1
|
Ingersoll B, Frost KM, Straiton D, Ramos AP, Casagrande K. Telehealth coaching in Project ImPACT indirectly affects children's expressive language ability through parent intervention strategy use and child intentional communication: An RCT. Autism Res 2024. [PMID: 39233512 DOI: 10.1002/aur.3230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024]
Abstract
Parent-mediated, naturalistic developmental behavioral interventions (NDBIs) are a promising approach for supporting social communication development in young autistic children. This study examined the effect of telehealth delivery of a parent-mediated NDBI, Project ImPACT, on children's expressive language ability using a randomized control trial with intent-to-treat analysis. Sixty-four young autistic children and their primary caregiver were matched on age and developmental quotient and randomly assigned to receive 6 months of therapist-assisted Project ImPACT (i.e., telehealth coaching), self-directed Project ImPACT, or an active control. Parent-child interactions were recorded at intake and immediately post-treatment, and the children's expressive language skills were assessed at intake and a 9-month follow-up using standardized measures. Although there was no total effect of treatment group assignment on child outcomes, a serial mediation analysis revealed that therapist-assisted ImPACT had an indirect effect on children's expressive language ability at follow-up through their parents' use of the intervention strategies and their intentional communication immediately post-treatment. Findings support Project ImPACT's program theory and highlight the importance of coaching in achieving positive outcomes when delivered via telehealth.
Collapse
Affiliation(s)
- Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Kyle M Frost
- Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center, Worcester, Massachusetts, USA
| | - Diondra Straiton
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Karis Casagrande
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| |
Collapse
|
2
|
Cullenward J, Curtin M, Dos Santos V. Characteristics of effective parent-mediated interventions for parents of children with neurodevelopmental disorders in rural areas: a systematic review protocol. BMJ Open 2024; 14:e083464. [PMID: 39142676 PMCID: PMC11331994 DOI: 10.1136/bmjopen-2023-083464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/17/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Parent-mediated interventions are therapeutic approaches that use parent training to enable parents to provide primary support and intervention to their child through the development of necessary skills, knowledge, and resources.Parent-mediated interventions can be broadly divided into two stages: (1) Clinicians educating, training and coaching parents in the implementation of an intervention and relevant information regarding their child's condition and (2) Parent(s) mediating and implementing the intervention based on the coaching and education received. These interventions can act as the primary intervention for children or supplement clinical interventions. This review will include both stages of the implementation process as well as both primary and supplementary interventions. Outcomes of parent-mediated interventions include long-term symptom reduction, improved prognosis for a wide range of behavioural and brain functions and enhanced parent-child dyadic social communication. METHODS AND ANALYSIS This systematic review aims to synthesise existing evidence and identify the characteristics of effective parent-mediated intervention for parents of children with neurodevelopmental disorders residing in rural areas. Systematic searches of CINAHL, PsycINFO, ProQuest allied health and nursing database, Ebscohost Psych and Behavioural database and SocINDEX were conducted twice with the latest completed on 5 March 2024 using preidentified search terms. Citations will be imported into EndNote V.20.6 (Clarivate Analytics, Pennsylvania, USA) to organise and de-duplicate and then Covidence to complete screening and extraction. The articles will be screened and reviewed following the Joanna Briggs Institute (JBI) guidelines for systematic reviews of Mixed methods. The JBI appraisal tools for systematic reviews will be used to assess the trustworthiness, relevance and results of qualitative, quantitative and mixed-methods studies. The scope of the literature analysed will include articles published between 2013 and 2024 in English. Literature was limited to the last 10 years to ensure the relevance of results as the intention is to report on current evidence. The start date of the study was March 2023 and the planned completion date is October 2024. ETHICS AND DISSEMINATION This study will neither involve human nor animal subjects and does not require ethics approval. Results will be disseminated to relevant groups in peer-reviewed journal(s) and at relevant children and parent health conferences or rural conferences. The key outcomes will also be shared on social media to support access for non-research audiences.
Collapse
Affiliation(s)
- Julia Cullenward
- School of Allied Health, Exercise & Sport Sciences, Charles Sturt University, Albury/Port Macquarie, New South Wales, Australia
| | - Michael Curtin
- School of Allied Health, Exercise & Sport Sciences, Charles Sturt University, Albury/Port Macquarie, New South Wales, Australia
| | - Vagner Dos Santos
- School of Allied Health, Exercise & Sport Sciences, Charles Sturt University, Albury/Port Macquarie, New South Wales, Australia
| |
Collapse
|
3
|
Bin Zuair HM, Baird JM, Caldwell AR. Parent-Mediated Occupational Therapy Interventions for Children with Developmental Disabilities: A Scoping Review. Phys Occup Ther Pediatr 2024:1-17. [PMID: 39014870 DOI: 10.1080/01942638.2024.2378063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
AIM This scoping review synthesizes literature about occupational therapy parent-mediated interventions (PMIs) that target occupation-based outcomes for children with developmental disabilities (DD). METHODS A search of PubMed, Web of Science, and CINAHL from 2010 through 2023 was performed resulting in 471 publications. Studies were included if they involved PMIs for participants with DD aged 3-12 years and were published in English. Studies were excluded if the outcomes were not occupation-based. A thematic analysis was conducted following an iterative review of charted data. RESULTS Twelve studies met the inclusion criteria reflecting four themes across occupational therapy PMIs, including variation in terminologies, types of PMIs, key components of PMIs, and the overall impact. While the effects of PMIs are difficult to define due to the variability in the samples, interventions, and outcomes, this review suggests general positive impacts of PMIs. CONCLUSION The emerging body of evidence supporting PMIs within the field of occupational therapy suggests they are feasible and have the potential to improve child and parent outcomes when delivered to children with DD. Further research is needed to clarify PMIs' components, unify the identification terminology, and test the efficacy of different types of PMIs for specific populations.
Collapse
Affiliation(s)
- Hessah M Bin Zuair
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Joanne M Baird
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, United States of America
| | - Angela R Caldwell
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, United States of America
| |
Collapse
|
4
|
Conrad CE, Jørgensen R, Amstrup C, Gottschau TE, Thomsen PH, Lauritsen MB. "It Seems Much More Enjoyable Now": Parental Perception of Relational Change from Participating in Paediatric Autism Communication Therapy (PACT). CHILDREN (BASEL, SWITZERLAND) 2024; 11:838. [PMID: 39062287 PMCID: PMC11276199 DOI: 10.3390/children11070838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This qualitative study aims to examine parental experiences of feasibility and relational changes from participating in the Paediatric Autism Communication Therapy (PACT) intervention. METHODS Thirteen parents of children diagnosed with autism spectrum disorder (mean age 3.89 years) participated in semi-structured interviews. Thematic analysis was performed, inspired by an abductive approach informed by the theories of the attachment system, the caregiving system and mentalisation. RESULTS Three overarching themes were identified: the struggle of fitting PACT into everyday life, the fruit of relational connection and the cascading relational effects of PACT. Parents were challenged regarding finding time for the intervention but adapted PACT to their individual needs and possibilities. All parents experienced relational improvement, and a cycle of positive relational change through PACT was identified. CONCLUSIONS This study has several clinical implications. Therapists and clinics offering PACT interventions should encourage and support parents in their individual journey of implementing PACT into their everyday lives. Some of the parents described improvements in parental mentalisation, child attachment and mutual enjoyment in the parent-child relationship. Children with autism could benefit from parents increasing their sensitivity when caregiving, and clinicians may through interventions such as PACT facilitate this development.
