Caregiver-implemented Intervention Research Articles

Caregiver-Implemented Interventions for Autistic Adolescents and Young Adults: A Systematic Literature Review

Caregiver-Implemented Interventions for Autistic Adolescents and Young Adults: A Systematic Literature Review

Keep the Ball Rolling: Sustained Multiturn Conversational Episodes Are Associated With Child Language Ability.

The purpose of this study was to examine the relationship between interaction quality and child language ability. We focused on one promising interaction quality indicator-the rate of multiturn conversational episodes. We also explored whether the relationship between rate of single conversational turns and language ability changed when the child's nonverbal behaviors were considered in addition to verbal conversational turns. To limit the potential of socioeconomic status as a confounder, participants included only families living in underresourced households. Secondary analyses were conducted using baseline data (N = 41 dyads enrolled, N = 27 analyzed) from a longitudinal study. All families were living in low-income households (i.e., below 200% of the Federal Poverty Level) and 12 were English-Spanish bilingual (15 English-only). Mothers and their children (13 to 27 months) participated in video-recorded play and reading interactions at home. Trained observers transcribed and coded the child's and caregiver's verbal and nonverbal behaviors. Linear regression models examined the relationship between the number of conversational turns and child language ability. Child language ability was significantly and positively associated with the number of verbal-nonverbal single turns and multiturn conversational episodes, but not single verbal-only turns. For children still acquiring language, it is important to account for nonverbal contributions to conversation. Child language ability was significantly and positively associated only with the conversational turn variables that included the child's nonverbal behaviors. Further investigation is needed to understand whether number of turns within conversational episodes is a better indicator of interaction quality than sheer number of conversational turns. Implications for caregiver-implemented interventions are discussed. https://doi.org/10.23641/asha.20452575.

Caregiver-Implemented Communication Interventions for Children Identified as Having Language Impairment 0 Through 48 Months of Age: A Scoping Review.

Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions. We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies (N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence). We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures. Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations. https://doi.org/10.23641/asha.20289195.

Behavior Analytic Feeding Interventions: Current State of the Literature.

The purpose of this paper was to review the current state of the behavior analytic feeding intervention literature. We highlight studies that we found to be important contributions to the recent literature in the following areas: food selectivity, chewing, packing, and food refusal/tube weaning and provide suggestions for future research and clinical work in these areas. We also discuss several current topics relevant to the field in hopes to further advance research and clinical practice. These topics include considering the benefits of innovative models of service delivery such as telehealth and caregiver-implemented interventions, the importance of evaluating long-term outcomes of behavioral feeding interventions, and lastly, ethical issues to consider in the designing and implementation of behavioral feeding interventions and training of practitioners in our field.

Brief Report: Assessment of a Caregiver-Implemented Intervention for Improving Social Communication Skills in Toddlers and Young Children with Autism.

As early identification of autism improves, there is a critical need for interventions to support the development of social communication skills in toddlers. Caregiver coaching and parental involvement is crucial for improving outcomes and providing children with adequate hours of planned active engagement. This pilot study assessed a 4-week intervention for individual caregiver–child dyads. Eight toddlers 21- to 45-months of age participated. Standardized assessments were collected at four study visits to assess autism symptomatology, language development, and both caregiver knowledge and engagement. Results demonstrated the feasibility of the intervention. Social communication, receptive and expressive language all improved as measured by direct assessment. Caregiver knowledge and caregivers’ subjective feelings of engagement with their toddlers also improved.

