Introduction
Autism is a developmental condition that affects how a person communicates and interacts with others. Early intervention is important to help autistic children develop their skills and abilities. There are different types of early intervention programs, such as therapist-delivered or parent-mediated. Therapist-delivered programs involve trained professionals who work directly with the child, while parent-mediated programs involve coaching parents to use specific strategies with their child at home.
A recent study compared the outcomes of autistic pre-schoolers and their parents who received different types of early intervention in a community-based setting in Australia. The study involved 53 families who were randomly assigned to one of three groups:
- Group 1: Therapist-delivered Early Start Denver Model (ESDM), a naturalistic developmental behavioral intervention that focuses on social communication and play skills.
- Group 2: Therapist-delivered ESDM plus parent-coaching ESDM (P-ESDM), which involves teaching parents to use ESDM strategies with their child at home.
- Group 3: Usual community services, which may include speech therapy, occupational therapy, or other programs.
The study measured the children’s cognitive skills, adaptive behavior, autism symptoms, and language skills, as well as the parents’ mental health, wellbeing, and parenting stress, at three time points: before the intervention, after 10 months of intervention, and after 6 months of follow-up.
What did the study find?
The study found that all children made significant improvements in their cognitive skills and adaptive behavior over time, regardless of the type of intervention they received. There were no significant differences between the groups in terms of child outcomes. This suggests that both ESDM and usual community services are effective in supporting the development of autistic pre-schoolers.
However, the study also found that parents reported increased parenting stress over time, regardless of the type of intervention they received. There were no significant differences between the groups in terms of parent outcomes. This suggests that parent-mediated intervention does not necessarily reduce the stress or improve the wellbeing of parents of autistic children.
What are the implications of the study?
The study has several implications for practice and research. For practice, the study suggests that parents of autistic pre-schoolers can choose the type of early intervention that suits their preferences and availability, as both therapist-delivered and parent-mediated programs are likely to benefit their child’s development. However, the study also suggests that parents may need additional support to cope with the stress and challenges of raising an autistic child, as parent-mediated intervention alone may not be enough.
For research, the study highlights the need for more studies to explore the effects of parent-mediated intervention on both child and parent outcomes, as well as the factors that may influence the effectiveness of such programs. The study also acknowledges some limitations, such as the small sample size, the lack of a control group, and the variability of the usual community services. Future studies may address these limitations by using larger and more diverse samples, including a no-intervention group, and standardizing the comparison interventions.
Conclusion
The study provides valuable insights into the outcomes of different types of early intervention for autistic pre-schoolers and their parents in a community-based setting. The study shows that both therapist-delivered and parent-mediated programs are effective in improving the children’s cognitive skills and adaptive behavior, but not in reducing the parents’ stress or improving their wellbeing. The study also calls for more research to understand the mechanisms and moderators of parent-mediated intervention, as well as the additional support that parents may need.
Faq
What is early intervention?
Early intervention is the provision of specialized services and support for young children with developmental delays or disabilities and their families. Early intervention aims to enhance the child’s development, prevent or reduce the impact of the delay or disability, and promote the child’s participation and inclusion in various settings and activities.
Why is early intervention important for children with ASD?
Early intervention is important for children with ASD because it can help them develop their skills and abilities, especially in the areas of social communication and play. Early intervention can also help the children and their families cope with the challenges and needs associated with ASD, and improve their quality of life and wellbeing.
What are the best practices for early intervention for ASD?
The best practices for early intervention for ASD are based on the best available evidence and the consensus of experts and stakeholders in the field. Some of the best practices are:
- Providing early intervention as soon as possible after the diagnosis or identification of ASD, preferably before the age of 3 years.
- Providing early intervention that is individualized, comprehensive, intensive, and family-centered, and that addresses multiple domains of development.
- Providing early intervention that is based on naturalistic developmental behavioral interventions, such as ESDM, which use everyday activities and interactions as the context and the opportunity for learning and development.
- Providing early intervention that involves parents and family members in the delivery and implementation of the intervention, and that supports their knowledge, skills, and wellbeing.
- Providing early intervention that is coordinated and integrated with other services and programs that the child and the family may need or access.
How can parents and family members be involved in early intervention for ASD?
Parents and family members can be involved in early intervention for ASD in various ways, such as:
- Seeking information and advice from professionals and other sources about ASD and early intervention, and making informed decisions about the type, frequency, and duration of the intervention they want for their child.
- Participating in parent-mediated intervention, such as P-ESDM, which involves learning and using specific strategies and techniques with their child at home, under the guidance and support of trained therapists.
- Collaborating and communicating with the professionals who deliver early intervention, such as therapists, teachers, or doctors, and sharing their observations, feedback, and concerns about their child’s progress and needs.
- Advocating and accessing the services and resources that their child and their family may need or benefit from, such as speech therapy, occupational therapy, special education, or financial assistance.
- Taking care of their own mental health, wellbeing, and stress, and seeking help and support from their family, friends, or other sources when needed.
What is the Early Start Denver Model (ESDM)?
The ESDM is a naturalistic developmental behavioral intervention that focuses on social communication and play skills for children with autism spectrum disorder (ASD). It is based on the principles of applied behavior analysis (ABA) and developmental psychology. It can be delivered by therapists or parents in various settings, such as home, clinic, or preschool.
What is parent-coaching ESDM (P-ESDM)?
P-ESDM is a form of parent-mediated intervention that involves teaching parents to use ESDM strategies with their child at home. It aims to enhance the child’s learning opportunities and outcomes by providing consistent and individualized support across different contexts.
What are the main differences and similarities between the ESDM and P-ESDM interventions?
The main differences and similarities between the ESDM and P-ESDM interventions are:
- The differences are:
- The ESDM intervention is delivered by trained therapists in a clinic or preschool setting, while the P-ESDM intervention is delivered by trained therapists and parents in the home setting.
- The ESDM intervention involves 15 hours per week of direct therapy with the child, while the P-ESDM intervention involves 15 hours per week of direct therapy with the child plus 1.5 hours per week of parent coaching.
- The ESDM intervention focuses on the child’s social communication and play skills, while the P-ESDM intervention also focuses on the parent-child relationship and interaction.
- The similarities are:
- Both interventions are based on the same theoretical and empirical framework, which is the naturalistic developmental behavioral intervention (NDBI) approach.
- Both interventions use the same curriculum and materials, which are the ESDM manual and the ESDM fidelity checklist.
- Both interventions have the same objectives and outcomes, which are to improve the child’s cognitive skills and adaptive behavior.
What is usual community services?
Usual community services refer to the range of interventions and programs that are typically available for children with ASD and their families in the community. They may include speech therapy, occupational therapy, special education, or other services that vary depending on the location and availability.
What are the main strengths and weaknesses of the usual community services?
The main strengths and weaknesses of the usual community services are:
- The strengths are:
- They are accessible and available for the families who need them, and may not require a long waiting time or a referral process.
- They are flexible and adaptable to the preferences and choices of the families, and may allow them to select the type, frequency, and duration of the services they want.
- They are diverse and varied, and may offer different options and alternatives for the families, such as speech therapy, occupational therapy, special education, or other programs.
- The weaknesses are:
- They vary widely in terms of their quality, quantity, and content, depending on the location and availability of the services and the preferences and choices of the families.
- They may not be based on the best available evidence or practices for children with ASD and their families, and may not follow the guidelines and recommendations of the field.
- They may not be coordinated or integrated with each other or with the ESDM and P-ESDM interventions, and may create confusion or inconsistency for the families.
Source:
https://link.springer.com/content/pdf/10.1007/s10566-024-09792-x.pdf