Toddlers and Families Together: Caregiver Implementation and Perceptions of Strategies to Facilitate Joint Engagement

Background:

Research on early intervention programs targeting toddlers with or at risk for autism spectrum disorder (ASD) primarily involve individual sessions with the caregiver and child in the home which may be isolating or impractical for some families. In Toddlers and Families Together (Together), toddlers and their families participate in eight weekly group sessions that take place during the weekend and focus on increasing joint engagement with their child. Specifically, families have an opportunity to practice strategies and receive feedback within a context of everyday routines and activities for toddlers (e.g., play, snack, art, gross motor, music) within 3-hour long group sessions that also include a family education/support segment to learn and discuss strategies with a facilitator and other caregivers while the toddlers are engaged in various learning activities.

Objectives:

With an overarching goal of promoting joint engagement for children with ASD through the Together program, the specific questions of this study include:

1. Does participation in the program result in changes in caregiver implementation of strategies to facilitate joint engagement with their children?
2. After participating, what are caregiver perceptions of the strategies and the program?

Methods:

The study utilized a multiple baseline design across four toddlers (24-31 months) with or at risk for ASD and their families that included an initial baseline period (of 4, 6, 8, or 10 weeks) followed by participation in the 8-week Together program. The weekly sessions included a 10-minutes video-recorded interaction between the child and the primary caregiver that was rated on eight items that were scored on a three-point Likert scale for implementation of strategies to promote joint engagement. In addition, at the end of treatment, caregivers completed a brief questionnaire reporting their ability (e.g., time, comfort, confidence) to implement and perceptions (acceptability) of the treatment strategies. Families also participated in a semi-structured interview to provide their opinions about the intervention.

Results:

Results show increased caregiver implementation of strategies during intervention and demonstrated family acceptability of the intervention. Visual analysis indicates a functional relationship between the intervention and caregiver implementation of the strategies with increased level changes observed during the intervention phases for all caregivers. Furthermore caregiver responses to the questionnaire and interview indicated overall acceptability of the strategies and program. Most family members felt comfortable and confident with the strategies but did note that it did take a little effort and time to implement the strategies. They also reported that the family support/education sessions were the most helpful aspect of the intervention.

Conclusions:

The results from this SCD provide preliminary efficacy and social validity data supporting the Together program. However, further study needs to test the program with a larger sample of children and families in randomized controlled trial. Furthermore, additional analysis is required to examine caregiver outcomes of stress and coping as well as child outcomes of joint engagement. Overall, it may be beneficial to both toddlers and families to use a group-based model of intervention for families of young children with or at risk for ASD.