Abstract
Because of the key role parenting plays in a child's development, parent-mediated interventions that train one parent are a common approach to intervention for young children with autism spectrum disorder (ASD). However, this approach has resulted in mixed findings and may lead to increased parental stress. The purpose of this study was to examine whether a two-parent occupation-centered intervention using a coaching approach improved the quality of social interactions of a family with a toddler with ASD.
Primary Author and Speaker: Abigail M. Carroll
Contributing Authors: Emily Anderson, Lindsey Hatton, Mary Ferarro, Elyse C. Kelly, Katherine E. Schlager, Amanda Shea, and Kerianne Watlington
Due to the key role parenting plays in a child's development, parent-mediated interventions that train one parent are a common approach to intervention for young children with autism spectrum disorder (ASD). However, this approach has resulted in mixed findings (Oono et al., 2013) and may lead to increased parental stress. Engaging parents together in collaborative problem solving has been suggested as a means of empowering families. Therefore, the purpose of this study was to examine whether a two-parent implemented occupation-centered intervention using a coaching approach improved the quality of social interactions of a family with a toddler with ASD. Two changing criterion designs (CCDs) were used to measure the effects of a family occupation-centered intervention on the quality of social interactions for one family unit (two parents and their toddler with ASD) during engagement in a preferred occupation. Each CCD had four phases: a baseline phase, three intervention series, and post intervention data collection. The independent variable was a family occupation-centered intervention using a coaching approach to train two parents to implement evidence-based strategies for learning social interaction skills with their toddler with ASD. The intervention was measured using coaching fidelity forms. The dependent variable was the quality of family social interactions during play quantified using 10-minute videos. The Indicator of Parent Child Interaction (IPCI) Model and coding framework (Baggett et al., 2010) was used to code parent-child interaction. Data was visually analyzed and presented to the parents as graphs and tables at training sessions. Video feedback was also provided. The interventionist and the parents used data to navigate intervention decisions and prioritize goals to support the toddler and family. Ongoing data analysis and contextualized intervention drove the group's implementation during each phase. The intervention yielded a 55.3% improvement in the quality of social interactions for the family, 69.3% for the mother, 64.1% for the father, and 30.7% for the child. The magnitude of effect of the study, standard mean difference, was 5.2 for the mother, 4.9 for the father, and 7.2 for the parents as group. The quantitative and qualitative data showed that the two-caregiver implemented approach yielded optimal outcomes through the parent's participation together. The multiple caregiver approach proved valuable because it provided: 1) multiple skilled social models for positive affect sharing; 2) social support for stress reduction and skill acquisition; 3) increased dosage of intervention through routine family practice; 4) generalization; and 5) increased stability, and decreased variability, of facilitative interactions provided to the child by his parents. In sum, it provided increased predictability of engagement in quality social interactions for the child with ASD. The study demonstrated the value of a multiple caregiver approach for interventions with families with toddlers with ASD, building knowledge of a how shared family engagement can support positive family outcomes and toddler development. Furthermore, the research demonstrated the use of changing criterion designs as an innovative methodology. Replication with additional family units engaged in different occupations is needed.
Baggett, K. M., Carta, J. J., & Horn, E. A. (2010). The Indicator of Parent Child interaction. Individual growth and developmental indicators: Tools for monitoring progress and measuring growth in very young children. Brookes Publishing Company, Baltimore.
Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Evidence-Based Child Health: A Cochrane Review Journal, 8(6), 2380-2479.