Collapse
Affiliation(s)
- Charlotte Engberg Conrad
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
- Department of Clinical Medicine, Aalborg University, 9260 Gistrup, Denmark
| | - Rikke Jørgensen
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
- Department of Clinical Medicine, Aalborg University, 9260 Gistrup, Denmark
| | - Cecilie Amstrup
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
| | - Tine Ellitsgaard Gottschau
- Research Unit, Department of Child and Adolescent Psychiatry, Copenhagen University Hospital—Psychiatry Region Zealand, 4000 Roskilde, Denmark;
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Marlene Briciet Lauritsen
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
- Department of Clinical Medicine, Aalborg University, 9260 Gistrup, Denmark
| |
Collapse
|
5
|
Weitlauf AS, Foster T, Slaughter JC, Fleck M, Harris J, Coffield C, Simcoe K, Baggett J, Stainbrook A, Warren ZE. Screening Options in Autism Telediagnosis: Examination of TAP, M-CHAT-R, and DCI Concordance and Predictive Value in a Telediagnostic Model. J Autism Dev Disord 2024:10.1007/s10803-024-06427-x. [PMID: 38833028 DOI: 10.1007/s10803-024-06427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
Tele-assessment of autism in early childhood has increased. However, it is unclear how autism screening tools (M-CHAT-R, DCI) function as part of tele-assessment and relate to a commonly used tele-assessment instrument, the TAP. 361 families from a clinically referred sample of children (mean age: 27.63 months, sd = 4.86 months) completed the M-CHAT-R and DCI prior to a tele-assessment visit utilizing the TAP. Data was collected on demographic background, measure scores, and diagnostic outcome. No significant differences in measure scores or diagnostic findings emerged in age at referral, age group, age at diagnosis, or child sex, ethnicity, or racial background. The M-CHAT-R and DCI correlated strongly and positively. Older age was associated with lower risk scores on screening instruments. Children with autism had significantly higher scores on all screener and subdomain scores, with the exception of DCI Behavior. Subdomains of the DCI emerged as the strongest predictor of diagnostic outcome. Both the DCI total score and the M-CHAT-R significantly related to diagnostic outcome and TAP score in this tele-assessment model, regardless of child age or sex. Findings also support use of the DCI for children under 24 months of age.
Collapse
Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA.
| | - Tori Foster
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Fleck
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Jill Harris
- Department of Pediatrics, Children's Specialized Hospital, New Brunswick, New Jersey, USA
| | - Caroline Coffield
- Department of Pediatrics, Robert Wood Johnson Medical School at Rutgers University, New Brunswick, New Jersey, USA
| | - Kathleen Simcoe
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Jenny Baggett
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Special Education, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Reichow B, Kogan C, Barbui C, Maggin D, Salomone E, Smith IC, Yasamy MT, Servili C. Caregiver skills training for caregivers of individuals with neurodevelopmental disorders: A systematic review and meta-analysis. Dev Med Child Neurol 2024; 66:713-724. [PMID: 37786292 DOI: 10.1111/dmcn.15764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
AIM To systematically review the effectiveness of caregiver and parent skills training programs, including caregiver-mediated interventions, for caregivers of individuals with neurodevelopmental disorders. METHOD We conducted a systematic review with a random-effects meta-analysis. We searched 11 electronic databases through July 2021 and used a snowball methodology to locate relevant articles of randomized controlled trials. Effect size estimates were pooled using Hedges' g from data extracted from study reports and through author requests using random-effects meta-analyses for three child outcome categories (child development, adaptive behavior, and problem behavior) and three caregiver outcome categories (parenting skills and knowledge, psychological well-being, and interpersonal family relations). RESULTS We located 44 910 records, from which 75 randomized controlled trials involving 4746 individuals with neurodevelopmental disorders and their caregivers were included. Random-effects meta-analyses showed improvements in child development (g = 0.30; 99% confidence interval [CI] = 0.07-0.53) and reduction in reported problem behaviors (g = 0.41; 99% CI = 0.24-0.59), but not a statistically significant improvement in adaptive behavior (g = 0.28; 99% CI = -0.42 to 0.98). Caregivers showed improvements in parenting skills and knowledge (g = 0.72; 99% CI = 0.53-0.90), psychological well-being (g = 0.52; 99% CI = 0.34-0.71), and interpersonal family relations (g = 0.76; 99% CI = 0.32-1.20). INTERPRETATION Caregiver skills training programs benefit both caregivers and children with neurodevelopmental disorders. Skills training programs improve child development and behavior, improve parenting skills, reduce caregiver mental health issues, and improve family functioning. Programs using culturally appropriate training material to improve the development, functioning, and participation of children within families and communities should be considered when caring for children with neurodevelopmental disorders. WHAT THIS PAPER ADDS Caregiver skills training programs are effective interventions for both caregivers and children. Children with neurodevelopmental disorders benefit from improvements in development and reduction of problematic behaviors. Caregivers benefit from enhanced skills and psychological well-being. Improvements in interpersonal family relationships have also been documented.
Collapse
Affiliation(s)
- Brian Reichow
- AJ Pappanikou Center for Excellence in Developmental Disabilities Education, Research, and Service, University of Connecticut Health Center, Farmington, CT, USA
- University of Florida, Gainesville, FL, USA
| | - Cary Kogan
- University of Ottawa, Ottawa, ON, Canada
| | - Corrado Barbui
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | | | | | - Isaac C Smith
- AJ Pappanikou Center for Excellence in Developmental Disabilities Education, Research, and Service, University of Connecticut Health Center, Farmington, CT, USA
- Yale University, New Haven, CT, USA
- Virginia Tech, Blacksburg, VA, USA
| | | | | |
Collapse
|
7
|
Miletic K, Servais M, Cardy JO, Denusik L. Do Caregiver Perceptions of the Virtual More Than Words® Program Differ Based on Autistic Children's Attributes? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1127-1141. [PMID: 38381120 DOI: 10.1044/2024_ajslp-23-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE More Than Words® (MTW) is a caregiver-mediated intervention program led by a speech-language pathologist (SLP) who teaches caregivers strategies to support their autistic child's early social communication and play development. The program includes group sessions composed of multiple families with children of varying profiles. We explored whether caregiver experiences and perceived outcomes of the virtual MTW program differed depending on the child's age and social communication stage. METHOD As part of a program evaluation of virtual MTW delivered to over 2,000 families in Ontario, Canada, between 2020 and 2021, we randomly selected 31 families across four social communication stages and two age groups using stratified sampling (n = 4, in all but one subgroup). The Final Reflection and Evaluation form was analyzed both qualitatively and quantitatively, and a modified RE-AIM framework guided our analyses, including theme development. RESULTS Child attributes did not appear to impact caregivers' experiences, but perceived child skill improvements varied by children's social communication stage. The majority of caregivers reported changes in how they interact with their child. Four themes emerged: (a) perceived child skill improvements differed by social communication stage, (b) caregivers gained new knowledge and strategies regardless of child attributes, (c) SLPs effectively managed families' individual needs, and (d) program components were appropriate for a variety of families. CONCLUSIONS Findings suggest that the content taught in the MTW program was relevant for a variety of children, including those beyond the program's intended age of 5 years and under. Grouping families of children with varying profiles does not appear to negatively influence caregivers' experiences or perceived outcomes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25237009.
