Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT.

This pilot RCT compared the effect of a self-directed and therapist-assisted telehealth-based parent-mediated intervention for young children with ASD. Families were randomly assigned to a self-directed or therapist-assisted program. Parents in both groups improved their intervention fidelity, self-efficacy, stress, and positive perceptions of their child; however, the therapist-assisted group had greater gains in parent fidelity and positive perceptions of child. Children in both groups improved on language measures, with a trend towards greater gains during a parent-child interaction for the therapist-assisted group. Only the children in the therapist-assisted group improved in social skills. Both models show promise for delivering parent-mediated intervention; however, therapist assistance provided an added benefit for some outcomes. A full-scale comparative efficacy trial is warranted.

A comparison of developmental social-pragmatic and naturalistic behavioral interventions on language use and social engagement in children with autism.

PURPOSE: Developmental social-pragmatic and naturalistic behavioral interventions share a number of features, but they differ in their use of facilitative strategies and direct elicitation of child language. In this study, the authors investigated whether these approaches produce different language and social outcomes in young children with autism. METHOD: The authors used an ABACAD design to compare the effects of a developmental social-pragmatic, naturalistic behavioral, and combined intervention on language type and function and social engagement in 5 children with autism. RESULTS: Milieu teaching and the combined intervention produced higher rates of language targets than did responsive interaction. An analysis of the type and function of language targets suggested that differences between conditions were driven primarily by prompted-and, to a lesser extent, spontaneous-requests. Social engagement ratings were higher during each intervention than at baseline, but differences between treatment conditions were not consistent across children. CONCLUSIONS: For children with autism, naturalistic interventions that use direct elicitation of child language lead to greater short-term gains in the use of expressive language targets-in particular, prompted requests-than interventions that use facilitative strategies only. All 3 naturalistic language interventions can promote social engagement. For some children, the combined use of direct elicitation and responsiveness-based strategies may enhance treatment response.