Objective To evaluate the effectiveness of the PLAY Project Home Consultation (PLAY) model, in combination with usual community services (CS), to improve parent-child interaction, child development, and autism symptomatology in young children with autism spectrum disorders (ASD) compared to CS only. Methods Children (N=128) with autism or PDD-NOS (DSM IV criteria), 2 years-8 months to 5 years-11 months, recruited from five disability agencies in four U.S. states, were randomized in two one-year cohorts. Using videotape and written feedback within a developmental framework, PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction. CS included speech/language and occupational therapy and public education services. Primary outcomes included change in: parent and child interactions; language and development; and autism-related diagnostic category/symptoms. Secondary outcomes included parent stress and depression; and home consultant fidelity. Data were collected pre and post intervention. Results Using intent-to-treat analysis (ITT), large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales. Child language and developmental quotient did not differ over time by group though functional development improved significantly. PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule (ADOS). PLAY caregivers’ stress did not increase; depressive symptomatology decreased. Home Consultants administered the intervention with fidelity. Conclusions PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parent stress/depression. ADOS findings must be interpreted cautiously as results do not align with clinical experience. PLAY offers communities a relatively inexpensive, effective intervention for children with ASD and their parents.
This study investigates the effectiveness of relationship-focused intervention on the social and emotional well-being of children with autism spectrum disorders. Relationship-focused intervention is a general approach to developmental intervention that encourages and supports parents to enhance their use of responsive interactive strategies during routine interactions with their children. The sample for this study consisted of 20 young children diagnosed with autism or pervasive developmental disorder and their parents. Parents and children received weekly intervention sessions for 8 to 14 months. These sessions focused on encouraging parents to use a Responsive Teaching curriculum to promote children's socioemotional development. Comparisons of pre- and postassessments indicated that the intervention was successful at encouraging mothers to engage in more responsive interactions with their children. Increases in mothers' responsiveness were associated with significant improvements in children's social interaction, as well as in standardized measures of their social— emotional functioning. These results indicate that relationship-focused intervention holds much promise for enhancing the social—emotional functioning of children with autism spectrum disorders.
This study compares the effects of relationship-focused early intervention on toddlers and preschool-age children who were classified as having either pervasive developmental disorders (PDDs) (N = 20) or developmental disabilities (DDs) (N = 30). The intervention was conducted over a 1-year period through weekly individual parent-child sessions. It focused on helping parents use responsive teaching strategies to encourage their children to acquire and use pivotal developmental behaviors that addressed their individualized developmental needs. Before and after comparisons indicated significant increases in parents' responsiveness and children's pivotal behavior. Both groups of children made significant improvements in their cognitive, communication, and socioemotional functioning. However, children with PDDs made statistically greater improvements on the developmental measures than children with DDs. On several developmental measures, children's improvements were related to increases in both their parents' responsiveness and their own pivotal behavior.
The results from four early intervention evaluation studies are described in relationship to their impact on parent-child interaction as measured by the Maternal Behavior Rating Scale. Intervention studies included the Infant Health and Development Program, the Longitudinal Studies of the Effects and Costs of Alternative Types of Early Intervention, the Play and Learning Strategies Program, and the Family-Centered Outcome study. Results from these analyses indicated that intervention effects on child development were unlikely to occur unless mothers modified their style of interacting with their children. Although these studies indicated that mothers of children who participated in intervention modified several different parameters of interactional style, only their level of responsiveness was positively associated with their children's developmental outcomes. These results are discussed in relationship to child-focused and relationship-focused models of early intervention.
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