Family Implemented Teacch for Toddlers (FITT) Reduces Parent Stress and Improves Toddler Social-Communication Skills: Results from a Small, Randomized Controlled Trial

Background:  FITT was designed using core TEACCH principles of Structured TEACCHing and evidence based practices for toddlers with ASD. One core principle of TEACCH is the inclusion of parents as co-therapists, but the effects of this component on parent well-being have not yet been studied.  In addition, there is limited research examining the effects of structured teaching on toddler skills. 

Objectives:  The objectives of this study were to examine the effects of FITT on child and parent factors, including child social-communication and developmental skills and parent stress. 

Methods:  Forty-nine toddlers with ASD (ages 17 mos – 35 mo at baseline) enrolled in a 6-month RCT comparing FITT (n = 32) to community services as usual (SAU; n = 15).  Approximately 50% of participants lived in rural communities.  A majority of the sample (88%) demonstrated moderate to high autism symptoms on the ADOS and 72% scored below 70 on the Mullen ELC, with 28% scoring at the floor (Early Learning Composite = 49).  There were no baseline differences between FITT and SAU for key demographic variables. FITT included 20 90-minute in-home parent coaching sessions and 4 parent group sessions over 6 months. Child outcome measures included the Mullen Scales of Early Learning and Parent Interview for Autism-Clinical Version. Parent stress was measured using the Parental Stress Index-Short Form. 

Results:  Attrition was greater in the SAU group than the FITT group.  The final sample included 42 participants (FITT n =30; SAU n = 12). To produce an ITT estimate of treatment effects for child and parent outcomes, we used ANCOVA models where the outcome at Time 2 was modeled as a function of the Time 1 pre-test, treatment status, gender, and age at Time 1.  Treatment status, pre-tests, age, and gender were centered at zero before analysis so that the intercept of each model reflects the sample average performance on the modeled outcome at Time 2.  Children in the FITT group had higher PIA Total scores at Time 2 than children in the SAU group (B =.26, p < .05).  Parents in the FITT group had lower Total Stress scores at Time 2 than parents in the SAU group (B = -13.20, p = .05).  While parent stress increased over time in the SAU group, it decreased over time for the FITT group (see Figure 1). There were no statistically significant treatment effects on Mullen Early Learning Composite.

Conclusions:  Results supported the use of FITT for toddlers with ASD and their parents, with treatment effects found for social communication skills and parent stress. Treatment effects were not detected for developmental skills as measured by the Mullen ELC.  The severity of the ASD symptoms and developmental delays in a majority of the sample may have contributed to these findings. The low intensity of the parent coaching intervention may have also played a role.  The significant decrease in parent stress for these families new to a diagnosis of ASD was encouraging given that stress increased for SAU parents during this time.