Effects of Video Feedback on Parent Implementation of Pivotal Response Treatment

Background:  

A myriad of parent education treatment approaches for parents of children with autism spectrum disorders (ASD) have been developed. Despite the critical nature of parent education programs, however, not all parents benefit equally. Unfortunately, there are relatively few studies that directly address how to conduct parent education sessions, especially for the parents who continue to struggle with the intervention techniques. Because of this, research identifying specific teaching methods that facilitate learning the intervention skills are necessary. Literature in related fields has found video feedback to facilitate learning through the process of self-observation, and that such feedback results in improved performance. In light of these positive findings, this study extended the use of video feedback to parent education for parents of children with autism. This study addresses the research gap and evaluates the effectiveness of video feedback as a training technique for parents who struggle with accurately implementing Pivotal Response Treatment (PRT) techniques.

Objectives:  

The purpose was to evaluate the effectiveness of using video feedback for parents who did not meet treatment fidelity for an empirically supported autism intervention (PRT).

Methods:  

To examine the effects of video feedback in parent education, a multiple baseline design across three parent-child dyads (children: ages 3 – 7; parents: two mothers, one father) was used with parents with a history of not meeting treatment fidelity. During the baseline condition, parent education consisted of modeling and in-vivo feedback. In the intervention condition, parent education sessions consisted of clinician modeling and video feedback. This approach was evaluated to examine the impact on parents, children, and parent education variables.

Results:  

The incorporation of video feedback into parent education yields positive results. Specifically, all three parents met treatment fidelity and displayed positive levels of affect, decreased parenting stress (Parenting Stress Index-Short Form), increased parental self-efficacy (Parenting Sense of Competence scale), and reported satisfaction with the intervention. Children displayed higher levels of affect and improved their individualized social communication target behavior. The type (e.g., constructive versus positive and general versus specific) and amount of feedback delivered by the clinician did not significantly differ between the conditions.  Finally, findings suggest that the parents increased their amount of self-reflective feedback statements.

Conclusions:  

The successful use of video feedback contributes to the literature identifying video feedback an effective teaching tool that can be implemented in the natural environment. Parents not only met and maintained treatment fidelity, but also, showed positive collateral effects on affect, confidence, stress, and self-efficacy measures. Similarly, the children exhibited improvement in affect and made improvements in their individualized target behavior. Finally, the investigation found that parent’s self-reflective statements might be an important component to successful skill acquisition. In other words, the video feedback technique, which uses self-observation, results in increases in one’s awareness. As the parents’ awareness increases, positive behavior change is observed. Given this mechanism of change, video feedback has positive implications for use in parent education. Future research should examine these variables and identify characteristics of parents who may benefit from this intervention model.