Collapse
Affiliation(s)
| | - Michelle Servais
- University of Western Ontario, London, Canada
- Thames Valley Children's Centre, London, Ontario, Canada
| | | | | |
Collapse
|
8
|
Murphy AN, Moskowitz K, Fernandez F, Risser HJ. Perceived Parent Needs for Improving Parent Participation in School-Based Therapies for Children with Disabilities Using the Parent-Therapist Partnership Survey. J Autism Dev Disord 2024:10.1007/s10803-024-06282-w. [PMID: 38393438 DOI: 10.1007/s10803-024-06282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Rehabilitative and habilitative therapies can help children with disabilities increase independence and overall wellbeing. However, children and their caregivers face many barriers to accessing these therapies and often rely on the school for therapy access. Given the limited resources available within the special education system, increasing parent involvement in special education therapies could improve service delivery. However, providers must first understand what parents need to participate in therapies before attempting to engage families. 217 parents completed an online survey consisting of the Parent-Therapist Partnership Survey and demographic questionnaires about theirfamiliesand their child[ren] with disabilities. The percentage of needs parents endorsed as important and thepercentageofimportantneedsendorsedasunmetwere calculated. Differences across demographic variables were assessed. Overall, parents reported an average of 75% of needs as important with significantly more needs endorsed as important regarding being an informed, engaged member of the child's care team (M = 83%) than needs related to support and guidance (M = 65%, p < 0.001). Furthermore, parentsreportedan average of 58% of important needs as unmet, with no significant differences in subscale averages. Significant associations were found for race/ethnicity, education, income, partner availability, number of children with disabilities in the household, transportation access, neighborhood opportunities, parent efficacy and social, emotional, and behavioral concerns. Parents reported a high percentage of needs as important, but a large percentage of these important needs were considered unmet. Significant disparities based on racial/ethnic identities and access to resources were found. In order to successfully engage parents in special education therapy activities, providers must work to understand and address parents' engagement needs, paying special attention to each family's unique circumstances to optimize engagement.
Collapse
Affiliation(s)
- Ashley N Murphy
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA.
| | - Kathleen Moskowitz
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA
| | - Francesca Fernandez
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA
| | - Heather J Risser
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA
| |
Collapse
|
9
|
Carruthers S, Pickles A, Charman T, McConachie H, Le Couteur A, Slonims V, Howlin P, Collum R, Salomone E, Tobin H, Gammer I, Maxwell J, Aldred C, Parr J, Leadbitter K, Green J. Mediation of 6-year mid-childhood follow-up outcomes after pre-school social communication (PACT) therapy for autistic children: randomised controlled trial. J Child Psychol Psychiatry 2024; 65:233-244. [PMID: 37095645 PMCID: PMC10953331 DOI: 10.1111/jcpp.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND There are very few mechanistic studies of the long-term impact of psychosocial interventions in childhood. The parent-mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre-school to mid-childhood. We investigated the mechanism by which the PACT intervention achieved these effects. METHODS Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5-6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non-verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. RESULTS Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow-up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow-up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near-significant total effect on follow-up TVABS. No moderation of this mediation was found for AE, CSBS or IS. CONCLUSIONS Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long-term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long-term generalised outcome effects.
Collapse
Affiliation(s)
- Sophie Carruthers
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Helen McConachie
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ann Le Couteur
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Vicky Slonims
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
| | - Patricia Howlin
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Rachel Collum
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Erica Salomone
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Department of PsychologyUniversity of Milano‐BicoccaMilanItaly
| | | | - Isobel Gammer
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Jessica Maxwell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jeremy Parr
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jonathan Green
- Manchester Academic Health Sciences Centre, Royal Manchester Children's HospitalUniversity of ManchesterManchesterUK
| |
Collapse
|
10
|
Pattison E, Papadopoulos N, Fuller-Tyszkiewicz M, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Bellows ST, Marks D, Howlin P, Rinehart N. Randomised Controlled Trial of a Behavioural Sleep Intervention, 'Sleeping Sound', for Autistic Children: 12-Month Outcomes and Moderators of Treatment. J Autism Dev Disord 2024; 54:442-457. [PMID: 36414853 PMCID: PMC9684935 DOI: 10.1007/s10803-022-05809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5-13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p < .001, effect size: - 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support.
Collapse
Affiliation(s)
- Emily Pattison
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Susannah T Bellows
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Deborah Marks
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nicole Rinehart
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
| |
Collapse
|
11
|
Drmic I, Brian J, Roncadin C, Shaver C, Pase M, Rugajs N, Tofano K, Dowds E, Zwaigenbaum L, Smith IM, Bryson SE. Community implementation of a brief parent mediated intervention for toddlers with probable or confirmed autism spectrum disorder: feasibility, acceptability, and drivers of success (IE Drmic et al.). Front Pediatr 2024; 11:1295294. [PMID: 38322245 PMCID: PMC10844426 DOI: 10.3389/fped.2023.1295294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/27/2023] [Indexed: 02/08/2024] Open
Abstract
Background Social ABCs is a caregiver-mediated Naturalistic Developmental Behavioral Intervention for toddlers with confirmed/suspected Autism Spectrum Disorder (ASD), with evidence in controlled research settings. Information is lacking on implementation in community settings. We reported on the treatment effectiveness of this program within a community setting, and the current paper describes the implementation phase of this work. Distinguishing between treatment and implementation effectiveness is critical for transporting interventions from laboratory to community. Objectives Describe the implementation of Social ABCs through a large public autism service, supported by a research-community partnership. Methods We describe this project through the Exploration, Preparation, Implementation, Sustainment (EPIS) framework as it focuses on implementation of evidence-based practices in publicly funded services. We apply this framework to the reporting stage. This project took place in the context of a 3-year government-funded pilot at a hospital-based publicly funded autism service. Participants: Program developers; Autism Service team; toddlers with suspected/confirmed ASD aged 14-34 months (M = 25.18 months) and their caregivers. Training/supervision: Provided by program developers at tapering intensity. Evaluation: Caregivers completed the Caregiver Diary and satisfaction surveys. We explored training processes, intervention uptake, acceptability, adaptations to fit community context, appropriateness, perceived impact, and facilitators/barriers. Results Six coaches were trained to fidelity, and three of these were further trained as Site Trainers. 183 clinically referred families enrolled and 89.4% completed the 12-week program. Caregivers reported increases in adherence and competence, high satisfaction and perceived benefits for their children. Coaches reported high satisfaction. Toddlers were appropriately identified to receive the intervention. Referral processes improved, including decreased referral age, and increased family readiness for diagnostic assessment and subsequent services. Conclusions Social ABCs was successfully implemented in a community service through a research-community partnership. The program was feasible, acceptable, and appropriate within a community context. Drivers of success included funding, institutional support, shared decision-making, adaptations to fit context, leadership support, perceived positive impact, and commitment to evaluation.
