Kasari, C., Lawton, K., Shih, W., Barker, T. V., Landa, R., Lord, C.,…Senturk, D. (2014). Caregiver-mediated intervention for low-resourced preschoolers with autism: An RCT. Pediatrics. doi: 54.5986/peds., 6457-3229.
Reviewed by: Casey L. Nottingham
Caldwell University
Why research this topic?
Previous research evaluating interventions targeting behaviors characteristic of autism spectrum disorders (ASDs) may under-represent low income families. A number of barriers (e.g., location, travel expenses, work schedules) may make it difficult for caregivers in these families to participate in research and implement interventions. The purpose of the current study was to compare two interventions that were designed to be more accessible to low-income caregivers. Both interventions focused on improving joint attention, play skills, and engagement with caregivers.
What did the researcher do?
The researchers in this study compared participants who were randomly placed into one of two intervention groups: the Caregiver-Mediated Module or the Caregiver Education Model. Participants were between the ages of 2 and 5 years, were diagnosed with ASD, and were classified as low-resourced based on having a primary caregiver who
- had a high school diploma or lower,
- was unemployed, or
- was receiving government assistance (e.g., Medicaid).
147 families were initially recruited for participation and 112 of these families entered the intervention phase of the study. The researchers randomly assigned families to one of the two treatment conditions. In both conditions, the intervention targeted social engagement, play skills, and other daily activities in the context of child-led play activities by using Caregiver-Mediated Module or Caregiver Education Model. Caregiver-Mediated Module is a treatment model in which caregivers were coached by the researchers to provide intervention to their children, based on a manualized treatment plan. In the Caregiver-Mediated Module group, the intervention took place in two, 1- hour treatment sessions each week for 12 weeks. During these sessions, the researchers directly coached caregivers as they provided intervention to the child. The researchers taught new skills each week to the caregivers.
Caregiver Education Model is a treatment model in which caregivers are also coached to provide intervention to their children, but in small group settings and without their children being present. In the Caregiver Education Model group, caregivers attended 2-hour group sessions each week without the child present; these sessions covered the same content as Caregiver-Mediated Module sessions and were also based on a manualized treatment plan. The researchers made an effort to make these treatment plans accessible to the families by holding sessions in the families’ homes and neighborhoods and by working within the families’ preferred dates and times, and in their preferred language.
What did the researchers find?
The researchers looked at changes in child engagement, joint attention, and play skills following the interventions and compared changes in these skills between the two intervention groups. For engagement and joint attention, they found that both groups improved, but that the improvements in the Caregiver-Mediated Module group surpassed the improvements in the Caregiver Education Model group. These improvements were maintained when assessed again three months later. For play skills, the researchers found that children in neither group showed improvements in play skills following intervention.
What are the strengths and limitations of the study?
One strength of this study was that the researchers included participants and families who have been previously underrepresented in research on interventions for children with ASD. Additionally, the researchers evaluated interventions with caregivers themselves providing intervention to the children. Because caregivers spend extended time with their children, greater improvements may be possible if caregivers are effectively trained to provide intervention. Another strength of this study was that intervention occurred in the participants’ homes rather than in clinical settings and targeted specific skill deficits that are typically characteristic of ASDs. A final strength of this study is that the characteristics of the two groups were similar with regard to the participants’ ages, gender, ethnicity, history of receiving intervention prior to the study, as well as caregivers’ education level, income, and receipt of government assistance.
Several limitations to the study and the findings also exist. Despite the researchers’ attempts to increase the accessibility of the treatment, 35 families dropped out before participating in coaching, although almost all families who started intervention ultimately completed the study. It would be important to understand the reasons for the high dropout rate at the beginning of the study and to identify strategies that would reduce this problem. For example, families may have dropped out of the study because they did not find the treatments acceptable, were unable to travel to group sessions, or were unable to schedule time to participate. Additionally, little improvements were found in play skills with these interventions, suggesting a need for additional work on how to promote play skills children with ASD. Also, data were not obtained on caregivers continuing to provide intervention on their own and whether they could apply the intervention techniques to teach other skills to their children.
What do the results mean?
Overall, the findings suggest that, if appropriately designed, caregiver-mediated intervention can be effective for low-resourced caregivers and their children, particularly if the intervention involves a “hands-on” approach in which professionals provide direct coaching to caregivers as they teach their children.
Citation for this article:
Nottingham, C. L. (2015). Caregiver-mediated intervention for low-resourced preschoolers with autism. Science in Autism Treatment, 12(1), 16-17.
