A Meta-Analysis Comparing Parent- and Therapist- Implemented Early Interventions for Children with Autism Spectrum Disorders
Researchers and practitioners generally recommend that parents be involved in the early intervention (EI) programming for children with ASD (Lord & McGee, 2001). There is a lack of consensus, however, regarding the extent to which parents should be responsible for implementation. Involving parents as therapists has the potential to provide increased opportunities to improve the parent-child social relationship, foster the generalization of skills, and increase the active intervention a child receives. Despite the promise of parent-implemented interventions to improve outcomes for children with ASD, results of intervention trials have been inconsistent. For example, one recent randomized control trial of a parent-implemented intervention did not demonstrate significant benefit compared with services available in the community (Rogers et al., 2012), but large effects were observed when the same intervention was implemented primarily by therapists (Dawson et al., 2010). These results highlight a potentially important difference in the efficacy of parent and therapist-implemented interventions. However, to date, the relative efficacy of parent and therapist implemented programs have not been examined using meta-analytic techniques. Rather than counting up the number of significant findings (as in previous reviews), which can be dependent on sample size, this approach estimates the strength of findings based on the pattern of effect sizes.
To conduct a meta-analysis comparing the effects of parent- and therapist implemented EI on cognition, communication, social behavior, and adaptive behavior outcomes.
Randomized trials and quasi-experimental studies of EI programs for children with ASD were identified through a systematic search of online databases (PsycInfo, Medline, Eric, and Proquest Dissertations and Theses), hand-searching relevant journals, and citation reviews. Standardized mean difference effect sizes (Hedges’ g) for parent- and therapist- implemented interventions were assessed in separate meta-analyses for cognitive, adaptive behavior, communication, and social outcomes. Overall effect sizes were estimated using random effects models. Parent- and therapist implemented interventions were compared using adjusted indirect comparisons (analysis of variance of mixed-effects models). Meta-regression was used to assess the potential influence of additional covariates.
Twenty-two studies were identified that compared an EI program to a control group; half of the interventions were primarily delivered by a therapist and half trained parents as therapists. Parent-implemented intervention groups demonstrated significantly better communication outcomes than children in control conditions (Hedges’ g = 0.2). Therapist-implemented intervention groups demonstrated significantly greater cognitive, communication, social, and adaptive behavior outcomes compared to control conditions, with Hedges’ g of 0.5, 0.4, 0.5, and 0.6, respectively. Therapist-implemented interventions had significantly better cognitive outcomes than parent-implemented ones, and reached a marginal level of significance for social and adaptive behavior outcomes. The results of the meta-regression indicated that adjusting the comparison of parent and therapist-implemented interventions for study and participant covariates did not significantly change the magnitude of the difference in effect sizes between the two types of interventions.
These findings highlight both the important role of the therapist in facilitating improved outcomes for young children with ASD and suggest the need for improved parent-training practices.
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