Coaching Caregivers of Young Children With Autism via Telepractice to Collect Assessment Data and Implement Interventions

Purpose:The purpose of this review article was to (a) scope the literature related to coaching caregivers of children with autism to provide an overview of current practices for assessment and intervention conducted via telepractice in collaboration with caregivers and (b) examine commonly reported challenges related to telepractice and potential solutions.Method:We conducted a search of relevant literature and identified seven articles that are related to the topic of caregiver involvement in remote assessments and interventions for children with autism.Results:Seven studies that include 10 caregiver-implemented interventions were identified. Researchers have used telepractice to conduct both assessments and interventions, and they generally reported having successful interactions with caregivers using different telepractice platforms. The most common telepractice modality was conducting live videoconferencing to provide services. These articles also contained rich information related to the commonly reported barriers and needs of caregivers to conduct telepractice, such as challenges in using telepractice technology and providing adequate training to caregivers. The studies also address different strategies researchers and professionals may utilize to alleviate these practical challenges to provide more streamlined telepractice services.Conclusions:Although there are challenges related to conducting assessments and interventions via telepractice, it was suggested that telepractice can be a supplement in delivering evidence-based interventions. As there are implications for future research and practice, we call for more research and practice to examine how professionals may optimize service delivery to caregivers.

Family Routines Within Caregiver-Implemented Early Interventions: A Scoping Review

Family routines provide young children with predictable, repeatable, and functional contexts for learning about the world. Participating in family routines is a critical pathway by which all children learn. While the use of family routines in caregiver-implemented interventions (CIIs) is supported by theories, research, and recommended practices, few investigations examine the degree to which interventions take place within routines across developmental domains in early childhood intervention research. We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist to examine an interdisciplinary body of CIIs. We coded 42 articles for the presence and types of routines, child and family demographics, developmental targets, and how routines were identified within CIIs. Autism spectrum disorder was the highest represented disability; many studies included play routines or a combination of play with another routine. In this article, we discuss the importance of family routines in CIIs, how to jointly identify a range of routines with caregivers, and we describe the need for research on family routines in CIIs across disabilities and diverse family backgrounds.

Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation.

As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.

Teaching spanish‐speaking caregivers to implement EMT en Español: a small randomized trial

The primary purpose of this study was to examine the effects of using the Teach-Model-Coach-Review approach to teach Spanish-speaking caregivers from low-income households to implement EMT en Español with their young children with language delays. A secondary purpose was to explore the effects of the caregiver-implemented intervention on children's vocabulary. A final and more exploratory goal was to gain insight into caregivers’ perceptions of the intervention.21 caregiver-child dyads participated in the intent-to-treat randomized control trial. Their children were 30-43 months old with language delays. Dyads were randomly assigned to receive 24 caregiver training sessions delivered at home in Spanish or a wait list control group. Pre, post and 3-month follow assessments included observational measures of caregiver-child interactions and child standardized vocabulary assessments. Caregivers completed surveys rating their perception of the intervention.Caregivers in the intervention group had significantly higher percentages of matched turns, expansions, and targets at post-assessment and of expansions and targets at follow-up compared to the control group. Overall, children in the intervention condition had significantly higher receptive vocabulary scores and performed better than children in the control condition on observational measure of their lexical diversity, with moderate effect sizes for most outcomes. Caregivers perceived the intervention as effective and culturally appropriate.Teach-Model-Coach-Review is effective in increasing Spanish-speaking caregivers’ use of EMT en Español strategies with their young children with language delays. The intervention also appears to be effective for child vocabulary outcomes and acceptable to caregivers.

A Two Caregiver-Implemented Intervention Using Occupation-Centered Coaching

ABSTRACT With the rising number of children diagnosed with autism spectrum disorder (ASD), interventions that are evidence-based and responsive to the occupational needs of families as a unit are needed. Two single-case changing criterion designs (CCDs) were used to examine the effect of a two caregiver-implemented coaching intervention on play, specifically the quality of social interactions for a family with a toddler with ASD. The fidelity and social validity of the intervention were also examined. The intervention yielded improvements in the child’s performance of play, the caregivers’ satisfaction with his play, and the quality of social interactions of each family member participating in playtime. The intervention was delivered with fidelity and had strong social validity, with the caregivers valuing shared decision-making, doing together to enhance learning and spousal support, and feedback in graphic and video forms. The findings support the use of a two caregiver-implemented and occupation-centered coaching approach to intervention focused on play for a family unit; however, replication of the study procedures with additional family units is needed.

