This pilot RCT compared the effect of a self-directed and therapist-assisted telehealth-based parent-mediated intervention for young children with ASD. Families were randomly assigned to a self-directed or therapist-assisted program. Parents in both groups improved their intervention fidelity, self-efficacy, stress, and positive perceptions of their child; however, the therapist-assisted group had greater gains in parent fidelity and positive perceptions of child. Children in both groups improved on language measures, with a trend towards greater gains during a parent-child interaction for the therapist-assisted group. Only the children in the therapist-assisted group improved in social skills. Both models show promise for delivering parent-mediated intervention; however, therapist assistance provided an added benefit for some outcomes. A full-scale comparative efficacy trial is warranted.

BackgroundThere has been growing interest in using telehealth to increase access to parent-mediated interventions for children with ASD. However, little is known about how parents engage with such programs.ObjectiveThis paper presents program engagement data from a pilot study comparing self-directed and therapist-assisted versions of a novel telehealth-based parent-mediated intervention for young children with autism spectrum disorders (ASD).MethodsParents of young children with ASD were randomly assigned to receive a self-directed or therapist-assisted version of ImPACT Online. Parent engagement and satisfaction with the different components of the program website were examined using the program’s automated data collection and a post-treatment evaluation survey. We examined the relationship between program engagement and changes in parent knowledge and implementation and participant characteristics associated with program engagement.ResultsOf the 27 parent participants, the majority were female (26/27, 96%), married (22/27, 81%), with a college degree or higher (15/27, 56%), and less than half were not employed outside of the home (10/27, 37%). The mean chronological age of the child participants was 43.26 months, and the majority were male (19/27, 70%) and white (21/27, 78%). Most of the families (19/27, 70%) resided in a rural or medically underserved area. Parents logged into the website an average of 46.85 times, spent an average of 964.70 minutes on the site, and completed an average of 90.17% of the lesson learning activities. Participants in the therapist-assisted group were more likely to engage with the website than those in the self-directed group: F 2,24=17.65, P<.001. In total, 85% of participants completed the program, with a significantly greater completion rate in the therapist-assisted group (N=27): χ2 1=5.06, P=.03. Lesson learning activities were visited significantly more often than the supplemental activities (all Ps<.05). Multiple regression controlling for pretreatment performance indicated that program completion (beta=.51, P=.02) predicted post-treatment intervention knowledge, and program completion (beta=.43, P=.03) and group assignment (beta=-.37, P=.045) predicted post-treatment intervention fidelity. Partial correlations indicated that parent depressive symptoms at pretreatment were negatively associated with program completion (r=-.40, P=.04), but other key parent and child demographic factors were not. Post-treatment measures of website usability (r=.65, P<.001), treatment acceptability (r=.58, P=.002), and overall satisfaction (r=.58, P=.002) were all related to program completion.ConclusionsParent engagement and satisfaction with ImPACT Online was high for both self-directed and therapist-assisted versions of the program, although therapist assistance increased engagement. Program completion was associated with parent outcomes, providing support for the role of the website in parent learning. This program has the potential to increase access to parent-mediated intervention for f...

The ability to recognize when one is being imitated has been hypothesized to be an important developmental process related to the emergence of more advanced social-cognitive skills. While a series of behaviors indicating progressively more mature imitation recognition (IR) skills has been assessed in typically developing children, empirical work with children with autism spectrum disorders (ASDs) has largely focused on basic social responses to an imitative adult (e.g. increases in eye contact). Limited work has explored more mature IR behaviors in this population. This study compared the degree to which children with ASD engage in different behaviors thought to be indicative of IR during a naturalistic imitation task and the relationship between different types of IR behaviors and social-cognitive skills (i.e. imitation, language, social reciprocity, and joint attention). Thirty children with ASD were administered standardized measures of cognitive level, language, joint attention, social reciprocity, and imitation. IR behaviors were observed during periods of contingent imitation by an adult. Participants engaged more frequently in less mature (e.g. looking at the experimenter's toy or face) than more mature IR behaviors (e.g. testing the experimenter's intent to imitate). After controlling for developmental level, social reciprocity, object imitation, and gesture imitation were positively correlated with more mature IR. These findings suggest that the development of more mature IR skills is related to the development of other social-cognitive skills in children with ASD and provide additional empirical support for reports of more mature IR observed in this population. , Inc.

Event-related potentials (ERPs) and behavioral accuracy judgments were recorded in a letter name rhyming paradigm (e.g., A-J versus A-B) with 6- to 8-year-old beginning readers and adults. A typical N450 rhyming effect was evident for both children and adults, with few differences in mean amplitude or peak latency between groups. The size and timing of the electrophysiological effect were not correlated with standardized measures of phonological or reading ability, but accuracy in the ERP task was. Single letters elicit a similar ERP rhyming effect in young children and adults, suggesting the early establishment of neurocognitive systems used in the rhyme task.

Previous visual event-related potential (ERP) studies using prime-target pairs of word and pseudoword stimuli have reported a robust rhyming effect such that nonrhyming targets elicit a larger N450 than rhyming targets. However, results of similar studies using simpler linguistic stimuli-single letters-are equivocal. We used lowercase and uppercase letter pairs in a simple ERP prime-target rhyming paradigm to further investigate whether single letters could elicit the typical rhyming effect and, if so, whether the rhyming effect was sensitive to physical orthography (which differed between the case conditions). The typical N450 rhyming effect was observed in both the lowercase and uppercase letter pair conditions, with similar amplitude and latency between conditions. This pattern of results suggests that the N450 rhyming effect is not sensitive to physical (case) orthography and likely primarily indexes phonological processing related to the rhyme task.