Intervention in the Assessment Clinic: Feasibility and Efficacy of an Abbreviated Group-Based Intervention Model for Toddlers

Background: Recent evidence from parent-mediated early intervention models for toddlers with ASD has demonstrated child- and parent-level gains following 3-12 months of intervention. These models are relatively resource-efficient, but demand continues to grow and is outpacing capacity such that toddlers may be missing out on intervention at a key time in development when neuroplasticity is optimal. In response to this increasing demand, our team developed an abbreviated, group-based version of our 12-week, in-home parent-mediated Social ABCs intervention. The Social ABCs parent-mediated intervention (standard model) is a 12-week in-home model, with demonstrated efficacy based on a cross-site RCT.

Objectives: To develop, pilot, and evaluate an abbreviated group-based model of an evidence-based parent-mediated intervention for toddlers with ASD or related social-communication challenges. The motivation for this work was to increase access to intervention, at the earliest signs of concern, for toddlers within the course of their clinical diagnostic care pathway, including before a diagnosis may be confirmed.

Methods: We adapted the original 12-week, one-on-one model to be delivered in a small-group format over six weeks (5 group-based didactics and 9 one-on-one parent coaching sessions in the clinic). Referrals were received from diagnosing clinicians (Psychologists or Developmental Paediatricians) or Social Workers within the clinical assessment service (Child Development Program) at Holland Bloorview Kids Rehab Hospital in Toronto, Ontario. To date, we have completed 4 groups (n = 12 toddler-parent dyads). Data from the first 3 groups were coded from video tape and analyzed, including measures of parent implementation fidelity (% correct use of strategies) and child responsivity (rate of responding to parent-provided language opportunities). Data from 20 dyads (6 groups) will be included for presentation at INSAR in May 2019.

Results: Interim analyses of group 1 led to program modifications which have been maintained for subsequent groups. Parents achieved implementation fidelity at a mean rate of 75% by the end of the program (week 6), increasing significantly from baseline, t = 7.98, p < .001. Child Responsivity increased by 43% from baseline to week 6 (t = 6.32, p < .001), at a pace commensurate with that reported in our previous RCT based on the original, 12-week one-to-one home-based model. Within the clinic-delivery model, our team has trained two Speech-Language Pathologists to provide parent-coaching. Parents and clinical staff have reported high levels of satisfaction with the program.

Conclusions: Findings reveal the feasibility and acceptability of our abbreviated group-based intervention model for toddlers with ASD and related social-communication concerns. Results demonstrate that the abbreviated model can be implemented in a clinical setting for toddlers within the context of a diagnostic assessment service. This abbreviated, group-based approach adds to the suite of services that can be offered to families very early in their diagnostic assessment journey, in many cases before a definitive diagnosis may be confirmed, and/or while awaiting more intensive intervention services. Weaving a brief intervention program into a clinical assessment pathway has the added value of providing clinicians with information about a child’s response-to-treatment in cases of diagnostic uncertainty.