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Running Head: A Pilot Study Comparing Tele-Therapy and In-Person Therapy: Perspectives from Parent- Mediated Intervention for Children with Autism Spectrum Disorders

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Conclusions about the efficacy of tele-therapy for parent-mediated intervention for children with Autism Spectrum Disorders (ASD) are limited, due to the shortage of direct comparisons between tele-therapy and traditional face-to-face therapy. In this study, we implemented a parent training program, which targeted on language facilitating intervention strategies. Fifteen parents of children with ASD participated in person, and 15 participated via online video conferencing. We measured parents' intervention fidelity and children's initiations, responses, lexical diversity and morphosyntactic complexity. Results indicated significant improvements in parents' fidelity and children's lexical diversity and morphosyntactic complexity. No significant differences were detected between the two therapy delivery groups on any outcome measures. Finally, children's progress on morphosyntactic complexity was significantly correlated with parents' improvement on fidelity. 3
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Journal of Autism and Developmental Disorders (2021) 51:129–143
A Pilot Study Comparing Tele‑therapy andIn‑Person Therapy:
Perspectives fromParent‑Mediated Intervention forChildren
withAutism Spectrum Disorders
YingHao1,2· JessicaH.Franco2· MadhuSundarrajan2,3· YaoChen2
Published online: 6 May 2020
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Conclusions about the efficacy of tele-therapy for parent-mediated intervention for children with Autism Spectrum Disorders
(ASD) are limited, due to the shortage of direct comparisons between tele-therapy and traditional face-to-face therapy. In
this study, we implemented a parent training program, which targeted on language facilitating intervention strategies. Fif-
teen parents of children with ASD participated in person, and 15 participated via online video conferencing. We measured
parents’ intervention fidelity and childrens initiations, responses, lexical diversity and morphosyntactic complexity. Results
indicated significant improvements in parents’ fidelity and children’s lexical diversity and morphosyntactic complexity. No
significant differences were detected between the two therapy delivery groups on any outcome measures. Finally, children’s
progress on morphosyntactic complexity was significantly correlated with parents’ improvement on fidelity.
Keywords Tele-health· In-person therapy· Parent training· Children with ASD
Parent training has been found to yield improved linguistic
skills in children with Autism Spectrum Disorders (ASD)
(e.g., Gengoux etal. 2015). However, barriers like the geo-
graphical distance between specialists and patients restrict
service delivery to many families that are in need of help
(Boisvert etal. 2010). Tele-therapy takes advantage of com-
puter and Internet-based technologies, and potentially over-
comes the barriers (Pickard etal. 2016). Previous studies
have demonstrated the initial efficacy of tele-therapy (e.g.,
Ingersoll etal. 2016). However, as there is a shortage of
direct comparisons between tele-therapy and traditional
onsite therapy for parent training in children with ASD,
conclusions about the efficacy of tele-therapy in this area
are limited (Boisvert etal. 2010; Boisvert and Hall 2014).
To address the gap, in this study, we compared the efficacy
of parent training for children with ASD that were delivered
in clinic and via Internet. In the following, we firstly con-
sidered significant areas of deficits in children with ASD to
specify focuses in our comparisons. We then reviewed the
extant literature of parent training and preliminary findings
of tele-therapy for parent-mediated intervention for children
with ASD before discussing the gap and raising our research
Significant Areas ofDeficit
Language remains a major deficit for an overwhelming
majority of children with ASD (Kasari etal. 2008), even
though it has been removed from the defining criteria for
the diagnosis of ASD (American Psychiatric Association
2013). Children with ASD demonstrate reduced language
usage, which is associated with reduced social interactions
(Deitchman etal. 2010). Early language development has
been widely found to predict future social functioning, and
inversely relate to atypical behaviors among children with
ASD (Barokova and Tager-Flusberg 2018; Howlin etal.
