Green, J., Charman, T., Pickles, A., Wan, M. W., Elsabbagh, M., Slonims, V., … Jones, E. J. (2015). Parent-mediated intervention versus no intervention for infants at high risk of autism: A parallel, single-blind, randomised trial. The Lancet Psychiatry, 2(2), 133-140.
Reviewed by: Eileen M. Milata
Caldwell University
Why research this topic?
Studies have found that infants who have an older sibling with autism spectrum disorder (ASD) are also likely to develop ASD, and other social and communication disorders. The characteristics linked to a later diagnosis of ASD during an infant’s first year of life are lack of attention to parent, poor eye contact with others, and difficulty shifting eye gaze between objects. During the infant’s second year of life, the child may have challenges with visual attention skills and have more behavior issues than a toddler of typical development. The purpose of this study was to test whether early intervention to improve parent interaction and attention skills with infants at high-risk of ASD could reduce early signs of ASD and the risk of later ASD.
What did the researcher do?
The researchers compared a parent-mediated intervention to no intervention for 54 infants at high risk of ASD, ages 7-10 months. Twenty-eight infants and their parents received intervention, and 26 did not. The intervention was a modification of the Video Interaction to Promote Positive Parenting (VIPP) program. The VIPP used video feedback to help parents understand and learn their child’s communication style, and then improve their child’s social and communication skills. To measure infant attentiveness to parents, the researchers used the Manchester Assessment of Caregiver-Infant Interaction (MACI). An eye tracker system measured the infants’ shift in attention between objects. An event-related-potential to speech sounds (ERP) paradigm measured whether they attended to speech sounds. Three standardized assessments were also used: a test of infants’ early motor, language, and cognitive development, and parent reports of adaptive behavior (i.e.., motor, communication, socialization, and daily living skills) and communication (vocabulary and gestures). The researchers then used a statistical procedure to combine the measures into eleven independent domains: infant attention to parent, infant affect, caregiver sensitive responding, caregiver interactions, parent-child mutual responsiveness, receptive skills, expressive skills, gestures, communication, socialization, visual attention skills, and recognizing unfamiliar speech sounds. They then compared change on these measures in the intervention and no-intervention groups.
What did the researchers find?
The researchers found that, compared to no intervention, the intervention increased infant attentiveness to parents, improved shifting attention between objects, reduced autism-risk behaviors, and enhanced parent-child interactions. Parents who received the intervention reported a positive change in their child’s adaptive behaviors but a possible reduction in communication. The intervention and no -intervention groups did not differ on vocabulary scores, responsiveness to language sounds, or language development.
What are the strengths and limitations of the study?
An important strength of this study is that it is the first randomized control trial study that examined an intervention beginning under 1 year in infants at high risk of developing ASD. Data showed a reduction in ASD-related behaviors, suggesting this intervention may prevent the short-term emergence of these behaviors during the child’s early development and improve brain functioning. However, there are also a few limitations to the study. The participating families were self-referrals or clinic referrals and earned an above average annual household income. This makes it unclear whether researchers could replicate this study with a broader population and range of clinical settings, and still find similar results. Also, the sample size of this study was small for a randomized trial, so these findings should be interpreted with caution before making any definitive conclusions.
What do the results mean?
Overall, infants made gains in attentiveness to parents following parent-mediated intervention. This suggests that the VIPP program is a promising intervention for infants at high risk for ASD to reduce the early characteristics and risk for later ASD. Replications are needed to confirm the findings and determine the applicability of the VIPP program to diverse families in varying clinical settings.
Citation for this article:
Milata, E. (2017). Research synopses: Effect of parent training vs. parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. Science in Autism Treatment, 14(4), 23-24.
