Child-Directed Interaction Training for Young Children With Autism Spectrum Disorders: Parent and Child Outcomes

Parent Training for Disruptive Behaviors in Referred Children with Autism Spectrum Disorder: A Randomized Controlled Trial

The purpose of this study was to investigate whether face-to-face and therapist-assisted online (i.e., blended) behavioral parent training are effective on reducing disruptive behaviors in children with autism spectrum disorder (ASD) in routine mental health care. Ninety-seven children with ASD (4-13 years; 76 boys) were randomized to face-to-face parent training, blended parent training, or a waitlist control condition. We assessed treatment effects on parent-rated child noncompliance (primary outcome) and irritability (secondary outcome). This involved comparing both formats separately to the control condition using linear regression models. Child behaviors at 6 months follow-up were also examined. Children in the face-to-face parent training condition improved significantly more on noncompliance and irritability than children in the waitlist condition and improvements sustained to 6 months follow-up. Children in the blended condition did not improve more than children in the waitlist condition and attrition was high. Our results extend findings from efficacy studies to routine mental health care and advocate the use of face-to-face parent training for disruptive behaviors in children with ASD. More research into blended parent training programs for children with ASD and disruptive behaviors in routine mental health care should be conducted to draw more definite conclusions about the value of blended parent training for these children. Trial registration number NL4712; date of registration 22-10-2014.

The effectiveness of parent-Child observation in parent-Mediated programmes for children with developmental disabilities and externalizing disorders: A systematic review and meta-analysis

This systematic review evaluated the treatment effects of communication-focused parent-mediated interventions (CF-PMT), a form of intervention that involves therapists observing parent-child interactions and giving feedback to parents on how they can practice positive parenting strategies to prevent or reduce externalizing behaviours in children with developmental disabilities. A literature search was conducted on three electronic databases. To be included in the review, studies had to: evaluate CF-PMT where therapists give feedback after observing parent-child interactions; examine changes in externalizing behaviours amongst children with any forms of developmental disability; and adopt a randomised controlled trial study design. Fifteen studies met eligible criteria for the literature review, of those, 13 studies had available data on changes in the primary (child externalizing behaviours) and secondary outcomes (parental stress, child linguistic abilities and child social responsiveness). We found significant treatment effects for CF-PMT in reducing child externalizing behaviours (d = -.60) but not for any of the secondary outcomes. A sensitivity analysis showed a small but significant treatment effect for parental stress (d = -.18). Considerable bias was observed due to the lack of available information reported by studies on aspects measured by the Mixed Methods Appraisal Tool. Overall, we found evidence to support the benefits of complex interventions which incorporate direct parent-child observations and feedback to improve behavioural outcomes amongst children with developmental disabilities.

Community-based Agency Delivery of Parent-Child Interaction Therapy: Comparing Outcomes for Children with and Without Autism Spectrum Disorder and/or Developmental Delays

While externalizing behaviors are common among children with autism spectrum disorder (ASD), there is a shortage of specialist community-based clinicians to provide treatment. Parent-Child Interaction Therapy (PCIT), an intervention designed to reduce child disruptive behaviors, may be effective for families of children with ASD but has rarely been studied outside of university-based research settings. We examined the effectiveness of PCIT delivered for children with (N = 109) and without (N = 2,324) ASD/developmental delays (DD) across community-based agencies in Oregon. Findings revealed significant reductions in disruptive behavior and positive changes in the parent-child relationship in both groups. These findings support PCIT as an efficacious intervention for children with ASD/DD and demonstrate PCIT's promise in community-based agencies with non-specialized clinicians.

Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis

Children with autism spectrum disorder (ASD) have been shown to benefit from parent-implemented interventions (PIIs). This meta-analysis improved on prior reviews of PIIs by evaluating RCTs and multiple potential moderators, including indicators of research quality. Fifty-one effect sizes averaged moderately strong overall benefits of PIIs (g = 0.553), with studies having lower risk of research bias yielding lower estimates (g = 0.47). Parent and observer ratings yielded similar averaged estimates for positive behavior/social skills (g = 0.603), language/communication (g = 0.545), maladaptive behavior (g = 0.519), and to a lesser extent, adaptive behavior/life skills (g = 0.239). No other study, intervention, or participant characteristic moderated outcomes. PIIs with children with ASD tend to be effective across a variety of circumstances.

Scoping review of behavioral coding measures used to evaluate parent responsiveness of children with autism or elevated risk of autism

LAY ABSTRACT

The topic of how parents react (e.g., how they talk and act) to their child with autism or elevated likelihood of autism, often called parent responsiveness, has been studied by researchers for over 50 years. Many methods for measuring behaviors around parent responsiveness have been created depending on what researchers were interested in discovering. For example, some include only the behaviors that the parent does/says in reacting to something the child does/says. Other systems look at all behaviors in a period of time between child and parent (e.g., who talked/acted first, how much the child or parent said/did). The purpose of this article was to provide a summary of how and what researchers looked at around parent responsiveness, describe the strengths and barriers of these approaches, and suggest a "best practices" method of looking at parent responsiveness. The model suggested could make it more possible to look across studies to compare study methods and results. The model could be used in the future by researchers, clinicians, and policymakers to provide more effective services to children and their families.

Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder

The purpose of the current study was to examine engagement with Behavioral Parent Training (BPT) for families of children with Autism Spectrum Disorder (ASD) and assess openness to novel delivery formats for BPT (e.g., telehealth, group). Participants were caregivers of 501 children with ASD (ages 2-6) enrolled in the SPARK (Simons Foundation Powering Autism Research for Knowledge) online national registry. The study assessed: (1) rates of child disruptive behavior diagnoses, (2) engagement and satisfaction with BPT, (3) parent and child factors (e.g., diagnostic history), and (4) openness to novel delivery formats. Almost 25% of young children with ASD in this sample had disruptive behavior problems rising to the level of a diagnosis of ADHD or ODD and thus would benefit from BPT. However, only one third of these families had actually been referred to BPT. Families indicated high level of interest in participating in BPT, with a particular interest in Parent Child Interaction Therapy (PCIT) as well as novel delivery formats such as telehealth and group. Specific components of the therapy and delivery formats were indicative of parent satisfaction (e.g. groups, longer treatment sessions, longer treatment length). Specific parent and child characteristics were predictive of openness to novel formats (e.g. parental depression, more severe behavioral challenges, lower verbal skills). Results underscore the need for increased referrals and access to BPT programs the ASD population. Both parent and child characteristics are important for determining appropriate delivery formats.

Evidence-Based Treatment in Practice: PCIT Research on Addressing Individual Differences and Diversity Through the Lens of 20 Years of Service

Parent-Child Interaction Therapy (PCIT) is an intensive parent support program for caregivers and their children who exhibit difficult-to-manage disruptive behaviors. After more than four decades of research supporting its efficacy for reducing children's disruptive behaviors and improving parent-child relationships, PCIT has become one of the most popular and widely disseminated parenting support programs in the world. The evidence for the efficacy of PCIT can be found in many reviews of randomized clinical trials and other rigorous studies. To add to those reviews, our aim was to provide practical guidance on how PCIT can be part of an evidence-based program for families that depends on practitioner expertise, as well as attention to families' diverse needs. To do this, we describe the evolution of PCIT as practiced in a university-community partnership that has continued for over 20 years, alongside a narrative description of selected and recent findings on PCIT and its use in specific client presentations across four themes. These themes include studies of 1) whether the standard manualized form of PCIT is efficacious across a selection of diverse family situations and child diagnoses, 2) the mechanisms of change that explain why some parents and some children might benefit more or less from PCIT, 3) whether treatment content modifications make PCIT more feasible to implement or acceptable to some families, at the same time as achieving the same or better outcomes, and 4) whether PCIT with structural modifications to the delivery, such as online or intensive delivery, yields similar outcomes as standard PCIT. Finally, we discuss how these directions in research have influenced research and practice, and end with a summary of how the growing attention on parent and child emotion regulation and parents' responses to (and coaching of) their children's emotions has become important to PCIT theory and our practice.

Tele-PCIT: Initial Examination of Internet Delivered PCIT for Young Children with Autism

PURPOSE

Parent-Child Interaction Therapy (PCIT) is an empirically supported behavioral parenting program for disruptive behavior and has been shown to also be effective for children with autism spectrum disorder (ASD). Telehealth delivery of PCIT (Tele-PCIT) is also supported, but no trials have focused on children with ASD. The purpose of the study was to examine the initial efficacy of a time limited version of Tele-PCIT within an ASD sample.

METHODS

Participants included parents of 20 children (ages 2-6) with ASD who received 10 sessions of Tele-PCIT. Parents reported on their parenting stress, parenting practices, and child behavior. A play observation was coded for parent use of treatment skills and for child compliance.

RESULTS

80% of participants completed treatment (n = 16) and results revealed significant improvements across parenting and child outcomes. Parents reported decreases in parenting stress from pre-to-post-treatment, which were maintained at a 3-month follow-up, along with decreases in negative parenting practices (i.e., Laxness and Overactivity) from pre-to-post treatment that were also maintained at follow-up. Significant increases in parent use of positive parenting skills (i.e., "Do" Skills) during child-led play and decreases in negative parenting skills (i.e., "Don't" Skills) were observed. Results also revealed significant reductions in parent rated child externalizing behavior problems from pre-to-post-treatment that were also maintained at follow-up.

CONCLUSIONS

Results of the current study support the initial efficacy of Tele-PCIT for treating disruptive behavior in young children with ASD. Findings from this pilot will inform larger examinations of Tele-PCIT for youth with ASD.

Scientific collaborations and research trends in Parent-Child Interaction Therapy: a bibliometric analysis

Parent-child interaction therapy (PCIT) is considered to be an effective intervention for children aged 2-7 years with conduct problems. PCIT research has been conducted for approximately 50 years; however, an analysis of general research patterns has not been published. In this context, the present study outlines a bibliometric analysis of scientific collaborations, prevalence across locations on the basis of countries and organizations, leading researchers, and trends within PCIT research. Findings demonstrate that PCIT is an area in which international scientific collaborations are intense and current, and collaborations continue to be formed around the world. Additionally, results indicate that dissemination of intercultural PCIT adaptations are continuous.

