Parent-implemented Intervention Research Articles

자폐 조기중재의 부모 코칭에 대한 사례 연구

This case study explores the factors that may influence the parent coaching fidelity and intervention fidelity in a parent-implemented intervention within the context of early intervention for autism. Drawing from Stahmer et al.’s (2020) research, the study involved one early intervention provider, two parents, and two toddlers either diagnosed with or at a high likelihood of autism. Video behavior coding was used as the primary method for data collection, focusing on (1) the duration spent on each coaching strategy, (2) the frequency of feedback types, and (3) the frequency of toddlers’ behaviors that were challenging to address. The study data, parent coaching fidelity, and intervention fidelity outcomes were analyzed and compared, and implications and recommendations for early intervention settings were summarized based on the results. The discussion focuses on the importance of adopting the implementation science framework for promoting effective parent coaching and parent-implemented intervention practices, the significance of support for early intervention providers and families, the need for factor analysis in studies with larger sample sizes to facilitate more statistically meaningful outcomes, and the importance of implementing cultural adaptation processes when introducing evidence-based parent-implemented intervention programs from other countries to South Korea.

Empowering and Educating Parents to Implement a Home Intervention: Effects on Preschool Children's Engagement in Hands-on Constructive Play.

Constructive play is a creative process-oriented activity that promotes children's engaged learning through building and designing with materials. This study investigated a parent-implemented intervention to promote active engagement in constructive play for preschool-aged children at risk for developmental delay. This study utilized a single-subject multiple-baseline across-participants design with four participants. Visual analysis of the data identified a functional relation between the temporal, physical, and social-emotional environmental support provided by the parents and the children's active engagement in constructive play. Parents reported the intervention as meaningful to their lives, indicating strong social validity. These findings highlight the importance of centering and working with parents in their home environment and provide evidence that empowering parents to provide support and minimize barriers facilitates children's active engagement in constructive play.

Parent-implemented interventions in Chinese families of children with autism spectrum disorder

This study aims to test the effects of the parent-implemented interventions (PIIs) on children with autism spectrum disorder (ASD) in China and to explore the effects of PIIs on the family quality of life of families of children with ASD in China. This study adopted a randomized controlled trial (RCT) design based on PIIs. Participants is divided into intervention group (N(parents) = 35, Age(M ± SD) = 35.69 ± 3.45; N(children) = 35, Age(M ± SD) = 5.49 ± 2.74) and control group (N(parents) = 35, Age(M ± SD) = 36.06 ± 4.28; N(children) = 35, Age(M ± SD) = 5.71 ± 3.25); parents in intervention group were trained with PIIs and required to implement family interventions for their children with ASD as they learned. This study will provide data to support the development and improvement of PIIs, and will also benefit the well-being and sustainability of children with ASD and their families. Compared to control group, the children in intervention group had a significant improvement in social communication ability (p < 0.05), and the families in intervention group had a significant enhancing in family quality of life (satisfaction) (p < 0.001). This study found that PIIs are effective in enhancing the social communication ability of children with ASD in China and the family quality of life (satisfaction) of their families. PIIs is a good and cost-effective complement to rehabilitation training in professional institutions, and have positive significance for the well-being and sustainability of children with ASD and their families.

Context and education affect the quality of parents' speech to children

The present study examined the influence of the context of interaction, parent education level, and parent gender on the quantity and language acquisition-supporting quality of parents' talk with their 3- to 5-year-old children. The conversations of 155 Danish parent-child dyads (41 fathers; 79 boys) in book sharing, reminiscing, and LEGO toy play were recorded, transcribed, and coded for indicators of linguistic and interactive quality. Book sharing and reminiscing elicited higher quality speech than toy play but did not diminish education-related differences in parent speech quality. Higher levels of parent education were associated with higher linguistic quality and linguistic contingency of parent speech. There were no effects of parent gender. The findings support the use of book sharing and reminiscing in parent-implemented interventions to enhance children's language experience, with the caveat that these interventions will not eliminate gaps in children's early language-learning experience associated with parent education.

What works, how and in which contexts when supporting parents to implement intensive speech and language therapy at home for children with speech sound disorder? A protocol for a realist review

IntroductionSpeech and language therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact...

Parent-Implemented Reading Intervention for Children With Intellectual and Developmental Disability

Children with intellectual and developmental disabilities (IDDs) require intensive multicomponent interventions to learn to read. Parent-implemented interventions have been shown to be effective for children with disabilities and are one potential method for providing intervention. This study used a multiple probe single case design to evaluate the effectiveness of an early multicomponent reading intervention implemented by parents in the home. This study was designed as a conceptual replication of Lemons et al. in response to concerns with the overall quality of instruction during schooling at home during the COVID-19 pandemic. Three parents of children with IDD (ages 4–7 years) participated in this study. Results indicated that with systematic training, coaching, and feedback, parents were able to positively impact their child’s reading abilities and implement the intervention with fidelity.

