31545
Comparing Child-Directed and Parent-Mediated Interventions Delivered in Community Care Settings with Diverse Children with ASD
There has been increasing support for the efficacy of both child-directed and parent-mediated interventions to improve skills in children with Autism Spectrum Disorder (ASD)(Kasari et al., 2010). There continues to be a need for effectiveness intervention studies when implemented in diverse community settings (e.g., National Advisory Mental Health Council, 2018; IACC, 2013). Thus, this study examines the effectiveness of 4 evidence-based intervention models implemented in ethnically diverse community-based settings.
Objectives:
The purpose of this study was to evaluate change across multiple distinct well-established treatments delivered in community care settings including 2 child-directed and 2 parent-directed interventions. Using a longitudinal repeated measures design, this study examined the degree to which specific autism symptom domain scores changed over time in response to separate treatments delivered in community care.
Methods:
This sample includes 264 children (82% male) ages 2-9 years (M = 4.4 years; SD = 2.2) and their primary caregivers. All children had a diagnosis of Autism Spectrum Disorder (all cases validated by positive ADOS-2), and 63% identified as racial or ethnic minority. The treatment groups included: ImPACT; n=69 (parent-mediated), PBS/PRT; n=33 (parent-mediated), EIBI; n=122 (child-directed) and PLAYC; n=40 (child-directed preschool program). All participants were assessed at baseline and approximate 6-week intervals over the course of treatment. Participants receiving the briefest intervention (ImPACT=3 month tx) were assessed at 3 time points, those receiving medium-term interventions ( PBS/PRT=4.5 month tx) were assessed at 4 time points, and those receiving ongoing long-term interventions (EIBI & PLAYC=7.5 months tx) were assessed at 5 time points. The primary outcome measure, Autism Impact Measure (AIM), was collected for all participants at each assessment time point. The AIM is a parent-report questionnaire that includes 41 items rated on corresponding 5-point scales regarding the frequency and includes the following 5 domains: Repetitive Behavior, Atypical Behavior, Communication, Social Reciprocity, and Peer Interaction (Mazurek et al., 2018). To examine the degree to which AIM scores changed over time in response to treatment, the study focused on AIM domains and the nature of change over time across all individuals. Measurement models of growth were built separately for each AIM domain using the mixed model procedure in SAS 9.4. In addition, the model estimated average T-score for AIM domains at both baseline and final time points which are presented along with the average difference in T-scores between baseline and final time point, and the effect size of this difference.
Results:
Each model found significant treatment effects. Parent-mediated treatments (ImPACT and PBS-PRT) showed greater change T-scores and effect sizes on 3 of the 5 domains including repetitive behaviors, atypical behaviors and social reciprocity. The PBS-PRT group also showed the greatest gains in the communication domain and ImPACT showed the greatest gains in peer interaction domain. The PLAYC preschool group revealed the least gains in most domains. Refer to Tables.
Conclusions:
Overall, the current study provides the first large-scale examination of change across well-established treatments delivered in community care. The results indicate that parent-directed interventions outperform child-directed treatment modalities delivered in a community setting.