Pathways Early ASD Intervention as a Moderator of Parenting Stress on Parenting Behaviors: A Randomized Control Trial

A systematic review and meta-analysis of the effectiveness of interventions targeting the parent-child relationship in families of children with an intellectual disability

BACKGROUND

The review aimed to investigate the effectiveness of parent-child relationship interventions for families of children with intellectual disability up to 12 years old.

METHODS

Quasi-experimental or randomised controlled trials (RCTs) of interventions targeting the parent-child relationship where ≥50% of children had an intellectual disability were included. Meta-analyses of parent-child relationship outcomes and child outcomes used standardised mean difference as the effect size.

RESULTS

Twenty-seven papers were included (N = 1325). Parent-child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication.

CONCLUSIONS

Findings suggest that interventions targeting parent-child relationship quality are associated with substantial improvements in parent-child relationship and may improve child outcomes related to socialisation and communication.

Examining Cultural and Linguistic Sensitivity of Pathways Early Autism Intervention with Hispanic Families

PURPOSE

This research aimed to evaluate evidence of Pathways parent-mediated early autism intervention as a culturally and linguistically sensitive intervention (CLSI) for Hispanic families with autistic children.

METHODS

We used Bernal et al.'s ecologically valid (EV) framework to evaluate current practice and Hispanic parents' perceptions of Pathways 1 ½ years after completing the intervention. Both quantitative and qualitative methods were used. Nineteen parents were contacted, of which 11 completed a semi-structured interview about their experience with Pathways.

RESULTS

On average, the group that completed the interview was less educated, had more monolingual Spanish speakers, and rated their general experience with the intervention slightly more positively than those who did not agree to complete the interview. A review of Pathways's current practices through the lens of the EV framework suggested that Pathways was a CLSI for Hispanic participants in the domains of context, methods, language, and persons. Parental interviews echoed these strengths. However, Pathways did less well balancing evidence-based intervention strategies for autistic children with the heritage value of respeto.

CONCLUSION

Pathways demonstrated strengths regarding cultural and linguistic sensitivity for Hispanic families with young autistic children. Future work with our community stakeholder group will integrate heritage and majority culture perspectives to strengthen Pathways as a CLSI.

Do Naturalistic Developmental Behavioral Interventions improve family quality of life? A systematic review and meta-analysis

LAY ABSTRACT

Naturalistic Developmental Behavioral Interventions have been described as culturally responsive and family-friendly interventions, with research demonstrating improvements in children's development following the receipt of these interventions. Given the child-directed nature of Naturalistic Developmental Behavioral Interventions and the intervention's integration within families' daily routines, many studies have examined the impact of Naturalistic Developmental Behavioral Interventions on family and family member quality of life. We conducted a systematic review and meta-analysis to explore the relationship between Naturalistic Developmental Behavioral Interventions and family quality of life. Results suggest that the provision of a Naturalistic Developmental Behavioral Intervention neither improved nor worsened family or family member quality of life. For those involved in delivering Naturalistic Developmental Behavioral Intervention services, there is an immediate need to convey to families that children's improvements will likely not translate into improvements in family quality of life.

Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts

Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.

Reexamining Pathways Early Autism Intervention in Children Before and After the Third Birthday: A Randomized Control Trial

We reexamined the efficacy of Pathways early autism intervention using generalized measures of social communication and language skills administered by an unfamiliar adult in a novel environment. Generalized measures improve on sources of measurement bias. Sixty-seven autistic children blocked on age (under versus over 3 years) were randomly assigned to 15 weeks of Pathways or services-as-usual. Age moderated the effects of Pathways for social communication. Specifically, Pathways had a significantly large effect for children under 3 and a small effect that approached significance for children over 3. Pathways also had a small effect on expressive speech/language skills. Results replicate previous findings of the efficacy of Pathways on proximal and distal skills and support the importance of early intervention.

Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis

AIM

To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship.

METHOD

Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences.

RESULTS

Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence).

INTERPRETATION

Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.

A multicenter clinical study on parent-implemented early intervention for children with global developmental delay

OBJECTIVE

Early identification and intervention for children with global developmental delay (GDD) can significantly improve their prognosis and reduce the possibility of developing intellectual disability in the future. This study aimed to explore the clinical effectiveness of a parent-implemented early intervention program (PIEIP) for GDD, providing a research basis for the extended application of this intervention strategy in the future.

