The Impact of Intervention on Parent-Child Communication Following Early ASD Screening

Background: A major component in the argument for early ASD screening is that it may hasten a child’s enrollment in early interventions, which studies show can be critical in facilitating development.  However, there is only limited information about how obtaining a diagnosis leads parents to seek interventions in the period just after diagnosis and how these early increases in intervention might affect parent-child interactions and parent perception of child communication.

Objectives:  The current study sought to explore how early diagnosis affects enrollment in interventions and, in turn, how interventions that occur soon after diagnosis affect parent-child interactions and parent perception of child communication.  We hypothesized that increases in intervention will be evident in parents’ contributions to interactions with their child and increased perception of their success in supporting their child’s communication. 

Methods: 66 toddlers who screened positive on the M-CHAT with Follow-Up (a 2-stage screening tool for ASD) were observed just before a diagnostic evaluation (T1; mean age = 23.8 months) and approximately 7 months after diagnosis (T2); 39 were diagnosed with ASD and 27 with a non-ASD developmental delay (DD).  At each visit, 30-minute semi-naturalistic observations of parent-child interaction were video recorded and subsequently reliably rated for child’s supported joint engagement, coordinated joint engagement, parent scaffolding, topic sustainability, and fluency and connectedness of topic.  Parents completed a questionnaire about the child’s communication (Parent Perception of Language Development; PPOLD) that generates two factor scores, parent success (how effective the parent thinks he or she is in supporting communication) and child difficulty (parent’s perception of the child’s difficulties communicating).  Parents also reported the type and number of hours of child intervention.  Children were divided into two groups based on whether they experienced an increase in intervention between T1 and T2; 35% (n = 23, 18 with ASD) were assigned to the increased intervention group because of an increase in hours and/or specificity of the intervention.  

Results: Mixed design ANOVAs with intervention group (no increase, increase) as the between-subjects factor and time as the within-subjects factor indicated significant increases over time in the 5 ratings of parent-child interaction and in parent success, but not in child difficulty (partial eta-squares > .20, ps < .001 for all).  Increases in parent scaffolding and topic sustainability were greater and increases in supported joint engagement, fluency and connectedness, and parent success were marginally greater in the increased intervention than in the no increased intervention group (group by time interaction ps = .02, .01, .08, .10, and .07, respectively).  

Conclusions:  This study demonstrates that relatively small increases in intervention that follow early diagnosis can have a marked impact on parent-child interactions and parents’ beliefs about their ability to help their children communicate.   These findings underscore the importance of increasing intervention as soon as possible after diagnosis and highlight the critical need for understanding how to help parents rapidly arrange appropriate early intervention.