Parent-implemented AAC verb symbol intervention with children with ASD.

A multiple-probe across participants design was used to examine whether three young children diagnosed with autism spectrum disorder (ASD) could learn to use verb symbols presented on an AAC application to request actions. Using researcher coaching (involving joint planning, descriptive instructions, and guided practice) parents of participants were taught to (a) embed opportunities for children to request actions in daily home routines, (b) model AAC responses, (c) use a prompt hierarchy with a time delay, and (d) contingently reinforce correct aided AAC responses. Following intervention delivered by parents, all three participants increased their use of verb symbols to request actions and parents implemented procedures with high fidelity. There were, however, individualized differences in rate of acquisition, variability of responding, readiness for fading supports, and moving to more advanced skills. One of the three participants was able to master two-step responses involving navigation to a category folder. Generalization of requesting actions to labeling actions was limited.

Parent coaching increases conversational turns and advances infant language development.

Parental language input is one of the best predictors of children's language achievement. Parentese, a near-universal speaking style distinguished by higher pitch, slower tempo, and exaggerated intonation, has been documented in speech directed toward young children in many countries. Previous research shows that the use of parentese and parent-child turn-taking are both associated with advances in children's language learning. We conducted a randomized controlled trial to determine whether a parent coaching intervention delivered when the infants are 6, 10, and 14 mo of age can enhance parental language input and whether this, in turn, changes the trajectory of child language development between 6 and 18 mo of age. Families of typically developing 6-mo-old infants (n = 71) were randomly assigned to intervention and control groups. Naturalistic first-person audio recordings of the infants' home language environment and vocalizations were recorded when the infants were 6, 10, 14, and 18 mo of age. After the 6-, 10-, and 14-mo recordings, intervention, but not control parents attended individual coaching appointments to receive linguistic feedback, listen to language input in their own recordings, and discuss age-appropriate activities that promote language growth. Intervention significantly enhanced parental use of parentese and parent-child turn-taking between 6 and 18 mo. Increases in both variables were significantly correlated with children's language growth during the same period, and children's language outcomes at 18 mo. Using parentese, a socially and linguistically enhanced speaking style, improves children's social language turn-taking and language skills. Research-based interventions targeting social aspects of parent-child interactions can enhance language outcomes.

Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review.

Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.

Parent Coaching in Early Intervention for Autism Spectrum Disorder: A Brief Report.

Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers' use of parent coaching in an early intervention system. Twenty-five early intervention sessions were coded for fidelity to established caregiver coaching techniques. We found low use of coaching techniques overall, with significant variability in use of coaching across providers. When providers did coach caregivers, they used only a few coaching strategies (e.g., collaboration and in-vivo feedback). Results indicate that targeted training and implementation strategies focused on individual coaching components, instead of coaching more broadly, may be needed to improve the use of individual coaching strategies. A focus on strengthening the use of collaboration and in-vivo feedback may be key to improving coaching fidelity overall.

Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems.

PURPOSE: Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS: Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS: Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION: These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.

The Effects of Telehealth Parent Coaching on Occupational Performance and Executive Function of Children with Attention-Deficit/Hyperactivity Disorders, and Parent Self-Efficacy: A Preliminary Study.

This study examined the effectiveness of telehealth parent coaching on occupational performance and executive functions of children with attention-deficit/hyperactivity disorders (ADHD) and executive function deficits and parent self-efficacy. A one group pretest-posttest design was implemented with nine parents of children with ADHD ages 7-12 years old. The intervention consisted of ten, 60-minute, individual sessions, one per week delivered via telehealth. The parent program had three coaching components: goal setting, education, and the problem-solving process. Using strategies from the Four-Quadrant Model of Facilitated Learning, the results showed statistical improvement in performance and satisfaction of occupational performance and all executive functions scores of children except for the Shift and Emotional Control. Parent self-efficacy was also improved. These preliminary results suggest that the telehealth parent coaching program may potentially support a family who has a child with ADHD and executive function deficits.

Parents' New Role and Needs During the COVID-19 Educational Emergency.