Effectiveness of Group Parent-Child Interaction Therapy on Problem Behaviors in Chinese Kindergartners

Problem behaviors in early childhood may put young children at risk for negative behavioral and psychosocial problems. This study examined the effectiveness of group PCIT on Chinese young children's externalizing and internalizing problems. The participants were 58 mothers with their children aged 2-3 years (M = 2.95 years, SD = 0.22), assigned to an immediate treatment (n = 26) group or to a waitlist (n = 32) control group. The program involved comprehensive group intervention and featured weekly 60-90-min sessions, totaling ten sessions over three months. Results indicate that group PCIT not only significantly improved teacher-reported problem behaviors in children, but also improved observed maternal parenting behavior. These findings support the use of group PCIT in Chinese children and provide mothers with an evidence-based tool to address problem behaviors in a non-clinical population.

Parent-Child Interaction Therapy for Children with Disruptive Behaviors and Autism: A Randomized Clinical Trial

A relatively large number of children with autism spectrum disorder (ASD) exhibit disruptive behavioral problems. While accumulating data have shown behavioral parent training programs to be efficacious in reducing disruptive behaviors for this population, there is a dearth of literature examining the impact of such programs across the range of ASD severity. To evaluate the effectiveness of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for children with problem behaviors and their families, in reducing disruptive behaviors among children (4-10 years) with ASD (without intellectual disabilities). Fifty-five children (85.5% male, 7.15 years; SD 1.72) were enrolled from pediatric offices and educational settings into a randomized clinical trial (PCIT: N = 30; Control: N = 25). PCIT families demonstrated a significant reduction in child disruptive behaviors, increase in positive parent-child communication, improvement in child compliance, and reduction in parental stress compared to the control group. Exploratory analyses revealed no differential treatment response based on ASD severity, receptive language, and age. Results are promising for the use of PCIT with children demonstrating disruptive behaviors across the autism spectrum.

Clinicians’ Perceptions of Parent-Child Arts Therapy with Children with Autism Spectrum Disorders: The Milman Center Experience

Different types of arts offer a wide variety of modes of nonverbal communication and expressive tools for children with Autism Spectrum Disorders (ASD). The present study was designed to characterize therapists’ perspectives on the implementation of a parent-child arts therapy model for children with ASD. Semi-structured interviews were conducted with 13 arts therapists who participated in the study. The thematic analysis (qualitative analysis) approach yielded seven themes: (1) Therapeutic goals. (2) Adjusting the therapeutic intervention. (3) The advantages of parent-child arts therapy. (4) Difficulties in parent-child arts therapy. (5) The unique contribution of the participants to parent-child arts therapy. (6) The different types of arts in the therapy room. (7) The arts therapists’ assessment of the progress of therapy. The discussion focuses on the four central components of parent-child arts therapy room: the child in therapy, the parent, the arts therapist, and the creative arts.

Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.

Parent-Implemented Positive Behavior Support Strategies for Young Children on the Autism Spectrum: A Pilot Investigation

PURPOSE

Parents of children on the autism spectrum enrolled in early intervention often receive coaching to address both social communication and disruptive behavior, which are the two most frequently reported concerns by parents. Intervention techniques for both are often recommended to be implemented across daily routines and require the parents to learn new ways of interacting with their child. A sequential approach to instructing parents in these key intervention targets may reduce burden and increase adherence.

METHOD

This multiple-baseline design pilot study included three mother-child dyads who received instruction in a disruptive behavior intervention immediately following a social communication intervention. Maternal maintenance of social communication strategies and child disruptive behaviors were measured during probes throughout the study.

RESULTS

Results indicate that although mothers readily learned to implement the techniques, fidelity of implementing social communication strategies declined after introduction of the positive behavior support strategies.

CONCLUSIONS

A sequenced approach to parent-mediated intervention is feasible and acceptable. Clinical implications and future directions are discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19528978.

mHealth apps delivering early intervention to support parents of children with autism: a scoping review protocol

OBJECTIVE

This review aims to identify the mhealth apps delivering early intervention to support parents of children with autism spectrum disorders (ASD). We aim to explore the concept, context and methodology of implementation that is, theoretical framework, feasibility, quality of evidence, for such apps.

BACKGROUND

To improve outcomes for children with autism, early intervention has been found to be promising. Parental training, parent psychoeducation and parent-mediated intervention are regarded as the gold standard, to achieve early childhood development goals. Digital health technologies like tele-health, web-based services, have been used to deliver this at a reduced cost. There is little evidence about their use and efficacy in empowering parents of children with ASD.

INCLUSION CRITERIA

The studies reporting the use of mhealth apps to support parents of children with ASD, in community settings, school settings, special schools, clinics, hospitals or child development centres. There will be no exclusion based on region, gender or sociocultural factors. The types of studies included will be quantitative, qualitative, mixed-methods study designs, case reports, grey literature, systematic reviews, clinical trials and studies reporting feasibility of digital mhealth applications.

