Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis

Understanding the impact of preemptive interventions on development for those with a high likelihood for autism is a critical step in building a transdiagnostic model of optimized intervention. The purpose of this systematic review and meta-analysis is to examine the impact of preemptive autism interventions on parent outcomes and child developmental outcomes. A total of 345 unique records were assessed for eligibility yielding 13 unique studies with 715 total infant/toddlers with a high likelihood for autism. There was a significant association between the early interventions on parent implementation of intervention strategies immediately following the intervention. However, there was no significant association between the early interventions and child developmental outcomes. The studies reporting moderator and/or mediator analyses suggest a meaningful association between parent implementation and long-term child social communication outcomes. Taken together, these findings suggest that parent-mediated interventions are associated with improved parent use of strategies, and although these results do not translate into immediate or short-term child developmental outcomes, there is evidence that parents with the greatest implementation facilitate later improved communication outcomes for their children. There is an urgent need to develop a nuanced intervention approach during a time of ever-changing concern about child development. Lay abstract Interventions to address core symptoms for young children on the autism spectrum have a strong and growing evidence base. Adapting and delivering evidence-based interventions to infants and toddlers with a high likelihood for autism is a logical next step. This systematic review and meta-analysis summarize the association between infant and toddler interventions and developmental and family outcomes. Results indicate that these early interventions are effective for improving parent implementation of core strategies, yet the effects do not readily translate to child outcomes. However, key studies demonstrate conditional results that indicate that parent implementation is associated with child outcome. Implications for research and practice toward building adaptive interventions that respond to parent implementation and changing child characteristics are discussed.

Assessing Parent Implementation of Behavior Support Strategies and Self-Monitoring to Enhance Maintenance

Teaching parents to serve as interventionists for their children is a common approach to enhance child learning. Research demonstrates that parents are able to implement evidence-based interventions with high integrity; however, there is limited research indicating the extent to which parents are able to maintain skills. We taught parents of two children, age 10 and 11, to implement three positive behavior support skills: praise, choice making, and setting expectations. Using a multiple baseline across skills design, parents demonstrated criterion level use of all three skills; however, only one skill for one parent maintained. We then taught parents to self-monitor the use of skills that did not maintain. Following self-monitoring, parents demonstrated immediate increases in strategy implementation. In addition, both children demonstrated significant increases in engagement and decreases in problem behavior. Social validity results indicated high acceptability by both parents.

A Parent-Implemented Gross Motor Intervention for Young Children with Disabilities

Children with disabilities often experience gross motor delays. Adults, including parents, can play a crucial role in supporting children’s motor development. However, a limited number of research studies have focused on building parents’ capacity to support their young children’s motor skill development. The purpose of this study was to examine the effects of a training and coaching program on parent implementation of prompting procedures and children’s gross motor skills. A multiple-probe single-case design across three parent–child dyads was used to evaluate the effectiveness of the intervention. The findings show that parents learned how to implement prompting procedures with high fidelity. In addition, the parents reported improvements in their children’s gross motor performance.

Coaching Parents of Children With Developmental Disabilities to Implement a Modified Dialogic Reading Intervention Using Low Technology via Telepractice

Purpose Storybook reading provides a naturalistic context to promote bonding and increase oral communication between the reader and child. This study investigated the impact of modified dialogic reading procedures, which included a prompting component on the language skills of children with autism spectrum disorder and Down syndrome in the children's homes. Method A multiple-probe-across-participants design was used to investigate the efficacy of the intervention for this population. Parent training and coaching were provided via telepractice. Maintenance and generalization sessions were also conducted. Results A functional relation was observed between parent implementation and telepractice coaching. Conclusion While the child responses to comprehension questions did not change, changes in the parent implementation of modified dialogic reading procedures in response to coaching via telepractice were noted in this study. Supplemental Material https://doi.org/10.23641/asha.13382831

Using Telehealth and Expert Coaching to Support Early Childhood Special Education Parent-Implemented Assessment and Intervention Procedures

Researchers and clinicians have successfully demonstrated the use of telehealth in supporting parents to conduct functional analyses (FAs) and subsequent functional communication training (FCT). We replicated and extended previous research by utilizing telehealth to train an existing Early Childhood Special Education (ECSE) Behavior Specialist to support parent implementation of behavioral procedures. Board Certified Behavior Analysts (BCBAs) coached the existing Behavior Specialist via telehealth, who in turn trained and supported parents to conduct FAs and implement FCT in a community clinic. In four children, 3 years of age and younger, the function of challenging behavior was successfully identified according to a multielement research design. Challenging behavior reduced, and the selected appropriate communication response increased for all participants, evaluated using an AB research design. This study provides initial evidence that parents in rural settings can successfully implement assessment and intervention procedures with the support of an existing ECSE Behavior Specialist receiving coaching from BCBAs via telehealth.

Effects of coaching on the fidelity of parent implementation of reciprocal imitation training

Imitation is an important early social communicative skill that is often impaired in young children with autism. Reciprocal imitation training is an easy-to-implement intervention that targets social imitation and can be taught to parents or other caregivers to implement at home and in the community. In this study, parents of children with autism were taught to implement reciprocal imitation training. The quality of parent fidelity of intervention implementation and rates of child spontaneous imitation were examined in three phases: baseline, post-didactic training, and after the introduction of 1:1 coaching. The results suggest that coaching improved parent fidelity with all parent participants, and this correlated to an increase in spontaneous imitation with some of the child participants.

A Systematic Review of Parent-Implemented Functional Communication Training for Children With ASD

Supporting parents in reducing challenging behavior of children with autism spectrum disorder (ASD) requires the identification of effective, feasible, and sustainable interventions. Functional communication training (FCT) is one of the most well-established interventions in the behavioral literature and is used increasingly by parents. However, there is a need for additional evaluation of the literature related to parent-implemented FCT. In the present review, we identified 26 peer-reviewed studies on parent-implemented FCT. We conducted systematic descriptive and social validity analyses to summarize the extant literature. Across studies, parent-implemented FCT was effective in reducing child challenging behavior, and in some cases, intervention outcomes maintained and generalized to novel settings and implementers. However, few studies reported fidelity data on parent implementation of FCT, and data regarding sustained use of FCT by parents were limited. Results of the social validity analysis indicate that while FCT is often implemented by natural change agents in typical settings, parent training is often provided by professionals not typically accessible to parents. These findings suggest that future research is warranted in the areas of parent training and long-term sustainability of parent-implemented FCT.

Functional Assessment Based Parent Intervention in Reducing Children’s Challenging Behaviors: Exploratory Study of Group Training

This study examined the effects of group parent training on children’s challenging behaviors in home settings. Eight parents of young children with challenging behaviors were trained in a large group setting on using functional assessment to design interventions that fit the strengths and needs of individual families. The training included information sharing and collaborating with parents on designing functional-assessment based interventions. An Interrupted Time Series Design was used to examine the effects of large group training by comparing parent and child behaviors prior to intervention with behaviors after the intervention. Data were analyzed using Repeated Measures ANOVA. The results indicated that group training increased parents’ ability to implement functional assessment based strategies and these strategies resulted in a significant reduction in children’s challenging behaviors. Furthermore, parent implementation of functional assessment based strategies and children’s decreased levels of challenging behaviors were maintained after the completion of the intervention.