This article contributes to the on-going discussion of parental involvement in the education of children, with emphasis on new and unfamiliar roles of parents during the COVID-19 pandemic. The case study undertaken focuses on parents of first graders who belong to non-vulnerable and vulnerable social groups, and the first-grade teachers of a public primary school in the north of Greece. Research questions address the experience of 'parents-teachers', the need for technological tools and the required digital literacy, as well as the impact of homeschooling on the wellbeing of the family unit. Data were collected using semi-structured individual interviews. The data analysis shows that parents of both social groups took on the role of the teacher to accommodate the learning challenges of first graders. Mothers from vulnerable groups, in particular, encountered various challenges when attempting to support their children mainly in language lessons. Regarding the use of new technologies, the pandemic found parents of both groups unprepared and unfamiliar with the process of distance education. Stress and worry were the dominant emotions from the very start of homeschooling during the early stages of the pandemic while towards the end of the first lockdown, exhaustion overwhelmed parents and pupils. The article concludes with emphasizing the importance of active parental involvement and coaching that enables parents to contribute substantially to their children's education in emergency situations.

Parent coaching at 6 and 10 months improves language outcomes at 14 months: A randomized controlled trial.

Previous studies reveal an association between particular features of parental language input and advances in children's language learning. However, it is not known whether parent coaching aimed to enhance specific input components would (a) successfully increase these components in parents' language input and (b) result in concurrent increases in children's language development. The present randomized controlled trial assigned families of typically developing 6-month-old infants to Intervention (parent coaching) and Control (no coaching) groups. Families were equivalent on socioeconomic status, infants' gender, and infants' age. Parent coaching took place when infants were 6 and 10 months of age, and included quantitative and qualitative linguistic feedback on the amount of child-directed speech, back-and-forth interactions, and parentese speech style. These variables were derived from each family's first-person LENA recordings at home. Input variables and infant language were measured at 6, 10, and 14 months. Parent coaching significantly enhanced language input as measured by two social interaction variables: percentage of speech directed to the child and percentage of parentese speech. These two variables were correlated, and were both related to growth in infant babbling between 6 and 14 months. Intervention infants showed greater growth in babbling than Control infants. Furthermore, at 14 months, Intervention infants produced significantly more words than Control infants, as indicated by LENA recordings and parent report via the MacArthur-Bates Communicative Developmental Inventory. Together, these results indicate that parent coaching can enrich specific aspects of parental language input, and can immediately and positively impact child language outcomes. A video abstract of this article can be viewed at: https://youtu.be/7wqR28gPiwo.

Feasibility of parent communication training with remote coaching using smartphone apps.

BACKGROUND: Communication training for parents of young children with neurodisability is often delivered in groups and includes video coaching. Group teaching is problematic when there is wide variation in the characteristics and needs amongst participants. AIMS: To assess the potential feasibility and acceptability of delivering one-to-one parent training supported by remote coaching using smartphone apps and of conducting further trials of the intervention. METHODS & PROCEDURES: We aimed to recruit eight children aged 12-48 months with motor disorders and communication difficulties and to provide families with individual parent training in six weekly home visits supplemented by remote coaching via smartphone apps. For outcome measurement, parents recorded their interaction with their child thrice weekly during baseline (3 weeks), intervention, post-intervention (3 weeks) and follow-up (1 week). Measures comprised parent responsiveness and counts of children's communication and vocalization. Research design feasibility was measured through rates of recruitment, attrition, outcome measure completion and agreement between raters on outcome measurement. Intervention feasibility was assessed through the proportion of therapy sessions received, the number of videos and text messages shared using the apps in remote coaching, and message content. Parents were interviewed about the acceptability of the intervention and trial design. Interviews were transcribed and analyzed using inductive thematic analysis. OUTCOMES & RESULTS: Nine children were recruited over 16 weeks. All fitted the inclusion criteria. Four families withdrew from the study. Five families completed the intervention. No family submitted the target number of video recordings for outcome measurement. Interrater agreement was moderate for child communication (K = 0.46) and vocalization (K = 0.60) and high for The Responsive Augmentative and Alternative Communication Style scale (RAACS) (rs = 0.96). Parents who completed the intervention reported positive experiences of the programme and remote coaching via the apps. Therapist messages via the app contained comments on parent and child behaviour and requests for parental reflection/action; parental messages contained reflections on children's communication. CONCLUSIONS & IMPLICATIONS: The intervention and study design demanded high levels of parental involvement and was not suitable for all families. Recording shorter periods of interaction via mobile phones or using alternative methods of data collection may increase feasibility of outcome measurement.

