Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism

Abstract

This study tested the effects of a parent-mediated intervention on parental responsiveness with their toddlers at high risk for an autism spectrum disorder (ASD).Participants included caregivers and their 66 toddlers at high risk for ASD. Caregivers were randomized to 12 sessions of an individualized parent education intervention aimed at improving parental responsiveness or to a monitoring control group involving 4 sessions of behavioral support. Parental responsiveness and child outcomes were measured at three time points: at beginning and end of the 3-month treatment and at 12-months post-study entry. Parental responsiveness improved significantly in the treatment group but not the control group. However, parental responsiveness was not fully maintained at follow up. There were no treatment effects on child outcomes of joint attention or language. Children in both groups made significant developmental gains in cognition and language skills over one year. These results support parental responsiveness as an important intervention target given its general association with child outcomes in the extant literature; however, additional supports are likely needed to fully maintain the treatment effect and to affect child outcomes.

Increasing Responsive Parent–Child Interactions and Joint Engagement: Comparing the Influence of Parent-Mediated Intervention and Parent Psychoeducation

“…Due to the significant role of joint engagement in children’s development, it is critical to target joint engagement for children with ASD in order to maximize their opportunities to learn from interactions with parents. Evidence of improvement in child-initiated joint engagement for children with ASD is found in a number of recent randomized controlled trials of parent-mediated interventions (Kasari et al 2010, 2014a, b, 2015). While time jointly engaged is positively associated with parental responsive behaviour at baseline of intervention (Patterson et al 2014), parental responsiveness has not been examined in relation to changes in joint engagement over the course of a parent-mediated intervention.…”

“…Pickles et al (2015) report partial mediation of the effect of the Preschool Autism Communication Trial (PACT) treatment on autism symptoms by both parent synchrony and child initiations. However, intervention studies of the Focused Playtime Intervention targeting parental synchrony (Siller et al 2013; Kasari et al 2014a, b) have focused on improved outcome in children’s communication skills. In the case of these two studies, both documented increases in parental responsivity post treatment, however, Kasari et al (2014a, b) found no related gains in children’s communication outcomes and Siller et al (2013) found only small gains for children with the greatest language delays.…”

“…However, intervention studies of the Focused Playtime Intervention targeting parental synchrony (Siller et al 2013; Kasari et al 2014a, b) have focused on improved outcome in children’s communication skills. In the case of these two studies, both documented increases in parental responsivity post treatment, however, Kasari et al (2014a, b) found no related gains in children’s communication outcomes and Siller et al (2013) found only small gains for children with the greatest language delays. Further, responsiveness measured as a result of the parent-mediated Early Start Denver Model reported no significant effect of treatment over community control on parents’ responsivity or children’s social attention or initiations (Elder 2011; Rogers et al 2012).…”

Autism spectrum disorder in infancy

“…Interventions aimed at fostering early socialemotional development in ASD may need to focus first on increasing child orienting to a social partner and parent responsiveness [4,48]. Some existing parent-or teacher-mediated approaches with toddlers have yielded gains related to social orienting or engagement [49][50][51].…”

A Systematic Review of Social Communication and Interaction Interventions for Patients with Autism Spectrum Disorder

“…We identified 2 additonal studies of EIBI (118,119), one of TEACCH (120), four of social skills training (121)(122)(123)(124), and five of interventions involving significant others related to the parent-mediated treatment of children with ASD (excluding EIBI) (125)(126)(127)(128)(129). All studies reported findings that were in favor of the respective intervention method evaluated, with small to large effect sizes; however, study samples were mostly small to medium large (i.e., N = 11 to N = 86).…”