2004; Lord etal. 2004). Therefore, language is still a major
* Ying Hao
1 Department ofCommunication Sciences andDisorders,
School ofApplied Sciences, University ofMississippi, 2301
South Lamar, NE, Suite 1200, Oxford, MS38655, USA
2 Department ofCommunication Sciences andDisorders,
University ofTexas atAustin, Austin, USA
3 Department ofSpeech-Language Pathology, University
ofthePacific, Stockton, USA
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... Currently affecting 1 in 68 children [2], it remains a prevailing concern that, to date, lacks any definitive treatment [3,4]. While the exact etiology of this disorder remains elusive, various therapies and interventions have been developed to support children with ASD in achieving their full potential and leading fulfilling lives [5][6][7][8][9][10][11]. ...
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This paper aims to investigate the possibility of combining humanoid robots, particularly the NAO robot, with a mobile application to enhance the educational experiences of children with autism spectrum disorder (ASD). The NAO robot, interfaced with a mobile app, serves as a socially assistive robotic (SAR) tool in the classroom. The study involved two groups of children aged three to six years old, exhibiting mild to moderate ASD symptoms. While the experimental group interacted with the NAO robot, the control group followed the standard curriculum. Initial findings showed that students in the experimental group exhibited higher levels of engagement and eye contact. However, certain limitations were identified, including the NAO robot’s limited capacity for concurrent interactions, language difficulties, battery life, and internet access. Despite these limitations, the study highlights the potential of robots and AI in addressing the particular educational requirements of children with ASD. Future research should focus on overcoming these obstacles to maximize the advantages of this technology in ASD education.
... Remote training for parents of children with ASD can increase their skills in managing problem behaviors and improve their ability to conduct a functional analysis and use functional communication techniques [7,8]. Telemedicine tools are thus effective in managing problem behaviors in family contexts. ...
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Remote healthcare services have emerged as a viable approach to behavior management interventions and provide emotional support to healthcare professionals in various clinical domains. They have been shown to impact the mental well-being of children diagnosed with autism spectrum disorder (ASD) and also their parents. Managing challenging behaviors in children with autism is often one of the frequent challenges parents and caregivers have to face. Our study demonstrates that the online Behavioral Skill Training (BST) program can support clinical Applied Behavior Analysis (ABA) interventions in the management of problem behaviors. In fact, in our case report the use of telemedicine led to effective results including an increase in collaborative behaviors and a reduced frequency of problematic behaviors.
... Early intervention systems may be able to increase the number of families that they serve, especially in rural and underserved areas, and decrease the program costs by using such innovative models of service delivery, such as combining face-to-face interactions with telehealth sessions. (Little et al., 2018;Pickard et al., 2016) Recent research comparing in-home vs. telehealth delivery of Project ImPACT found no differences in parent or child outcomes (Hao et al., 2021), suggesting that virtual delivery may be a cost-effective option. To explore this possibility, future studies should evaluate cost effectiveness of different delivery modes. ...
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Programmatic cost assessment of clinical interventions can inform future dissemination and implementation efforts. We conducted a randomized trial of Project ImPACT (Improving Parents As Communication Teachers) in which community early intervention (EI) providers coached caregivers in techniques to improve young children’s social communication skills. We estimated implementation and intervention costs while demonstrating an application of Time-Driven Activity-Based Costing (TDABC). We defined Project ImPACT implementation and intervention as processes that can be broken down successively into a set of procedures. We created process maps for both implementation and intervention delivery. We determined resource use and costs, per unit procedure in the first year of the program, from a payer perspective. We estimated total implementation cost per clinician and per site, intervention cost per child, and provided estimates of total hours spent and associated costs for implementation strategies, intervention activities and their detailed procedures. Total implementation cost was $43,509 per clinic and $14,503 per clinician. Clinician time (60%) and coach time (12%) were the most expensive personnel resources. Implementation coordination and monitoring (47%), ongoing consultation (26%) and clinician training (19%) comprised most of the implementation cost, followed by fidelity assessment (7%), and stakeholder engagement (1%). Per-child intervention costs were $2619 and $9650, respectively, at a dose of one hour per week and four hours per week Project ImPACT. Clinician and clinic leader time accounted for 98% of per child intervention costs. Highest cost intervention activity was ImPACT delivery to parents (89%) followed by assessment for child’s ImPACT eligibility (10%). The findings can be used to inform funding and policy decision-making to enhance early intervention options for young children with autism. Uncompensated time costs of clinicians are large which raises practical and ethical concerns and should be considered in planning of implementation initiatives. In program budgeting, decisionmakers should anticipate resource needs for coordination and monitoring activities. TDABC may encourage researchers to assess costs more systematically, relying on process mapping and gathering prospective data on resource use and costs concurrently with their collection of other trial data.