Content Validity of the Parentship Protocol: A Multidimensional Intervention for Parents of Adolescents with High-Functioning Autism Spectrum Disorder.

The Parentship protocol is a short-term intervention program in occupational therapy for parents of adolescents with High-Functioning Autism Spectrum Disorder (HFASD). Its purpose is to promote parental resilience and enhance adolescents' participation in daily life. Aims: To explore and analyze the perceptions of occupational therapists and parents of individuals with HFASD, regarding the content of the protocol and its theoretical framework. Methods: Implementation of a phenomenological qualitative approach using two focus groups (six occupational therapists and five parents). A transcript-based analysis was used for analyzing the data. Results: The degree of agreement regarding the potential purposes and contents of the protocol was high. In addition, nine themes were raised and led to changes and additions in the protocol. Conclusions: The study provided support for content validity and acceptability of the Parentship protocol. Future research should test the feasibility of this new intervention program.

New Therapy for a New Normal: Comparing Telehealth and in-Person Time-Limited Parent-Child Interaction Therapy.

Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (N = 380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.

'I wouldn't want one or the other': Understanding parents' preferences for direct support or parent coaching for young autistic children.

LAY ABSTRACT: Professionals often support autistic children by working with them directly (direct support) or by coaching their parents. We know a lot about what parents think about parent coaching, but we do not know as much about what they think about direct support. We also do not know whether parents prefer parent coaching or direct support. The current study involved 22 parents who each received 2 h a week of direct support for their autistic child and up to 1 h a week of parent coaching for 6 months. At the end of 6 months, all these parents indicated in a survey whether they preferred parent coaching or direct support. Eleven of these participating parents also chose to take part in an interview to understand more about these preferences. Our findings suggest that parents generally liked both supports and believed they worked well together; however, they preferred direct support over parent coaching. While parents think that both approaches are beneficial, there are strengths and challenges of each. These findings emphasise the importance of parent choice in the delivery of support. It may also be possible to adapt both approaches to address some of the identified challenges and improve the whole family's experience.

Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial.

Background: Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children. Methods: This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2-3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1-4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529. Findings: From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, ηp 2 = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support. Interpretation: A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited. Funding: Emerging Researcher First Grant from the Health Research Council of New Zealand.

Field Testing the Family Behavior Support Mobile Application (FBSApp) During a Global Pandemic.

We developed and tested an evidence-based mobile application designed to support families in using functional assessment-based intervention strategies with their young children with disabilities and challenging behaviors in home settings. Five families participated in the study. We utilized a multiple-probe across participants design to examine the effects of the FBSApp on parents' use of intervention strategies and childrens' use of challenging behaviors and replacement behaviors. We adapted our procedures to include individualized coaching to provide meaningful and effective support after the onset of the COVID-19 pandemic. A functional relation was not identified between access to FBSApp and caregiver use of strategies; however, the addition of coaching did lead to increased strategy use for two of four caregivers. A functional relation was identified between the use of the FBSApp plus coaching and CB. Families reported the app and coaching procedures favorably. We found that responsive, family-centered research CAN be conducted in spite of significant history events, and that mobile apps and virtual meeting platforms can be an accessible and efficient method for supporting families. The use of single case design allowed for flexible, yet methodologically sound procedures. More work is needed examining effective and efficient virtual supports for families.

Parent coaching to enhance community participation in young children with developmental disabilities: A pilot randomized controlled trial.

BACKGROUND: Parent coaching emerges as a preferred approach for enhancing performance and participation of children with developmental disabilities (DD), but limited clinical trials examine its effects on community participation. AIM: To evaluate whether parent coaching, specifically using Occupational Performance Coaching (OPC), enhances community participation among young children with DD. METHOD AND PROCEDURES: A pilot double-blind randomized controlled trial was conducted. Parents of 50 children with DD (31 male, 19 female, mean age 4 years 10 months) were randomly assigned to the OPC group (n = 25) or parent consultation group (n = 25). Each parent received a maximum of eight coaching sessions or consultations. The primary outcome was children's community participation as assessed through parent-report measures at baseline, pre-intervention, post-intervention, and an 8-week follow-up. OUTCOMES AND RESULTS: Both groups showed significant improvements in parent-identified, goal-specific community participation after the intervention (mean difference [MD]=2.26-2.56), and these improvements were sustained during the follow-up. Despite a trend favoring parent coaching, the group difference in the improvements was not evident (MD=0.18-0.28). Both groups displayed positive improvements in children's overall community involvement post-intervention (MD=0.32); however, the time effects were not statistically significant. CONCLUSIONS AND IMPLICATIONS: OPC, by coaching parents, could enhance goal-specific community participation in children with DD, producing effects similar to those achieved through parent consultation.

