Telehealth for delivering parent-mediated intervention (PMI) is a cost-effective method to expand service access, particularly in low- and middle-income countries. We used a randomized controlled trial to evaluate a self-directed telehealth program for parents of children newly diagnosed with autism in China. Sixty-six parents were randomized to either a 10-week intervention (n = 33) or a waitlist control group (n = 33). Primary outcomes included parenting stress, self-efficacy, and intervention fidelity, while secondary outcomes assessed parent autism knowledge, child social communication behaviors, and program feasibility. The intervention group reported reduced parenting stress (g = 0.61), increased self-efficacy (g = 0.93), and improved fidelity (g = 0.77), with gains in autism knowledge (g = 0.69) and child joint attention (g = 0.62). The program also demonstrated high feasibility and acceptability. These findings support telehealth PMIs as an accessible and effective approach to empowering families in China following their child’s diagnosis.
AbidinR. R. (1995). Manual for the Parenting Stress Index. Psychological Assessment Resources.
2.
BearssK.JohnsonC.SmithT.LecavalierL.SwiezyN.AmanM.McAdamD. B.ButterE.StillitanoC.MinshawiN.SukhodolskyD. G.ScahillL. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. Journal of the American Medical Association, 313(15), 1524–1533. https://doi.org/10.1001/jama.2015.3150
3.
BenjaminiY.HochbergY. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B (Methodological), 57(1), 289–300. https://doi.org/10.1111/j.2517-6161.1995.tb02031.x
4.
BernalG.BonillaJ.BellidoC. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23(1), 67–82. https://doi.org/10.1007/BF01447045
BrookeJ. (1996). SUS: A “quick and dirty” usability scale. In JordanP. W.ThomasB.WeerdmeesterB. A.McClellandA. L. (Eds.), Usability evaluation in industry (pp. 189–194). Taylor and Francis.
7.
ClarkE.ZhouZ.DuL. (2019). Autism in China: Progress and challenges in addressing the needs of children and families. International Journal of School and Educational Psychology, 7(2), 135–146. https://doi.org/10.1080/21683603.2019.1570885
8.
CohenJ. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.
9.
DaiY. G.BrennanL.ComoA.Hughes-LikaJ.Dumont-MathieuT.Carcani-RathwellI.MinxhoziO.AliajB.FeinD. A. (2018). A video parent-training program for families of children with autism spectrum disorder in Albania. Research in Autism Spectrum Disorders, 56, 36–49. https://doi.org/10.1016/j.rasd.2018.08.008
10.
DaiY.ChenM.DengT.HuangB.JiY.FengY.LiuS.ZhangL. (2024). The importance of parenting self-efficacy and social support for family quality of life in children newly diagnosed with autism spectrum disorder: A one-year follow-up study. Autism Research, 17(1), 148–161. https://doi.org/10.1002/aur.3061
11.
DivanG.BhavnaniS.LeadbitterK.EllisC.DasguptaJ.AbubakarA.ElsabbaghM.HamdaniS. U.ServiliC.PatelV.GreenJ. (2021). Annual Research Review: Achieving universal health coverage for young children with autism spectrum disorder in low-and middle-income countries: A review of reviews. Journal of Child Psychology and Psychiatry, 62(5), 514–535. https://doi.org/10.1111/jcpp.13404
FairburnC. G.PatelV. (2014). The global dissemination of psychological treatments: A road map for research and practice. The American Journal of Psychiatry, 171(5), 495–498. https://doi.org/10.1176/appi.ajp.2013.13111546
14.
Gibaud-WallstonJ.WandersmannL. P. (1978). Development and utility of the parenting sense of competence scale. John F. Kennedy Center for Research on Education and Human Development.
15.
HemmeterM. L.OstroskyM. M.FoxL. (2021). Unpacking the pyramid model. Brookes.
16.
HongY. A.ZhouZ.FangY.ShiL. (2017). The digital divide and health disparities in China: Evidence from a national survey and policy implications. Journal of Medical Internet Research, 19(9), e317. https://doi.org/10.2196/jmir.7786
17.
IbañezL.KobakK.SwansonA.WallaceL.WarrenZ.StoneW. (2018). Enhancing interactions during daily routines: A randomized controlled trial of a web-based tutorial for parents of young children with ASD. Autism Research, 11(4), 667–678. https://doi.org/10.1002/aur.1919
18.
IngersollB.ShannonK.BergerN.PickardK.HoltzB. (2017). Self-directed telehealth parent-mediated intervention for children with autism spectrum disorder: Examination of the potential reach and utilization in community settings. Journal of Medical Internet Research, 19(7), e248. https://doi.org/10.2196/jmir.7484
19.
