One size does not fit all for parent-mediated autism interventions: A randomized clinical trial

Abstract

Coaching parents to use language facilitation strategies improves long-term language outcomes for autistic children. To optimize parent-mediated interventions, more studies need to explore factors that influence parents’ learning. This study involved 119 autistic children (18–48 months) and their biological mothers enrolled in a single-site, factorial randomized clinical trial. Mothers were taught to use one of two types of language facilitation strategies (responsive or directive) during eight weekly, hour-long instructional sessions. We explored the impact of (a) type of language facilitation strategy, (b) maternal Broad Autism Phenotype (subclinical traits of autism spectrum disorder), and (c) preintervention strategy use on mothers’ outcomes measured immediately and 3 months after intervention sessions. At postintervention, mothers who learned responsive strategies demonstrated significantly greater use of taught strategies than mothers who learned directive strategies ( d = 0.90, 95% CI =[0.47, 1.32]). Mothers’ use of taught strategies did not differ by Broad Autism Phenotype status. However, a significant two-way interaction was found between preintervention strategy use and Broad Autism Phenotype status on taught strategy use ( F(1, 107) = 6.04, p = 0.016, Δ R2 = 0.053). Findings suggest that strategy type, maternal Broad Autism Phenotype status, and preintervention strategy use may be important factors to be considered to individualize parent-mediated interventions. Lay Abstract Parent-mediated interventions support parents’ use of language facilitation strategies to improve their autistic child’s communication and language development. To improve the effectiveness of parent-mediated interventions, it is important to individualize interventions. This article evaluates how different components of parent-mediated interventions and mothers’ learning styles influence the effectiveness of the intervention. In a randomized clinical trial, mothers were taught to use one of two types of language facilitation strategies: responsive and directive. Mothers’ learning styles were characterized by the Broad Autism Phenotype (BAP) and their natural tendency to use language facilitation strategies before intervention. Findings suggest that it was easier for all mothers (irrespective of learning style) to use responsive strategies compared to directive strategies. In addition, mothers with learning styles that were not consistent with the BAP were more likely to benefit from the intervention if they did not naturally use strategies before the intervention. In contrast, mothers with learning styles that were consistent with the BAP were more likely to benefit from the intervention if they did naturally use strategies before the intervention. Teaching mothers to use responsive strategies results in greater strategy use. Consideration of BAP and mothers’ natural use of language facilitation strategies may inform intervention individualization.

Characterizing mechanisms of caregiver-mediated naturalistic developmental behavioral interventions for autistic toddlers: A randomized clinical trial

“…Results of the current study demonstrated that children in the directive group obtained better language outcomes than children in the responsive group. However, findings of Roberts et al (2022) demonstrated that caregivers in the responsive group used strategies more frequently and accurately than caregivers in the directive group, regardless of their learning style (as indicated by BAP status). Taken together, a critical next step to characterizing the mechanisms of caregiver-mediated NDBIs is understanding the extent to which caregiver fidelity (i.e.…”

“…The randomization sequence was computer generated by the senior project statistician and contained random block sizes with a 1:1 assignment ratio within blocks. Based on the primary aims of the clinical (Roberts et al, 2022), randomization was stratified on child verbal status and maternal BAP status (i.e. presence or absence of subclinical characteristics of autism).…”

“…Thus, the primary aim of the current clinical trial addressed the extent to which the strategy type (i.e. responsive or directive) influenced caregivers’ use of language facilitation strategies (Roberts et al, 2022). Results of the primary aim of the clinical trial demonstrated that caregivers taught to use responsive strategies demonstrated greater proficiency in strategy use than caregivers taught to use directive strategies ( d = 0.90, 95% CI = [0.47, 1.32]).…”

Parenting and Gender as Impact Factors for Social Participation, Quality of Life, and Mental Health in Long COVID

“… 3 This variability underlines the need for tailored interventions and support structures, moving away from the idea that one-size-fits-all solutions, as often promoted in evidence-based research, are sufficient. 55 - 58 Various social factors and medical comorbidities among our studied population showed different impacts on social participation, which needs to be considered when developing interventions and support structures.…”

Validity of the multidimensional assessment profile of disruptive behavior in autistic toddlers

“…Roberts et al. ( 2022 ) provides further information about intervention strategies. This study contained three time points: participants were assessed and completed questionnaires before intervention (i.e., T0), immediately after intervention (i.e., T1), and at 3 months post‐intervention follow‐up (i.e., T2).…”