Solomon R., Van Egeren, L. A., Mahoney, G., Quon Huber, M. S., & Zimmerman, P. (2014). PLAY project home consultation intervention program for young children with autism spectrum disorders: A randomized control trial. Journal of Developmental & Developmental Pediatrics, 35(8), 475-485.
Reviewed by Antonia R. Giannakakos
Caldwell University
Why research this topic?
Many children with ASD have difficulty in the area of social communication. Previous research has shown that early intensive intervention is effective in improving outcomes and decreasing skill deficits in this area. Intensive intervention can be very costly and there may be a shortage of trained personal to administer treatment. The authors suggest that a parent-mediated intervention may provide a more affordable alternative.
What did the researcher do?
The present study was a randomized clinical trial (RCT) that evaluated the effects of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation program in combination with usual community services (CS) as compared to CS services only. PLAY is based on Greenspan and Wieder’s developmental, individual-difference, relationship (DIR) model, commonly called Floortime. One hundred and twenty-eight families with children ages 3-5 participated in the study. The children were randomly placed in either a group that received CS only or a group that received PLAY+CS. In the PLAY + CS group, consultants trained in the PLAY program provided each parent with training on how to play one-on-one with their child and provide appropriate developmental challenges. In the CS group children received special education public school services. Assessments were conducted before and after treatment, on parent stress and depression, parent-child interactions, and each child’s social and communication behaviors. The results of these assessments were used to evaluate if changes occurred in the communication and social skills of the children in each group.
What did the researchers find?
Overall 54.3% of children in the PLAY + CS group and 32.6% of children in the CS only group showed improvement in social and communication skills according to the ADOS-G (Autism Diagnostic Observation Schedule – Generic; Lord, Rutter, & LeCouteur, 1995). The ADOS-G is a standardized test that assesses social and communication skills. The remaining children in each group showed either no change in social and communication skills or a decline (CS-5%, PLAY-4%). The PLAY + CS group also showed larger improvements than the CS group on behavior observations of parent-child interaction, but not on standardized tests of cognitive or language skills. The parent measures indicated that parental stress and depression reduced over time regardless of what treatment their child received.
What are the strengths and limitations of the study?
One strength of this research was the use of a standardized assessment for measuring the effects of the PLAY + CS or CS alone on the social and communication skills of the children in the study. The use of these measurements administered by outside practitioners provides a more objective measure of the children’s skills. A significant limitation is that children in the PLAY+CS group received an average of 732 hours of intervention during the course of the study as opposed to children in the CS group who received only 101.87 hours. This biases the results toward the intervention with most hours, preventing a conclusion that PLAY + CS is really more effective than CS only. Another limitation is that the authors did not provide enough detail on the components of the PLAY program to allow full evaluation of its procedures, and a written manual of the program has not been developed.
What do the results mean?
This is the third RCT to show benefits from parent training in DIR. The first two studies were pilot studies. The current study is a larger, more definitive test and indicates that more children in the PLAY + CS group showed improvement in their social and communication skills than in the CS only group. However, the study is limited by the absence of detail about the intervention and the much larger number of treatment hours given to the PLAY + CS than to the CS group. Based on the available research, parent training in DIR may be considered possibly efficacious, but additional research is still needed to draw clear conclusions about this intervention.
Reference
Lord, C., Rutter, M., & Le Couteur, A. (1995). Autism Diagnostic Observation Schedule (ADOS) Manual. Los Angeles, CA: Western Psychological Services.
Citation for this article:
Giannakakos, A. R. (2015). Research review: PLAY project home consultation intervention program for young children with autism spectrum disorders: A randomized control trial. Science in Autism Treatment, 12(3), 41-42.
