Examining mechanisms of parent mediated intervention with toddlers on the autism spectrum

Background: Parent participation in early intervention is a leading evidence-based practice in autism, but the strategies parents learn vary by intervention (Ingersoll, 2010; Oono et al., 2013). Two different evidence-based intervention approaches—structured behavioral interventions and naturalistic developmental behavioral interventions (NDBI)—are most frequently utilized. These approaches differ in the methods they emphasize in parent-delivery of the intervention. Both types of interventions rely on adapting adult-child interactions to increase access to learning opportunities for the child, but little attention has been paid to how parent behaviors vary as a function of intervention approach. To our knowledge, no studies have compared parent implementation of structured behavioral and NDBI interventions.Methods: This study compares the parent-child interactions for 80 parent-child dyads with children with ASD. Parents received coaching in a structured behavioral intervention, Discrete Trial Training (DTT) and the manualized Parent Early Start Denver Model (ESDM) as part of a larger study in which children received intensive, therapist-implement treatment of either DTT or ESDM. Video recordings were collected monthly for 12 months of a toy play activity between the parent and child. We coded 287 videos from months 1, 4, 8, and 12 for: (1) parent sensitivity/responsivity; (2) the variety, frequency, and quality of learning opportunities provided and the use of motivational strategies; and (3) the child’s dyadic engagement with the goal of understanding the effects of intervention training on the parent-child interaction. Results: Parent sensitivity/responsivity started high and did not improve significantly over the intervention. Change in parent sensitivity/responsivity was associated with higher child engagement. Parents in both conditions improved equally in their delivery of all learning opportunities strategies with motivational strategies most strongly predicting greater child engagement, even when controlling for sensitivity/responsivity. Conclusions: Parent sensitivity/responsivity is an important component of child dyadic engagement to consider and to examine in initial assessments Focusing solely on parent sensitivity/responsivity as a primary mechanism for child engagement may not be sufficient. Focusing on parent teaching strategies inside learning opportunities, especially child motivation, has a positive impact on increasing child dyadic engagement. As researchers and community practitioners endeavor to support parents of children on the autism spectrum, these findings may help inform coaching programs