Pilot Study of the Incredible Years for Autism Spectrum and Language Delays: Examining Changes in Verbal Behavior During Parent-Child Play Interactions

Background. Autism spectrum disorder (ASD) is characterized by persistent difficulties with social communication (American Psychiatric Association, 2013). Due to the high prevalence of ASD there’s a significant demand for services to support these individuals and the involvement of caregivers is considered a crucial element of effective early intervention for young children with developmental disabilities (Siller & Morgan, 2018). The Incredible Years ® is an evidence-based behavioral parent training program with a large body of research demonstrating its efficacy with enhancing positive parenting practices during parent-child interactions for children with behavior problems (Menting et al., 2013). The program is built on the foundational concept of child-led free play. Recently, the program has been adapted for families with young children with developmental disabilities, Incredible Years Program for Autism Spectrum Disorder and Language Delays Ages 2-5® (IY-ASLD). IY-ASLD aims to help parents learn developmentally-attuned language and play strategies to effectively engage with toddlers with ASD or social communication delays. There are few published evaluations of IY-ASLD currently. However, the findings from pilot studies are promising in terms of the feasibility of implementation, with high levels parent satisfaction and attendance. The present study uses data from a pilot study of the IY-ASLD program (N=17), which was adapted to telehealth during COVID-19 pandemic with the assistance of program developer. This dissertation contributes to an emerging body of research by evaluating the IY-ASLD program in a community setting. By examining IY’s group treatment model in a telehealth format, we also gain valuable insight about virtual parenting interventions, which have the potential to significantly expand treatment to more families. Methods. Families were recruited from a specialized early intervention and preschool program that utilizes an Applied Behavior Analysis approach to education. Seventeen (N=17) parent-child dyads from the school enrolled in the program. All or virtually all children referred to this school by their school district are at-risk for or have been diagnosed with ASD. All of the children had an IEP or IFSP with mandated speech services, 71% of the children met criteria for ASD (N = 12) on the Childhood Autism Rating Scale-2-SF, and 2/3 of the sample had adaptive behavior composites below a standard score of 70 on the Vineland Adaptive Behavior Scales- Third Edition Comprehensive Teacher Form (Sparrow et al., 2016) at baseline. The parent participants, all mothers, began and completed a 12-week IY-ASLD telehealth intervention delivered over HIPAA protected Zoom. Mothers were from diverse backgrounds (41% non US born), well-educated (94% college graduate) and had a high median household income. Data from participants was gathered through questionnaires administered to parents, child-functioning measures completed prior to treatment by school personnel, and parent-child interactions videos recorded in the home at pre-, mid-, and post-treatment across a 12-week IY-ASLD intervention. Primary outcome variables were parent verbal behaviors during 5-minute parent-child free play sessions recorded at each time point. Each vocal utterance during free play sessions was coded for function, consistent with the parenting skills that were targeted in the IY-ASLD program (e.g., reducing commands, questions, and corrections, increasing descriptive narration and praise, following the child’s lead). The independent variables were time and dosage (minutes spent in treatment) and the moderators were child’s functioning levels (special education teacher/clinician ratings on the Vineland Adaptive Behavioral Scales- Third Edition (Vineland-3, Sparrow et al., 2016) and Childhood Autism Rating Scale, Second Edition- Standard Form (CARS2= ST, Schloper et al., 2010). Results. Mothers in the IY-ASLD program significantly decreased the ratio of parent-directed language and increased the ratio of child-directed language they used during the free play sessions with large effect sizes and most of the change occurring in the mid-to-post interval. Descriptive statements (tacts) also increased significantly for all participants with large effect sizes; the number of directive or question statements (mands) decreased with medium effect sizes, though the results were not significant. Dosage was not a significant predictor of outcomes at post-treatment when pre-treatment parenting behaviors were taken into consideration, possibly due to low variability in attendance. When child level was analyzed as a moderator, there were large effect sizes for the observed changes in tacts, mands, and overall ratio of child-directed language when children were divided into ASD vs No ASD groups, but small effect sizes when looking at low vs high adaptative behavior groups. There was a significant interaction effect between change in parent language over time and ASD severity of the child; parents of children with ASD did not significantly reduce the number of mands over time, while parents of children without ASD significantly reduced their number of mands over time. This research provides support for a full-RCT of IY-ASLD in this setting, suggesting that the intervention promotes maternal use of child-directed language, particularly for children with language delays as opposed to those with more severe symptoms of ASD. Interventions such as IY-ASLD may help empower parents of preschoolers with disabilities with strategies to facilitate more rewarding free play interactions at home