of online and clinic or tele-health intervention modalities, thus, additional investigations are needed to test the independent contributions of online and tele-health components. Future studies should also explore factors that may moderate parent engagement and child outcomes. Additionally, future studies should target more diverse samples in terms of SES, parental education, and prior experience with parenting interventions.