METHODS

During the period between September 2019 and August 2020, children aged 3 to 6 months diagnosed with GDD were selected from each research center as the experimental group and the control group. For the experimental group, the PIEIP intervention was conducted for the parent-child pair. Mid-term and end-stage assessments were performed, respectively, at 12 and 24 months of age, and parenting stress surveys were completed.

RESULTS

The average age of the enrolled children was 4.56 ± 1.08 months for the experimental group (n = 153) and 4.50 ± 1.04 months for the control group (n = 153). The comparative analysis of the variation in the progress between the two groups by independent t-test showed that, after the experimental intervention, the developmental quotient (DQ) of locomotor, personal-social, and language, as well as the general quotient (GQ) of the Griffiths Mental Development Scale-Chinese (GDS-C), the children in the experimental group demonstrated higher progress than those in the control group (P < 0.05). Furthermore, there was a significant decrease in the mean standard score of dysfunctional interaction, difficult children and the total level of parental stress in the term test for the experimental groups (P < 0.001 for all).

CONCLUSIONS

PIEIP intervention can significantly improve the developmental outcome and prognosis of children with GDD, especially in the areas of locomotor, personal-social, and language.

A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes

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.

Pragmatic contributions to early vocabulary and social communication in young autistic children with language and cognitive delays

INTRODUCTION

There are limited data on the interrelationships among pragmatic skills and expressive vocabulary and their contribution to later social communication. Understanding these relationships could inform developmental processes and early intervention strategies. This study explored the relationship among pragmatics skills (i.e., communicative intents and responding to parents' preceding utterances) and concurrent expressive vocabulary as well as the predictive nature of these skills on later social communication in young autistic children with language and cognitive delays.

METHOD

Data from 56 autistic children (age 18-57 months) who participated in a larger randomized control trial of Pathways Early Autism Intervention were used in this secondary analysis. Video recordings of pre-intervention (Time 1) parent-child interactions were analyzed for number of different words (NDW; expressive vocabulary), number of different (ND) communicative intents, and response to parents' preceding utterances. Residual scores from an assessment of social communication were used to measure Time 2 social communication. First-order correlations and hierarchical regression were used for analyses.

RESULTS

Adjusting for age and receptive language, both ND communicative intents and response to parents' preceding utterances were associated with pre-intervention NDW. Further, adjusting for receptive language age and intervention group, NDW and response to parents' preceding utterances - but not ND communicative intents-was related to Time 2 social communication. NDW, however, was no longer related to Time 2 social communication skills after accounting for response to parents' preceding utterances.

CONCLUSIONS

This study provides evidence that autistic children with language and cognitive delays use their expressive vocabularies to respond, hence allocating attention to parent speech, a rudimentary form of social orienting. Our results support approaches to intervention that leverage responding as a rudimentary form of social orienting while encouraging more mature forms of social attention (i.e., social orienting to faces and joint attention) within developmentally appropriate activities, such as routines.

Caregiver-Implemented Communication Interventions for Children Identified as Having Language Impairment 0 Through 48 Months of Age: A Scoping Review

PURPOSE

Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions.

METHOD

We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies (N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence).

RESULTS

We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures.

CONCLUSION

Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20289195.

A Study on the Use of Milieu Teaching to Promote Overseas Marketers’ Communication Skills and Confidence in Language Learning

Language plays an extremely important role for people in terms of engaging in various learning activities. Due to the progress of network technologies, it is an immediate goal for enterprises to take a completely new development direction with the application of network technology. Nevertheless, they encounter many difficulties in carrying out overseas marketing such as localization transformation, jet lag, lack of professional marketers, problems with sellers’ product quality, problems with customers’ credit checks, international payment problems, and logistics and delivery problems. These problems mainly result from a difference in language families. The current study was conducted as an experimental study with the participation of overseas marketers in Hebei province. Milieu teaching was implemented with an experimental group and traditional teaching was maintained in the control group for a 20-week (3 h per week) experimental procedure. The research results revealed significantly positive effects of (1) milieu teaching on communication skills, (2) milieu teaching on language learning confidence, and (3) communication skills on language learning confidence. Based on the results, it can be stated that the study is expected to help effectively enhance the communication skills and language learning confidence of overseas marketers to achieve the goals of promoting oral expression and language-use skills.

