Video-Feedback Approach Improves Parental Compliance to Early Behavioral Interventions in Children with Autism Spectrum Disorders during the COVID-19 Pandemic: A Pilot Investigation

Enhancing autism care through remote support: A family-centered approach

Autism spectrum disorder (ASD) poses significant challenges for families, with limited access to specialized care being a critical concern. The coronavirus disease 2019 pandemic has accelerated the adoption of remote support, highlighting its potential to enhance family-centered care for children with ASD. In this editorial, we comment on the article by Lu et al, emphasizing the effectiveness of integrating remote support courses with traditional caregiver-mediated interventions. We further explore the benefits of remote support in delivering family-centered care, summarize the essential components of effective family-centered remote support, outline key considerations for implementation, and discuss potential future research directions. We conclude that family-centered remote support has the potential to significantly improve outcomes and quality of life for individuals with ASD and their families.

Feasibility of a videoconferencing-based parent-mediated intervention: a mixed-method pilot study

Background

Autism Spectrum Disorder (ASD) presents early communication and social challenges, necessitating timely and accessible intervention. Pre-school Autism Communication Therapy (PACT), a parent-mediated intervention, empowers parents to facilitate their child's development. However, accessibility issues often hinder families from accessing evidence-based intervention. This pilot study assessed the feasibility of videoconferencing-based PACT as a precursor for a multicenter randomized controlled trial.

Methodology

A mixed-methods approach integrated quantitative retrospective measures and semi-structured interviews. Participants included children diagnosed with ASD who received PACT, and PACT-trained professionals with videoconferencing experience. Feasibility was assessed through audio and video quality, internet stability, and session length. Professionals' experiences were analyzed using a qualitative thematic analysis. Autism severity, parent-child interaction, and therapeutic changes were also described.

Results

Nine parent-child dyads and eight PACT therapists were included in the study. Videoconferencing-based PACT intervention proved feasible, with 95.1% of the 41 sessions rated as feasible on the scale. Technical challenges such as audio quality (7.3%) and screen sharing (19.1%) have emerged, which therapists circumvented to maintain intervention quality. Autism severity and parent-child interaction showed positive trends, supported by qualitative findings reporting increased parental confidence and enhanced synchrony. The core components of PACT were successfully adapted to the remote setting.

Conclusion

This pilot study suggests that delivering PACT via videoconferencing is a feasible approach to enhance the accessibility of evidence-based interventions for ASD. Larger-scale research with rigorous controls is required to validate these promising findings. An ongoing multicenter randomized trial aims to address this gap.

Telecoaching for Parents of Young Autistic Children Using Strength-Based Video Feedback

Parent-implemented Naturalistic Developmental Behavioral Interventions (NDBIs), rooted from applied behavioral and developmental sciences, focus on empowering families by training and coaching natural change agents to embed evidence-based strategies during regular events or contexts (e.g., play time). No research, however, has relied on strength-based video feedback coaching within parent-implemented NDBIs while providing flexibility with self-recorded sessions. We conducted a single case multiple-baseline design across five parent-child dyads to evaluate the effects of a telepractice-based parent-training on five NDBI strategies (i.e., Follow and Imitate, Model Language, Arrange Environment, Wait Time, Reward and Expand), utilizing strength-based video feedback coaching with parents (i.e., two mothers and three fathers) of young autistic children (i.e., ages 2 to 5) on parent strategy use and child social communication. An additional coaching package (i.e., parent self-reflections, goal setting, and joint discussions) was introduced to parents who did not meet a predetermined criterion. Maintenance data were collected 2-, 4-, and 6-weeks after intervention concluded. Visual analyses, nonoverlap calculations, and standardized mean difference effect sizes indicate strong effects for parent strategy use and small, varied effects on child social communication. Maintenance of parent strategy use and child social communication varied, with most remaining at equivalent or higher levels. Parent-implemented interventions that are delivered via telepractice may continue to be successful when coaching is focused on the parents' strengths, all coaching feedback is provided asynchronously, and families can flexibly record sessions based upon their week's schedules rather than relying on regularly scheduled meeting times with a coach.

"We were the best people to do the job": Caregivers' reported outcomes of a virtual caregiver-delivered program for autistic preschoolers

Background and aims

Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers' perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers' perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program.

Methods

This study was a secondary analysis of data from individual interviews conducted with 21 caregivers who had recently participated in a virtual MTW program. A hybrid codebook thematic analysis approach was taken to analyze the interview data. Program outcomes were coded and analyzed within the International Classification Functioning, Disability, and Health (ICF) framework. Additionally, caregivers completed an online survey and rated Likert Scale items about perceived program outcomes, which were analyzed descriptively.

Results

Five themes were identified: (1) caregivers learned new strategies to facilitate their child's development, (2) caregivers developed a new mindset, (3) children gained functional communication skills, (4) caregiver-child relationships improved, and (5) caregivers gained a social and professional support network. These themes fell within four of five ICF framework components (activities, participation, personal factors, and environmental factors). No themes were identified under Body Structures and Functions. Survey results indicated most caregivers reported learning new communication strategies (n = 20, 95%), and identifying new teaching opportunities with their child (n = 21, 100%).

Conclusions

Some reported outcomes, related to Activities and Participation, were consistent with previous reports in the literature on the MTW program. In line with previous research, caregivers learned strategies to support their child's communication development. Contrary to previous quantitative studies, caregivers in this study rarely commented on gains in vocabulary and instead focused on gains in skills that positively impacted their child's ability to engage in meaningful social interaction. Novel outcomes were identified within the Participation, Personal Factors, and Environmental Factors components of the ICF framework.

Implications

Caregivers in this study identified important outcomes for themselves and their child that have not been the focus of prior research, suggesting it is important to integrate their perspectives in the development and evaluation of caregiver-delivered programs. Clinicians should include goals that address outcomes identified as important by caregivers, including those that address children's Participation, and those that target caregivers' Personal and Environmental Factors. Developers of caregiver-delivered programs could integrate identified goals to ensure they are meeting families' needs.