Systematic review of factors that may influence the outcomes and generalizability of parent‐mediated interventions for young children with autism spectrum disorder

Abstract

Parent mediated interventions have the potential to positively influence the interactions and developmental outcomes of children with autism spectrum disorder (ASD). However, a range of factors relating to children, parents and caregivers, and study design may impact on outcomes and thus the generalizability of these interventions to the broader community. The objective of this review was to examine factors that may influence the feasibility, appropriateness, effectiveness, and generalizability of parent mediated interventions for children with ASD. We conducted a systematic review, yielding 41 articles. There was substantial variability in the intervention type, intensity, and study quality. Notably, 46 different inclusion/exclusion criteria were reported across studies including factors relating to children's development, access to other services, comorbidities, parental factors, and access to the intervention. Fifteen articles included examination of 45 different factors potentially associated with, or influencing, intervention outcomes including child (e.g., language skills, ASD severity, cognition) and parent (e.g., adherence and fidelity, education) factors. Although there is clear evidence for an increasingly sophisticated (e.g., systematic phased research for some interventions) and diverse (e.g., studies in geographical diverse contexts including low-resource communities) approach to research examining parent mediated interventions, there remains a need for improved study quality and measurement consistency in research, including a detailed examination of factors that may predict, moderate, and mediate intervention effectiveness for children and their parents.Lay Summary: Parent mediated interventions-in which parents adapt their own behavior or deliver interventions to help their children learn-appear to be effective for some children with autism spectrum disorder. In this review, we identified a range of child, parent, and study design factors that may influence intervention outcomes and ultimately the uptake of these approaches in the community. We suggest that research in this area could be further improved by ensuring that studies include diverse groups of children and parents, and by using study designs that help to establish not only if interventions work, but for whom they work best and why.

Challenges and contributors to self-efficacy for caregivers of toddlers with autism

“…This research addressed a knowledge gap identified by Wainer and colleagues (2017) in an area related to early intervention’s central purpose, facilitating family empowerment to promote child learning (IDEA, Part C, 2004). In response to calls for isolating specific intervention features that demonstrate effective practices (Institute of Medicine and National Research Council, 2012; Trembath et al, 2019), the study identified particular aspects that participants perceived as contributing to or detracting from their sense of personal efficacy in supporting toddler learning.…”

“…The Institute of Medicine and National Research Council (2012) recommended a shift from evidence testing of intervention models as a whole toward understanding particular features of successful approaches, a need also identified in a review of parent-mediated intervention for young children with autism (Trembath et al, 2019). For families of toddlers with autism, exploring parents’ perspectives directly could expand the field’s knowledge of factors that contribute to or detract from parent self-efficacy during the formative period when autism first becomes recognizable.…”

Early Diagnostics and Early Intervention in Neurodevelopmental Disorders—Age-Dependent Challenges and Opportunities

“…Parents play a central role in early psychosocial interventions, as the interventions are designed to incorporate learning opportunities in daily activities [141]. Families experience the interventions as demanding, as they are often performed for 20-40 h per week for periods up to two years [141,168]. Similar to the situation of early intervention in infants at (very) high risk of CP and intellectual disability, future studies need to address the question of optimal dosage of intervention, that is, the search of the optimal balance between child development and family well-being.…”

Balancing Fidelity and Flexibility: Usual Care for Young Children With an Increased Likelihood of Having Autism Spectrum Disorder Within an Early Intervention System

“…Although the outcomes associated with NDBIs are promising (Nevill et al 2018;Trembath et al 2019), accessing these intervention models within community settings is often contingent on having a medical diagnosis of ASD. Unfortunately, this contingency is at odds with the capacity to identify ASD symptoms and to diagnose ASD.…”

“…Understanding the degree to which providers use broader NDBI strategies and the relative advantage of doing so is imperative. There is also growing awareness of the variability in resources that are required to learn manualized NDBI programs, with some programs being relatively costly and time intensive to be trained in (Trembath et al 2019). These factors may impact the fit of these programs within community contexts and may ultimately lead EI providers to circumvent training efforts or to adapt manualized NDBI programs to be delivered in context-consistent ways (Chambers et al 2013;Stirman et al 2013).…”