Project Impact for Toddlers: Pilot Outcomes of Community Adaptation of an Evidence-Based Intervention for ASD Risk

Background: Parent-mediated naturalistic developmental behavioral interventions (NDBI) have demonstrated positive child and family outcomes for young children with ASD (Zwaigenbaum et al., 2015; Burrell & Borrego, 2012). Intervening at the first signs of ASD risk, prior to a formal diagnosis, may be a powerful option and prevent the onset of symptoms for some children (Dawson, 2008; Lavelle et al., 2014). Despite demonstrated benefits, however, there has been little dissemination of parent-mediated NDBI into community settings, where the majority of children receive services (Stahmer et al., 2016). Community providers with expertise in both the NDBI strategy use and partnering with parents are needed to effectively deliver NDBIs. Based on the range of funding mechanisms and agencies through which children with ASD may receive services, however, community providers have variable educational backgrounds and ASD specific experience. As communities struggle to serve the growing number of young children with ASD with effective interventions, more information is needed about whether community implemented parent-mediated NDBI leads to improved family outcomes.

Objectives:

The objective of this presentation is to demonstrate parent and child outcomes from a community effectiveness pilot study of an evidence-based, parent-mediated NDBI (Project ImPACT for Toddlers or PI^T; Ingersoll & Dvortscak, 2010).

Methods:

A quasi-experimental design was used to examine effectiveness of PI^T implemented in low-intensity, public early intervention. Families of children with social communication challenges and/or risk for ASD were assigned by the early intervention coordinator to a provider trained in PI^T or to usual care (UC), based on typical referral practices. The final sample included 25 caregiver/child dyads (PI^T n=12; UC n=13). Measures included an ADOS and Mullen Scales of Early Learning to characterize the sample. Parent outcome measures included objective ratings of parent use of PI^T strategies with their child, general positive parent-child interaction, satisfaction, social support, and intervention engagement. Child outcomes included the Infant Toddler Checklist, MacArthur Bates CDI, and Vineland Adaptive Behavior Scales. Dependent measures were collected at intake, post intervention, and at a 3-month follow up.

Results:

Children were 68% male, averaged 23 months of age at intake, and had average developmental scores of 72.14 (SD=16.97). Caregivers were all mothers. were 48% Hispanic/Latinx and 28% received services in Spanish. Mothers represented a wide range of maternal education and employment. Groups were comparable at intake. Parents in the PI^T group had higher engagement in the intervention compared to UC (t(21)=-2.66, p<.02), but similar rates of parent satisfaction and social support. Significant differences were seen in favor of the PI^T group in all areas of parent-child interaction. Children in the PI^T group had significantly greater words produced and CSBS Symbolic Composite and had generally larger effect sizes in many areas. Most changes maintained or improved at follow up.

Conclusions:

This study represents one of the first demonstrations of effectiveness for an adapted evidence-based practice in community early intervention programs. The results indicate promise for use of parent-implemented interventions in community early intervention to support children and families, even prior to an ASD diagnosis.