Scoping the Evidence of the National Autistic Society (NAS) Early Bird Parent Education Training Programmes

Background:

The EarlyBird (EB) programme is a Parent Education Training (PET) programme designed to assist parents and caregivers shortly after their child is diagnosed with an Autism Spectrum Disorder (ASD). The United Kingdom-based National Autistic Society (NAS) developed the twelve week group-based programme in 1997. Its broad aims are to 1) support parents immediately after diagnosis, 2) empower parents and encourage a positive perception of the child’s ASD, and 3) help parents establish good practice. The EarlyBird Plus (EB+) course was designed in 2003 for parents of school-going children under the age of 9 years.

Both programmes are run internationally in many High Income Countries (HIC), and more than 20,000 families to date have attended the courses. Many clinical and research teams in low- and middle-income countries (LMIC) and other low-resource settings are seeking appropriate evidence-based parent education programmes to implement in these settings, where parent support is severely lacking. EB/EB+ may potentially fill such a need.

Objectives:

This study set out to perform a comprehensive scoping review of all peer-reviewed publications on the acceptability and outcomes of the EB and EB + programmes. We reviewed the context for programmes, study populations, design, outcome measures used, and overall evidence-base.

Methods:

A search was conducted between February and June 2016 using the following databases: EbscoHost, Sabinet, SAGE journals, Directory of Open Access Journals, BioMed Central, Scopus and Science Direct, as well as ‘grey literature’. The searches were conducted using the following keywords: EarlyBird, EarlyBird Plus, Autism, Parent Skills Training, Psychoeducation, Parent Support, Parenting Programmes, and Parent Training. Two reviewers independently screened titles and abstracts of publications using the inclusion criteria.

Results:

The review identified 18 articles of which two were from New Zealand and 16 from the United Kingdom. No publications were identified from LMIC. Thirteen of the articles emphasised that the EB and EB+ programmes met their aims and parental satisfaction regarding the course was high. 72% of studies were non-randomized pre-post control in design and only one had a control group.

Acceptability of the programmes was reported on in 94%, and efficacy in 72%. Outcome measures included parental stress, parental perceptions severity of symptoms and of the intervention, parental knowledge and child adaptive behaviour. No randomized controlled trials or head-to-head studies with other parent education training programmes have been performed using of EB/EB+ to date.

Conclusions:

In spite of its widespread use, the evidence-base for EB/EB+ was surprisingly small, and was limited to findings from two English-speaking high-income countries. Whilst there is no doubt about the potential usefulness of these programmes, our findings suggest that much further research evidence may be required in order to determine the potential usefulness and appropriateness of these programmes in low-resource environments. Apart from the need for study designs other than pre/post designs, careful consideration should also be given to acceptability and cultural appropriateness, to outcome measures (including parent-child or child-specific), and to the potential scalability of such interventions.