METHOD

Using the NICE Healthcare Databases Advanced Search, we will search the following databases: MEDLINE, PUBMED, CINAHL, EMBASE, PsycINFO, Cochrane Library, EbscoHost, Sabinet, SAGE Journals, Directory of Open Access Journals, BioMed Central, Scopus, ScienceDirect. Furthermore, grey literature will be searched through Google Scholar, ShodhGanga, JSTOR, CORE, EBSCO, DOAJ, BASE. The searches will be limited to the age range of children between 2 and 6 years with ASD, and the date range is from the inception of the database to the current date. The terms for the ASD will be combined with terms for parent, early intervention and digital mhealth to identify eligible studies.

Application of Augmented Reality Technology in Children's Picture Books Based on Educational Psychology

To cultivate children's imagination, observation, thinking ability, and aesthetic consciousness, the questionnaire survey is adopted to analyze the design strategies and principles of children's picture books based on augmented reality (AR). Primarily, the related concepts and theories are expounded for the research content. Children in preschool aged 4-5 years are invited as primary participants in this work, and the psychological characteristics of the invited children are analyzed in depth. Then, a study is carried out on the existing AR children's picture books. The problems existing in the design of AR children's picture books are found, and then, related solutions are put forward based on the results of the questionnaire survey. Besides, a design is made on the strategies and interactive design principles of AR children's picture books on mobile terminals that are more in line with the needs of children. The results show that 41.07% of parents do not understand AR technology, and 37.5% of preschool children indicate that they do not operate mobile devices independently. However, they need the assistance of parents to use this kind of picture book. A total of 44.64% of parents believe that the main problem of AR picture books in the current market is the lack of interesting interaction. Given the above problems, five principles are proposed for the design of AR children's picture books based on mobile terminals, namely, easy operation principle, interesting principle, guiding principle, timely feedback principle, and safety principle. A set of universally applicable design methods are proposed for AR children's picture books based on mobile terminals, which provides certain theoretical guidance for the development of related types of products.

Parent-child interaction therapy (PCIT) with families of children with autism spectrum disorder

BACKGROUND AND AIMS

Parent-child interaction therapy (PCIT) is an evidence-based behavioral parent training program designed for preschool-age children that emphasizes supporting parent-child interaction patterns to improve child behavior and enhance the quality of parent-child relationships. PCIT has been deemed efficacious in treating children with disruptive behavior disorders, and recent studies have shown promising results utilizing aspects of PCIT with children with autism spectrum disorder (ASD), but none of these studies applied the entire PCIT intervention per manual protocol. The present study is the first to test the efficacy of PCIT, without modification, with families of preschool-age children with ASD without comorbid behavioral difficulties.

METHODS

This study employed a single-subject multiple-probe design to evaluate the efficacy of PCIT with four families with children with ASD between the ages of 2 and 4 years old (M = 40 months) over a 4-month period.

RESULTS

PCIT was effective in increasing positive parenting behavior, decreasing negative parenting behavior, and increasing child compliance to parental commands. Parents reported greater confidence in parenting abilities post-treatment and significant improvement in the core areas of autism symptomatology. Parents endorsed significant improvement in aspects of the parent-child relationship, such as attachment and involvement.

CONCLUSIONS

Parents of children with ASD demonstrated more positive and effective parenting behavior and reported enhancements in the parent-child relationship after participating in PCIT. Children were more compliant to parental commands and exhibited improvements in social and behavioral functioning. Increases in positive parenting behaviors and child compliance to parental requests were maintained 1 month after treatment and outside the clinic setting during generalization sessions. Parents of children with ASD reported a high degree of satisfaction with PCIT.

IMPLICATIONS

The present study provides initial evidence of the efficacy of utilizing PCIT with families of preschool-age children with ASD and supports the continued investigation of the efficacy of PCIT with this population.

Effectivity of Play-Based Interventions in Children with Autism Spectrum Disorder and Their Parents: A Systematic Review

Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB.

Effectiveness of Responsivity Intervention Strategies on Prelinguistic and Language Outcomes for Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Group and Single Case Studies

We conducted a systematic review to identify randomized controlled trials (RCTs) and single case research design (SCRD) studies of children with autism spectrum disorder that evaluate the effectiveness of responsivity intervention techniques for improving prelinguistic and/or language outcomes. Mean effect sizes were moderate and large for RCTs (33 studies; g = 0.36, 95% CI [0.21, 0.51]) and SCRD (34 studies; between-case standardized mean difference = 1.20, 95% CI [0.87, 1.54]) studies, respectively. Visual analysis (37 studies) revealed strong evidence of a functional relation for 45% of the opportunities and no evidence for 53%. Analyses of moderator effects and study quality are presented. Findings provide support for responsivity intervention strategies with more robust support for context-bound outcomes than more generalized outcomes.

A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes

Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.