Collapse
Affiliation(s)
- Irene Drmic
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Jessica Brian
- Autism Research Centre, Bloorview Research Institute, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Chantelle Shaver
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Marlene Pase
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Natalie Rugajs
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Kristina Tofano
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Erin Dowds
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | | | - Isabel M. Smith
- Department of Pediatrics and Department of Psychology & Neuroscience, Autism Research Centre, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Susan E. Bryson
- Department of Pediatrics and Department of Psychology & Neuroscience, Autism Research Centre, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
12
|
Settanni M, Suma K, Adamson LB, McConachie H, Servili C, Salomone E. Treatment mechanism of the WHO caregiver skills training intervention for autism delivered in community settings. Autism Res 2024; 17:182-194. [PMID: 38151484 DOI: 10.1002/aur.3058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023]
Abstract
This study examined the mechanism of effect of the WHO Caregiver Skills Training (CST) through secondary analysis of a pilot RCT conducted in community settings. Participants were 86 caregivers (77% mothers) of children with ASD (78% male, mean age: 44.8 months) randomized to CST (n = 43) or treatment as usual (n = 43). The primary outcomes, measured at baseline (t1), immediately post-intervention (t2), and 3 months post-intervention (t3), were derived from the coding of caregiver-child free play interactions with the Brief Observation of Social-Communication Change (BOSCC) and the Joint Engagement Rating Inventory scale (JERI). At t3 positive treatment main effects had been observed for caregiver skills supportive of the interaction and for flow of the interaction (JERI), albeit only non-significant changes in the expected direction for child outcomes: autism phenotypic behaviors (BOSCC), joint engagement and availability to interact (JERI). This study tested the theory of change of CST, hypothesizing that the intervention would lead to an improvement on all child and dyad outcomes through an increase in the caregiver skills supportive of the interaction. Serial mediation analyses revealed that the effect of the intervention was significantly influenced by change in caregiver skills. Participation in the intervention led to notable increases in caregiver skills at t2 and t3, which subsequently contributed to improvements at t3 in flow of the interaction, autism phenotypic behavior, joint engagement, and availability to interact. We confirmed our a priori hypothesis showing that change in caregiver skills significantly mediated the effect of treatment on the dyad primary outcome, as well as on the other child outcomes that had shown non-significant changes in the expected direction. Implications for intervention design and policy making in the context of public health services are discussed.
Collapse
Affiliation(s)
| | - Katharine Suma
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA
| | | | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Erica Salomone
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
13
|
Antezana L, Albright J, Scarpa A, Richey JA, Laugeson EA, Factor RS. PEERS® for Preschoolers preliminary outcomes and predictors of treatment response. J Autism Dev Disord 2023; 53:4671-4684. [PMID: 36103076 PMCID: PMC10011023 DOI: 10.1007/s10803-022-05724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
PEERS® for Preschoolers (P4P) is a social skills group program for young autistic children and their caregivers, which provides everyday tools for interacting and communicating with others. Twenty-two caregiver-child dyads participated and completed pre-treatment, post-treatment, and follow-up measures (4-16 weeks after). Using single-subject analyses to examine social skills, 60% demonstrated post-treatment improvement, and 53.85% demonstrated follow-up improvement. Regarding a secondary outcome of behavioral difficulties, 33.33% demonstrated post-treatment reduction, and 7.69% demonstrated follow-up reduction. Using regressions, autistic traits predicted outcomes; fewer social communication difficulties predicted both greater social skills and fewer behavioral difficulties at post-treatment, while fewer repetitive behaviors predicted fewer post-treatment and follow-up behavioral difficulties. These results preliminarily demonstrate the benefits of P4P and how autistic traits may impact P4P outcomes.
Collapse
Affiliation(s)
- Ligia Antezana
- Department of Psychology, Virginia Tech, 109 Williams Hall, 890 Drillfield Drive, 24061, Blacksburg, VA, USA.
- Virginia Tech Autism Clinic & Center for Autism Research, Virginia Tech, Blacksburg, VA, USA.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jordan Albright
- Department of Psychology, Virginia Tech, 109 Williams Hall, 890 Drillfield Drive, 24061, Blacksburg, VA, USA
- Virginia Tech Autism Clinic & Center for Autism Research, Virginia Tech, Blacksburg, VA, USA
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela Scarpa
- Department of Psychology, Virginia Tech, 109 Williams Hall, 890 Drillfield Drive, 24061, Blacksburg, VA, USA
- Virginia Tech Autism Clinic & Center for Autism Research, Virginia Tech, Blacksburg, VA, USA
| | - John A Richey
- Department of Psychology, Virginia Tech, 109 Williams Hall, 890 Drillfield Drive, 24061, Blacksburg, VA, USA
- Virginia Tech Autism Clinic & Center for Autism Research, Virginia Tech, Blacksburg, VA, USA
| | - Elizabeth A Laugeson
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Reina S Factor
- Department of Psychology, Virginia Tech, 109 Williams Hall, 890 Drillfield Drive, 24061, Blacksburg, VA, USA
- Virginia Tech Autism Clinic & Center for Autism Research, Virginia Tech, Blacksburg, VA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
14
|
Vismara LA, Nyugen L, McCormick CEB. Abbreviating the Early Start Denver Model for community-based family-centered care. Front Psychol 2023; 14:1167885. [PMID: 37546470 PMCID: PMC10399628 DOI: 10.3389/fpsyg.2023.1167885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Parent-mediated approaches for young children with or with a higher likelihood of autism have gained traction, with mounting evidence of efficacy, but a research-to-gap practice exists, and community effectiveness remains to be firmly established. Methods Using a community-participatory framework, a total of 10 parent-child dyads received a five-day workshop and six follow-up sessions of ESDM parent coaching. Intervention was implemented across two phases with in-person and telehealth delivery. Results From pre to post intervention across both phases, parents improved in their fidelity of intervention implementation and children maid gains on proximal measures of social communication. Discussion Community delivery of an evidence-based parent-mediated interventions for toddlers on the autism spectrum is feasible and promising. Giving resource efficiencies associated with parent-mediated approaches, particularly when delivered through government-funded programs, findings bolster current efforts to promote earlier and more widespread community access to necessary interventions. Facilitators and barriers to supporting parent learning and behavior change via interactive strategies are discussed.