Collateral Effects of the Tell Me MORE! Intervention on the Joint Reminiscing of Mothers of Children with Autism Spectrum Disorder.

The purpose of this study was to analyze secondary data from three mother-child dyads in order to evaluate how family photographs and training in naturalistic strategies affected the way mothers reminisce with their children with autism spectrum disorders. A secondary analysis (i.e., collateral effects) of a single-case dataset was conducted to assess the impact of family photographs and training in naturalistic strategies on the selected variables. The introduction of family photographs showed positive effects on the mother's reminiscing style and the child's memory responses across all dyads. Furthermore, additional improvements were observed in these areas after training and coaching in the target strategies. This study demonstrates the positive impact of using family photographs and naturalistic based strategies in joint-reminiscing conversations for mothers and children with autism spectrum disorder. The intervention improved the mothers reminiscing style and child's memory responses, highlighting the potential value of parent-implemented interventions, especially those based on naturalistic strategies, in supporting individuals with autism spectrum disorder and their caregivers.

Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations.

Challenging behavior, such as aggression, is highly prevalent in children and adolescents on the autism spectrum and can have a devastating impact. Previous reviews of challenging behavior interventions did not include interventions targeting emotion dysregulation, a common cause of challenging behavior. We reviewed emotion dysregulation and challenging behavior interventions for preschoolers to adolescents to determine which evidence-based strategies have the most empirical support for reducing/preventing emotion dysregulation/challenging behavior. We reviewed 95 studies, including 29 group and 66 single case designs. We excluded non-behavioral/psychosocial interventions and those targeting internalizing symptoms only. We applied a coding system to identify discrete strategies based on autism practice guidelines with the addition of strategies common in childhood mental health disorders, and an evidence grading system. Strategies with the highest quality evidence (multiple randomized controlled trials with low bias risk) were Parent-Implemented Intervention, Emotion Regulation Training, Reinforcement, Visual Supports, Cognitive Behavioral/Instructional Strategies and Antecedent-Based Interventions. Regarding outcomes, most studies included challenging behavior measures, while few included emotion dysregulation measures. This review highlights the importance of teaching emotion regulation skills explicitly, positively reinforcing replacement/alternative behaviors, using visuals and metacognition, addressing stressors proactively, and involving parents. It also calls for more rigorously designed studies and for including emotion dysregulation as an outcome/mediator in future trials.

Parent coaching via telerehabilitation for young children with autism spectrum disorder (ASD): study protocol for a randomised controlled trial

BackgroundEarly parent-implemented intervention enhances parent-child interaction and improves language skills in children with autism spectrum disorders (ASD). Parent coaching is often delivered as standard care for children with ASD, where parents are taught to apply strategies in their child’s play activities and daily routines to achieve the prior stated goals. However, the ability to conduct parent coaching in physical in-clinic sessions is limited by resource constraints such as clinic space and therapist manpower. Furthermore, parents may experience difficulties with the generalisation of intervention strategies taught in the clinic to their natural home environments. In this study, telerehabilitation is evaluated as an alternative platform to deliver parent coaching for parent-implemented interventions to children with ASD in their homes.MethodsThis parallel-group, randomised, controlled, non-inferiority trial aims to evaluate the effectiveness of parent coaching delivered through video conferencing (telerehabilitation) versus in-clinic (standard care) delivery. Children aged 15 to 48 months (n = 200) who meet the cut-off score for ASD on the Autism Diagnostic Observation Schedule-2 are eligible. Parent-child dyads are randomly assigned to receive parent coaching either through weekly telerehabilitation or standard care. The primary outcome is the child’s development as measured by the subscale and composite scores of a standardised developmental assessment. Primary analysis will determine if the lower boundary of the 95% confidence interval for the mean difference in pre-post change between groups exceeds −5 (the non-inferiority margin). Secondary outcomes are the child’s adaptive behaviour, parent-child interaction, parental stress, and family quality of life. Outcomes will be measured pre-intervention, midterm, and post-intervention. Secondary analysis will determine if there is any between-group difference for the pre-post change in scores at the 5% significance level using two-sample t-test or Mann-Whitney U test.DiscussionAs a randomised controlled trial of a moderately large scale, this study will contribute to the limited existing literature on the effectiveness of parent coaching via telerehabilitation for early parent-implemented intervention for children with ASD. The results of this study will provide insights on whether telerehabilitation is comparable to conventional in-clinic parent coaching in enhancing parent-child interaction and improving language skills.Trial registrationClinicalTrials.gov NCT05792449. Registered (retrospectively) on 31 March 2023.