Parent training intervention for autism symptoms, functional emotional development, and parental stress in children with autism disorder: A randomized clinical trial

OBJECTIVE

Today, early interventions to treat autistic children through parent training interventions is of outmost importance. Interventions are focused on developmental or behavioral approaches and are mostly individual or group ones. In the present study, both proposed approaches in the form of structured individual and group parent training sessions among Iranian families are investigated.

METHOD

This study was a randomized clinical trial which was performed in 2019-2020 in Tehran. Forty four 3-5 year-old children with autism participated in the study and were assigned to experimental (n = 22) and control (n = 22) groups through block randomization method. To evaluate the effectiveness of therapy on autism symptoms, Gilliam Autism Rating and Functional Emotional Assessment Scales were used. Also, Parenting Stress Index and Quality of Life Questionnaire were implemented to investigate the secondary effects of the therapy. After 12 therapy sessions, both groups took the posttest and 3 months later, follow up evaluations were performed.

RESULTS

The treatment group manifested significant improvement regarding autism symptoms in both the posttest and follow up (ŋ2 = .77, P < .05) as well as Functional Emotional Development (ŋ2 = .62, P < .05). Comparing the means indicates that the experimental group mean score is significantly higher in quality of life and lower in parenting stress than the control group's.

CONCLUSION

Parent training is effective on autism symptoms and functional emotional development. Regarding the fact that the follow-up phase coincided with Covid-19 pandemic and quarantine, it can be concluded that the therapy has been successful in maintaining the attained capabilities.

Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes

Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.

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.

An Evaluation of "Balance": a Home-Based, Parent-Implemented Program Addressing Emerging Problem Behavior

Programs that prevent the development of severe problem behavior in young children with autism spectrum disorder (ASD) are critically needed. We describe a program designed to do this, and we report on a preliminary evaluation of its effects with four 3- and 4-year-old children with ASD. Parents served as the primary implementers, with twice-weekly coaching from a Board Certified Behavior Analyst. Direct measures and Aberrant Behavior Checklist scores reflected decreases in emerging problem behavior. Direct measures also reflected increases in child communication, social, and cooperation skills, and parents rated the process as highly acceptable. A randomized controlled trial will be required to evaluate the extent to which the program prevents the development of problem behavior in young children with ASD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-020-00490-3.

Play interactions of parents toward children with autism spectrum disorder: NeuroPLAY parent play behavior assessment scale

PROBLEM

The aim of this study is to analyze the changes that NeuroPLAY, which is an intensive early intervention method for children with autism spectrum disorder (ASD) and ages of 12-42 months, has created in the play skills of the parents of children with ASD by using method strategies.

METHODS

The study cohort includes 91 children ages ranging from 18 to 42 months old. The study is designed for repetitive measurements performed pre- and post-intervention. Within the scope of the study, children's ASD symptoms were evaluated with the Childhood Autism Rating Scale (CARS) and changes in the play skills of parents were evaluated using NeuroPLAY Parental Play Behavior Assessment Scale (NPPBAS).

RESULTS

The NPPBAS score at the beginning of the intervention was 12.55; repeated measurements (46.22 after 3 months, 45.95 after 6 months, and 48.53 after 12 months) were observed to increase core. The older age of the parents in the intervention program is associated with lower final NPPBAS scores. However, it was determined that the CARS score, which is an indicator of the autism spectrum, will decrease after intervention regardless of the parents' age.

CONCLUSION

The results showed that NeuroPLAY led to significant improvement in play behaviors of the parents.

Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder

Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.

Understanding, Assessing, and Intervening with Emotion Dysregulation in Autism Spectrum Disorder: A Developmental Perspective

This article provides a comprehensive review of emotion dysregulation (ED) in individuals with autism spectrum disorder (ASD). The authors describe ED from a developmental perspective, and highlight how aberrations in social development and a restricted-repetitive repertoire of behaviors, render individuals with ASD more vulnerable to ED. The article also summarizes how ED in children and adolescents with ASD has been measured and conceptualized in research and clinic settings. Evidence-based pharmacologic and cognitive behavioral interventions targeting ED in ASD are summarized, with a focus on how such approaches are tailored to the developmental needs of individuals with ASD.

A Randomized Controlled Trial of Functional Communication Training via Telehealth for Young Children with Autism Spectrum Disorder

Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional communication training (FCT) to "treatment as usual" for young children with ASD (n = 38, ages 21-84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving "treatment as usual" during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.

Parents of children with autism spectrum disorder’s perception on parent-implemented home-based developmental, individual-difference and relationship (DIR)/Floortime® intervention

Purpose

The developmental, individual-difference and relationship (DIR)/Floortime® approach is a commonly used parent-implemented intervention with children with autism spectrum disorder (ASD). Currently, no evidence is available about the intervention’s implementation and utility in Malaysia. The aim of this paper is to investigate the applicability and impact of implementing the parent-implemented home-based DIR/Floortime® intervention program for children with ASD and their parents in a Malaysian context from parents’ perspectives.

Design/methodology/approach

A qualitative study using semi-structured interviews with eight mothers and four fathers of children with ASD was conducted. The interviews were analysed using qualitative content analysis.