Collapse
Affiliation(s)
| | - Lucy Nyugen
- Thrive Autism Collaborative, Denver, CO, United States
| | - Carolyn E. B. McCormick
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, United States
| |
Collapse
|
15
|
Roberts MY, Sone BJ, Jones M, Grauzer J, Sudec L, Stern YS, Kwok E, Losh M, Kaat A. One size does not fit all for parent-mediated autism interventions: A randomized clinical trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:443-455. [PMID: 35695680 PMCID: PMC9744957 DOI: 10.1177/13623613221102736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
LAY ABSTRACT Parent-mediated interventions support parents' use of language facilitation strategies to improve their autistic child's communication and language development. To improve the effectiveness of parent-mediated interventions, it is important to individualize interventions. This article evaluates how different components of parent-mediated interventions and mothers' learning styles influence the effectiveness of the intervention. In a randomized clinical trial, mothers were taught to use one of two types of language facilitation strategies: responsive and directive. Mothers' learning styles were characterized by the Broad Autism Phenotype (BAP) and their natural tendency to use language facilitation strategies before intervention. Findings suggest that it was easier for all mothers (irrespective of learning style) to use responsive strategies compared to directive strategies. In addition, mothers with learning styles that were not consistent with the BAP were more likely to benefit from the intervention if they did not naturally use strategies before the intervention. In contrast, mothers with learning styles that were consistent with the BAP were more likely to benefit from the intervention if they did naturally use strategies before the intervention. Teaching mothers to use responsive strategies results in greater strategy use. Consideration of BAP and mothers' natural use of language facilitation strategies may inform intervention individualization.
Collapse
Affiliation(s)
- Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
- Feinberg School of Medicine; Department of Medical Social Sciences, Northwestern University
| | - Bailey J. Sone
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Maranda Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Laura Sudec
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Yael S. Stern
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Elaine Kwok
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
- Feinberg School of Medicine; Department of Psychiatry and Behavioral Sciences, Northwestern University
| | - Aaron Kaat
- Feinberg School of Medicine; Department of Medical Social Sciences, Northwestern University
| |
Collapse
|
16
|
McCrossin J, Lach L, McGrath P. Content analysis of parent training programs for children with neurodisabilities and mental health or behavioral problems: a scoping review. Disabil Rehabil 2023; 45:154-169. [PMID: 34990567 DOI: 10.1080/09638288.2021.2017493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Several systematic reviews have examined parent training programs for families of children with autism spectrum disorder (ASD). The present review expands on this literature by describing the components, delivery methods, and level of parent involvement in parent training programs that target families of children with any neurodisability and comorbid disruptive behavior or other mental health problem. MATERIALS AND METHODS Following a scoping review protocol, the search strategy included randomized controlled trials of parent training programs conducted with families of children with neurodisabilities and comorbid disruptive behavior or mental health problems. Study characteristics, program content, delivery methods, and theoretical frameworks were extracted from eligible studies. RESULTS A total of 22 articles were included from the 453 full-text articles initially screened. Thirteen different programs fell into two general categories based on whether they targeted child disruptive behavior or anxiety. Analysis of the content yielded five themes: child skill enhancement, parenting as enacted, parenting as experienced, disability-related parenting, and parent-child relationships. The theoretical underpinnings were identified, when possible, from each study. CONCLUSIONS Parent training programs for parents of children with neurodisabilities targeting child anxiety involved parents in a complementary role in treatment while those targeting disruptive behavior involved parents in a primary role in creating behavior change. We suggest that the extent of parent involvement in interventions be guided by theory rather than diagnosis of the child.Implications for rehabilitationParents of children living with neurodisabilities play a key role in delivering interventions to address comorbid mental health or behavioral problems.Parent training programs for families of children with neurodisabilities vary in relation to their aims, involvement of parents in delivering interventions, disability-specific content, and delivery methods.When referring families, rehabilitation professionals should be aware of aspects of child, parent, and family relational well-being targeted by parent training programs and, when feasible, give families a choice of the style of program to meet their needs.
Collapse
Affiliation(s)
| | - Lucyna Lach
- School of Social Work, McGill University, Montreal, Canada
| | | |
Collapse
|
17
|
Balancing Fidelity and Flexibility: Usual Care for Young Children With an Increased Likelihood of Having Autism Spectrum Disorder Within an Early Intervention System. J Autism Dev Disord 2023; 53:656-668. [PMID: 33484371 PMCID: PMC7825383 DOI: 10.1007/s10803-021-04882-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 02/07/2023]
Abstract
Naturalistic developmental behavioral interventions (NDBIs) are evidence-based interventions for young children with autism spectrum disorder. There has been growing interest in implementing manualized NDBIs within the early intervention (EI) system without a clear understanding of how these programs and the broader strategies encompassed within them are already used by EI providers. This study examined the use of manualized NDBI programs and broader NDBI strategies within an EI system and factors that impacted their use. Eighty-eight EI providers completed a measure of NDBI program and strategy use. Thirty-three providers participated in a supplemental focus group or interview. Overall, providers described using broader NDBI strategies and the need to adapt manualized NDBI programs. Provider-, intervention-, and organization-level factors impacted their use of NDBI programs and strategies.
Collapse
|
18
|
Weitlauf AS, Broderick N, Alacia Stainbrook J, Slaughter JC, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dorris K, Garrett LJ, Hopton M, Kinsman A, Morton M, Vogel A, Dykens EM, Pablo Juárez A, Warren ZE. A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes. J Autism Dev Disord 2022; 52:5403-5413. [PMID: 35040001 PMCID: PMC9289080 DOI: 10.1007/s10803-021-05399-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.
Collapse
Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Neill Broderick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy G Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madeline Santulli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Dorris
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michelle Hopton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Kinsman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Morton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley Vogel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Dykens
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - A Pablo Juárez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
19
|
Carruthers S, Mleczko N, Page S, Ahuja S, Ellis C, Howlin P, Leadbitter K, Taylor L, Slonims V, Charman T. Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1011-1025. [PMID: 36314780 PMCID: PMC10115939 DOI: 10.1177/13623613221125630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Many early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy-Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2 years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy-Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child's behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Vicky Slonims
- King's College London, UK
- Guy's and St Thomas' NHS Foundation Trust, UK
| | | |
Collapse
|
20
|
Hendrix NM, Pickard KE, Binion GE, Kushner E. A systematic review of emotion regulation in parent-mediated interventions for autism spectrum disorder. Front Psychiatry 2022; 13:846286. [PMID: 36213921 PMCID: PMC9544248 DOI: 10.3389/fpsyt.2022.846286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Autistic individuals are at elevated risk for difficulties with emotion regulation (ER) that emerge early in life and are associated with a range of internalizing and externalizing disorders. Existing interventions that support ER have focused on school-age autistic children and adolescents as well as adults. Proactive approaches to improving ER in early childhood are thus needed, as is understanding the approaches by which ER skills can be feasibly supported in this young population. This review summarizes how ER has been measured within parent-mediated interventions for children at or under the age of 6 years and the extent to which ER is measured concurrently with or distinctly from observable behaviors that have been referenced in existing literature as externalizing or challenging behavior. Using PsycInfo, EBSCOhost, and PubMed databases, we searched for peer-reviewed journal articles published through August 2021, that focused on the use of parent-mediated interventions targeting ER and/or challenging behavior. The systematic search resulted in 4,738 publications; following multi-stage screening, the search yielded 20 studies. Eighteen of 20 studies were designed to target challenging behavior using manualized curricula or behavior analytic methodologies and assessed child outcomes through validated caregiver rating scales and/or direct behavioral observation. One study measured changes in ER as secondary to the social communication skills that were targeted in the intervention. Only one study specifically supported ER skill development and measured changes in ER as the primary intervention outcome. Findings highlight the need for better assessment of ER outcomes within the context of parent-mediated interventions for toddlers and young autistic children.
