Effects of Parent-Mediated Intervention Coaching Vs. Psychoeducation on Social Communication Development of Lower-Resourced Young Children with Autism Spectrum Disorder: A Feasibility Study

Background: As children with autism spectrum disorder (ASD) are identified at increasingly younger ages, parent-focused intervention has become an essential component of comprehensive early intervention programs. However, the implementation and effectiveness of these parent-focused intervention programs varies widely across intervention providers, particularly for lower-resourced families. This study examined how traditional parent-focused intervention programs for young children with ASD may be modified to be more practical for lower-resourced families (i.e. those with limited resources and education, low incomes).

Objectives: The purpose of the proposed project was to adapt and evaluate a modified version of an early intervention program working with caregivers from a lower-resourced population. We hypothesized that a parent-mediated intervention (PMI) would demonstrate greater change in child language and social communication behaviors, as well as increased effectiveness in parents’ use of specific treatment strategies when compared to a parent psychoeducation intervention consisting of information, education, and support(IES). Further, it was hypothesized that the design and modifications to the protocol (i.e., liberal cancellation and rescheduling policy, individualized home visits, case management and advocacy, and crossover design) would promote engagement in the treatment and decrease attrition compared to previous studies.

Methods: Six mother-child dyads participated in a randomized crossover design in which PMI was compared to IES over 3 months of treatment. Parent outcome was measured using parent fidelity of implementation (FI) of treatment techniques. Child outcome was measured using the Brief Observation of Social Communication Change (BOSCC), a new social communication behavior measure.Account was taken of the repeated measures on estimated confidence intervals and significance by fitting random effects models.

Results: Parent and child outcomes did not differ by type of parent-focused intervention (PMI vs. IES) in our sample. However, overall parent FI scores measured across both conditions improved significantly over the course of treatment [5.18 per month (95% CI 1.88 to 8.49; p=.002)], and was mirrored by nonsignificant but similar changes in the children’s scores on the BOSCC [-1.88 per month (95% CI -4.06 to 0.31; p=.093)]. In addition, rich qualitative data gathered during the study concerning parent experiences, as well as feedback regarding the research protocol are discussed and recommendations for implementing parent-focused intervention programs with lower-resourced families are proposed. Four major themes emerged regarding the importance of 1) the intervention strategies and psychoeducation information learned, 2) parent coach flexibility and social support, 3) case management and advocacy, and 4) the relationship between the child and the parent coach.

Conclusions: This study provides preliminary evidence that parent-focused intervention programs can be carried out in a positive fashion with families with few resources in order to teach parent intervention techniques to support the social communication development of their young children with ASD. Parents of children with ASD are generally stressed and overscheduled, especially lower-resourced families. Partnering with families to provide a parent-focused intervention program based on the needs of the families they serve would help practitioners get the most “bang for their buck”, particularly when implementing evidence-based programs within resource-poor community settings.