Efficacy of an Ehealth Parent-Mediated Intervention for Young Children with ASD: Comparison of Two Delivery Approaches

Background:  Parent-mediated intervention for children with ASD has been shown to improve both parent and child functioning.  However, access to parent-mediated intervention services is often limited in rural and under-resourced areas.  eHealth, the delivery of health information over the internet, has the potential to increase access to parent-mediated intervention in these communities.

Objectives:  The goal of this study was to examine the effect of two versions of an eHealth intervention for parents of young children with ASD on parent learning and child social communication skills.   

Methods:  A randomized control trial was used to examine the effects a self-directed eHealth program used alone (n=15) or in combination with remote coaching (n=15) on parent and child behavior.  Children were matched with 3 months of expressive language age on the Mullen and then randomly assigned to the self-directed only (SC-Only) or self-directed plus remote coaching (SD+RC) condition.  Parents were given up to 6 months to complete the program.  Outcome variables included parent intervention knowledge, parent intervention fidelity during a parent-child interaction in the home, parent-report and observational measures of child social communication skills, and parenting stress.  In addition, program usage data was monitored and treatment acceptability was measured at post-treatment.  

Results:  Preliminary analyses from the first 13 parents indicate high rates of program engagement in both groups with parents completing an average of 92% of program elements.  Treatment acceptability rates were similarly high across both groups.  There was a main effect of time on parent knowledge and parent fidelity from pre-post treatment, with parents demonstrating greater knowledge and higher fidelity at post-treatment and pre-treatment.  There was a trend for greater gains in both in the SD+RC group.  Children in both groups demonstrated significant gains in expressive vocabulary on the M-CDI and social communication skills on the SCC.  There was a significant interaction, such that children in the SD+RC group made significantly more gains in standard scores on the socialization domain of the Vineland than the children in the SD-Only group.  Parents in both groups showed increased positive feelings towards child, but no change in negative feelings on the FIQ.  Exploratory analyses revealed a positive association between treatment acceptability and program elements completed.  Program elements completed were associated with change in parent fidelity.  Change in parent fidelity was positively associated with changes in positive feelings on FIQ and marginally with Communication Domain scores on Vineland.  Parent report of regular use of intervention was associated with improvements in Socialization Domain standard scores on Vineland and words produced on MCDI.

Conclusions:  Both approaches show promise for increasing parents’ use of evidence-based intervention techniques.  Program use and treatment acceptability were high and were associated with gains on parent report measures of child social communication.   There was a trend toward greater parent learning and child improvements in the group that received remote coaching.  Additional research that can identify parents who are most likely to need remote coaching would assist in the development of a stepped care model that can increase parent access to evidence-based services in underserved communities.