Home-Based Parent-Implemented Early Intervention for Young Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

Background: Family-centered practices are part of a developing literature base in early intervention to help parents/caregivers to support the positive development of their young children with autism spectrum disorders (ASD). One way in which these practices are being implemented is through parent training of early intervention strategies so they will be able to implement interventions with their children in the natural home setting. While there are a variety of parent training programs, many are conducted in clinical or group settings with the expectation the parent will generalize those strategies to the home setting. It is important to investigate the research that examines training a parent within a natural setting and determine the effect on child outcomes, as well as overall parent/family outcomes.

Objectives: The objective of this systematic review is to explore the effects of parent-implemented interventions on communication and behavioral outcomes of young children with ASD, as well as parent skills to conduct the intervention following training and implementation based primarily in the home. A secondary objective is to examine additional outcomes related to the child (i.e. ASD symptomology) and those related to parent/family well being due to the home-based training. 

Methods: Studies included in this review were conducted using a randomized control trial design comparing the home-based parent implemented intervention to community services, and/or waitlist interventions. Studies were located through an extensive search of multiple electronic databases, as well as utilizing a snowball method identifying other possible inclusions. All studies were by two authors independently and discrepancies were resolved. After data extraction, the components of these studies, as well as the effects on child and family outcomes were synthesized using descriptive narratives; visual displays using harvest plots, and other meta-analytic techniques.

Results: The search yielded an initial result of 17,528 articles and following initial screening, 135 full-text articles were assessed for eligibility resulting in the inclusion of 15 studies. Table 1 provides a descriptive summary of the included studies. The studies included 448 child participants in treatment, and 430 in control groups. Overall, the primary outcome assessed most often across these studies was responsive interactions between parent and child, followed by child communication. Eight different types of interventions were used across studies with focused play being the most used intervention. Results were limited in reporting of implementation fidelity and maintenance data.

Conclusions:  While effects on the interaction between parent and child were positive, demonstrating that parents can act as primary interventionists in this setting, this poster will discuss the limitations of the studies including the study quality, use of fidelity measures, as well as the varied, inconsistent training strategies that have been used across these interventions. Intervention packages often consistent of multiple training strategies which make it difficult to parcel out the most effective way to teach parent to implement interventions. Additionally, measures used in these studies were not sensitive enough to capture the change over time needed. These results will be used to suggest areas for future research involving parent training and young children with ASD.