An Exploratory Investigation of the Role of Parenting Stress in Relationship Focused Intervention.

BACKGROUND: Mothers of young children with Pervasive Developmental Disorders (PDD) and other disabilities (DD) have been reported to experience high levels of stress. This investigation examined the effects of parental stress on mothers' participation in a Relationship Focused intervention (RFI). METHODS: Mothers and young children who had either PDD (n = 18) or DD (n = 26) received weekly RF intervention for one year. RESULTS: Pre-post comparisons indicated significant increases in mothers' responsiveness and children's development and social emotional functioning. Intervention effects were greater for mothers of children with PDD than for mothers of children with DD. There were three findings related to the role parenting stress. First, high levels of parenting stress did not interfere with mothers' ability to learn RFI strategies; second, there were non-significant decreases in parenting stress during intervention; third, parenting stress enhanced the effects of mothers' responsiveness on children. CONCLUSION: High levels of parenting stress does not appear to interfere with parent participation in RFI.

Pivotal behavior as the mediator of the relationship between parental responsiveness and children's symbolic behavior.

Previous research with parents and children with developmental disabilities indicated that the relationship between mothers' responsive style of interaction and children's rate of development was mediated by the simultaneous relationship between mothers' responsiveness and children's social engagement, or pivotal behavior. In this study, we attempted to determine whether children's pivotal behavior might also mediate the relationship between responsiveness and child development in a sample of 165 typically developing toddlers and their Taiwanese parents. Child development was assessed with a parent report measure of children's symbolic behavior. Parental responsiveness and children's pivotal behavior were assessed from observations of parent-child play. Results indicated that parental responsiveness was correlated with children's pivotal behavior, and that both of these variables were correlated with children's symbolic behavior. Structural equation models indicated that the relationship between responsiveness and children's symbolic behavior was fully mediated by children's pivotal behavior.

The role of parents in early motor intervention.

In this article we discuss the results of a motor intervention study that we conducted with young children with Down syndrome and other disabilities (Mahoney, Robinson & Fewell, 2001). Results from this study indicated that neither of the two major treatment models that are commonly used with young children with motor impairments was effective at enhancing children's rate of motor development or quality of movement. These findings add to an increasing body of literature indicating that early motor intervention procedures are not adequately meeting the goals envisioned for this endeavour. We argue that there are at least two interrelated reasons why this may be occurring. The first is that parents, who are the people with the greatest opportunities to promote children's motor learning, are not being asked to become active participants in their children's motor intervention. The second is that contemporary models of motor intervention have been focusing on motor learning activities that are incompatible with contemporary theories and research on early motor learning.

Responsive teaching: early intervention for children with Down syndrome and other disabilities.

Responsive Teaching is an early intervention curriculum designed to address the cognitive, language, and social emotional needs of young children with developmental problems. This innovative intervention model was derived from research conducted primarily with children with Down syndrome and their mothers. Results from these studies indicated that during the early childhood years, parents promote their children's development by engaging in highly responsive interactions throughout their daily routines. The effects of responsiveness are mediated by the impact it has on children's use of several pivotal developmental behaviours, such as social play, attention, initiation and persistence. Responsive Teaching helps parents learn to use Responsive Teaching strategies to promote the pivotal developmental behaviours that are relevant to their children's developmental needs. Research with 50 children with developmental problems and their parents indicated that Responsive Teaching was highly effective at addressing children's developmental and social emotional needs. The effects of this intervention were mediated by the impact that RT strategies had on children's pivotal developmental behaviours.

Mechanism of Developmental Change in the PLAY Project Home Consultation Program: Evidence from a Randomized Control Trial.