... Other features included the use of a webcam and document camera to show materials such as word cards, a phonology software to help children differentiate phonemes (Sound Contrast in Phonology; SCIP), [32] and patients taking and uploading photographs (software unspecified) so therapists could monitor posture outside of sessions to compare pre-and post-intervention. In parent-training programs, Microsoft PowerPoint was used to present intervention content to parents in real-time [33], and via printed copies of slides [34]. Other features included: (a) the use of 'e-helpers' (e.g., additional support staff on the videoconferencing call) to troubleshoot technology issues [35], (b) the use of screen recording software to provide families with the session information as a reference [36], and (c) the addition of a transcription service to increase accessibility by presenting captions in real-time during the intervention session [37]. ...
Purpose: To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention. Methods: Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries. Results: Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement. Conclusion: This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions.
The COMPASS framework, while implemented most extensively in schools, is flexible and readily applied to other contexts, including homes by caregivers who seek help to understand and address concerns of behavior. Often the magnitude of behavioral challenges and their impact on caregivers makes the need for interventions to support families a priority. C-HOPE addresses behavioral challenges by enhancing environmental supports with the people most central and critical in the lives of children with autism – their caregivers, parents, and family members. While the basic behavior principles discussed in C-HOPE apply across the age span, C-HOPE is a parenting program designed to empower parents and caregivers to best help and care for their children between the ages of 3 and 12 years. C-HOPE is comprised of eight sessions. Half are individual sessions with a COMPASS-trained therapist, and the other half are group facilitated sessions with other caregivers. To increase the reach of C-HOPE, we adapted the intervention so that it could be provided via telehealth and tested its effectiveness. We conclude the chapter with a case study of C-HOPE, including outcomes across the 8-week sessions and a follow-up parental report 3-month post-intervention.KeywordsC-HOPE; COMPASSParent-mediatedBehavior interventionTelehealth
Purpose: Telehealth delivery increases accessibility of parent-mediated interventions that teach parents skills and support autistic children's social communication. Reciprocal Imitation Training (RIT), an evidence-based Naturalistic Developmental Behavioral Intervention (NDBI) focused on imitation skills, a common difficulty in autism, holds promise for telehealth-based parent training. Imitation is also a core component of musical play during childhood and the affordances of musical play/song naturally shape parent-child interactions. We evaluate the feasibility of a music-based, telehealth adaptation of RIT-music-enhanced RIT (tele-meRIT)-as a novel format for coaching parents in NDBI strategies. Methods: This single-subject, multiple baseline design study included 4 autistic children (32-53 months old) and their mothers. Parent-child dyads were recorded during 10-min free play probes at baseline, weekly tele-meRIT sessions, and one-week and one-month follow-up. Probes were coded for parents' RIT implementation fidelity, parent vocal musicality, and children's rate of spontaneous imitation. Results: No parent demonstrated implementation fidelity during baseline. All parents increased their use of RIT strategies, met fidelity by the end of treatment, and maintained fidelity at follow-up. Parent vocal musicality also increased from baseline. Intervention did not consistently increase children's imitation skills. A post-intervention evaluation survey indicated high parent satisfaction with tele-meRIT and perceived benefits to their children's social and play skills more broadly. Conclusion: Implementing tele-meRIT is feasible. Although tele-meRIT additionally involved coaching in incorporating rhythmicity and song into play interactions, parents achieved fidelity in the RIT principles, suggesting one avenue by which music can be integrated within evidence-based parent-mediated NDBIs.
