Parental Perspectives on Parent-Mediated Intervention for Toddlers Suspected of Autism Spectrum Disorder to Support Parent during the Waiting Period Surrounding the Diagnostic Evaluation

Background:  Knowing that interventions for children suspected of autism spectrum disorder (ASD), are most effective when offered as early as possible, interventions that are tailored to very young children presenting early difficulties in social interaction or communication is needed. Parents-mediated interventions may be a useful way to support developmental and functional outcomes in vulnerable young children and to bring benefits to the whole family by improving the parents’ sense of competence and empowerment.

Objectives: The study aims to assess the effects of a 12-week parent-mediated intervention adapted from the Early Start Denver Model (ESDM) and the Social Communication Emotional Regulation Transactional Support (SCERTS) model for families with low-socioeconomic status (SES) having a toddler suspected of ASD on 1) parents’ use of strategies, 2) parent-child interactions, and 3) parental well-being.

Methods: The proposed intervention offers 12 individual coaching sessions to parents of children suspected of ASD at their home on how to interact with their young children and thus stimulate their development through daily interactions. An experimental study was conducted with 19 families with low SES having a child with a suspicion of ASD aged between 15 and 30 months and at least one of their parents, randomly assigned to the group receiving the intervention right away (group 1) or having to wait 3 months before having access to the intervention (group 2).

Parental perspectives were collected three to four times; before waitlist (T0, only for group 2), pre-intervention (T1), post-intervention (T2), and three-month follow-up (T3) and analyzed using Mann-Whitney and Wilcoxon signed-rank tests. Parents’ use of strategies and parent-child interactions were rated using respectively the ESDM Fidelity Checklist and Adamson’s engagement rating scale via videotapes of a 10-minute free play period between the child and his parent at each assessment time. Parental well-being was assessed through two questionnaires completed by parents themselves, the Parental Stress Index – Short Form (PSI-SF) and the Parent Sense of Competence (PSOC).

Results: 18 of the 19 parent-child dyads participated in the 12 weekly parents coaching sessions. Data analysis shows significant improvement in parents’ use of strategy and parent-child interactions during the intervention phase (T1 – T2), but no significant change before (T0 – T1) or after intervention (T2 – T3). Regarding parental well-being, no significant changes were noted in parental well-being at any time points.

Conclusions: This study shows promising results on proximal outcomes (parents’ use of strategies and parent-child interactions). Knowing so, parent-mediated interventions may be an interesting alternative to increasing timely access to interventions, especially before children has any diagnosis, and thus very few services. In fact, this study shows that it helps parents to use strategies to promote their child's development and to interact adequately with their child during free play periods. However, parental support should be targeted more specifically to improve parental well-being. Also, more distal outcomes, such as child development and parental satisfaction toward the program should be assessed.