Early Analysis of the Feasibility and Acceptability of Family Implemented Teacch for Toddlers (FITT)

Background:  

Interventions based on the TEACCH model are widely accessible for children with ASD; however, there is limited evidence of the efficacy of the approach for young children with autism.  FITT was developed as a structured teaching intervention adapted to be developmentally appropriate for toddlers with ASD, and more responsive to needs of families from a range of socioeconomic backgrounds. FITT is a 6-month intervention that includes 4 group-based parent education sessions and 20 in-home individualized coaching and feedback sessions from a trained therapist. The goals of FITT sessions address social-communication skills, play skills, prevention of problem behaviors, and positive home routines. Study of the efficacy of FITT on child and family outcomes is ongoing in a three-year randomized control trial.

Objectives:  

The objectives of this early analysis are to (a) examine the feasibility of FITT through study of therapist implementation and parent adherence data, as well as parent attendance and session completion data, and (b) examine the acceptability of FITT through study of social validity measures.

Methods:  

Participants include 11 toddlers with ASD between 17 and 35 months of age at enrollment, as well as their primary caregivers (all mothers). Only those toddlers randomly assigned to FITT are included in the present study.  Treatment fidelity data were collected at 100% of sessions (IOA at approximately 15% of sessions), and parent adherence ratings were also collected at each session. Parents completed a social validity rating form upon completion of the 6-month intervention period. Social validity ratings covered 5 domains: overall satisfaction, goals, procedures, perceived child outcomes, and parent outcomes. Items in each domain were rated using a Likert scale (1 – 5), with higher ratings associated with greater satisfaction.

Results:  

Feasibility results were promising: attendance levels were excellent, with all participants completing all 20 in-home sessions during the 6-month period.  Treatment fidelity ratings of project interventionists was strong, with average fidelity ratings of 93% (range: 68% - 100, Inter Observer Agreement ranging from 80% - 100%). Parent adherence to FITT was adequate but variable, with parents achieving an average of 74% of total possible adherence points (Range: 65% - 87%).  Social validity ratings were high in all domains: satisfaction (mean = 4.8, s.d. = .3), goals (mean = 4.7, s.d. = .4), procedures (mean = 4.7, s.d. = .4), perceived child outcomes (mean = 4.8, s.d. = .4), and parent outcomes (mean = 4.7, s.d. = .5). Associations between social validity ratings and child outcomes will be explored.

Conclusions:  

Results suggest that FITT is a feasible and acceptable parent training program for parents of toddlers with ASD as rated by parents and interventionists, and evidenced by parent completion and adherence to intervention practices. Strong parent ratings suggested parents felt the program was helping both them and their toddler, that the strategies were ones they would continue to use, and that the goals of the intervention were appropriate. Treatment fidelity for project interventionists was also high. Parent adherence ratings were more variable and factors associated with these ratings will be discussed.