Building Better Bridges: Outcomes of a Community-Partnered New School Transition Intervention for Students on the Autism Spectrum.

New school transitions can be challenging for students on the autism spectrum. No published, evidence-based interventions exist to support families and teachers of students transitioning to elementary and secondary school during this critical period. Using Community Partnered Participatory Research, we developed Building Better Bridges (BBB), a caregiver coaching intervention that includes training on effective school communication, educational rights, advocacy, and child preparation strategies. We compared BBB (n = 83) to a module/resources-only comparison (n = 87) in a four-site randomized controlled trial in racially and ethnically diverse, under-resourced communities. In our intent-to-treat analysis, caregivers and teachers in BBB rated students' transitions to the new classroom as more positive, relative to the comparison group. Results suggest this low-cost intervention can improve the transition process for families and students at high risk of poor transitions.

The Efficacy of a Culturally-Adapted Group-based Parent Coaching Program for Autistic Children in China via Telehealth: A Randomized Controlled Trial.

The study aimed to examine the efficacy of a culturally-adapted, group-based parent coaching program for autistic children in China delivered via telehealth. A randomized controlled trial was conducted, with 18 parents allocated to the self-directed group that received the intervention through an online learning platform, and 19 parents allocated to the web + group therapy group, which included the same program along with weekly 1.5-hour group coaching sessions via videoconferencing. The primary outcomes were parents' mental health and children's adaptive functioning, while the secondary outcomes focused on the child behaviors, parenting stress and parenting style, and family quality of life. Linear Mixed Models were used to evaluate treatment effects across time and to model longitudinal trajectories of outcomes in both children and parents. Both intervention groups showed significant improvements in children's communication skills (F (1, 60.27) = 29.86, p < 0.001) and social engagement (F (1, 60.07) = 11.73, p = 0.001), as well as reductions in parenting stress (F (1, 59.07) = 8.76, p = 0.004) and anxiety levels (F (1, 57.62) = 4.84, p = 0.032). Additionally, the group-based parent coaching via videoconferencing was associated with greater improvements in children's quality of life (F (1, 59.95) = 5.90, p = 0.018) and parents' anxiety outcomes (F (1, 57.62) = 4.84, p = 0.032). This study demonstrated the efficacy of a culturally adapted telehealth intervention for both autistic children and their parents. The preliminary findings suggest positive outcomes in children's adaptive functioning and parents' mental well-being. Group-based parent coaching through videoconferencing could be a promising and practical model for in-home services, particularly for families with limited access to in-person services.

A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka.

LAY ABSTRACT: Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2-4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent-child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children's overall development need to be looked into using larger and more generalised studies.

Effectiveness of parent coaching on the literacy skills of Hong Kong Chinese Children with and without dyslexia.

Literacy skills are important for children's development. The present study explored the effectiveness of a parent coaching approach on the reading and spelling skills and compared cognitive-linguistic skills performances between Chinese children with and without dyslexia. Participants were 33 children with dyslexia and 77 children without dyslexia, as well as their parent, in Hong Kong. Children were divided into three groups: dyslexia with training, non-dyslexia with training, and non-dyslexia without training. Parents in both training groups were instructed to facilitate children's literacy skills. A series of cognitive-linguistic skills were tested on children at pretest. Children received measures of character reading, word reading, and word spelling before and after the parent coaching. Results showed that, compared to children without dyslexia, children with dyslexia performed significantly more poorly on all cognitive-linguistic skills. Analyses of the training effect demonstrated that the dyslexia with training group significantly improved their performances on word reading and word spelling following the intervention. In addition, those without dyslexia who experienced training performed significantly better on character reading and word spelling at posttest than pretest. These results suggest that parent coaching can be one potentially effective method of promoting literacy skills among children both with and without dyslexia.

The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum.

LAY ABSTRACT: Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.