Comparative Efficacy of Parent Training Plus Individual Targeted-ABA Therapy Versus Parent Training Alone: A Preliminary Analysis

Thursday, May 12, 2016: 11:30 AM-1:30 PM
Hall A (Baltimore Convention Center)
R. Embacher1, T. W. Frazier1, T. N. Gray2 and A. Y. Hardan3, (1)Cleveland Clinic Center for Autism, Cleveland, OH, (2)Center for Autism, Cleveland Clinic Children's, Cleveland, OH, (3)Stanford University, Stanford, CA
Background:  Extensive support exists in the literature for early intensive behavioral intervention following an autism spectrum disorder (ASD) diagnosis. Demand for services far exceeds availability, especially for young children with a recent diagnosis. Low access and high expense of intensive behavioral intervention programming creates the need for effective treatment modalities. Parent training has been shown to be effective for improving child skills and decreasing challenging behavior; however it is not yet clear to what extent simultaneous individual behavior therapy adds to this model. In addition to the type and frequency of services provided, a number of variations on behavior therapy teaching approaches exist and have been implemented as both parent training and individual therapy packages. These include structured Applied Behavior Analysis (ABA) approaches and methods that are more child-led and involve the use of natural opportunities and reinforcers, such as Pivotal Response Training and the Early Start Denver Model. A known weakness of structured ABA is that the therapist-driven structure of sessions can decrease spontaneous responding. Conversely, a weakness of child-led, naturalistic approaches is that low functioning children may not be able to lead interaction and instead prefer to engage in repetitive sensory motor behavior. Targeted ABA (T-ABA) blends structured ABA and naturalistic, child-led approaches by emphasizing the approach which matches most closely to the child’s abilities and needs.

Objectives:  The primary aim was to compare the efficacy of T-ABA therapy delivered using a combination of parent-training and individual sessions versus parent-training alone.

Methods:  The study uses a 20-week, randomized, two-group, cross-over design. During the first 10 weeks of the study, both groups received five T-ABA parent training sessions followed by five parent-therapist in vivo coaching sessions (1 hr each). The T-ABA parent training plus individual therapy group also received eight individual therapist-child sessions (1 hr each). During the final 10 weeks, the T-ABA parent training alone group crossed-over to receive individual therapy sessions. Eight outcome measures were examined in this preliminary analysis including measures of autism symptoms, communication skills, and quality of life. 

Results:  To date, 15 parent-child pairs have been recruited and completed treatment and an additional 8 parent-child pairs are in progress. Preliminary analyses indicated that both treatment arms produced improved manding, tacting, echoic behavior, motor imitation, and listener responding measured by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), and improved overall quality of life (p<.05) as measured by the Child and Family Quality of Life-Second Edition. Adding individual therapy resulted in greater improvements in autism symptoms (p<.001) as measured by the Social Responsiveness Scale and a trend toward greater improvements in visual matching (p=.082) as measured by the VB-MAPP relative to the T-ABA parent-training alone group. 

Conclusions: T-ABA parent-training alone or in combination with individual therapy appears to be an effective less-intensive treatment approach for young children with ASD. Improvements in autism symptoms may be stronger with the addition of individual therapy sessions. Sample size is small and results should be considered very preliminary.