Towards understanding the active ingredients of parent-mediated social communication interventions for young children with ASD

Background: One approach to teaching social communication to young children with ASD has been the use of parent–mediated interventions.  These interventions typically teach parents to use naturalistic intervention techniques to promote their child’s social communication skills during play and other daily routines.   A number of such interventions have been developed and there is growing evidence that they lead to improvement in children’s social communication development.   However, the active ingredients of many of these interventions have not yet been identified or systematically evaluated.  A better understanding of the active ingredients of promising parent-mediated interventions is needed, especially as these interventions are moved into community settings. 

Objectives: The goal of this presentation is to discuss what is currently known and not yet known regarding the active ingredients of parent-mediated social communication interventions for young children with ASD.  In addition to a review of current work in the field, we will present data from a series of single-case design (SCD) studies that aim to illuminate the active ingredients of a parent-mediated intervention model during its development and initial evaluation phase. 

Methods: Intervention techniques were chosen based on prior efficacy studies and combined into a parent training model that could be implemented in community settings.  A series of SCD studies were used to examine the effect of the intervention on child language.  To understand the efficacy of the intervention package, a multiple-baseline SCD study was used across 9 children and trained therapists.  An alternating-treatments SCD was then used to systematically examine the relative contributions of individual treatment techniques from the intervention package on child language.  Finally, a multiple-baseline SCD was used to examine the effect of the parent training model on parent fidelity and child language.  Multilevel modeling was used to examine the association between parents’ use of individual intervention strategies and their child’s language use. 

Results: Across studies, there was evidence for the efficacy of the program for improving child expressive language.  In addition, several active ingredients of the intervention were identified.  Specifically, parents’ use of responsiveness-based strategies (following the child’s lead and imitating the child) and prompting and reinforcement strategies within child-directed activities were found to be related to improvements in child expressive language within the session, while another set of techniques, modeling and expanding language, was not.   Direct instruction in the intervention techniques was related to parent fidelity; although, the frequency of instruction (once vs. twice per week) did not affect parent learning.

Conclusions:   The results provide preliminary support for the efficacy of key components of a parent training program that can be feasibly implemented in community settings, and identify the active ingredients of the intervention (responsiveness-based strategies, language prompting).  Similar approaches can be taken with other parent-mediated approaches to better understand how they are working and to facilitate implementation in community settings.