Internet-Based Parent-Implemented Intervention for Young Children With Autism: A Pilot Study
Abstract
Focuses on the effectiveness of a training and coaching program for parents implementing naturalistic teaching strategies for their children with autism.
Training and coaching were delivered over the Internet to enhance fidelity in strategy implementation.
Positive correlations found between parent fidelity in strategy execution and improvements in child communication skills.
Discussion on limitations and implications of these findings is included.
Keywords
Parent-implemented intervention
Training and coaching
Social-communication skills
Naturalistic intervention
Telepractice
Introduction
Autism Spectrum Disorder (ASD): CDC data indicates prevalence of ASD is 1 in 68 children in the U.S.; 1 in 42 for boys.
ASD includes deficits in social communication and interaction as per DSM-5.
Increased prevalence presents challenges in meeting demands for effective early intervention (EI) services for children and families.
Naturalistic Teaching Strategies
Social-communication skills are essential for academic success and overall quality of life (Schalock et al., 2011).
Milieu language interventions and naturalistic strategies are effective for developing these skills (Hancock & Kaiser, 2002).
Naturalistic strategies can be seamlessly integrated into daily routines at home and in the community, facilitating repeated practice and skill generalization.
Parent-Implemented Intervention
Growing number of ASD diagnoses increases demand for effective interventions accessible to families (Boyd et al., 2010).
Parent-implemented interventions are logical due to parents’ extensive time with children and effectiveness in teaching strategies (Roberts & Kaiser, 2011).
Quality training and coaching are essential for fidelity and consistent implementation of these strategies (Wong et al., 2013).
Addressing Barriers to EI Services
Challenges: Shortage of EI providers, particularly in rural areas and low-income families (Cason et al., 2012).
Technology Solution: Increasing high-speed Internet availability in the U.S. can facilitate service delivery, reduce travel costs, and enhance service accessibility.
Limited research exists on the effectiveness of Internet-based EI services (telepractice) for parents of children with ASD, indicating a need for further investigation (Meadan et al., 2013).
Purpose of the Study
The study aims to evaluate the effects of a training and coaching program (i-PiCS) delivered online concerning:
Parent fidelity in implementing naturalistic teaching strategies.
Children's social-communication skills related to parental strategy use.
Parents’ perceptions of the social validity of the program objectives, methods, and outcomes.
Method
Participants
Three mother-child dyads participated:
Madiha: Mother, Middle Eastern descent, married with three sons; son Ali diagnosed with autism, age 3, language skills below average.
Karen: Mother, Caucasian descent, married with one son; son George, age 2, also diagnosed with autism, language skills extremely low.
Melissa: Mother, Caucasian descent, married with two children; daughter Wendy, age 4, diagnosed with autism, language skills low.
Settings
Intervention sessions conducted in families’ homes or chosen locations via Skype.
Research Design
A multiple-baseline design was employed across three families to assess the effects of the intervention on parent and child behavior.
Each family served as its own control, with demonstrations occurring in phases across strategies.
Independent Variable
Two-phased intervention involving training sessions and coaching sessions.
Training Phase: 45-minute Skype sessions where coaches taught three naturalistic teaching strategies:
Modeling: Parents model a communication behavior for children to imitate.
Mand-model: Parents ask guiding questions to evoke a response from children.
Time delay: Parents wait for children to initiate communication during set intervals (5-15 seconds).
Incorporation of Environmental Arrangement (EA) to enhance motivation for communication.
Fidelity of Implementation
Fidelity during training sessions assessed via checklists and reliability checks, with 100% fidelity rates achieved for most dyads.
Parent Coaching
Ongoing coaching incorporated pre-observation conferences, observation of interactions, and post-observation feedback crucial for strategy application.
Video feedback was provided to parents to enhance learning and implementation.
Dependent Variables
Primary Dependent Variable: Quality and rate of parent strategy implementation.
Secondary Dependent Variable: Child communication skills, focusing on both initiating and responding to communicative acts.
Parent-child interactions were recorded for analysis during various phases (baseline, training, coaching).
Interobserver Agreement (IOA)
Observers independently coded interactions to assess fidelity, achieving at least 80% IOA on all coding categories.
Results
Parent and Child Behavior
A visual analysis of performance data showed fluctuations across program phases for each dyad, with general trends indicating improvements in parental implementation of strategies.
Increases in response rates by children corresponded to enhancements in parent strategy use during coaching.
Social Validity
Post-intervention interviews revealed high satisfaction among parents regarding the goals, procedures, and outcomes of the i-PiCS program.
Discussion
This study substantiates the effectiveness of distance-delivered training and coaching in enhancing parent strategy implementation.
It highlights the importance of telepractice in mitigating barriers to in-person services, suggesting potential for broad applicability in early intervention.
Recommendations for future research involve improving measures for capturing nuanced changes in child behavior and addressing the variability in parent performance.
