The Relationship Between Intervention Fidelity and Child Social Communication Gains in a Parent-Mediated Intervention.

Background:

Parent-mediated naturalistic developmental behavioral interventions (NDBIs; Schriebman et al., 2015), teach caregivers to increase their responsiveness to their child’s behavior and to elicit communication and play within child-directed activities. Previous research on a parent-mediated NDBI, Project ImPACT, has shown improvement in parent fidelity and rate of child language targets (Ingersoll & Wainer, 2013; Ingersoll et al., 2015); however, the relationship between parent use of specific fidelity components and broader child social communication outcomes is less clear. In this study, we examined the association between parent changes in Project ImPACT fidelity and child improvement on the Brief Observation of Social Communication Change (BOSCC; Grzadzinski et al., 2016).

Objectives:

We examined whether improvement in parent use of Project ImPACT intervention strategies was associated with improvement in child social communication on the BOSCC. We hypothesized that improvements in several key dimensions of parent fidelity (parent responsiveness, parent elicitation of child initiations, and parent prompting and reinforcement of child language) would be associated with improvements in child social communication on the BOSCC, whereas changes in other dimensions (parent modeling of language, parent prompting of child play skills) would be less closely associated with child improvements.

Methods:

Participants were drawn from two studies of online adaptation of Project ImPACT (Ingersoll & Dvortcsak, 2010). Parents of young children with ASD completed an online, interactive tutorial on Project ImPACT either on their own (n=21) or in combination with twice-weekly therapist assistance (n=21). Families completed lab-based assessments pre- and post- intervention, in addition to completing unstructured parent-child play interactions in the home. Video-recorded play interactions were then rated for parent intervention fidelity, as well as child social communication behaviors using the BOSCC.

Results:

Preliminary analyses were conducted with a subset of the pilot study participants (n = 15). Significant improvement was observed from pre to post on parent fidelity, t(14) = 4.68, p < .01, d = 1.20, and child BOSCC Social Communication (SC) total scores, t(14)=3.885, p < .01, d = 1.00 (Table 1). In addition, there was a significant association between improvements in parents’ use of elicitation of child initiations and direct language prompting and improvement in child social communication skills on the BOSCC SC Total (Table 2). Additional analyses will confirm these findings in the full sample (n=42), as well as supplement findings using multiple regression to clarify the amount of variance in child BOSCC change scores that are accounted for by changes in the different parent fidelity dimensions.

Conclusions:

These data suggest that parent use of certain strategies, particularly elicitation of initiations and direct teaching of language, are associated with increased child social communication. Other strategies, such as parent responsiveness, parent modeling of language, and parent prompting of play, were not associated with child social communication behavior. However, it is possible that these behaviors support the interaction, and allow for the efficacy of teaching strategies. Further research should investigate potential “active ingredients” of parent-mediated treatments as they relate to child intervention response over time.