Relations Between Parental Use of Esdm Intervention Techniques and Communication Growth in Toddlers with ASD

Background:  Communication difficulties are a core domain of impairment for young children with autism spectrum disorders (ASD), and some of the earliest appearing symptoms and most frequently reported parental concerns (Zwaigenbaum et al., 2013). Parent-implemented interventions can be effective in promoting communication skills, but the specific features of parent delivery that underlie developmental change are not well understood.

Objectives:  Here, we investigate relations between toddlers’ communication skills and two parental variables hypothesized to contribute to treatment-related communication gains: parental use of treatment techniques (fidelity) and the rate of high quality learning opportunities. We hypothesized that parental use of these two delivery features would explain significant variation in toddlers’ communication skills.  These questions are examined in the context of parent-implemented Early Start Denver Model (P-ESDM), a comprehensive developmental-behavioral intervention for young children with ASD.

Methods: 30 Toddlers with ASD and their parents completed the study. Following baseline assessments, families received 12 weeks of coaching in ESDM followed by a 12 week maintenance phase and a final post-maintenance assessment. Standardized assessments were collected pre-treatment, post-treatment, and post-maintenance. Communication skills were measured monthly using an adapted version of the ESDM Curriculum Checklist (Rogers and Dawson, 2010). Parent treatment delivery was coded from video captured by families in their home at several points over the course of the study. From each video, 3-minute clips of each of three activity types were used for scoring song and game routines, toy-based interactions, and caregiving activities (ex. bath or meal). 

Fidelity scores were obtained from ratings of parent techniques used across 13 domains. Learning opportunity scores were calculated for both the rate of successful learning opportunities provided, where success was defined as providing an appropriate response to child behavior (i.e. reinforcing desired behavior and ignoring/correcting unwanted behavior) as well as the percentage of attempted opportunities scored as successful. Successful learning opportunities were further characterized as either parent-initiated or child-initiated to examine effects of parental responsiveness versus elicitation, respectively, in promoting learning.

Results:  30 families contributed data both pre-treatment and post-maintenance. Learning opportunity data pre- and post-maintenance (n=23), and fidelity (n= 30) has been scored. Paired t-tests demonstrate that 1) toddlers made significant gains in standardized measures of language, t(29) = 6.11, p<.0, and 2) parents demonstrated significant increases in both ESDM fidelity and percentage of successful, high-quality learning opportunities (Fidelity: t(17) = 2.57, p = .02, Percent successful opportunities:  t(10) = 4.68, p = .001). Marginally increases in the frequency of parent-initiated learning opportunities were also observed (t(10) = 2.19, p= .054).

Conclusions:  These data demonstrate that a low-intensity parent coaching intervention results in significant increases in parent behaviors hypothesized to support language and communication development and replicate previous reports of child behavior change. Hierarchical models of the relations between parent and child behavior will be discussed.