Introduction: The COVID-19 pandemic necessitated a rapid restructuring of the clinical management of voice and upper airway disorders by speech-language pathologists (SLPs). As in-person therapy sessions were suspended, voice-specialized SLPs across healthcare settings shifted to online teletherapy. In this survey study, we queried voice therapists on their experiences with and opinions regarding the adoption of teletherapy into routine clinical practice. Methods: Voice-specialized SLPs were recruited nationwide to complete an online survey which included questions about the usability of software and hardware, patient management, the effectiveness of therapy, overall satisfaction, and suggestions for improvement. Results: 48 participants completed the survey. The majority of respondents reported frequent technical difficulties and poor access to or understanding of appropriate equipment. Overall, participants endorsed better patient access, attendance, and compliance, as well as increased scheduling flexibility. While 95% of the respondents stated they would recommend teletherapy to another SLP, only 20% supported a shift to exclusively virtual sessions. Forty percent of respondents endorsed a hybrid model consisting of initial in-person sessions followed by virtual ones. Discussion: Incorporating teletherapy into clinical voice practice has, for the most part, followed Carl May's normalization process theory framework, in that clinicians have invested understanding, training, time and effort, and appraisal into its implementation. However, the unusually rapid pace of change necessitated by the pandemic has presented its own set of challenges. Given the inherent conveniences of virtual therapy, the online modality is likely here to stay. It is critical that we understand the facilitators and barriers to its successful adoption.
Parents play a vital role in the assessment, diagnosis, and treatment of individuals with autism spectrum disorder (ASD). Parents can assist in the early identification of warning signs that can potentially lead to hastier access to services, and they can also act as agents of change during the intervention process. Parent training programs as well as individualized parent-mediated interventions are well established in the research and demonstrate how highly capable and effective parents can deliver treatment strategies with a strong degree of fidelity for an extensive range of challenging behaviors and adaptive skill sets. In addition, advances in technology, diverse modes of treatment delivery, and the more recent demand for remote services are leading toward further studies establishing the numerous benefits in support of telehealth with parents taking the lead in providing the interventions. The importance, advantages, and challenges of continuing to involve, train, and work with parents of high-risk children or those diagnosed with ASD are examined in this chapter.KeywordsCaregiver Parent Caregiver training Parent training programs Behavioral skills training Telehealth Autism
Objectives: The purpose of this meta-analysis study was to systematically investigate the extant literature on parent training and to evaluate its effectiveness on children’s language and communication skills, and to identify the difference of effect sizes between tele-therapy and in person therapy.Methods: Seven electronic databases, RISS, DBpia, Academic Search Complete, CINAHL Plus with Full Text, ERIC, PsyINFO, and PudMed were searched through to July 2022 for analysis. Using Meta-Analysis (CMA3: comprehensive meta-analysis version 3, 2022), a systematic literature review approach was taken to analyze 21 studies which met the inclusion and exclusion criteria of our research. Effect sizes for children’s language and communicative skills were analyzed via the random effect model.Results: There were three main findings. First, parent training programs had a small effect size on language ability in children with ASD. Second, tele-therapy had higher effect size than inperson therapy. Lastly, two intervention models, Pivotal Response Treatment and ABA, showed large treatment effects.Conclusion: The results from the present study suggest that parent training programs are helpful for children with ASD in increasing language ability. Tele-therapy showed more efficacy than the in-person therapy. These findings support the efficacy of tele-therapy compared with in-person therapy. Therefore, this study provides preliminary evidence for the use of a digital therapeutics.
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The role of language in autism spectrum disorder (ASD), more specifically, its function in social communication and strong predictive power on future outcomes, warrants language assessments that have good psychometric properties that capture the heterogeneity of language ability found among diagnosed individuals. Given the rapid growth in intervention and treatment research, there is an urgent need for the development and implementation of outcome measures that are easily obtained and sensitive to change. In this commentary, we argue for the use of natural language samples as measures of expressive language and communication for this purpose and review the literature on their implementation in ASD research. Conceptual and measurement issues are discussed and future developments are outlined.