Limitations
The study faced challenges including sample size, variability in strategy use, insensitivity of measures regarding coding expectations, and sequence effects of training and coaching.
Implications for Practice
The findings advocate for the potential integration of telepractice modalities in early intervention frameworks to empower families and support children's skill development more effectively.
Abstract
The study focuses on the effectiveness of a training and coaching program for parents implementing naturalistic teaching strategies for their children with autism. The training and coaching are delivered over the Internet to enhance fidelity in strategy implementation, showing positive correlations between parent fidelity in strategy execution and improvements in child communication skills. The discussion includes limitations and implications of these findings.
Keywords
Keywords include parent-implemented intervention, training and coaching, social-communication skills, naturalistic intervention, and telepractice.
Introduction
Autism Spectrum Disorder (ASD) affects approximately 1 in 68 children in the U.S., with a higher prevalence noted among boys at 1 in 42. ASD is characterized by deficits in social communication and interaction, as outlined in the DSM-5. Increased prevalence challenges the demand for effective early intervention services for these children and their families.
Naturalistic Teaching Strategies
Social-communication skills are essential for academic success and overall quality of life. Research indicates that milieu language interventions and naturalistic strategies are effective for developing these skills. These strategies can be seamlessly integrated into daily routines at home and in the community, facilitating repeated practice and skill generalization.
Parent-Implemented Intervention
As the number of ASD diagnoses grows, there is an increasing demand for interventions that are accessible to families. Parent-implemented interventions are particularly logical due to the extensive time parents spend with their children and the proven effectiveness of teaching strategies when utilized by parents. Quality training and coaching are essential for ensuring fidelity and consistent implementation of these strategies.
Addressing Barriers to EI Services
Challenges exist, such as the shortage of early intervention providers, especially in rural areas and among low-income families. The growing availability of high-speed Internet in the U.S. presents a potential solution by facilitating service delivery, reducing travel costs, and enhancing accessibility. There is limited existing research on the effectiveness of Internet-based early intervention services (telepractice) for parents of children with ASD, highlighting the need for further investigation.
Purpose of the Study
This study aims to evaluate the effects of an online training and coaching program (i-PiCS) concerning parent fidelity in implementing naturalistic teaching strategies, improvements in children's social-communication skills linked to parental strategy use, and parents’ perceptions regarding the social validity of the program's objectives, methods, and outcomes.
Method
Participants
The study involved three mother-child dyads: Madiha, a mother of Middle Eastern descent with a son diagnosed with autism; Karen, a Caucasian mother with a son also diagnosed with autism; and Melissa, another Caucasian mother with a daughter diagnosed with autism. The ages of the children ranged from 2 to 4 years, exhibiting varying levels of language skills.
Settings
Intervention sessions were conducted in the families’ homes or other chosen locations via Skype.
Research Design
A multiple-baseline design was employed across the three families to assess the intervention's effects on both parent and child behavior, with each family serving as its own control, demonstrating strategies in phases.
Independent Variable
The intervention consisted of two phases: training and coaching. During the training phase, parents participated in 45-minute Skype sessions where coaches taught three naturalistic teaching strategies: modeling (parents model communication behaviors), mand-model (guiding questions to evoke responses), and time delay (waiting for children to initiate communication during intervals). Additionally, environmental arrangements were made to enhance motivation for communication.
Fidelity of Implementation
Fidelity during training sessions was assessed through checklists and reliability checks, achieving high fidelity rates for most dyads.
Parent Coaching
Ongoing coaching involved pre-observation conferences, observations of interactions, and post-observation feedback, essential for strategy application. Video feedback was provided to enhance parents’ learning and implementation.
Dependent Variables
The primary dependent variable was the quality and rate of parent strategy implementation, while the secondary dependent variable focused on child communication skills, assessing both initiating and responding to communicative acts. Parent-child interactions were recorded for analysis across the program phases.
Interobserver Agreement (IOA)
Observers independently coded interactions to assess fidelity, achieving at least 80% IOA across all coding categories.
Results
Parent and Child Behavior
Visual analysis of performance data indicated fluctuations in behavior across program phases for each dyad, generally showing improvements in parental implementation of strategies and increases in children's response rates corresponding to enhanced parent strategy use during coaching.
Social Validity
Post-intervention interviews revealed high satisfaction among parents regarding the goals, procedures, and outcomes of the i-PiCS program.
Discussion
The study supports the effectiveness of distance-delivered training and coaching in enhancing parent strategy implementation. It underscores the importance of telepractice in overcoming barriers to in-person services, suggesting broad applicability in early intervention. Future research should aim to enhance measures for capturing nuanced changes in child behavior and address variability in parent performance.
Limitations
The study faced limitations including sample size, variability in strategy use, insensitivity of measures regarding coding expectations, and sequence effects arising from training and coaching phases.
Implications for Practice
The findings advocate for integrating telepractice modalities in early intervention frameworks to empower families and support children's skill development more effectively.