Photographs and Parent Training to Support Conversations about Past Events between Caregivers and Children with Autism.

Children with autism spectrum disorder experience communication difficulties that can make it challenging to engage in conversations. Their caregivers also often struggle with finding ways to support the child's communication. Parent-implemented interventions and visual supports are evidence-based practices to support the communication skills of children with autism. A multi-method design (single-case multiple probe and qualitative) was used to evaluate the effects of family photographs, training, and telecoaching on parental implementation of communication strategies. Three parents and their children with and at risk for autism participated. Results indicate that the use of photographs increased the communication strategies used by all parents. Telecoaching further increased the overall strategy use for two parents. Interviews with the parents indicate spontaneous generalization and maintenance of strategy use. Family photos and naturalistic developmental behavior intervention approaches have the potential to improve communication about past events between parents and children with and at risk for ASD.

The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum.

Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.

What parents want: A qualitative analysis of a parent-implemented intervention for autistic children.

Guidelines regarding social cognitive interventions for autistic children suggest incorporating a holistic approach. This includes increasing the family's understanding of difficulties associated with autism, integrations of natural environments, and parents as active agents in the intervention while being supported for their well-being. The current availability of holistic parent-implemented interventions for autistic children is limited, with no qualitative understanding of how parents view the benefits for themselves or their children. The current study expands the literature regarding holistic approaches through a qualitative understanding of parent perceptions of a parent-implemented social communication intervention for autistic children (TalkAbility™), which incorporates a 6-month follow-up. This study sought to gain a deeper understanding from parents on their perceptions of a holistic approach, including the impact on themselves, their families, and their autistic child. Following Braun and Clarke's model of thematic analysis, data was coded into four themes: (a) communication difficulties, frustrations, and progress, (b) social relationships and concerns, (c) communication strategies, and (d) thoughts and emotions surrounding TalkAbility™. Parents report that many components of a holistic approach are instrumental in encouraging social communication in their autistic child. Results highlight the importance of considering parent experiences regarding interventions for their child's social communication skills through a qualitative viewpoint. Knowing the intervention aspects that parents view as most valuable allows targeted program modifications that reflect actual parent needs. Further understanding regarding the influence of holistic parent-implemented social communication interventions on child communication skills, parenting frustrations, and parent-child relationships is needed.

Identifying effective strategies to instruct parents during parent-implemented intervention: The role of parent practice with feedback

Parent-implemented interventions have positive effects on child and family outcomes, but the core components of these interventions that are used in research settings are rarely used in practice settings. One reason for this discrepancy may be uncertainty about the optimal instruction used to teach parents. This study includes an investigation the instructional strategies that were most effective in teaching different types of intervention strategies to parents of autistic children. Increased opportunities for “parent practice with feedback” (i.e., independent parent practice with immediate clinician feedback) was most predictive of parent strategy use regardless of the type of intervention strategy or parent baseline skills. Further analysis revealed that clinicians used the instructional strategy of parent practice with feedback more often when teaching intervention strategies that parents were already using to some degree before intervention (i.e., responsive strategies) and when parents had higher baseline intervention strategy use. These results suggest that instructional strategies targeting parents’ existing capacities may be most effective in improving parent learning, and in the future, researchers should investigate ways to modify and individualize parent instruction.

Parent-Implemented Interventions via Telepractice in Autism Research: A Review of Social Validity Assessments.

Parent-implemented autism interventions are considered empirically validated interventions and the use of telepractice in these interventions is reported as effective. However, little is known about the social validity assessments and outcomes of these interventions. The purpose of this review is to explore the current practices of conducting social validity assessment and reporting its outcomes within parent-implemented telepractice autism interventions. The 11 reviewed studies included caregivers as participants, telepractice intervention focusing on social communication outcomes of young autistic children, and were published in a peer-reviewed journal within the past five years. The researchers in the reviewed articles reported positive outcomes for parent-implemented telepractice autism interventions. Notably, however, information about social validity assessments of the interventions was limited. Researchers are encouraged to evaluate the social validity of interventions using multiple data sources and methods, and report on their findings as they relate to other types of data.

