Objectives: To examine post-training and follow-up gains in: (1) child early communication skills, (2) positive affect sharing, and (3) child engagement (looking at parent’s face); and (4) to evaluate the feasibility and acceptability of our intervention.
Methods: Intervention included 12 weeks of in-home, live parent coaching, followed by 12 weeks of implementation by parents, and a follow-up assessment (at week 24). Parent satisfaction was measured through a Parent Satisfaction Questionnaire. Positive Emotion Sharing and Engagement were coded in 10-second intervals at Baseline (BL), Post-treatment (PT), and Follow-up (FUp). Communication was measured at all 3 time points using videotape analysis, as well as standardized assessment (at BL and FUp). Paired samples t-tests were used to evaluate change across time points.
Results: Twenty-three toddlers (mean age @BL = 21.8 mos; FUp = 29.7 mos) with suspected or confirmed ASD were included. Treatment duration varied due to variances related to families’ schedules, illnesses, and competing demands. Communication: Standardized measure of language (Mullen) revealed non-significant T-score gains from BL to FUp for Receptive (M=44.1 vs. 45.4) and Expressive Language (M=44.79 vs. 47.57). However, significant Age Equivalent gains (BL vs. FUp) were obtained for both Receptive (M=18.7mo vs. 25.9mo); p=.001, and Expressive (M=19.1 vs. 27.9mo); p=.006, representing 7-8 months of gain in a mean duration of 8 months. Video analysis of Functional Language revealed statistically significant gains from BL to PT, that remained at FUp, in: Responsivity (.62, .82, .82), Initiations (14, 28, 28), and Total Functional Utterances (46, 77, 75), but no changes in child gesture use or rate of inappropriate responses. Positive Emotion Sharing: Gains in child smiling approached significance from BL (M=27.9%, SD=19.0) to PT (M=36.6, SD=19.8), p = .06. Shared smiling increased from BL (M=16.9, SD=10.8) to PT (M=24.8, SD=14.6), t = -2.6, p = .02, but was attenuated at FUp (M=20.7, SD=11.4; n.s.). Child Engagement increased from BL to PT (26% vs. 36%; p<.05), and this was maintained at FUp (34%). Satisfaction: Parent ratings were extremely positive (mean = 30 out of 35). Correlations between raters for video-coding are very strong (p’s < .001); Kappas will be calculated and reported.
Conclusions: Significant gains were observed in children’s communication on video-coded measures, and standardized measures (age equivalent gains commensurate with typical developmental rates). Gains in shared smiling and engagement were observed post-treatment, but gains in smiling were not consistently maintained at follow-up. The model of training parents as mediators presents an opportunity for the integration of intervention into daily activities, thus allowing for intensive intervention at a very young age. Next steps include a randomized controlled trial (underway), and eventually community translation.
See more of: Treatments: A: Social Skills; School, Teachers
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