Parent Training in Pivotal Response Treatment: Bridging Disparity Among English- and Spanish-Speaking Families of Children with Autism Spectrum Disorder

Background: Training parents to provide behavioral intervention can be a practical and cost effective treatment strategy. Little is known about effective training models for parents for whom Spanish is their primary language. Fidelity of implementation (FOI) is critical to success in parent training models (Coolican et al., 2010); thus, delineating the most effective method of training for this population is of importance. JumpStart is a parent education program conducted in both English and Spanish that includes brief parent training in pivotal response treatment (PRT) using guided observation of interventionist-child sessions.

Objectives: To compare the change in parent FOI among English JumpStart (EJS) and two models of Spanish JumpStart (SJS). 

Methods: Participants were 46 parent-child dyads: 23 completed EJS (child: Mage = 3.79, SD = 1.41; parent: Mage = 34.03, SD = 6.81); 18 completed SJS-1 (child: Mage = 3.88, SD = 0.98; parent: Mage = 33.35, SD = 5.21), and 5 completed SJS-2 (child: Mage = 4.48, SD = 1.58; parent: Mage = 35.07, SD = 3.64). Children had an independent ASD diagnosis or at-risk classification. During SJS-1, intervention sessions were conducted in English and guided observation was conducted in Spanish. The guide needed to translate the interventionist-child interactions, which resulted in substantially fewer opportunities to explain PRT techniques. In SJS-2, intervention sessions were conducted in Spanish, allowing the guide to fully explain the PRT techniques. Videotaped 10-minute probes pre- and post-JumpStart completion were coded for overall parent FOI.

Results:  Results of a 2x2 repeated measures ANOVA indicate that both EJS and SJS-1 groups demonstrated significant positive change in FOI from pre- to post-JumpStart [F (1, 39) = 114.80, p < .001]. However, a significant group by time interaction revealed that the EJS group demonstrated a larger positive change in FOI than the SJS-1 group [F (1, 39) = 13.20, p = .001]. When compared to change in FOI in the SJS-2 group (M = 35.20%, SD = 21.57), EJS parents demonstrated larger positive change (M = 50.65%, SD = 21.71) and SJS-1parents demonstrated smaller positive change (M = 25.00%, SD= 23.35). Mann-Whitney U tests revealed that these comparisons were not significant. 

Conclusions: Change in FOI was significantly lower among SJS-1 parents compared to EJS parents, indicating a need for more effective training techniques for Spanish speaking parents. Preliminary data from SJS-2 provide evidence for conducting both intervention and guided observation in Spanish. Although not statistically significant, SJS-2 parents demonstrated larger positive change in FOI than SJS-1 parents. Future examination of SJS-2 with a larger sample size may demonstrate a statistically significant benefit of this method. These findings support previously reported ethnic disparities in resource availability among families of children with ASD (Magana et al., 2012) and identify a potential method for reducing this disparity during training of parents for whom Spanish is their primary language.