Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial

Abstract

Short-term low intensity parent implemented intervention studies for toddlers with autism spectrum disorder (ASD) have found it difficult to demonstrate significantly improved developmental scores or autism severity compared to community treatment. We conducted a randomized comparative intent-to-treat study of a parent implemented intervention to (1) test the effects of an enhanced version on parent and child learning, and (2) evaluate the sensitivity to change of proximal versus distal measures of child behavior. We randomized 45 children with ASD, 12-30 months of age, into one of two versions of parent-implemented Early Start Denver Model (P-ESDM), the basic model, in which we delivered 1.5 h of clinic-based parent coaching weekly, and an enhanced version that contained three additions: motivational interviewing, multimodal learning tools, and a weekly 1.5-h home visit. We delivered the intervention for 12 weeks and measured child and parent change frequently in multiple settings. We found a time-by-group interaction: parents in the enhanced group demonstrated significantly greater gains in interaction skills than did parents in the non-enhanced group. Both interventions were associated with significant developmental acceleration; however, child outcomes did not differ by group. We found a significant relationship between degree of change in parental interaction skill and rate of children's improvement on our proximal measure. Parents in both groups reported satisfaction with the intervention. These findings suggest that parent skills improved more in the enhanced group than the comparison group. Children in the two groups showed similar improvements. Rate of individual parent learning was associated with greater individual child progress on a measure quite proximal to the treatment, though not on standardized assessments.

The Developmental Sequence and Relations Between Gesture and Spoken Language in Toddlers With Autism Spectrum Disorder

“…Data for this project were collected as part of a larger multisite parent‐implemented treatment randomized control trial (RCT) for toddlers with ASD (Rogers et al ). Toddlers and their families were recruited for the larger project at two sites: University of Washington and the University of California Davis MIND Institute.…”

“…The two treatments differed in frequency of coaching sessions, use of motivational interviewing techniques, and use of multimodal materials, but the parent strategies and overall approach were the same across the two groups and both groups of children showed accelerated language development. More detailed information regarding the two treatment variations is provided in: Rogers et al, .…”

ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment

“…Many claims for treatments for autism have little or no scientific basis, but, in recent years, there has been a significant increase in the numbers of randomised-controlled trials [7], especially for very young children. There is now strong evidence for the effectiveness, and in some cases of the longer term impact, of interventions that focus on early parent-child interactions [84][85][86]. There is also evidence that interventions conducted in highly resourced settings can be modified to meet the needs of individuals in other cultures and more economically deprived settings [87].…”

Revisión de evidencias de las técnicas de DIR/Floortime™ para la intervención en niños y niñas con Trastornos del Espectro del Autismo

“…El método centrado en el desarrollo más conocido es el "Early Start Denver Model" (ESDM); en este programa los padres reciben entrenamiento por parte de los profesionales para que sean capaces de replicar lo aprendido en terapia en otros contextos del niño. El objetivo principal es lograr avances en el desarrollo funcional, las habilidades sociales y el desarrollo del lenguaje, así como incrementar la atención, motivación y mejorar las dinámicas familiares (Rogers et al, 2012;Rogers et al, 2014;Vivanti et al, 2014;Rogers et al, 2018).…”