An Analysis of Changes in Child Behavior during Esdm Parent Coaching

Background:  Children with ASD or ASD risk under the age of 3 are eligible for public early intervention services and for those who live in low resource communities, these are often their only services. Providers from those settings typically use parent coaching to serve a wide range of young children with developmental problems and may have little knowledge of the specific intervention needs of toddlers with ASD. The Early Start Denver Model (ESDM) is an evidence-based practice developed specifically for toddlers with or at risk for ASD. ESDM is appropriate for public early intervention services because of its combination of developmental and behavioral strategies, its defined and manualized developmental curriculum and teaching practices, its interdisciplinary orientation, and its family-centered focus. However, the impact that each ESDM Parent Coaching strategy has on child behavior is unknown. Helping providers and families in low resource areas to adapt Community ESDM requires us to determine the most important strategies of ESDM Parent Coaching as the first step toward adapting ESDM for very young children and families living in rural or low income, and highly diverse settings.

Objectives:  This study assessed the effect of four different ESDM Parent Coaching topics on target child behaviors. In addition, we assessed the impact of the order in which the strategies are taught.

Methods:  Four children with ASD, ages 17-27 months old, and their parents participated in a single subject multiple baseline component analysis design across subjects. Each child and family received parent coaching sessions in the clinic 3 times per week for 4 weeks. Ten-minute video recordings of parent-child dyad interactions during baseline and treatment sessions were coded for child behaviors.

Results:  Preliminary data from the first two participants suggest differential changes in child behavior based on strategies parents learned during sessions. Increases in sensory social play were seen for the first time when parents learned 4 step joint activity routines and these increases persisted through the rest of the treatment. Parent learning to (1) balance social communication exchanges (nonverbal communication; developmentally appropriate language; narrating and pointing) and (2) gain child attention were associated with greater instances of children imitating object related actions. Object toy play increased throughout all conditions regardless of component order. Additional patterns and order effects will be examined once the remainder of the data is coded.

Conclusions:  Results will be discussed in terms of the active ingredients of ESDM and the implications of this data for adapting ESDM for diverse early intervention service systems.