Findings

Five themes were developed. Theme 1 described the implementation of DIR/Floortime® intervention; Theme 2 reported challenges parents faced when implementing the intervention; Theme 3 explored parents’ perspective on play; Theme 4 explained the improvements and changes in children with ASD and parents’ abilities and skills; and Theme 5 reported parents’ comments and suggestions about the intervention program.

Research limitations/implications

Involvement of a limited number of participants and an absence of baseline data limits the interpretation of the impacts of the DIR/Floortime® program’s implementation by parents with their children with ASD.

Originality/value

Utilization of DIR/Floortime® intervention is practical and appropriate in the Malaysian context. From the parents’ perspective, the DIR/Floortime® approach was beneficial for children with ASD and parents’ skill development and well-being. Further refinement to the program and involvement of participants from various cultural backgrounds are recommended. A greater emphasis for parents on child-led interaction style and play with children are also recommended.

Parent-Mediated Interventions for Children and Adolescents With Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

There has been increasing interest in parent-mediated interventions (PMIs) for children with autism spectrum disorders (ASDs). The objective of this systematic review and meta-analysis was to examine the effect of PMIs compared to no PMI for children with ASD aged 2-17 years. The primary outcome was adaptive functioning rated by a parent or clinician. The secondary outcomes were long-term adaptive functioning rated by the parents, adverse events, core symptoms of ASD, disruptive behavior, parental well-being, quality of life of the child rated by the parents and anxiety. The MEDLINE, PsycInfo, Embase, and CINAHL databases were searched in March 2020. The Cochrane Risk of Bias Tool was used to rate the individual studies, and the certainty in the evidence was evaluated using GRADE. We identified 30 relevant randomized controlled trials (RCTs), including 1,934 participants. A clinically relevant effect of PMIs on parent-rated adaptive functioning was found with a low certainty of evidence [Standard mean difference (SMD): 0.28 (95% CI: -0.01, 0.57)] on Vineland Adaptive Behavior Scales (VABS), whereas no clinically relevant effect was seen for clinician-rated functional level, with a very low certainty of evidence [SMD on Clinical Global Impressions (CGI)-severity scale: SMD -0.45 [95% CI: -0.87, -0.03)]. PMIs may slightly improve clinician-rated autism core symptoms [SMD: -0.35 (95% CI: -0.71, 0.02)]. Additionally, no effect of PMIs on parent-rated core symptoms of ASD, parental well-being or adverse effects was identified, all with a low certainty of evidence. There was a moderate certainty of evidence for a clinically relevant effect on disruptive behavior [SMD: 0.55 (95% Cl: 0.36, 0.74)]. The certainty in the evidence was downgraded due to serious risk of bias, lack of blinding, and serious risk of imprecision due to few participants included in meta-analyses. The present findings suggest that clinicians may consider introducing PMIs to children with ASD, but more high-quality RCTs are needed because the effects are not well-established, and the results are likely to change with future studies. The protocol for the systematic review is registered at the Danish Health Authority website (www.sst.dk).

A Systematic Literature Review of Autism Research on Caregiver Talk

Describing how caregivers' talk to their autistic children, and how their talk may influence social and language outcomes, has important implications for developmental theory and intervention research. In this systematic literature review, we examine 294 caregiver talk variables extracted from 65 studies, provide a narrative overview of research findings, and link measurement approaches to various theories of language development. The majority of variables included only talk directed to children (90%), and specified the speech act being performed (57%). More than one-third of variables measured talk that was responsive to children's attention, activities, or communication (38%), and slightly less than a third measured variables that elicited children's communication or engagement. Semantic aspects of talk were specified in 41% of variables, structural features were measured in 20% of variables, and suprasegmental features were measured in only 1% of variables. Talk quantity (without reference to other aspects of talk) was measured in 8% of variables. We found strong support that talk related to children's attention is implicated in autistic children's language development, but this construct has been measured inconsistently in terms of semantic, structural, and functional features. There is also evidence for bi-directional relationships between caregiver's talk and autistic children's development on a variety of semantic and structural variables. LAY SUMMARY: In our review, we found many differences in how researchers measured caregiver's talk, but also some promising leads. Researchers should continue examining caregiver talk related to children's focus of attention to clarify how this type of language contributes to autistic children's development. We also found interesting research on how children influence caregiver's talk, and encourage researchers to continue to study how this occurs.

Comparative Effectiveness of Parent-Child Interaction Therapy for Children with and Without Autism Spectrum Disorder

Youth with autism spectrum disorder (ASD) often display disruptive behavior and noncompliance. Disruptive behavior in youth with ASD may limit their participation in educational and therapeutic activities and impact family functioning. Several evidence-based interventions are available for typically developing children, such as Parent-Child Interaction Therapy (PCIT). The current study examined the comparative effectiveness of PCIT for youth with ASD and without ASD. Results indicate that PCIT significantly improves parent-reported disruptive behavior in children with ASD at levels comparable to children without ASD. Additionally, improvements in ASD-related symptoms were noted for youth with ASD. These findings support the use of PCIT for children with ASD and provide clinicians with an evidence-based tool to address disruptive behavior in a wide spectrum of presenting children.