Innovations in Parent-Implemented Interventions in EI/ECSE

Innovations in Parent-Implemented Interventions in EI/ECSE

Effectiveness of Evidence-based Nursing Intervention on communication and Social skill among Autism Spectrum Disorder Children and Quality of life of the parents

Objective: Evidence based intervention is an effective method for improving autism spectrum disorder (ASD) in children on socialization, communication and quality of life of the parents may have an effect on the brain activity. This aim of this study is to find the effectiveness of picture exchange communication system (PECS) and parent implemented intervention (PII) among ASD children and quality of life of the parents. Methods: Sixty ASD Children who fulfilled the inclusion criteria were selected and assigned into control (n=30) and experimental (n=30) groups. Experimental group received evidence-based intervention with PECS and PII for 6 months, whereas the control group received routine care. The children were assessed for social relationship and reciprocity (SRR), speech language communication (SLC) and Quality of life of the parents before and after the intervention. For the experimental group a 3-month post intervention along with Quality of life of the parents were also assessed. Parametric and nonparametric statistical methods were used. Results: The data showed that male, nuclear family and birth order above one was more among ASD. Two-way RM ANOVA showed significant difference among groups and tests (p&lt;0.001), and interaction of groups with tests (p&lt;0.001). Experimental post-test-2 i.e., after 6 months showed significant improvement in SRR, SLC and Quality of life of parents compared with control group. Conclusion: The present study shows that the PECS and PII as nursing strategy can improve ASD children socialization, communication and quality of life of the parents.

Parent-implemented intervention for children in third to fifth grade with dyslexia

BackgroundFew studies have investigated the acceptability and efficacy of intensive parent-implemented interventions for children with dyslexia. MethodsWe carried out a randomized controlled trial on 22 dyslexic children from 3rd to 5th grade. Reading performance was measured before (T1) and after (T2) summer by a selection of tests from the BALE and EDA batteries. One group received a specific parent-implemented repeated reading training (RR group) and the other group received a general training based on a summer vacation workbook (SVW group), adapted for children with reading impairment. The training lasted 6 weeks during the summer vacation. ResultsIn both groups, the reading performances of the dyslexic children were stable before and after the summer. No group difference was found on our primary outcome corresponding to an aggregate score of the z-scores of the BALE reading lists of regular, irregular and pseudo-words. However, secondary analyses revealed that the score of the EDA subtest “number of words read in one minute” (tapping reading fluency) differed significantly between the two groups (T2-T1=0.17 SD for the RR group and T2-T1=-0.24 SD for the SVW group; P=0.015). Acceptability was generally good (dropout rate of 9% in the RR group). ConclusionsA repeated reading intervention applied by parents may improve reading fluency of dyslexic children during summer vacation, with a good acceptability. Further studies are needed to confirm these findings.

Evaluation of Low-intensity Therapist-Delivered Intervention in Addition to Parent Coaching for Young Children with Autism Spectrum Disorder

ABSTRACT Parents are often expected to be the primary implementers of intervention for their young children with autism spectrum disorder (ASD). The provision of a few hours a week of intervention by a trained therapist, in addition to parent-implemented intervention, could increase child outcomes compared to parent-implemented intervention in isolation. This study evaluated the effects of a 12-week parent coaching program based on the Early Start Denver Model (ESDM) followed by 12-weeks of therapist-delivered ESDM intervention for four children with ASD. The effects of these interventions on child participation, functional utterances, and imitation were evaluated using a multiple probe across participants design. Children’s participation improved during both interventions. Children generally showed greater improvements in imitation with the therapist than with their parents but showed minimal improvements in functional utterances. This suggests there may be some benefit to low-intensity therapy in addition to parent coaching, but more research is needed.

Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis

Children with autism spectrum disorder (ASD) have been shown to benefit from parent-implemented interventions (PIIs). This meta-analysis improved on prior reviews of PIIs by evaluating RCTs and multiple potential moderators, including indicators of research quality. Fifty-one effect sizes averaged moderately strong overall benefits of PIIs (g = 0.553), with studies having lower risk of research bias yielding lower estimates (g = 0.47). Parent and observer ratings yielded similar averaged estimates for positive behavior/social skills (g = 0.603), language/communication (g = 0.545), maladaptive behavior (g = 0.519), and to a lesser extent, adaptive behavior/life skills (g = 0.239). No other study, intervention, or participant characteristic moderated outcomes. PIIs with children with ASD tend to be effective across a variety of circumstances.

Developing Parents Plus

In this article, we describe the development and investigation of the social validity of Parents Plus, a parent-implemented intervention for preschool children with developmental language disorder. Parents Plus is a fully online intervention that is delivered through three components: (a) training delivered through an app that educates parents on how to use focused stimulation (FS), a language facilitation strategy; (b) parent implementation of FS during naturally occurring routines; and (c) remote practice-based coaching provided by a coach via Zoom. Parents Plus was developed in three steps: (a) initial content development with input from parents and professional advisory board members, (b) brief field test with five parent–child dyads, and (c) full-length field test with seven parent–child dyads. Throughout the development process, we collected social validity data on the intervention's goals, procedures, content and outcomes. Each step was followed by revisions to Parents Plus. Findings suggest that Parents Plus has strong social validity. Recommendations for early intervention practice are provided based on lessons learned, such as different methods to scaffold learning experiences for parents.