Procedures and Compliance of a Video Modeling Intervention for Parents of Children with ASD

Background:  

Video modeling using ABA techniques is one of the most promising procedures to improve social skills in the ASD population. This method requires less time for training/implementation than live modeling, which can enable its use on a large scale. These aspects are particularly relevant in low-middle-income countries like Brazil, where there is a lack of specialized, trained professionals. However, there are a few studies using video modeling specifically for ASD parental training and most of the clinical trials focus on high-functioning ASD.

Objectives:  

(1) to describe a low-cost video modeling parental training intervention based on ABA to improve eye contact, joint attention and decrease disruptive behaviors among children with ASD and (2) to assess the compliance of these participants.

Methods:  

Study Design: descriptive study of a clinical trial. Site: three specialized health units for children with ASD in São Paulo-Brazil. Sample: 66 parents of children with ASD aged 3-6 and with IQ lower than 70, randomized into two groups: 36 families as the intervention group and 36 families as the control group (receiving treatment as usual). Inclusion criteria: children having (1) an ASD diagnosis according to the Brazilian version of the ADI-R and a clinical evaluation based on DSM-V, and (2) IQ 50-70 assessed by the SON-R 2½-7, a non-verbal standardized instrument validated in Brazil. Intervention Model: the primary outcome of the intervention was to assess the impact of video modeling training on eye contact, joint attention, and disruptive behaviors. The intervention was carried out during 22 weekly sessions. Assessments: a package of standardized instruments to assess participants before and after the intervention. To evaluate children: ADI-R; SON-R 2½-7; Autism Behavior Checklist–ABC; Vineland Adaptive Behavior Scales; Eye-tracking tasks; Structured Observation for Autism Screening-OERA; Child Behavior Checklist-CBCL and SNAP-IV Rating Scale. To evaluate parents: Hamilton Depression Rating Scale, Zarit Burden Interview and Adult Self-Report Scale- ASRS-18.

Results:  

One of the main results of the study was the development of 15 standardized videos, with varied themes for parents to use on a daily basis with their ASD children. The main themes were related to: (i) management of disruptive behaviors, (ii) prompting hierarchy, (iii) preference assessment, and (iv) acquisition/improvement of eye contact and joint attention.

Compliance with the full intervention program varied from good (75-100% frequency) to reasonable (50-74% frequency) in 70.6% of the participants from the intervention group, distributed as follows: good compliance 32.4% of the group (11 families) and reasonable compliance 38.2% of the group (13 families). 29.4% of the sample (10 families) did not achieve good/reasonable compliance, distributed as follows: 5.9% (2 families) low compliance (25-49% frequency), and 23.5% (8 families) no compliance (0-25%).

Conclusions:  

The video modeling parental training model seems promising, feasible, and an inexpensive way to offer assistance to children with ASD and low IQ. After proving its efficacy, this model can be replicated in bigger samples and populations with a lack of access to treatment services, making a major impact on ASD treatment in Brazil and potentially in other Portuguese speaking countries.