Parent Engagement With a Telehealth-Based Parent-Mediated Intervention Program for Children With Autism Spectrum Disorders: Predictors of Program Use and Parent Outcomes.

BACKGROUND: There has been growing interest in using telehealth to increase access to parent-mediated interventions for children with ASD. However, little is known about how parents engage with such programs. OBJECTIVE: This paper presents program engagement data from a pilot study comparing self-directed and therapist-assisted versions of a novel telehealth-based parent-mediated intervention for young children with autism spectrum disorders (ASD). METHODS: Parents of young children with ASD were randomly assigned to receive a self-directed or therapist-assisted version of ImPACT Online. Parent engagement and satisfaction with the different components of the program website were examined using the program's automated data collection and a post-treatment evaluation survey. We examined the relationship between program engagement and changes in parent knowledge and implementation and participant characteristics associated with program engagement. RESULTS: Of the 27 parent participants, the majority were female (26/27, 96%), married (22/27, 81%), with a college degree or higher (18/27, 66%), and less than half were employed outside of the home (10/27, 37%). The mean chronological age of the child participants was 43.26 months, and the majority were male (19/27, 70%) and white (21/27, 78%). Most of the families (19/27, 70%) resided in a rural or medically underserved area. Parents logged into the website an average of 46.85 times, spent an average of 964.70 minutes on the site, and completed an average of 90.17% of the lesson learning activities. Participants in the therapist-assisted group were more likely to engage with the website than those in the self-directed group: F2,24=17.65, P<.001. In total, 85% of participants completed the program, with a significantly greater completion rate in the therapist-assisted group (N=27): χ(2) 1=5.06, P=.03. Lesson learning activities were visited significantly more often than the supplemental activities (all Ps<.05). Multiple regression controlling for pretreatment performance indicated that program completion (beta=.51, P=.02) predicted post-treatment intervention knowledge, and program completion (beta=.43, P=.03) and group assignment (beta=-.37, P=.045) predicted post-treatment intervention fidelity. Partial correlations indicated that parent depressive symptoms at pretreatment were negatively associated with program completion (r=-.40, P=.04), but other key parent and child demographic factors were not. Post-treatment measures of website usability (r=.65, P<.001), treatment acceptability (r=.58, P=.002), and overall satisfaction (r=.58, P=.002) were all related to program completion. CONCLUSIONS: Parent engagement and satisfaction with ImPACT Online was high for both self-directed and therapist-assisted versions of the program, although therapist assistance increased engagement. Program completion was associated with parent outcomes, providing support for the role of the website in parent learning. This program has the potential to increase access to parent-mediated intervention for families of children with ASD.

Applying a User-Centered Design Framework to Develop a Remote Research Assessment Protocol for a Randomized Clinical Trial for Toddlers with Early Autism Characteristics.

COVID-19 required many research teams to shift from in-person to remote assessments, which posed both procedural and theoretical challenges. While research has explored the utility of remote assessments for autism diagnosis from the perspective of families and clinicians, less is known about their application in clinical trials. This paper describes the development of a remote research assessment protocol for a randomized clinical trial focusing on the implementation of reciprocal imitation teaching (RIT) with toddlers in Part C early intervention. This project spans two phases. For Phase 1, our team developed and documented a series of steps utilizing user-centered design (UCD) strategies (e.g., recruiting potential users, creating a prototype, engaging in iterative development) for the purpose of redesigning an assessment protocol for a remote environment. For Phase 2, we examined preliminary outcomes of the redesign process. Primary end users (assessors) rated post-redesign usability and acceptability, while acceptability was examined using attrition data from secondary end users (family participants). Preliminary fidelity of implementation was also examined. The iterative redesign process allowed the research team to refine aspects of the assessment that ultimately led to promising preliminary ratings of usability, acceptability, and feasibility, as well as high fidelity. Preliminary data suggest that the redesigned assessment appears to be an acceptable, feasible, and usable tool for autism clinical trial research and that assessors can use it with fidelity. Further research is needed to examine the reliability and validity of the assessment, as well as implementation characteristics on a larger scale.

Characterizing Available Tools for Synchronous Virtual Assessment of Toddlers with Suspected Autism Spectrum Disorder: A Brief Report.

The COVID-19 pandemic, and associated social distancing mandates, has placed significant limitations on in-person health services, requiring creative solutions for supporting clinicians engaged in the diagnosis of autism spectrum disorder (ASD). This report describes the five virtual instruments available at the time of manuscript development for use by experienced clinicians making diagnostic determinations of ASD for toddlers across the 12- to 36-months age range. We focus on synchronous virtual assessments in which clinicians guide the child's caregiver through a range of assessment activities and observe spontaneous and elicited behaviors. Assessments are compared on dimensions of targeted behavioral domains, specific activities and presses employed, scoring approaches, and other key logistical considerations to guide instrument selection for use in varied clinical and research contexts.

Brief Report: The Preliminary Psychometric Properties of the Social Communication Checklist.

Despite the expansion of early intervention approaches for young children with ASD, investigators have struggled to identify measures capable of assessing social communication change in response to these interventions. Addressing recent calls for efficient, sensitive, and reliable social communication measures, the current paper outlines the refinement and validation of the Social Communication Checklist (SCC). We discuss two small studies exploring the psychometric properties of the SCC and the SCC-R (revised Social Communication Checklist), including sensitivity to change, inter-rater reliability, and test-retest reliability, in two samples of children with ASD and one sample of typically-developing children. Results indicate this measure is reliable, sensitive to change after a brief social communication intervention, and strongly related to well-established measures of social communicative functioning.

Efficacy of low intensity, therapist-implemented Project ImPACT for increasing social communication skills in young children with ASD.