The contribution of maternal executive functions and active coping to dyadic affective dynamics: Children with autism spectrum disorder and their mothers

Parenting is a cognitive, emotional, and behavioral endeavor, where parents' control capacities, including executive functions and active control coping, help parents to guide and regulate interactions with their children; yet limited research investigates how these capacities are associated with parent-child affective regulation processes during parent-child interactions. This study examined whether maternal executive functions (sustained attention, interference inhibitory control, working memory) and active engaged coping were related to dyadic affective flexibility and positive mutual affective interactions between mothers and their young children with autism spectrum disorders (N = 40). Dyadic flexibility and mutual positive affect were measured using dynamic systems-based modeling of second-by-second affective patterns during a mother-child interaction. The results showed that higher levels of maternal sustained attention and inhibitory control were related to increased dyadic affective flexibility. In addition, higher levels of maternal sustained attention and higher use of engaged coping were related to dyadic mutual positive affect. The findings highlight the importance of maternal cognitive control capacity in promoting adaptive parent-child dyadic regulatory processes.

Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis

IMPORTANCE

Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language.

OBJECTIVE

To examine the association between parent training and language and communication outcomes in young children.

DATA SOURCES

Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018.

STUDY SELECTION

Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included.

MAIN OUTCOMES AND MEASURES

Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment.

RESULTS

This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedges g, -0.33 [0.06]; P < .001). The association between parent training and parent use of language support strategies was large (mean [SE] Hedges g, 0.55 [0.11], P < .001). Children with developmental language disorder had the largest social communication outcomes (mean [SE] Hedges g, 0.37 [0.17]); large and significant associations were observed for receptive (mean [SE] Hedges g, 0.92 [0.30]) and expressive language (mean [SE] Hedges g, 0.83 [0.20]). Children at risk for language impairments had moderate effect sizes across receptive language (mean [SE] Hedges g, 0.28 [0.15]) and engagement outcomes (mean [SE] Hedges g, 0.36 [0.17]).

CONCLUSIONS AND RELEVANCE

The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.

Parent–Child Interaction Therapy for children with autism spectrum disorder and a matched case-control sample

Parent–Child Interaction Therapy is an empirically based, behavioral parent training program for young children exhibiting disruptive behaviors. Parent–Child Interaction Therapy shows promise for treating disruptive behaviors in children with autism spectrum disorder. Treatment processes (i.e. treatment length and homework compliance), parenting skills, parenting stress, and behavioral outcomes (i.e. disruptive and externalizing behaviors and executive functioning) were compared in 16 children with autism spectrum disorder and 16 children without autism spectrum disorder matched on gender, age, and initial intensity of disruptive behaviors. Samples were statistically similar in terms of child receptive language, child race and ethnicity, parent age, gender and education, and number of two-parent families in treatment. Families received standard, mastery-based Parent–Child Interaction Therapy. Both groups demonstrated significant and clinically meaningful improvements in child disruptive and externalizing behavior and executive functioning, parenting skills, and parenting stress. Length of treatment, homework compliance, and parent and child outcomes did not differ significantly between groups. A subset of children with autism spectrum disorder also showed significant improvements in social responsiveness, adaptive skills, and restricted/repetitive behaviors. This study replicates and extends prior research by demonstrating that children with and without autism spectrum disorder experience similar benefits following Parent–Child Interaction Therapy. Findings may expand the availability and dissemination of time-limited, evidence-based interventions for autism spectrum disorder and comorbid disruptive behaviors.

Parental experiences using the Therapy Outcomes by You (TOBY) application to deliver early intervention to their child with autism

PURPOSE

As computer-based interventions become commonplace for parents of children with neurodevelopmental disorders, this study sought to understand the experience of using a parent-delivered supplementary early intervention therapy for children with autism spectrum disorder grounded in a variety of behavioral, sensory, developmental, and relationship-based approaches and delivered via a tablet device.

METHODS

Parental experiences using the 'Therapy Outcomes by You' (TOBY) application were collected through semi-structured interviews with 17 parents.

RESULTS

Parents reported TOBY facilitated parent-child engagement, provided ideas for therapeutic activities, created feelings of empowerment, and positively impacted their child's development. Barriers to use included preparation time, execution of the intervention, and individual strengths and weaknesses of their child.

CONCLUSION

The overall parental experience of TOBY was positive when use of the application aligned with parental proficiency, opportunities for use, and importantly, the needs of the child.

A Case Study of Parent–Child Interaction Therapy for the Treatment of High-Functioning Autism Spectrum Disorder

Youth with autism spectrum disorder (ASD) may have difficulties with compliance, impulsivity, and attention, which can affect daily adaptive functioning leading to disruptions in family social interactions, communication skills, academic achievement, and engagement in the community. Although previous research has identified behavioral treatments such as applied behavior analysis (ABA) therapy for youth with ASD, it is important to explore more interventions that can be effective in decreasing problematic behaviors while also building positive social skill development. This case study illustrates the effectiveness of Parent–Child Interaction Therapy (PCIT) to address behavioral problems in a 7-year-old boy with high-functioning ASD (HF-ASD) and comorbid ADHD. Overall, the results demonstrated a decrease in child challenging behaviors and an increase in child compliance. In addition, the child’s mother increased her use of positive parenting skills and effective commands. This study provides additional support for PCIT for children with ASD, but was not without challenges. These challenges, characteristic of families affected by ASD, and treatment implications for clinicians working with this population are discussed.

