Randomized Trial of Telehealth Parent-Implemented Intervention to Improve Social-Communication Outcomes in Young Children with ASD
Abstract
Study Rationale: During the COVID-19 pandemic, clinically validated, parent-implemented intervention services for young children with autism spectrum disorder (ASD) quickly shifted from in-person to telehealth. However, no studies have examined the efficacy of telehealth coaching relative to in-person coaching for empowering parents to use developmentally appropriate strategies to improve the core symptoms of ASD in toddlers. We will conduct the first study to examine the efficacy of telehealth naturalistic developmental behavioral intervention (NDBI) parent coaching (TC) compared to in-person coaching (IPC). The coaching goal is to help parents use NDBI strategies to improve their children’s social-communication skills (core ASD deficit) during interactions with their child throughout their daily routines at home. Objectives: Our study aims address three FY20 ARP Clinical Trial Award Areas of Interest: (1) behavioral, cognitive and other non-pharmacological therapies for ASD core symptoms or to alleviate co-occurring conditions through the use of an evidenced-based, parent-implemented NDBI to target ASD core symptom of social-communication in very young children with ASD; (2) improving access to services through telehealth as an alternative to in-person coaching as a service-delivery modality; and (3) understanding heterogeneity in treatment response by examining child and parent characteristics as moderators of children s social communication outcomes across the two NDBI service-delivery modalities: telehealth versus in-person. This study s main goal is to examine the efficacy of TC of parents to implement NDBI strategies compared to IPC for improving social-communication functioning (including joint engagement and functional communication) in toddlers with ASD ages 18-33 months. Another thrust is to examine the efficacy of the TC modality compared to IPC for teaching parents to use NBDI strategies with high accuracy when interacting with their young child with ASD. Last, we will examine how pre-intervention child and parent characteristics (child behavioral dysregulation, active engagement, developmental quotient, and parent stress) may affect the development of children’s social-communication skills. We will see whether the relationship between these pre-intervention characteristics and children’s outcomes are the same or different in the TC and IPC groups. To answer these questions, 188 parents and their child with ASD will be randomly assigned to the TC or IPC group (94 per group). For both TC and IPC groups, the same family-centered, collaborative coaching approach using the same NDBI strategies will be used. Both groups will receive coaching for 12 weeks, with two sessions per week, differing only in whether the services are provided via telehealth (TC) or in-person (IPC). Parents will be coached in their homes to implement NDBI strategies during daily routines with their young child with ASD. Applicability and Impact: Parents (or primary caregivers) are the primary sources of interaction and learning for toddlers with ASD. If we show that TC is not less effective than IPC, TC will be recognized as an evidenc-based approach for empowering NDBI use by families. Our results could lead to clinical practice changes whereby TC is established as a service-delivery option for families. This could translate into increased accessibility and intensity of intervention for young children with ASD anywhere Internet capabilities exist, especially for military or other families who are not located close enough to a reputable clinical facility to access ASD services or where service providers are limited in number or have long distances to travel to families’ homes. It would also allow continuity of services for families who may need to move during their child s treatment since they can access services via telehealth. Also, it would have a major positive impact on families who experience other barriers to in
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110232
Entities
People
- Rachel Reetzke
Organizations
- Kennedy Krieger Institute
- United States Army