Effectiveness of a parent-mediated intervention for toddlers with autism spectrum disorder: Evidence from a large community implementation

Abstract

Recent efforts have focused on developing and evaluating early intervention for toddlers with probable or emerging autism spectrum disorder. Parent-mediated approaches have gained traction, with mounting evidence of efficacy, but a research-to-practice gap exists, and community effectiveness remains to be firmly established. We report outcomes of a parent-mediated toddler intervention delivered through a research-community partnership, using a community-partnered participatory framework. Data were available for 179 of 183 toddler-parent dyads receiving Social ABCs parent coaching (mean toddler age: 25.18 months; range, 14–34 months). Of these, 89.4% completed the 12-week program and 70.6% returned for 3-month follow-up assessment. Parents attained implementation fidelity exceeding 75%, and toddlers made gains on proximal and distal measures of social communication. Parent fidelity was associated with toddlers’ responsivity at week 12, and responsivity predicted later language gains and reduced autism spectrum disorder symptoms. The roles of child, family, and system factors are discussed. Community delivery of an evidence-based parent-mediated intervention for toddlers with autism spectrum disorder is feasible and effective. Given resource efficiencies associated with parent-mediated approaches, findings bolster current efforts to promote earlier and more widespread access to intervention at the first signs of developmental concern. Lay abstract In an effort to increase access to intervention as early as possible for toddlers with autism spectrum disorder or signs thereof, many researchers have developed interventions that can be delivered by parents in their own homes. These parent-mediated approaches have gained a lot of research attention in recent years and have been found to be helpful in terms of parent and toddler learning. Several studies have used a rigorous research design (a randomized controlled trial) to show that parent-mediated intervention can work under ideal well-controlled conditions. To build on this evidence, we also need to examine whether parent-mediated interventions can be taught well through community service providers and delivered in more “real-world” conditions. This study used a research-community partnership to provide a parent-mediated intervention (called the Social ABCs) to 179 families (mean toddler age was 25 months; ranging from 14 to 34 months). Almost 90% of the families completed the 12-week program and 70% returned for a follow-up assessment 3 months later. Analyses showed that parents learned the strategies that were designed to help them support their toddlers’ development. Also, toddlers made gains in their language, communication, and social skills. Importantly, parents’ use of the strategies was related to toddlers’ skill gains, suggesting that the use of the strategies made a difference for the toddlers. Findings support the use of parent-mediated intervention in this very young age group and suggest that such intervention approaches should be made available for community delivery.

Quickstart for toddlers with autism spectrum disorder: A preliminary report of an adapted community-based early intervention program

“…Low-dose EI is cost-friendly and results in significant main effects on parent behaviors, but changes for children on measures of verbal and nonverbal performance, or on ASD symptoms, have not been as reliably reported, depending on the program ( Rogers et al, 2019a , 2020 ; Sandbank et al, 2020 ; Wetherby et al, 2018 ). However, evidence is evolving of child gains following brief parent-mediated interventions, particularly in naturalistic developmental behavioral interventions ( Brian et al, 2022a ; Sandbank et al, 2020 ). Specifically, early development in infants and toddlers at high risk for ASD is augmented in lower-dose EI when parents learn to use child-responsive strategies ( Landa, 2018 ; Wetherby et al, 2018 ).…”

“…Moreover, EIs that are developmentally grounded, individualized, focused on comprehensive learning targets, and initiated as soon as concerns are noted, allow the best possible child development to begin ( Zwaigenbaum et al, 2015a ). Community-based, parent-mediated EI for toddlers at risk for ASD may provide a wider, cost-effective opportunity reach to all toddlers and their families who would benefit from an early launch to enriched learning ( Brian et al, 2022a ; Cidav et al, 2017 ; Wetherby et al, 2018 ; Zwaigenbaum et al, 2015a ).…”

“…Systematic reviews in the recent past identify methodological limitations to EI studies including small sample sizes, a paucity of randomized controlled trials (RCTs), and inconsistent outcome measures ( French & Kennedy, 2018 ; Karst & Van Hecke, 2012 ). Recently, there is emerging a body of RCT evidence ( Brian et al, 2017 , 2022a ; Stadnick et al, 2015 ; Wetherby et al, 2014 ) finding positive effects on social communication, language, and play skills development ( Sandbank et al, 2020 ). However, there remains a continuing concern for better study quality ( Sandbank et al, 2020 ).…”

“…Findings of comprehensive research reviews that have informed professional guidelines emphasize the need for readily available efficient, effective, and "communityviable" EI for families (Wetherby et al, 2018(Wetherby et al, , p. 2616. Models of parent-mediated EI that coach parents and other caregivers to serve as interventionists may be effective for short-and long-term learning outcomes for very young children with ASD (Brian et al, 2017(Brian et al, , 2022aLanda, 2018;Nevill et al, 2018;Schertz et al, 2013;Wetherby et al, 2014Wetherby et al, , 2018Zwaigenbaum et al, 2015aZwaigenbaum et al, , 2015b. Moreover, EIs that are developmentally grounded, individualized, focused on comprehensive learning targets, and initiated as soon as concerns are noted, allow the best possible child development to begin (Zwaigenbaum et al, 2015a).…”

The developing brain: Challenges and opportunities to promote school readiness in young children at risk of neurodevelopmental disorders in low- and middle-income countries

“…The evidence on the effect of intervention in infants at increased risk of ASD is very limited (55). The data available suggest that a caregiver-mediated social communication intervention may be associated with improved child attention and social communication and better caregiver responsiveness (55, 60,61).…”