Parent Coaching of Music Interventions for Children with ASD: A Limited-Efficacy Study

Background: Parent-mediated interventions are specific interventions where parents collaborate in goal setting and implement evidence-based strategies with their children with disabilities (Steiner, Koegel, Koegle, & Ence, 2012; Zwaigenbaum et al, 2015). These models have responded to the need of early intervention services, especially in areas where professional services are scarce (Oono, Honey, & Mcconachie, 2013). Concurrently, parent coaching is the professional service provided to train parents in those strategies (Steiner et al, 2012). Parent coaching is currently researched as a very cost-effective and useful strategy in the ASD field (Oono et al, 2013). In music therapy, parent participation studies are emerging in the research literature, particularly in the last 5 years (2012-2017). However, parent-mediated interventions and their coaching are very limited (Blind Review, 2018a). For this study, a parent coaching model based on the Parent-Early Start Denver Model was developed (Rogers et al., 2012). The theoretical framework conceptualizes music as a mediator of parent coaching through optimization of psychophysiological arousal of both child and parent, and through synchronization of their social communication (Blind Review, 2018b). Such optimization would increase parental responsiveness, and child attention and motivation (Baker et al, 2015; Feldman et al., 2012; Trainor & Cirelli, 2015).

Objectives: The purpose of this exploratory study was to test the limited-efficacy of parent coaching of music interventions on parental responsiveness and child communicative behaviors.

Methods: An alternating treatments design for three parent-child dyads was implemented. Parents received ten 1-hour coaching sessions based on the Parent-ESDM manual (Rogers & Vismara, 2015). Music and non-music conditions were offered in each session, counterbalancing to avoid order effects. Two trained observers coded parental and child behaviors in three baseline and ten treatment sessions.

Results: Only one parent-child dyad completed the treatment and was analyzed. Behavioral video analysis of parental verbal and nonverbal responsiveness, child joint attention and verbal behaviors, and parent and therapist fidelity provided quantitative data. A semi-structured follow-up interview with the parent addressed concerns, preferences, and suggestions for improvement. Parental verbal responsiveness seemed lower during the music condition, but non-verbal responsiveness increased notably during the music condition. Importantly, parental responses changed from directive instructions to responsive comments to child communication, but this fact was not reflected in quantitative data. Parent fidelity was achieved in the 6^th session. As theorized, parental fatigue due to personal circumstances impacted results in the last two sessions. Child receptive joint attention increased in the music condition only, and initiating joint attention was higher in most sessions during the music condition. Parental comfort with the music did not seem ideal with the brief time allotted to training despite familiarity with the music used.

Conclusions: Parent coaching of music interventions to enhance social communication of preschoolers with ASD seems feasible and potentially efficacious. Further research should investigate other approaches to teach the music, alternative schedules, and more precise measures of parental responsiveness, such as a ratio of directive vs. responsive parental communication.

The present manuscript is part of the author’s dissertation presented in partial fulfillment of a PhD degree.