Parent and Toddler Outcomes from a Wide-Scale Community Implementation of the Social ABCs Parent-Mediated Intervention

Background: Advances in early detection of ASD in the first years of life have motivated development of early intervention models directly targeted to the developmental needs of the toddler years. Several such models have demonstrated efficacy based on randomized control trials in controlled research settings. Next steps involve scaling up and wide-scale implementation.

Objectives: To evaluate the effectiveness of a parent-mediated intervention for toddlers with confirmed or suspected ASD in a large-scale community implementation.

Methods: Social ABCs parent-mediated intervention is one of four evidence-based models included in a government-funded pilot demonstration initiative currently underway in four regions of Ontario, Canada. The Social ABCs developers (“expert team”) trained 5 front-line staff (“coaches”) to deliver the Social ABCs parent coaching through the Ron Joyce Children’s Health Centre, the regional autism intervention service-provider in Hamilton Ontario (population ~750,000). Coaches attained fidelity of implementation and coaching, and 90 families have completed the 12-week coaching program to date (n > 120 anticipated by April 2019, for presentation at INSAR). To date, 159 toddlers have been enrolled (111 boys, 48 girls); age range: 15-34 months (M age = 25.4 months, SD = 4.16). Data were analyzed for those children who had completed week 12 (n = 90), including video-coded indices (parent implementation fidelity and child's rate of responding to parent-provided language opportunities; "responsivity") and standardized measures (Vineland Adaptive Behavior Scales (VABS) and Autism Diagnostic Observation Schedule-2; ADOS-2). Detailed information about the implementation process (i.e., training, referral/service delivery model, uptake, satisfaction, and acceptability, and other factors related to implementation are described in a linked submission: “Community Implementation of Social ABCs”). All parents received 12 weeks of one-on-one coaching, supported by the Social ABCs parent manual. Data were collected at baseline and weeks 1, 8, 12 (and 24 when available).

Results: Parents achieved implementation fidelity at a mean rate of 68% by week 4, and 80% by week 8, with significant gains compared to baseline (both p’s < .001); for the sub-set who have now completed their week 24 evaluation (n = 59), fidelity remained high (M = 73.76%). By week 8-12, 92.6% of families had achieved the pre-established target rate of 75% fidelity. Child Responsivity increased significantly from week 1 to week 12 (t = 13.32, p < .001). ADOS-2 scores pre-versus post-intervention revealed significant decreases in symptoms in the Social Affect domain (M = 14.3 vs. 11.8; t = 4.89, p < .001), but not the Restricted and Repetitive Behavior domain (p = .15). Standard scores for the VABS Communication domain (but no other domain) increased significantly from baseline (M = 71.0 to 73.4; t = 2.44, p = .02).

Conclusions: Findings demonstrate the successful implementation of the Social ABCs in a large, diverse community setting. Parents learned the techniques and toddlers made gains based on video-coded indices, direct assessment, and parent-reported function. These findings support the effectiveness of parent-mediated intervention for toddlers with confirmed or suspected ASD, and highlight both the scalability and portability of the Social ABCs for implementation within a community service-delivery model.