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Problem/condition: Autism spectrum disorder (ASD). Period covered: 2014. Description of system: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence of autism spectrum disorder (ASD) among children aged 8 years whose parents or guardians reside within 11 ADDM sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). ADDM surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by professional service providers in the community. Staff completing record review and abstraction receive extensive training and supervision and are evaluated according to strict reliability standards to certify effective initial training, identify ongoing training needs, and ensure adherence to the prescribed methodology. Record review and abstraction occurs in a variety of data sources ranging from general pediatric health clinics to specialized programs serving children with developmental disabilities. In addition, most of the ADDM sites also review records for children who have received special education services in public schools. In the second phase of the study, all abstracted information is reviewed systematically by experienced clinicians to determine ASD case status. A child is considered to meet the surveillance case definition for ASD if he or she displays behaviors, as described on one or more comprehensive evaluations completed by community-based professional providers, consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for autistic disorder; pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism); or Asperger disorder. This report provides updated ASD prevalence estimates for children aged 8 years during the 2014 surveillance year, on the basis of DSM-IV-TR criteria, and describes characteristics of the population of children with ASD. In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which made considerable changes to ASD diagnostic criteria. The change in ASD diagnostic criteria might influence ADDM ASD prevalence estimates; therefore, most (85%) of the records used to determine prevalence estimates based on DSM-IV-TR criteria underwent additional review under a newly operationalized surveillance case definition for ASD consistent with the DSM-5 diagnostic criteria. Children meeting this new surveillance case definition could qualify on the basis of one or both of the following criteria, as documented in abstracted comprehensive evaluations: 1) behaviors consistent with the DSM-5 diagnostic features; and/or 2) an ASD diagnosis, whether based on DSM-IV-TR or DSM-5 diagnostic criteria. Stratified comparisons of the number of children meeting either of these two case definitions also are reported. Results: For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. Overall ASD prevalence estimates varied among sites, from 13.1-29.3 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and race/ethnicity. Males were four times more likely than females to be identified with ASD. Prevalence estimates were higher for non-Hispanic white (henceforth, white) children compared with non-Hispanic black (henceforth, black) children, and both groups were more likely to be identified with ASD compared with Hispanic children. Among the nine sites with sufficient data on intellectual ability, 31% of children with ASD were classified in the range of intellectual disability (intelligence quotient [IQ] <70), 25% were in the borderline range (IQ 71-85), and 44% had IQ scores in the average to above average range (i.e., IQ >85). The distribution of intellectual ability varied by sex and race/ethnicity. Although mention of developmental concerns by age 36 months was documented for 85% of children with ASD, only 42% had a comprehensive evaluation on record by age 36 months. The median age of earliest known ASD diagnosis was 52 months and did not differ significantly by sex or race/ethnicity. For the targeted comparison of DSM-IV-TR and DSM-5 results, the number and characteristics of children meeting the newly operationalized DSM-5 case definition for ASD were similar to those meeting the DSM-IV-TR case definition, with DSM-IV-TR case counts exceeding DSM-5 counts by less than 5% and approximately 86% overlap between the two case definitions (kappa = 0.85). Interpretation: Findings from the ADDM Network, on the basis of 2014 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD among children aged 8 years in multiple communities in the United States. The overall ASD prevalence estimate of 16.8 per 1,000 children aged 8 years in 2014 is higher than previously reported estimates from the ADDM Network. Because the ADDM sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States. Consistent with reports from previous ADDM surveillance years, findings from 2014 were marked by variation in ASD prevalence when stratified by geographic area, sex, and level of intellectual ability. Differences in prevalence estimates between black and white children have diminished in most sites, but remained notable for Hispanic children. For 2014, results from application of the DSM-IV-TR and DSM-5 case definitions were similar, overall and when stratified by sex, race/ethnicity, DSM-IV-TR diagnostic subtype, or level of intellectual ability. Public health action: Beginning with surveillance year 2016, the DSM-5 case definition will serve as the basis for ADDM estimates of ASD prevalence in future surveillance reports. Although the DSM-IV-TR case definition will eventually be phased out, it will be applied in a limited geographic area to offer additional data for comparison. Future analyses will examine trends in the continued use of DSM-IV-TR diagnoses, such as autistic disorder, PDD-NOS, and Asperger disorder in health and education records, documentation of symptoms consistent with DSM-5 terminology, and how these trends might influence estimates of ASD prevalence over time. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.