LiuQ.HsiehW.-Y.ChenG. (2020). A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan. Autism, 24(8), 1960–1979. https://doi.org/10.1177/1362361320943380
LoudonK.TreweekS.SullivanF.DonnanP.ThorpeK. E.ZwarensteinM. (2015). The PRECIS-2 tool: Designing trials that are fit for purpose. BMJ (Clinical Research ed.), 350, h2147. https://doi.org/10.1136/bmj.h2147
22.
MaennerM. J.ShawK. A.BaioJ.WashingtonA.PatrickM.DiRienzoM.ChristensenD. L.WigginsL. D.PettygroveS.AndrewsJ. G.LopezM.HudsonA.BaroudT.SchwenkY.WhiteT.RosenbergC. R.LeeL. C.HarringtonR. A.HustonM.DietzP. M. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring tetwork, 11 sites, United States, 2020. Morbidity and Mortality Weekly Report. Surveillance Summaries, 72(2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1
23.
McCollumJ. A.GoolerF. J.ApplD.YatesT. (2001). PIWI: Enhancing parent-child interaction as a foundation for early intervention. Infants & Young Children, 14(1), 34–45. https://doi.org/10.1097/00001163-200114010-00007
24.
McDevittS. E. (2021). While quarantined: An online parent education and training model for families of children with autism in China. Research in Developmental Disabilities, 109, 103851. https://doi.org/10.1016/j.ridd.2020.103851
ParsonsD.CordierR.VazS.LeeH. C. (2017). Parent-mediated intervention training delivered remotely for children with autism spectrum disorder living outside of urban areas: Systematic review. Journal of Medical Internet Research, 19(8), e198. https://doi.org/10.2196/jmir.6651
27.
QuL.ColombiC.ChenW.MillerA.MillerH.UlrichD. A. (2024). The efficacy of a culturally-adapted group-based parent coaching program for autistic children in China via telehealth: A randomized controlled trial. Journal of Autism and Developmental Disorders. Advance online publication. https://doi.org/10.1007/s10803-024-06543-8
28.
ReimersT. M.WackerD. P.CooperL. J. (1991). Evaluation of the acceptability of treatments for children’s behavioral difficulties. Child and Family Behavior Therapy, 13(2), 53–71. https://doi.org/10.1300/J019v13n02_04
29.
RubinD. B. (1987). Multiple imputation for nonresponse in surveys. Wiley.
30.
SchreibmanL.DawsonG.StahmerA. C.LandaR.RogersS. J.McGeeG. G.KasariC.IngersollB.KaiserA. P.BruinsmaY.McNerneyE.WetherbyA.HalladayA. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8
31.
StahmerA. C.PellecchiaM. (2015). Moving towards a more ecologically valid model of parent-implemented interventions in autism. Autism, 19(3), 259–261. https://doi.org/10.1177/1362361314566739
32.
SteinbrennerJ. R.HumeK.OdomS. L.MorinK. L.NowellS. W.TomaszewskiB.SzendreyS.McIntyreN. S.Yücesoy-ÖzkanS.SavageM. N. (2020). Evidence-based practices for children, youth, and young adults with autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.
33.
SunX.AllisonC.AuyeungB.Baron-CohenS.BrayneC. (2013). A review of healthcare service and education provision of autism spectrum condition in Mainland China. Research in Developmental Disabilities, 34(1), 469–479. https://doi.org/10.1016/j.ridd.2012.08.013
34.
TarverJ.PalmerM.WebbS.ScottS.SlonimsV.SimonoffE.CharmanT. (2019). Child and parent outcomes following parent interventions for child emotional and behavioral problems in autism spectrum disorders: A systematic review and meta-analysis. Autism, 23(7), 1630–1644. https://doi.org/10.1177/1362361319830042
35.
VismaraL. A.McCormickC. E. B.WagnerA. L.MonluxK.NadhanA.YoungG. S. (2018). Telehealth parent training in the Early Start Denver Model: Results from a randomized controlled study. Focus on Autism and Other Developmental Disabilities, 33(2), 67–79. https://doi.org/10.1177/1088357616651064
ZhouH.XuX.YanW.ZouX.WuL.LuoX.LiT.HuangY.GuanH.ChenX.MaoM.XiaK.ZhangL.LiE.GeX.ZhangL.LiC.ZhangX.ZhouY., …The Members of LATENT-NHC Study Team. (2020). Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years. Neuroscience Bulletin, 36, 961–971. https://doi.org/10.1007/s12264-020-00530-6
38.
ZouM.HanY.JinM.XieW.ShangC.LiT.FengL.SunC.ZhangS.WuL. (2025). Supporting access to comprehensive services: A scoping review of national policies related to autism in mainland China. Autism, 29(7), 1646–1660. https://doi.org/10.1177/13623613241311736
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