Social ABCs for Toddlers with Autism: Evaluation of a Parent-Mediated Intervention

Background: Progress in identifying the earliest signs of autistic spectrum disorder (ASD) through prospective studies of high-risk infants has raised the question of whether intervention provided at such a young age could mitigate compromised developmental trajectories. We are addressing this need by evaluating our newly-developed ‘Social ABC’s’ intervention. This parent-mediated intervention is informed by emerging prospective data on early impairments in ASD, as well as evidence-based principles of Pivotal Response Treatment (PRT) for enhancing development in ASD (Koegel & Koegel, 2006), and the broader literature on effective parent training for infants at high risk for sub-optimal outcomes (e.g., Landry et al., 2001). Adaptation of PRT for younger children also draws on recent evidence of the effectiveness of parent training in PRT for newly diagnosed 3- to 4-year-olds with ASD (Coolican, 2008).

Objectives: The main aims were to (1) describe our newly developed Social ABC’s intervention model and (2) present data from our first 4 pilot families regarding fidelity of implementation and child outcome variables. Methods: In our pilot study, we have trained interventionists to fidelity both in implementing the intervention techniques and in training parents as implementers; established the feasibility and acceptability of our program to parents; manualized our treatment model and refined it based on parental feedback; tested and refined our behavioural coding schemes; and finalized our choice of outcome measures and established their sensitivity to changes both in toddlers with ASD and their parents.

Results: After describing our 24-week intervention model, we report on data regarding (1) interventionists’ fidelity in implementing PRT and in training parents (having achieved > 80%), and (2) parents’ fidelity of implementing the intervention techniques. A case series will demonstrate child gains in (1) functional communication skills (e.g., responsivity to verbal models, coded from video), and/or in (2) cognition, language/communication, and/or autistic symptoms (on standardized measures). Preliminary analyses show that three of four infants demonstrated reductions (i.e., less atypicality) in ADOS Communication scores (changes of 1, 2, and 3 points, respectively). The Mullen Scales of Early Learning/ Preschool Language Scales-4 captured improvements in Receptive Language for three cases (gains of 22, 26, and 36 T score points), and an Expressive Language gain in two children (16 points each). Negligible changes in T scores were noted for non-targeted Visual Reception or Gross/Fine Motor domains with only one exception (+13 T score points for VR in one case). Despite some variability in outcomes, gains are reported in all parents with respect to fidelity of implementation, and in all children on at least some variables of interest.

Conclusions: This is a user-friendly, highly practical and promising intervention for high-risk toddlers. The program is manageable and feasible for parents, and they are able to become highly skilled in the intervention techniques. Although individual variability exists in parent fidelity and child gains, we provide evidence of language-specific gains in high-risk infants using this intervention. Intervention provided by parents this early in life holds significant promise for minimizing, if not preventing, some of the most disabling features of ASD.