Change in Family Empowerment Following ABA Early Intervention Associated with Changes in Practical Adaptive Skills

Background: Applied Behavior Analysis (ABA) therapy is the standard of care for children with Autism Spectrum Disorder (ASD). The ABA Early Intervention Program (ABA EI) at Seattle Children’s Autism Center is a 12-week, multidisciplinary, classroom-based program that includes 12 hours per week of center-based, 1-1 ABA therapy, weekly SLP services, and a parent education/support package including didactics, coaching in ABA methods, and case management. Naturalistic Developmental Behavioral Intervention (NDBI) is the primary ABA methodology being used (Schreibeman et al., 2015). Previous research supports the efficacy of ABA interventions in increasing adaptive skills in children with ASD (Smith & Iadarola, 2015) and emerging research supports associated improvements in family empowerment and stress (Minjarez, et al., 2012). However, research is limited regarding the relationship between child improvements in adaptive functioning and parent functioning.

Objectives: To investigate how changes in adaptive skills relate to changes in family empowerment following participation in behavioral intervention.

Methods: Participants included parents and their children diagnosed with ASD (n=32) aged 19 to 65 months (M=40.69, SD=12.26) that completed the ABA EI program. Paired sample t-tests were used to compare baseline and post-intervention ratings of adaptive skills (Adaptive Behavior Assessment System (ABAS-3): General Adaptive Composite (GAC), and Conceptual, Social, and Practical composites) and sense of family empowerment (Family Empowerment Scale (FES)). Backwards stepwise linear regression (p=0.05 entry, p=0.10 removal) was used to investigate how changes in adaptive skills (conceptual, social, practical), combined with baseline characteristics (GAC, FES), predicted changes in sense of family empowerment.

Results: Paired sample t-tests revealed improvements in FES scores from baseline (M=3.79, SD=0.54) to post-intervention (M=3.98, S=0.57); t(31)=2.16, p=0.039. Similarly, there were improvements in GAC: baseline (M=68.50, S =18.10), post-intervention (M=73.96, SD=21.24), t(23)=2.73, p=0.012. All ABAS-3 composite scores were also significant. The backwards regression model with the most parsimonious predictor variables excluded change in the social composite: FES change=1.84 – 0.31 conceptual change + 0.33 practical change + 0.12 baseline GAC – 0.668 baseline FES + e, F(4, 17)=4.441, p=0.012, adjusted R²=.396, with practical change (t=2.279, p=0.036), baseline GAC (t=2.334, p=0.032), and baseline FES (t =-3.311, p=0.004) significant. Conceptual change (t=-1.836, p=0.084) was marginally negatively related to FES change.

Conclusions: These results are consistent with prior work showing improvements in adaptive skills following ABA intervention. Change in practical skills, but not conceptual skills, was positively associated with family empowerment. This may be due in part to ABAS-3 items at this age which inquire about skills explicitly taught in the intervention program (e.g., community use, health/safety, self-care) that could lead families to feel more able to manage daily routines. These findings are consistent with previous work (e.g., Noh, 1989) which found an association between child inability to interact with the environment and parental stress. Surprisingly, conceptual skills showed a marginally negative association with family empowerment, suggesting empowerment is more closely associated with daily living and community-related skills than communication and task management skills. This is a preliminary investigation and the study is ongoing.