Comparing Instructional Approaches in Caregiver-Implemented Intervention: An Interdisciplinary Systematic Review and Meta-Analysis

Family involvement is a cornerstone of early intervention (EI). Therefore, positive caregiver outcomes are vital, particularly in caregiver-implemented interventions. As such, caregiver instructional approaches should optimize adult learning. This study investigated the comparative efficacy of coaching and traditional caregiver instruction on caregiver outcomes across EI disciplines. A systematic search for articles was conducted using PRISMA guidelines. Meta-analysis methodology was used to analyze caregiver outcomes, and a robust variance estimate model was used to control for within-study effect size correlations. Seven relevant studies were ultimately included in the analysis. A significant, large effect of coaching on caregiver outcomes was observed compared to other models of instruction ( g = 0.745, SE = 0.125, p = .0013). These results support the adoption of a coaching framework to optimize caregiver outcomes in EI. Future research should examine how coaching and traditional instruction can be used in tiered intervention models with a variety of populations.

Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder.

Early intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.

A Review of Problem Solving and Reflection as Caregiver Coaching Strategies in Early Intervention

An increasing number of researchers are examining the benefits and outcomes of caregiver-implemented interventions for young children with delays or disabilities. Most report the incorporation of multiple coaching strategies within their approach; however, definitions and descriptions of coaching strategies and processes continue to be limited. This scoping review examined the use of various coaching strategies across models of caregiver coaching in early intervention, with a specific focus on problem solving and reflection coaching strategies occurring in the literature between 2011 and 2018. Problem solving and reflection are 2 coaching strategies incorporated into coaching approaches to build caregiver competency, confidence, and independence within intervention implementation. The results of this review may guide the field in further defining caregiver coaching as well as specific coaching strategies, such as problem solving and reflection.

The Cascading Coaching Model for Supporting Service Providers, Caregivers, and Children

Teaching caregivers to support their young children’s language development is recommended as an effective early language intervention, and caregiver-implemented interventions are recognized as evidence-based. However, as the natural change agents for training and coaching caregivers, early intervention (EI) service providers are in need of professional development to effectively coach caregivers to use interventions with their child. The purpose of this study was to examine the Coaching Caregivers Professional Development program (CoCare PD) in which researchers train and coach EI service providers via telepractice in caregiver coaching, a set of skills useful in nurturing partnerships with families to support caregivers’ use of evidence-based practices with their young children with disabilities. A single-case research study across four EI service providers was conducted and findings support a functional relation between training and coaching EI service providers via telepractice and providers’ use of coaching practices with families on their caseload.

Caregiver-Implemented Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review of Coaching Components

Caregiver-implemented intervention, commonly facilitated via coaching, is an increasingly common approach to early intervention for infants and toddlers with or at risk for autism spectrum disorder (ASD). The present systematic review examines four coaching components across the literature on caregiver-implemented intervention models for children under 36 months with or at risk for ASD. Systematic search procedures resulted in 26 studies for review. Results showed that although most studies addressed building on caregivers’ competence and guided practice, many neglected to address collaborative coaching components, including planning, reflection, and decision making. Less than a quarter of the studies reviewed described incorporating all four coaching components, highlighting remaining gaps in the literature. Implications of our findings and recommendations for future research are discussed.

Teaching and Coaching Caregivers in a Guatemalan Orphanage to Promote Language in Young Children

AbstractProviding evidence-based early intervention (EI) to caregivers is an effective way to promote development in young children. EI services in the United States have decreased risk factors associated with language impairment (LI) as they help improve both short and long-term outcomes for both caregivers and children. The positive results for EI services in the U.S. may generalize to Latin American countries, namely Guatemala. Guatemala has one of the weakest education systems in its region as well as poor access to early childhood services for low-SES and other disadvantaged groups. The purpose of this study was to provide brief EI services to a Guatemalan orphanage by training caregivers to implement naturalistic language support strategies with the young children they care for who are at risk for language impairment. Results indicate a brief caregiver-implemented intervention program was effective for teaching caregivers to implement language support strategies. Recommendations are made for future research as well as implications for policy and practice. Additional research is needed to determine how to facilitate maintenance over time.

