Siller, M., Hutman, T., & Sigman, M. (2013). A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: A randomized clinical trial. Journal of Autism and Developmental Disorders, 43(3), 540-555.
Reviewed by: Shin Er Teh, Doctoral Student, and Robert H. LaRue, PhD, BCBA-D, Rutgers, The State University of New Jersey
Why research this topic?
Research has demonstrated that responsive parental behaviors, which include being responsive to the child’s attention and activity during toy play, is predictive of long-term language outcomes in children with autism spectrum disorder (ASD). While similar findings have been identified for children with low birth weight, early developmental delay, Down Syndrome, and Fragile X syndrome, strategies that could enhance responsive parental behaviors have received limited attention. In the current investigation, the authors conducted a randomized clinical trial to evaluate the effects of Focused Playtime Intervention (FPI). The authors posed the following questions: 1) Does FPI increase parental responsiveness and child’s expressive language abilities; 2) Will parents’ baseline insightfulness and child’s baseline expressive language impact FPI’s treatment efficacy; and 3) Will the short-term gains of parental response through FPI predict FPI’s treatment effects on the child’s long-term language outcomes?
What did the researchers do?
Seventy children diagnosed with ASD participated in the current investigation (average age = five years). Children’s mothers participated in all assessment and intervention sessions. The parents were randomly assigned into two comparison groups: the experimental condition and the control condition. Those in the experimental group received three sessions of Parent Advocacy Coaching (PAC), a parent education program designed to help parents effectively advocate for their young child with ASD. In addition, participants in the experimental group received FPI. FPI is a 12-week, in-home training program delivered by trained graduate and postdoctoral students in developmental psychology and counseling programs. Parents in the control group were invited to four sessions of PAC.
For both control and experimental groups, assessments were conducted in the research labs and at participants’ homes to evaluate: 1) the child’s nonverbal cognitive and language abilities; 2) the child’s response to bids for attention; 3) the mother’s insightfulness, defined as the ability to describe the child’s “thoughts, feelings and behaviors in a rich, nuanced and accepting way;” and 4) the mother’s responsive parental communication (i.e., maternal synchronization; Siller and Sigman, 2002, 2008). One of the measures was the Insightfulness Assessment, a semi-structured interview based on videos of specific mother-child interactions. All assessments were conducted prior to the start of intervention (baseline), immediately after intervention ended (exit) and 12 months after intervention (follow-up).
What did the researchers find?
For parents who received the 12-week FPI intervention, only mothers classified as insightful at baseline saw improvement in their maternal synchronization. The intervention did not have an impact on mothers classified as non-insightful at baseline. This suggests that FPI intervention is moderated by mother’s baseline insightfulness. Interestingly, although insightful mothers in the experimental group benefited from FPI, insightful mothers in the control group did not benefit from the 4-week PAC intervention and even showed a decline in their post-treatment maternal synchronization. Results also suggested that for children who entered the study with expressive language skills below 12 months, FPI contributed partially to the children’s subsequent language gains.
What are the strengths and limitations of the study?
An important strength of this study is that the children were assessed after intervention and also at a 12-month follow-up, which allowed the researchers to evaluate the longitudinal effect of the intervention. A second strength is that the researchers randomly assigned the parent-child dyads into groups and made sure those groups were equivalent in terms of child’s gender, age, skill level before intervention, and parental education and socioeconomic status.
Regarding limitations, the intensity of services differed significantly between the experimental and control conditions (12 sessions for FPI vs. four sessions for PAC). Thus, increased clinical attention alone could have possibly contributed to the treatment effects identified. Secondly, a few underlying causal mechanisms were suggested as potentially confounding the results. For example, children with lower baseline language skills often suffer from more severe deficits in social communication or repetitive behaviors, which are all factors that impede the acquisition of expressive language. Also, parental insightfulness classifications were based on parents’ interactions with the children. The child’s age could potentially influence the parent’s skillfulness in interacting with the child, i.e., the older the child, the better the parent is at being insightful.
What do the results mean?
Overall, the researchers discovered that FPI significantly improved responsive parental behavior among insightful mothers but not among non-insightful mothers. However, insightfulness itself did not guarantee improvement in parental behavior. Insightful parents in the control condition (PAC-only) showed a decrease in responsive parental behavior, indicating that unless responsive parental behaviors are cultivated and encouraged by the child’s intervention team, even insightful parents may shift to a more adult-directed interactive style. Therefore, parent intervention should utilize a capacity-building approach that aims to engage parents to be active participants in the intervention process. Increasing responsive parental behaviors may be particularly effective during early stages of development. Finally, given that baseline parental insightfulness and baseline child’s language ability both influenced outcomes of FPI, future research should identify additional factors that indicate who a given intervention may be appropriate for and how it may benefit development.
Citation for this article:
Teh, S. E., & LaRue, R. (2019). Research synopsis: A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD. Science in Autism Treatment, 16(6).