Project ImPACT is a Naturalistic Developmental Behavioral Intervention (NDBI) for young children with ASD. Preliminary research supports its feasibility and efficacy as a parent-mediated intervention; however, its efficacy as a low-intensity, therapist-implemented intervention is unclear. A single-case, multiple-baseline design evaluated the effect of 2 h per week of therapist-implemented Project ImPACT on social engagement, language, and play in nine children with ASD. Language and play skills were targeted separately for five children and together for four children. Children increased their rates of social engagement and language when language or play was the sole target and when language and play were targeted together; however, gains in play skills were evident only when they were targeted separately. This study provides support for the efficacy of the Project ImPACT when implemented by therapists at a low intensity and suggests the way in which skills are targeted can affect child learning.

Establishing a Scale for Assessing the Social Validity of Skill Building Interventions for Young Children with Autism Spectrum Disorder.

This study evaluated the psychometric properties of the Scale of Treatment Perceptions (STP), a measure of treatment acceptability targeting skill-building interventions for Autism Spectrum Disorder (ASD). This scale utilizes a strength-based approach to intervention assessment, and was established by modifying the Behavior Intervention Rating Scale (Elliott and Von Brock Treuting in J School Psychol 29(1):43-51, 1991. doi: 10.1016/0022-4405(91)90014-I ) and the Treatment Evaluation Inventory (Kazdin in J Appl Behav Anal 13(2):259-273, 1980. doi: 10.1901/jaba.1980.13-259 ) to be appropriate for assessing multiple dimensions of acceptability across skill-building ASD treatments. Overall, the STP demonstrated good psychometric properties: the scale had appropriate internal consistency, demonstrated a stable three-factor structure that was invariant across samples, and discriminated among different skill-building treatments for ASD. This has important implications for dissemination, as perceived acceptability of a treatment relates to treatment utilization and adherence.

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.

An Evaluation of Imitation Recognition Abilities in Typically Developing Children and Young Children with Autism Spectrum Disorder.

Previous work has indicated that both typically developing children and children with Autism Spectrum Disorder (ASD) display a range of imitation recognition behaviors in response to a contingent adult imitator. However, it is unknown how the two groups perform comparatively on this construct. In this study, imitation recognition behaviors for children with ASD and typically developing children were observed during periods of contingent imitation imbedded in a naturalistic imitation task. Results from this study indicate that children with ASD are impaired in their ability to recognize being imitated relative to typically developing peers as demonstrated both by behaviors representing basic social attention and more mature imitation recognition. Display of imitation recognition behaviors was independent of length of contingent imitation period in typically developing children, but rate of engagement in imitation recognition behaviors was positively correlated with length of contingent imitation period in children with ASD. Exploratory findings also suggest a link between the ability to demonstrate recognition of being imitated and ASD symptom severity, language, and object imitation for young children with ASD.

A further investigation of goal-directed intention understanding in young children with autism spectrum disorders.

Findings from research investigating goal-directed intention understanding in children with autism spectrum disorders (ASD) have been equivocal, in part because of the varying methodologies used across studies. This study compares both object-oriented and social-communicatively cued goal-directed intention understanding in children with ASD and typically-developing children. Relative to matched controls, children with ASD did not exhibit deficits in object-oriented intention understanding. While children with ASD also demonstrated the ability to understand intention when cued by social-communication indicators, typically-developing children differentiated between intentional and unintentional acts at a significantly greater level. Group differences in performance were eliminated if only trials in which children attended to the experimenter's face were considered. Results suggest that children with ASD have intact object-oriented intention understanding abilities, and are able to use social-communicative cues to understand intention. However, their ability to demonstrate social-communicatively cued intention understanding is limited by a lack of attention to relevant social-communicative information.

An exploration of imitation recognition in young children with autism spectrum disorders.

The ability to recognize when one is being imitated has been hypothesized to be an important developmental process related to the emergence of more advanced social-cognitive skills. While a series of behaviors indicating progressively more mature imitation recognition (IR) skills has been assessed in typically developing children, empirical work with children with autism spectrum disorders (ASDs) has largely focused on basic social responses to an imitative adult (e.g. increases in eye contact). Limited work has explored more mature IR behaviors in this population. This study compared the degree to which children with ASD engage in different behaviors thought to be indicative of IR during a naturalistic imitation task and the relationship between different types of IR behaviors and social-cognitive skills (i.e. imitation, language, social reciprocity, and joint attention). Thirty children with ASD were administered standardized measures of cognitive level, language, joint attention, social reciprocity, and imitation. IR behaviors were observed during periods of contingent imitation by an adult. Participants engaged more frequently in less mature (e.g. looking at the experimenter's toy or face) than more mature IR behaviors (e.g. testing the experimenter's intent to imitate). After controlling for developmental level, social reciprocity, object imitation, and gesture imitation were positively correlated with more mature IR. These findings suggest that the development of more mature IR skills is related to the development of other social-cognitive skills in children with ASD and provide additional empirical support for reports of more mature IR observed in this population. , Inc.

Do u txt? Event-related potentials to semantic anomalies in standard and texted English.

Texted English is a hybrid, technology-based language derived from standard English modified to facilitate ease of communication via instant and text messaging. We compared semantic processing of texted and standard English sentences by recording event-related potentials in a classic semantic incongruity paradigm designed to elicit an N400 effect. In participants fluent in both text and standard English, an N400 effect was elicited in both the texted and standard English conditions. The amplitude and distribution of the N400 effect (300-500ms) in the texted and standard English conditions were similar, but the text semantic incongruity effect was characterized by a delayed peak latency and an extended duration into the 500-700ms epoch. This pattern of results replicates previous findings regarding differences in the N400 effect in native and non-native language processing, but for the first time extends the bilingual ERP literature to include the technological phenomenon of texted English.