Collapse
Affiliation(s)
- Nicole M. Hendrix
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Katherine E. Pickard
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Grace E. Binion
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Elizabeth Kushner
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| |
Collapse
|
21
|
Deniz E, Francis G, Torgerson C, Toseeb U. Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol. PLoS One 2022; 17:e0270153. [PMID: 35969530 PMCID: PMC9377609 DOI: 10.1371/journal.pone.0270153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Early years interventions have shown to be effective in improving the social communication and language skills of autistic children. Therefore, various play-based interventions have been developed to support those developmental areas of autistic children. Although researchers have previously reported the overall effectiveness of different types of play-based interventions on the social communication and language skills of autistic children, no previous systematic reviews have yet evaluated the effectiveness of parent-mediated play-based interventions in preschool autistic children. The overarching aims of the study will be to (i) report the key characteristics and (ii) synthesise the results of studies evaluating parent-mediated play-based interventions targeting the social communication and language skills of preschool autistic children using experimental designs. A comprehensive search for and screening of the relevant studies published between 2000 and 2021 will be undertaken. To be included, studies will have to (i) use either a randomised control trial or quasi-experimental design, (ii) focus on preschool autistic children aged six years old or younger, (iii) deliver a play-based intervention in non-educational settings, and (iv) include at least one parent as the mediator of the intervention. Data extraction of all included studies will be undertaken using a specially devised template and they will also be assessed for risk of bias using an adapted form from the Cochrane Risk of Bias tool. The overall characteristics of the included studies will be reported and a narrative synthesis of the results of the included studies will be undertaken. A meta-analysis may be performed (if justified) to report the pooled effect size of the parent-mediated play-based interventions on the social communication and language skills of preschool autistic children. Trial registration: The current study protocol was pre-registered with the international prospective register of systematic reviews (PROSPERO: CRD42022302220).
Collapse
Affiliation(s)
- Emre Deniz
- Department of Education, University of York, York, United Kingdom
| | - Gill Francis
- Department of Education, University of York, York, United Kingdom
| | - Carole Torgerson
- Department of Education, University of York, York, United Kingdom
| | - Umar Toseeb
- Department of Education, University of York, York, United Kingdom
| |
Collapse
|
22
|
Bradshaw J, Wolfe K, Hock R, Scopano L. Advances in Supporting Parents in Interventions for Autism Spectrum Disorder. Pediatr Clin North Am 2022; 69:645-656. [PMID: 35934491 PMCID: PMC11017782 DOI: 10.1016/j.pcl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The rising prevalence of autism spectrum disorder (ASD) calls for clear referral and treatment guidelines for children with ASD and their caregivers. Caregiver involvement in intervention is a standard practice of care and research suggests that teaching intervention strategies to caregivers can improve child outcomes and increase caregiver efficacy. Caregiver-mediated interventions that are naturalistic, developmental, and behavioral are effective in improving social and communication skills for children with ASD. Caregiver training models that use behavioral strategies are effective in reducing challenging behaviors. Finally, reducing caregiver barriers to treatment implementation, including stress and strain, are becoming critical components for improving the well-being and care of children with ASD and their families.
Collapse
Affiliation(s)
- Jessica Bradshaw
- University of South Carolina, 1800 Gervais Street, Columbia, SC 29201, USA.
| | - Katie Wolfe
- University of South Carolina, 820 Main Street, Columbia, SC 29208, USA
| | - Robert Hock
- University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Layne Scopano
- University of South Carolina, 1800 Gervais Street, Columbia, SC 29201, USA
| |
Collapse
|
23
|
Sterrett K, Magaña MT, Gulsrud A, Paparella T, Kasari C. Predictors of Attrition in a Randomized Trial of a Social Communication Intervention for Infant-Toddlers at Risk for Autism. J Autism Dev Disord 2022:10.1007/s10803-022-05616-w. [PMID: 35678946 DOI: 10.1007/s10803-022-05616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Addressing factors that make it more likely for families to attrite from early intervention trials will allow researchers to ensure that families reap the full benefits of participation. This study was an analysis of 78 children (Mage = 18.38 months, SD = 5.78) at risk for autism participating in a university-based randomized controlled trial of two 8-week long early intervention programs. Overall, attrition through 8-weeks was low, approximately 13%, however by the one-year follow-up attrition rates were approximately 50%. The most consistent predictor of attrition was the distance that families had to travel to the university. These data highlight the importance of providing services and support (e.g., financial and logistic) during follow-up to families to maximize their participation. Clincaltrials.gov Identifier: NCT01874327, 6/11/2013.
Collapse
Affiliation(s)
- Kyle Sterrett
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States. .,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza 68-262B, 90024, Los Angeles, CA, United States.
| | - Maira Tafolla Magaña
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Amanda Gulsrud
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Tanya Paparella
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Connie Kasari
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| |
Collapse
|
24
|
"Going Mobile"-increasing the reach of parent-mediated intervention for toddlers with ASD via group-based and virtual delivery. J Autism Dev Disord 2022; 52:5207-5220. [PMID: 35608785 PMCID: PMC9128315 DOI: 10.1007/s10803-022-05554-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
Evidence supports early intervention for toddlers with ASD, but barriers to access remain, including system costs, workforce constraints, and a range of family socio-demographic factors. An urgent need exists for innovative models that maximize resource efficiency and promote widespread timely access. We examined uptake and outcomes from 82 families participating in a parent-mediated intervention comprising group-based learning and individual coaching, delivered either in-person (n = 45) or virtually (n = 37). Parents from diverse linguistic, ethnic, and educational backgrounds gained intervention skills and toddlers evidenced significant social-communication gains. Few differences emerged across socio-demographic factors or delivery conditions. Findings highlight the feasibility, acceptability, and promise of group-based learning when combined with individual coaching, with added potential to increase program reach via virtual delivery.
Collapse
|
25
|
Davis PH, Elsayed H, Crais ER, Watson LR, Grzadzinski R. Caregiver responsiveness as a mechanism to improve social communication in toddlers: Secondary analysis of a randomized controlled trial. Autism Res 2022; 15:366-378. [PMID: 34799999 PMCID: PMC8821206 DOI: 10.1002/aur.2640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.