Caregiver-implemented intervention for an adult with autism spectrum disorder and complex communication needs

Background/Aims: Individuals with autism spectrum disorder often have significant speech deficits, or complex communication needs. People with complex communication needs frequently reach adulthood without sufficient tools to communicate effectively and require instruction in the use of augmentative and alternative communication. Because communication is ubiquitous, best practice in augmentative and alternative communication instruction involves primary communication partners, such as caregivers. The aim of this study was to evaluate the efficacy of the use of a speech generating app via a tablet, as implemented by a caregiver, to increase requesting in an adult with autism spectrum disorder. Methods: This case study is a pilot study involving the provision of instruction to a primary caregiver of a young woman with autism spectrum disorder and complex communication needs. First, the primary caregiver was trained to use the speech generating app. After the primary caregiver met the performance criteria, she taught the woman with autism spectrum disorder and complex communication needs how to use the app independently. Findings: The caregiver quickly learned the steps of implementing the augmentative and alternative communication intervention and maintained use of these skills at high rates several months after the intervention was completed. Furthermore, the young woman with complex communication needs also increased use of augmentative and alternative communication, although her results were variable and were not maintained. Conclusions: Despite the positive findings from this study regarding the accuracy of the primary caregiver's intervention implementation, future research should examine a better way to meet the needs of adult people with autism spectrum disorder and complex communication needs when using augmentative and alternative communication systems.

Caregiver-Implemented Intervention for Communication and Motor Outcomes for Infants and Toddlers

The purpose of this study was to examine the effects of coaching caregivers to embed both communication and motor outcomes concurrently within daily routines of their infants or toddlers with significant disabilities using Enhanced Milieu Teaching (EMT) strategies. The coaching and embedding practices were part of a multicomponent intervention known as Embedded Practices and Intervention with Caregivers (EPIC). Three children, aged 15 to 23 months with significant disabilities, their caregivers, and an early intervention provider participated in this single case multiple probe design study. Primary dependent variables were caregivers’ number of naturalistic teaching strategies used and rates of correctly embedded instruction for each learning target in each routine. Child motor and communication outcomes were also examined. Results provide initial support for the positive effects of the EPIC approach using EMT strategies to embed intervention on two developmental domains concurrently in caregiver’s daily routines.

Community-Based, Caregiver-Implemented Early Language Intervention in High-Risk Families: Lessons Learned.

High-quality, early caregiver-child interaction facilitates language, cognitive, and health outcomes. Children in low socioeconomic status households experience less frequent and lower-quality language interactions on average than their middle to high socioeconomic status peers. Early caregiver-implemented intervention may help to improve outcomes for these children. This article describes how we used community-based participatory research (CBPR) to develop and implement a community-based, caregiver-implemented early language intervention, including the challenges, solutions, and lessons learned in the process of CBPR. We adopted an ethnographic approach to document and analyze our CBPR experiences in multiple phases of the project, including intervention design, training, implementation, and evaluation. Developing the CBPR partnership, co-designing and implementing the study, and managing systems- level concerns like obtaining funding were central challenges for the researcher-community team. The CBPR model enhances early language intervention research by facilitating understanding of families in underserved communities and increasing the cultural relevancy of intervention materials.

A Systematic Review of Caregiver-Implemented Mealtime Interventions for Children With Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) frequently have difficult mealtimes. A systematic review analyzed current evidence relevant to occupational therapy (OT) and mealtime interventions (a) for children with ASD, (b) occurring in the natural contexts, and (c) with parents/caregivers as interventionists. Database search identified 13 relevant articles. Each article was reviewed for practicality of implementation through a modified Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME) scale and for quality of research design using three measures specifically designed for single-case experimental design research. The majority of articles reviewed demonstrated rigorous research design with strong evidence for the effectiveness of caregiver-implemented interventions. Six intervention techniques were identified, with all studies using a reinforcement strategy and at least one other technique. This review identifies evidence-based practices for OTs to support children with ASD and their families within the natural co-occupation of mealtimes. Effective techniques and recommendations for practice are included.