Child and parent outcomes following parent interventions for child emotional and behavioral problems in autism spectrum disorders: A systematic review and meta-analysis

There is growing interest in the development of behavioral parent interventions targeting emotional and behavioral problems in children with autism spectrum disorders. Such interventions have potential to improve a number of child and parental well-being outcomes beyond disruptive child behavior. This systematic review and meta-analysis assesses evidence for the efficacy of behavioral parent interventions for disruptive and hyperactive child behavior in autism spectrum disorders, as well as parenting efficacy and stress. A total of 11 articles from nine randomized controlled trials were included. Sufficient data were available to calculate standardized mean difference and show favorable effects of behavioral parent interventions on parent-reported measures of child disruptive behavior (standardized mean difference = 0.67), hyperactivity (standardized mean difference = 0.31) and parent stress (standardized mean difference = 0.37); effects on parent efficacy are less clear (standardized mean difference = 0.39, p = 0.17). There were insufficient data to explore intervention effects on internalizing behavior in autism spectrum disorders, parenting behaviors, or observational and teacher-reported outcomes, providing important avenues for future research. This review adds to growing evidence of the efficacy of behavioral parent interventions for child behavior and parental well-being in autism spectrum disorders (Prospero: CRD42016033979).

Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

Measuring Changes in Social Communication Behaviors: Preliminary Development of the Brief Observation of Social Communication Change (BOSCC)

Psychometric properties and initial validity of the Brief Observation of Social Communication Change (BOSCC), a measure of treatment-response for social-communication behaviors, are described. The BOSCC coding scheme is applied to 177 video observations of 56 young children with ASD and minimal language abilities. The BOSCC has high to excellent inter-rater and test-retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrates statistically significant amounts of change over time compared to a no change alternative while the ADOS CSS over the same period of time did not. This work is a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.

Parent-Child Interaction Therapy: current perspectives

Parent-Child Interaction Therapy (PCIT) is an empirically supported intervention originally developed to treat disruptive behavior problems in children between the ages of 2 and 7 years. Since its creation over 40 years ago, PCIT has been studied internationally with various populations and has been found to be an effective intervention for numerous behavioral and emotional issues. This article summarizes progress in the PCIT literature over the past decade (2006-2017) and outlines future directions for this important work. Recent PCIT research related to treatment effectiveness, treatment components, adaptations for specific populations (age groups, cultural groups, military families, individuals diagnosed with specific disorders, trauma survivors, and the hearing-impaired), format changes (group and home-based), teacher-child interaction training (TCIT), intensive PCIT (I-PCIT), treatment as prevention (for externalizing problems, child maltreatment, and developmental delays), and implementation are discussed.

Comprehensive Psychometric Analysis of the Eyberg Child Behavior Inventory in Children with Autism Spectrum Disorder

Many assessment measures have only been validated for one specific diagnostic population, which is costly and reduces the clinical utility of assessments. The Eyberg Child Behavior Inventory (ECBI) is one popular measure designed to assess disruptive behavior problems in youth. The ECBI has sound psychometric properties in typically developing youth, but the factor structure has never been examined in children with autism spectrum disorder (ASD). Therefore, the current study conducted a comprehensive psychometric analysis of the ECBI in children with ASD. Retrospective data from a nationally representative sample was collected from 335 children with ASD ages 2-12 years old. A four factor solution was identified for this sample. Implications of these findings and directions for future research are discussed.

[Parent-child interaction therapy (PCIT)]

Parent-child interaction therapy (PCIT), a manualized evidence-based intervention, was originally developed to treat disruptive behavior problems in children aged 2–6 years. It is also considered to be an evidence-based intervention for physical abuse among children. Moreover, PCIT has proved to be effective for attention deficit hyperactivity disorder, autism spectrum disorder, separation anxiety disorder, and depression. Thus, it could become the first evidence-based, transdiagnostic intervention method for 2–6-year-old children. PCIT is based on attachment theory as well as learning theory, combining aspects of play therapy and behavior therapy. It consists of two treatment phases: child-directed interaction (CDI) and parent-directed interaction (PDI). In both phases parents are taught special skills. When interacting with their child parents practice these skills and are live coached by the therapist. CDI aims at improving the parent-child relationship and is the basis for PDI. In CDI, parents learn to follow their child’s lead as long as the child shows appropriate behavior. In PDI, parents practice effectively taking the lead wherever necessary. On average, it takes about 15–20 sessions to complete PCIT, which can be terminated as soon as the parents demonstrate a mastery of the skills, when child disruptive behavior has been reduced to clearly normal levels, and when the parents have become confident in managing child behavior on their own.