Collapse
Affiliation(s)
- Paige Huguely Davis
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC
| | - Heba Elsayed
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,Phoniatrics unit, ENT Department, Faculty of Medicine, Alexandria University, Egypt
| | - Elizabeth R. Crais
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Linda R. Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Rebecca Grzadzinski
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC
| |
Collapse
|
26
|
Brian J, Drmic I, Roncadin C, Dowds E, Shaver C, Smith IM, Zwaigenbaum L, Sacrey LAR, Bryson SE. Effectiveness of a parent-mediated intervention for toddlers with autism spectrum disorder: Evidence from a large community implementation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1882-1897. [PMID: 35037520 DOI: 10.1177/13623613211068934] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
LAY ABSTRACT In an effort to increase access to intervention as early as possible for toddlers with autism spectrum disorder or signs thereof, many researchers have developed interventions that can be delivered by parents in their own homes. These parent-mediated approaches have gained a lot of research attention in recent years and have been found to be helpful in terms of parent and toddler learning. Several studies have used a rigorous research design (a randomized controlled trial) to show that parent-mediated intervention can work under ideal well-controlled conditions. To build on this evidence, we also need to examine whether parent-mediated interventions can be taught well through community service providers and delivered in more "real-world" conditions. This study used a research-community partnership to provide a parent-mediated intervention (called the Social ABCs) to 179 families (mean toddler age was 25 months; ranging from 14 to 34 months). Almost 90% of the families completed the 12-week program and 70% returned for a follow-up assessment 3 months later. Analyses showed that parents learned the strategies that were designed to help them support their toddlers' development. Also, toddlers made gains in their language, communication, and social skills. Importantly, parents' use of the strategies was related to toddlers' skill gains, suggesting that the use of the strategies made a difference for the toddlers. Findings support the use of parent-mediated intervention in this very young age group and suggest that such intervention approaches should be made available for community delivery.
Collapse
Affiliation(s)
- Jessica Brian
- Bloorview Research Institute, Canada.,University of Toronto, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Seng GJ, Chiu YN, Tsai WC, Lin HY, Li SC, Hsiao MN, Liu TJ, Chen HM, Shih A, Chang YC, Who Cst Team, Soong WT. Promotion and implementation effectiveness of World Health Organization's Caregiver Skills Training program in Taiwan. Front Psychiatry 2022; 13:904380. [PMID: 36117658 PMCID: PMC9470946 DOI: 10.3389/fpsyt.2022.904380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization (WHO) developed the Caregiver Skills Training for Families of Children with Developmental Delays and Disabilities (CST) with support from Autism Speaks to address the resource gaps and worldwide needs for interventions for children with developmental disorders or delays, especially those with autism spectrum disorder (ASD), and their families. Evidence has indicated that parent-mediated interventions benefit both caregivers and children by strengthening caregivers' knowledge and confidence and children's social communication skills and behavioral regulation. The CST-Taiwan team began the prepilot field trial in 2017 and developed the project to serve families in various locations. This study (1) delineated the adaptations and promotion of CST-Taiwan; (2) determined the program's effectiveness in the promotional stage, in terms of caregiver and child outcomes, and (3) examined the maintenance of its effects. The materials, delivery, and facilitator training procedure of the original CST were adapted to Taiwan. The quantitative data indicated that CST-Taiwan is a promising program, it positively affected caregiver knowledge and confidence and reduced the severity of the children's autistic symptoms. The 3-month follow-up results suggested that the effects persisted. Thus, CST-Taiwan, and its promotional strategies are feasible and effective.
Collapse
Affiliation(s)
- Guan-Jye Seng
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Nan Chiu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Su-Chen Li
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Ni Hsiao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tseng-Jung Liu
- Foundation for Autistic Children and Adults in Taiwan, Taipei, Taiwan
| | - Heng-Man Chen
- Foundation for Autistic Children and Adults in Taiwan, Taipei, Taiwan.,Department of Special Education, National Taipei University of Education, Taipei, Taiwan
| | - Andy Shih
- Autism Speaks, New York City, NY, United States
| | - Ya-Chih Chang
- Department of Special Education and Counseling, California State University, Los Angeles, CA, United States
| | - Who Cst Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Wei-Tsuen Soong
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
28
|
Ke X, Song W, Yang M, Li J, Liu W. Effectiveness of music therapy in children with autism spectrum disorder: A systematic review and meta-analysis. Front Psychiatry 2022; 13:905113. [PMID: 36276324 PMCID: PMC9582596 DOI: 10.3389/fpsyt.2022.905113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study was to investigated the efficacy of music therapy (MT) in children with autism spectrum disorder (ASD) via a meta-analysis that comprehensively evaluated data from all eligible research in this field. DESIGN Systematic review and meta-analysis. SETTING A systematic search of the PubMed, Embase, and Cochrane Library databases from inception to October 2021 to identify studies that administered MT to children with ASD. RESULTS Eight randomized controlled trials (RCTs) including 608 participants met the inclusion criteria. The meta-analysis showed that MT was associated with a significant increase in social reactions among children with ASD (standardized mean difference (SMD) = 0.24, 95% confidence interval (CI) [0.03, 0.46], I 2 = 0%, P = 0.03). However, MT did not elicit a significant increase in symptom severity (SMD = 0.17, 95% CI [-0.04,0.38], I 2 = 0%,P = 0.12), social adaptive behavior (SMD = 0.02, 95% CI [-0.44,0.48], I 2 = 0%,P = 0.93) or speech (SMD = 0.04, 95% CI [-0.39, 0.47], I 2 = 0%, P = 0.86) in children with ASD. CONCLUSION MT can improve social skills in children with ASD; however, there does not seem to be a consensus on the persistence of its effects. These findings can inform clinical practice. Promoting the use of MT in children with ASD and improving its symptoms are the ultimate goals.
Collapse
Affiliation(s)
- Xiaohua Ke
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Department of Rehabilitation Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Wei Song
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Minguang Yang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jianhong Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weilin Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| |
Collapse
|
29
|
Sengupta K, Shah H, Ghosh S, Sanghvi D, Mahadik S, Dani A, Deshmukh O, Pacione L, Dixon P, Salomone E, Servili C. World Health Organisation-Caregiver Skills Training (WHO-CST) Program: Feasibility of Delivery by Non-Specialist Providers in Real-world Urban Settings in India. J Autism Dev Disord 2021; 53:1444-1461. [PMID: 34853959 DOI: 10.1007/s10803-021-05367-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The World Health Organization-Caregiver Skills Training Program, a parent-mediated early intervention facilitated by non-specialist providers piloted in urban India was evaluated using mixed-methods for feasibility and effects on child and caregiver outcomes. Caregivers (n = 22) of children (2-9 years) with social-communication delays participated in a single-group pre-post study. High rates of caregiver attendance, improved caregiver fidelity, and facilitator competency suggested program feasibility. Caregivers voiced acceptability of various intervention-components. The intervention was associated with improved caregiver-reported skills and knowledge (p < 0.00), reduction in stress (p = 0.03), improved child developmental outcomes on communication and social interaction (p < 0.00), and adaptive behaviors (p < 0.00). Challenges about logistics and availability of time were highlighted. Implications of results in resource-poor settings and recommendations for future feasibility trials are discussed.