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Purpose: We aimed to study narrative skills in Mandarin-speaking children with language impairment (LI) to compare with children with LI speaking Indo-European languages. Method: Eighteen Mandarin-speaking children with LI (mean age 6;2 [years;months]) and 18 typically developing (TD) age controls told 3 stories elicited using the Mandarin Expressive Narrative Test (de Villiers & Liu, 2014). We compared macrostructure-evaluating descriptions of characters, settings, initiating events, internal responses,plans, actions, and consequences. We also studied general microstructure, including productivity, lexical diversity, syntactic complexity, and grammaticality. In addition, we compared the use of 6 fine-grained microstructure elements that evaluate particular Mandarin linguistic features. Results: Children with LI exhibited weaknesses in 5 macrostructure elements, lexical diversity, syntactic complexity, and 3 Mandarin-specific, fine-grained microstructure elements. Children with LI and TD controls demonstrated comparable performance on 2 macrostructure elements, productivity, grammaticality, and the remaining 3 fine-grained microstructure features. Conclusions: Similarities and differences are noted in narrative profiles of children with LI who speak Mandarin versus those who speak Indo-European languages. The results are consistent with the view that profiles of linguistic deficits are shaped by the ambient language. Clinical implications are discussed.
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Background There is a significant need for strategies to increase access to evidence-based interventions for children with autism spectrum disorder (ASD). One novel approach is to train parents to use evidence-based interventions for their child with ASD via telehealth. Pilot work examining the efficacy of one such program, ImPACT Online, demonstrated a high rate of parent program engagement, low attrition, and associated gains in parent learning and child social communication. Objective The objective of this study was to conduct an open trial of ImPACT Online to better understand its dissemination potential. Methods We examined the reach and representativeness of families who registered (n=36) compared to families who were referred (n=139) to the open trial for one referral site. We then compared the demographics of all families who enrolled in the open trial (n=112) to families who enrolled in one of two controlled trials of the same program (n=50). We also examined metrics of program engagement for the open and controlled trials, the relationship between program engagement and changes in parents’ intervention knowledge, and program evaluation for the participants in the open trial. Results In total, 25.8% (36/139) of the parents who were given information about the program at their child’s diagnostic feedback session registered with the program. The parents who enrolled in the open (OT) and controlled trials (CT), respectively, were similar in gender (OT: 84.8% (95/112); CT: 88% (44/50), female), marital status (OT: 80.4% (90/112) ; CT: 69.6% (32/46), married), education (OT: 58.0% (65/112); CT: 54.0% (27/50), college degree or higher), and employment status (OT: 58.0% (65/112); CT: 65.3% (32/49), employed outside the home). The child participants were similar in terms of gender (OT: 83.0% (93/112); CT: 76.0% (38/50), male) and race and ethnicity (OT: 38.4% (43/112); CT: 24.0% (12/50), minority). However, the mean chronological age of the child participants in the open trial group was significantly higher (Mean=60.0 months) than in the controlled trial group (Mean=43.0 months), with t160=5.22, P<.001. Parents in the open trial engaged with the program at a significantly lower rate than the controlled trial, F3,81=21.14, P<.001. Program engagement was significantly associated with gains in parent intervention knowledge across both the groups, beta=.41, t=2.43, P=.02. Participants in the open access trial evaluated the program highly, but several barriers were noted. Conclusions These data suggest that additional strategies may need to be developed to support families in using telehealth-based parent-mediated intervention in community settings.
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Objective: This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior. Methods: This was a 24-week, 6-site, randomized trial of parent training versus parent education in 180 children with ASD (aged 3-7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented. Results: At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p = .004; effect size = 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p = .11; effect size = 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gains in Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment. Conclusion: These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time. Clinical trial registration information-Randomized Trial of Parent Training for Young Children With Autism (RUBI);; NCT01233414.
Both naturalistic communication and parent-implemented interventions are evidence-based practices for young children with disabilities, but demonstrations of effective methods for teaching parents to implement naturalistic interventions successfully with their children are still warranted. The purpose of this study was to examine the effects of a training and coaching program on parent implementation of naturalistic teaching strategies and on concomitant child communication skills using a telepractice service-delivery model (i.e., Internet-Based Parent-Implemented Communication Strategies [i-PiCS]). We found that parents learned to implement the targeted naturalistic teaching strategies with fidelity when, and only when, they were provided with training and coaching over the Internet. The parents’ implementation of these strategies also corresponded with positive changes in their children’s communication skills. The limitations and implications of this investigation are discussed.