"Going Mobile"-increasing the reach of parent-mediated intervention for toddlers with ASD via group-based and virtual delivery

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.

Interventions to Improve Outcomes for Parents of Children with Autism Spectrum Disorder: A Meta-Analysis

This meta-analysis examines the impact of parent interventions on outcomes for parents of children with ASD. A systematic review of the literature produced 37 studies that met inclusion criteria. Random-effects models revealed small but significant impacts of intervention on parental outcomes, primarily in parenting confidence and mental health. No improvements were observed in caregiving burden, family adjustment, physical health, or stress. Significant heterogeneity was observed; however, no moderation effects were detected for intervention or sample characteristics. These findings suggest parent interventions improve parenting confidence and, to a lesser degree, mental health. More work is needed to develop interventions that address a wider range of outcomes for parents of children with ASD. Limitations and implications for future research are discussed.

Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress

When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress.

Mutual Gaze: An Active Ingredient for Social Development in Toddlers with ASD: A Randomized Control Trial

We examined the efficacy of an early autism intervention for use in early childhood intervention (ECI) and mutual gaze as a contributor to social development. Seventy-eight families were randomly assigned to one of three 12-week interventions: Pathways (with a mutual gaze component), communication, or services-as-usual (SAU). The Pathways/SAU comparison concerned the efficacy of Pathways for ECI, and the Pathways/communication comparison, mutual gaze. The Pathways group made significantly more change on social measures, communicative synchrony, and adaptive functioning compared with the SAU group and on social measures compared with the communication group. There were no group differences for communicative acts. The results support Pathways as a potential ECI program and mutual gaze as an active ingredient for social and communication development.

Perceptions, Experiences, and Needs of Parents of Culturally and Linguistically Diverse Children with Autism: a Scoping Review

A scoping review of studies carried out in the UK and the USA was conducted to explore the perceptions, experiences, and needs of culturally and linguistically diverse families of children with autism. Overall, 32 articles met the inclusion criteria, 25 studies were conducted in the USA and 7 studies in the UK. Four themes emerged including (a) knowledge and beliefs about autism and their impact on the family; (b) autism and family life; (c) family experiences of accessing services and support, and parents’ needs; and (d) multilanguage. Findings highlighted that family perceptions of autism are influenced by an often-reported lack of knowledge; experiences include social stigma as well as difficulties in having access to services. Needs indicate the development of culturally sensitive interventions, information in multiple languages, and parent–professional collaboration. Implications for research, policy, and practice are included.

Predictors of Change in Play-Based Communication and Behavior Intervention for High-Risk ASD: The Role of Mother-Child Dyadic Synchrony

Background: Interindividual variability is important in the evolution of adaptative profiles of children with ASD having benefited from an early intervention make up for deficits in communication, language and social interactions. Therefore, this paper aimed to determine the nature of factors influencing the efficacy variability of a particular intervention technique i.e., "Play-based communication and behavior intervention" (PCBI). Methods: The participants comprised 70 13-30-month-old toddlers with ASD enrolled in PCBI for 12 weeks. The Autism Treatment Evaluation Checklist (ATEC) was used to evaluate the efficacy of PCBI. Video recordings of 5 min of free-play before and after PCBI were used to examine behaviors of mothers and children and parent-child dyadic synchrony. Hierarchical multiple regression analyses and machine learning algorithms were performed to explore the effect of these potential predictors (mothers' factors, children's factors and videotaped mother-child interaction) of intervention efficacy. Results: The hierarchical regression analysis and the machine learning algorithms indicated that parenting stress, level of completion of training at home and mother-child dyadic synchrony were crucial factors in predicting and monitoring the efficacy of PCBI. Conclusions: In summary, the findings suggest that PCBI could be particularly beneficial to children with ASD who show a good performance in the mother-child dyadic synchrony evaluation. A better dyadic mother-child synchrony could enhance the PCBI efficacy through adapted emotional and behavioral responses of the mother and the child and has a beneficial influence on the child's psychological development.