Collapse
Affiliation(s)
- Koyeli Sengupta
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India.
| | - Henal Shah
- Department of Psychiatry, T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Subharati Ghosh
- Research Insights and Innovation, Population Health and Safety, SEIU 775 Benefits Group, Seattle, USA
| | - Disha Sanghvi
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Sanchita Mahadik
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Allauki Dani
- Department of Psychiatry, T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Oshin Deshmukh
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Laura Pacione
- Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Pamela Dixon
- Autism Speaks, 1060 State Rd, Princeton, NJ, USA
| | - Erica Salomone
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | | | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| |
Collapse
|
30
|
Srinivasan SM, Su WC, Cleffi C, Bhat AN. From Social Distancing to Social Connections: Insights From the Delivery of a Clinician-Caregiver Co-mediated Telehealth-Based Intervention in Young Children With Autism Spectrum Disorder. Front Psychiatry 2021; 12:700247. [PMID: 34276452 PMCID: PMC8280343 DOI: 10.3389/fpsyt.2021.700247] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sudha M. Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Mansfield, CT, United States
| | - Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Corina Cleffi
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Anjana N. Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Science, University of Delaware, Newark, DE, United States
| |
Collapse
|
31
|
Divan G, Bhavnani S, Leadbitter K, Ellis C, Dasgupta J, Abubakar A, Elsabbagh M, Hamdani SU, Servili C, Patel V, Green J. Annual Research Review: Achieving universal health coverage for young children with autism spectrum disorder in low- and middle-income countries: a review of reviews. J Child Psychol Psychiatry 2021; 62:514-535. [PMID: 33905120 DOI: 10.1111/jcpp.13404] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autism presents with similar prevalence and core impairments in diverse populations. We conducted a scoping review of reviews to determine key barriers and innovative strategies which can contribute to attaining universal health coverage (UHC), from early detection to effective interventions for autism in low- and middle-income countries (LAMIC). METHODS A systematic literature search of review articles was conducted. Reviews relevant to the study research question were included if they incorporated papers from LAMIC and focused on children (<eight years old) with autism or their caregivers. The database search was supplemented with bibliographic search of included articles and key informant suggestions. Data were extracted and mapped onto a Theory of Change model toward achieving UHC for autism in LAMIC. RESULTS We identified 31 articles which reviewed data from over fifty countries across Africa, Latin America, Middle East, and Asia and addressed barriers across one or more of four inter-related domains: (a) the social context and family experience for a child with autism; (b) barriers to detection and diagnosis; (c) access to appropriate evidence-based intervention; and (d) social policy and legislation. Key barriers identified included: lack of appropriate tools for detection and diagnosis; low awareness and experienced stigma impacting demand for autism care; and the prevalence of specialist models for diagnosis and treatment which are not scalable in LAMIC. CONCLUSIONS We present a Theory of Change model which describe the strategies and resources needed to realize UHC for children with autism in LAMIC. We highlight the importance of harnessing existing evidence to best effect, using task sharing and adapted intervention strategies, community participation, and technology innovation. Scaling up these innovations will require open access to appropriate detection and intervention tools, systematic approaches to building and sustaining skills in frontline providers to support detection and deliver interventions embedded within a stepped care architecture, and community awareness of child development milestones.
Collapse
Affiliation(s)
- Gauri Divan
- Child Development Group, Sangath, Bardez, Goa, India
| | | | - Kathy Leadbitter
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | | | - Amina Abubakar
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Syed Usman Hamdani
- Human Development Research Foundation, Punjab, Pakistan.,University of Liverpool, Liverpool, UK
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jonathan Green
- Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Royal Manchester Children's Hospital, Manchester, UK
| |
Collapse
|
32
|
Gevarter C, Najar AM, Flake J, Tapia-Alvidrez F, Lucero A. Naturalistic Communication Training for Early Intervention Providers and Latinx Parents of Children with Signs of Autism. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2021; 34:147-169. [PMID: 33935477 PMCID: PMC8079838 DOI: 10.1007/s10882-021-09794-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 05/13/2023]
Abstract
In this study, researchers implemented a brief training plus coaching program in naturalistic developmental behavioral intervention with three participant triads. Each triad consisted of an early intervention provider, an English-speaking Latinx parent, and that parent's young child with autism spectrum disorder (ASD) or early signs of ASD who had limited vocal speech. The effects a single training session, plus two researcher coaching sessions were evaluated using a nonconcurrent multiple probes across participants design. Primary dependent variables included (a) the number of completed targeted communication turns between the parent and child and (b) the number of child independent target communication responses (gestures and manual signs) during family-selected routines. Additional measures examined whether parents used strategies taught to them during training, and whether early intervention providers addressed strategies taught via coaching. A social validity measure was used to determine parent and provider views of the training. Due to COVID-19 restrictions, training and post-training sessions were delivered via telehealth for two triads. While data trends and variability differed across triads, following training, all three families increased the number of completed target communication turns and all three children showed higher rates of independent communication responses. Parents and providers implemented strategies taught and reported positive effects of the program. Implications regarding the use of naturalistic intervention methods for Latinx families, the utility of brief training models to meet the needs of under-resourced early intervention programs, and potential uses of telehealth are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10882-021-09794-w.
Collapse
Affiliation(s)
- Cindy Gevarter
- Department of Speech and Hearing Sciences, The University of New Mexico, 1700 Lomas NE, MSC01 1195, 1 University of New Mexico, Albuquerque, NM 87131 USA
| | | | - Jennifer Flake
- Department of Speech and Hearing Sciences, The University of New Mexico, 1700 Lomas NE, MSC01 1195, 1 University of New Mexico, Albuquerque, NM 87131 USA
| | | | | |
Collapse
|
33
|
Pacia C, Holloway J, Gunning C, Lee H. A Systematic Review of Family-Mediated Social Communication Interventions for Young Children with Autism. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021; 9:208-234. [PMID: 33821200 PMCID: PMC8012416 DOI: 10.1007/s40489-021-00249-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/11/2021] [Indexed: 12/02/2022]
Abstract
Social communication deficits are a core symptom of autism spectrum disorder (ASD). The present paper reviews 54 studies evaluating social communication interventions delivered by parents and siblings to children with ASD under 6 years old. Fifty studies evaluated parent-mediated intervention, and four studies evaluated sibling-mediated intervention. Fourteen studies evaluated interventions using telehealth. Treatment effects and research strength were variable across studies. Treatment modality, setting, and dosage had inconclusive impact on treatment effect. Parent-implemented intervention packages, Pivotal Response Treatment (PRT), Early Start Denver Model (ESDM), and Joint Attention, Symbolic Play, Engagement & Regulation (JASPER), qualified as established evidence-based practice for this population. Most studies reported successful generalization of skills for some, but not all, children. Telehealth and sibling-mediated intervention are promising areas of further research and clinical practice.
Collapse
Affiliation(s)
- Cressida Pacia
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Jennifer Holloway
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Ciara Gunning
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Helena Lee
- School of Psychology, National University of Ireland, Galway, Ireland
| |
Collapse
|
34
|
Parent-mediated intervention delivered through telehealth for children with autism spectrum disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd014793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
35
|
Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
Collapse
Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
| |
Collapse
|
36
|
Bradshaw J, Trumbull A, Stapel-Wax J, Gillespie S, George N, Saulnier C, Klaiman C, Woods J, Call N, Klin A, Wetherby A. Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1874-1884. [PMID: 32594763 DOI: 10.1177/1362361320928829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Early intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
Collapse
Affiliation(s)
| | | | - Jennifer Stapel-Wax
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Scott Gillespie
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Nisha George
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Celine Saulnier
- Emory University, USA.,Neurodevelopmental Assessment & Consulting Services, USA
| | - Cheryl Klaiman
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | | | - Nathan Call
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | | |
Collapse
|
37
|
Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurol 2020; 19:434-451. [PMID: 32142628 DOI: 10.1016/s1474-4422(20)30034-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
Abstract
Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.
Collapse
|