Leveraging technology to make parent training more accessible: Randomized trial of in-person versus online executive function training for parents of autistic children.

LAY ABSTRACT: This study compared the first online parent training program for executive function intervention for autism to in-person parent training on the same content. Participants were parents of autistic children, who were between 8 and 12 years of age and did not have intellectual disability. Parents were randomized to the in-person (n = 51) or online (n = 46) training conditions. Both trainings were developed with stakeholder (parents and autistic people) guidance. In this trial, most parents reported that they liked both trainings and that they were able to implement what they learned with their children. Parents in both groups spent equivalent amounts of time (about 8 hours) with the training materials, but while 94% of parents in the in-person training attended both parent trainings, only 59% of parents in the online group completed all 10 online modules. Parents reported that it was difficult to stay motivated to complete the online trainings over the 10-week trial. Parent and child outcomes did not differ significantly between the groups. Overall, parents reported that the trainings resulted in a reduction in their own parenting strain and improvements in their child's flexibility, emotional control, and global executive function, but not planning and organization. These findings indicated brief in-person and online training can help parents learn to support and improve their autistic children's executive function abilities, reducing their own experience of parenting strain. The finding that the online training was equivalent to the in-person trainings is important because it is accessible to parents who encounter barriers to in-person care.

Description and Preliminary Evaluation of a Curriculum for Teaching Conversational Skills to Children With High-Functioning Autism and Other Social Cognition Challenges.

PURPOSE: The purpose of this clinical focus article is to provide (a) a detailed description of a school-based intervention designed to teach children with high-functioning autism spectrum disorders (HF-ASDs) and other social cognition challenges both the how and the why of conversation and (b) a preliminary evaluation of program outcomes. METHOD: This pilot study involved (a) qualitative and quantitative analysis of video footage of participants' conversational skills at baseline, during intervention, and postintervention; (b) interviews with participants' speech-language pathologist (third author) about individual participant progress; and (c) interviews with instructors responsible for implementing the curriculum regarding overall program effectiveness. Participants were four elementary-aged children with HF-ASDs and other social cognition challenges with deficits in expressive language and auditory processing and comprehension. RESULTS: Analyses of video-recorded footage indicated increases for all four participants in terms of peer-directed interactions, questions asked, use of wh-words to introduce new topics and/or extend conversation on existing topics, and attempts at conversational repair. Three participants also demonstrated increased use of attention-gaining behaviors. Qualitative analysis of transcripts, as well as in-depth interviews with the participants' speech-language pathologist and other program instructors, supported these findings. CONCLUSIONS: Preliminary findings from this pilot study suggest that providing comprehensive instruction in many of the basic components required for successful conversation, including explanations for why these components are necessary, may be a promising means of teaching children with HF-ASDs and other social cognition challenges to engage in successful peer-to-peer conversation.

Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum.

BACKGROUND: Unstuck and On Target (UOT) is an executive function (EF) intervention for children with autism spectrum disorders (ASD) targeting insistence on sameness, flexibility, goal-setting, and planning through a cognitive-behavioral program of self-regulatory scripts, guided/faded practice, and visual/verbal cueing. UOT is contextually-based because it is implemented in school and at home, the contexts in which a child uses EF skills. METHODS: To evaluate the effectiveness of UOT compared with a social skills intervention (SS), 3rd-5th graders with ASD (mean IQ = 108; UOT n = 47; SS n = 20) received interventions delivered by school staff in small group sessions. Students were matched for gender, age, race, IQ, ASD symptomotolgy, medication status, and parents' education. Interventions were matched for 'dose' of intervention and training. Measures of pre-post change included classroom observations, parent/teacher report, and direct child measures of problem-solving, EF, and social skills. Schools were randomized and evaluators, but not parents or teachers, were blinded to intervention type. RESULTS: Interventions were administered with high fidelity. Children in both groups improved with intervention, but mean change scores from pre- to postintervention indicated significantly greater improvements for UOT than SS groups in: problem-solving, flexibility, and planning/organizing. Also, classroom observations revealed that participants in UOT made greater improvements than SS participants in their ability to follow rules, make transitions, and be flexible. Children in both groups made equivalent improvements in social skills. CONCLUSIONS: These data support the effectiveness of the first contextually-based EF intervention for children with ASD. UOT improved classroom behavior, flexibility, and problem-solving in children with ASD. Individuals with variable background/training in ASD successfully implemented UOT in mainstream educational settings.