Review of “Parent-Implemented Social Intervention for Toddlers with Autism: An RCT”

Studies on children with Autism Spectrum Disorder (ASD) reveal that parental involvement is key to positive improvements and long-term change (Lord, Luyster, Gurthrie, & Pickles, 2012; Anderson, Oti, Lord, & Welch, 2009). Yet, despite this knowledge, previous randomized controlled trials have been unable to find significant effects on children’s outcomes following parent-implemented interventions. These results may be a consequence of limited sessions, short study duration, and clinic-based interventions, which may not be generalizable to everyday life. The current study was created in order to examine the effects of parent-implemented interventions on outcomes of children with ASD in a new manner (Wetherby, Guthrie, Woods, Schatschneider, Holland, Morgan, & Lord, 2014).

This article describes a 9-month randomized controlled trial regarding interventions within the Early Social Interactions (ESI) project. 82 children with Autism Spectrum Disorder (ASD) between the ages of 16-20 months of age and their families were included in this study. Children were randomly assigned to one of two groups: an experimental group in which individual parent directed Intervention (Individual-ESI) was offered 2-3 times per week at home or in the community and a control group in which intervention was offered in a group setting once a week at a clinic. In both cases, the training was focused on teaching parents the importance of intervention and active engagement with their children. The manualized Social Communication, Emotional Regulation, and Transactional Supports (SCERTS) curriculum was used for both conditions, but the two conditions varied in how and where the parents were taught. In the control group, the parents were taught in a way that is similar to already existing programs, at a clinic in a group with 4-5 families. The experimental group utilized a new approach in which parents were taught individually at their homes or in the community. In both groups, parents were encouraged to incorporate evidence-based strategies for their children in everyday activities for more than 25-hrs per week.

Measures were collected before and after the 9-month intervention in regards to social communication, autism symptoms, adaptive behavior, and developmental level. The results were statistically significant in several of these categories. In terms of social communication skills, both groups showed significant improvement, but children in the individual-ESI intervention showed significantly greater improvement than controls (p = .04). Children who received individual-ESI showed significant improvement in regards to their adaptive behavior, whereas the control group showed no significant change (p = .02). In addition, the verbal skills of the children who received individual-ESI improved significantly, where there was no significant change in the verbal skills of the children in the control group. Lastly, children in both groups revealed decreased autism symptoms in regards to the autism symptoms severity algorithm of the ADOS. The ADOS is considered the gold standard examiner-administered diagnostic measure of ASD.

In conclusion, this article reports on the largest randomized controlled trial to compare two 9-month parent-implemented interventions for toddlers with ASD revealing significant outcomes for the children involved. Although the study cannot rule out confounding variables such as parent expectations or maturation, the study has many strengths including random assignment, blind diagnosticians, and standardized observational measures. With the current health care and educational struggle to provide sufficient interventions of adequate intensity to toddlers with ASD, this article is particularly relevant and important. This study supports the efficacy of a parent-implemented intervention that uses minimal professional time, and thus increases potential feasibility in the community.

Sunfield Center provides Individual-ESI for parents whose toddlers are diagnosed with an Autism Spectrum Disorder. Dr. Naguib (our clinical director and licensed psychologist) was one of the Individual-ESI clinicians who worked directly with parents in this study during her time at the University of Michigan Autism and Communication Disorders Center.

Resources:

Anderson, D. K., Oti, R. S., Lord, C., & Welch, K. Patterns of growth in adaptive social abilities among children with autism spectrum disorders. J Abnorm Child Psychol., 37(7).

Lord, C., Luyster, R., Guthrie, W., & Pickles, A. (2012). Patterns of developmental trajectories in toddlers with autism spectrum disorder. J Consult Clin Psychol., 80(3).

Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-implemented social intervention for toddlers with autism: An RCT. Pediatrics, 134(6).