Effects of a Parent-Implemented Developmental Reciprocity Program for Children with Autism Spectrum Disorder

Background: Developmental approaches to autism treatment are based on the premise that establishing strong interpersonal relationships through natural play will foster developmental progress and reduce symptomatology. A variety of developmental approaches are used in community treatment; however, there is limited empirical literature documenting the procedures or demonstrating their effectiveness. Well-designed studies using standardized outcome measures are needed to better understand whether these treatments are effective and how they compare to other available interventions for ASD.

Objectives: The current pilot study evaluated the effectiveness of a 12-week parent-delivered Developmental Reciprocity Program (DRP) on standardized outcome measures including Vineland Adaptive Behavior Scales-Second Edition (Vineland-II), Social Responsiveness Scale (SRS), MacArthur Communicative Development Inventories (CDI), Short Sensory Profile (SSP), and the Clinical Global Impression: Improvement scale (CGI-I).

Methods: Twenty-four children with ASD (mean age=45.5 months, SD=13.4) and a primary caregiver participated in 12 weekly sessions (90 minutes each) of parent training in the DRP model, covering topics including introduction to developmental approaches, supporting attention and motivation, sensory regulation and sensory-social routines, imitation/building nonverbal communication, functional language development, and turn taking. Parent questionnaires and a structured lab observation were completed at baseline, week 6, and week 12.

Results: Twenty-four subjects completed baseline measures and began the DRP treatment program. Twenty-two subjects completed the 12-week treatment and post treatment assessments; two subjects ended their participation in the study after week 6 and all available data were included in the analyses. Preliminary findings revealed improvement in communication skills (Vineland-II Communication Domain standard score; Baseline: 78.0 ± 14.5; Week 12: 81.2  ± 18.9; F(1,16): 6.251, p=.024). Trends toward significance were found in the overall Vineland-II Adaptive Behavior composite score (Baseline: 73.6 ± 10.5; Week 12: 77.1 ± 13.9; F(1,19): 4.116, p=0.061). Differences on the SRS raw scores were observed (Baseline: 80.8 ± 21.5; Week 12: 72.1 ± 18.7; F(1,19):7.620,  p=.012) but not on the SRS T-scores (Baseline: 75.0 ± 9.9; Week 12: 73.6 ± 10.3; F(1,19):1.218, p=.284).  Differences were also observed on the words produced out of 680 on CDI (Baseline: 243.4 ± 145.1; Week 12: 310.3 ± 237.3; F(1,18):18.104, p=.000). No significant differences in sensory sensitivity were observed as measured by the SSP. Finally, overall improvements were measured using the CGI-I, with 10 participants being judged as “Much Improved”, 13 as “Minimally Improved”, and only 1 showing “No Improvement.”

Conclusions:   Preliminary findings from this pilot study indicate that the DRP model shows promise in the treatment of children with ASD with possible improvement in communication deficits and adaptive skills. Randomized controlled trials are needed to determine whether the effects observed here will be replicated in a larger sample. These results will be discussed with respect to the need for future research in the area of developmentally-based interventions and the implications for autism early intervention services including parent training programs.