This investigation is a secondary analysis of data from a randomized control trial of the PLAY Home Consultation Intervention Program which was conducted with 112 preschool children with Autism Spectrum Disorders and their parents (Solomon et al. in J Dev Behav Pediatr 35:475-485, 2014). Subjects were randomly assigned to either a community standard (CS) treatment group or to the PLAY Project plus CS Treatment (PLAY). PLAY subjects received monthly parent-child intervention sessions for 1 year during which parents learned how to use the rationale and interactive strategies of the Developmental, Individual-differences, Relationship-based (DIR) intervention model (Greenspan and Weider in The child with special needs: encouraging intellectual and emotional growth. DeCapo Press, Cambridge, MA, 1998) to engage in more responsive, affective and less directive interactions with their children. This investigation examined whether PLAY intervention effects on parents' style of interacting with their children as well as on children's social engagement mediated the effects of PLAY on children's autism severity as measured by ADOS calibrated severity scores. Regression procedures were used to test for mediation. There were two main findings. First the effects of PLAY on children's social engagement were mediated by the increases in parental responsiveness and affect that were promoted by PLAY. Second, the effects of PLAY on the severity children's Social Affect disorders were mediated by changes in parental responsiveness and affect; however, the effects of Responsive/Affect were mediated by the impact these variables had on children's social engagement. Results are discussed in terms of contemporary models of developmental change including the developmental change model that is the foundation for DIR.

Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study.

This study compares the effects of relationship-focused early intervention on toddlers and preschool-age children who were classified as having either pervasive developmental disorders (PDDs) (N = 20) or developmental disabilities (DDs) (N = 30). The intervention was conducted over a 1-year period through weekly individual parent-child sessions. It focused on helping parents use responsive teaching strategies to encourage their children to acquire and use pivotal developmental behaviors that addressed their individualized developmental needs. Before and after comparisons indicated significant increases in parents' responsiveness and children's pivotal behavior. Both groups of children made significant improvements in their cognitive, communication, and socioemotional functioning. However, children with PDDs made statistically greater improvements on the developmental measures than children with DDs. On several developmental measures, children's improvements were related to increases in both their parents' responsiveness and their own pivotal behavior.

The effects of relationship focused intervention on Korean parents and their young children with disabilities.

This study was conducted to examine the impact of Relationship Focused Intervention (RFI) on a sample of Korean mothers and their preschool-aged children with disabilities. Subjects were 18 mothers of children with developmental problems (ages 3-8 years). Ten of these mothers were assigned to an RFI Treatment group and eight to a No RFI Control group. The RFI was adopted from the Family/Child Curriculum (Mahoney, G. (1999; Family/Child Curriculum: A relationship focused approach to parent education/early intervention. Tallmadge, OH: Family Child Learning Center). This intervention focused on teaching mothers to use responsive interactive strategies through a process of modeling, coaching, role-playing and video feedback. It was implemented with parents during weekly group and individual intervention sessions that were conducted over three months period. Comparison of pre- and post-intervention assessments of parent-child interaction indicated that RFI was effective at encouraging parents to become more responsive, affective and achievement oriented with their children. These changes in mothers' interactional style were associated with an 18% increase in children's interactive behaviors. Regression analyses indicated that increases in children's behavior were associated positively with maternal responsiveness and negatively with maternal achievement orientation. Results from this study are discussed in terms of (a) implementing RFI with Korean mothers and (b) the mechanisms by which RFI promotes children's development.

Relationship of preschool special education outcomes to instructional practices and parent-child interaction.

Developmental outcomes attained by children receiving preschool special education services in relationship to both the general instructional approach used by their teachers and their parents' style of interaction were examined. The sample included 70 children from 41 Early Childhood Special Education (ECSE) classrooms. The type of instructional model children received was determined by dividing the sample into three clusters based upon six global ratings of children's classroom environment: Choice; Cognitive Problem-Solving; Child-Initiated Learning; Developmental Match; Child-Centered Routines; and Rewards and Discipline Strategies. Based on this analysis, 27 children were classified as receiving developmental instruction; 15 didactic instruction; and 28 naturalistic instruction. Observations of parent-child interaction collected at the beginning and end of the year were classified along four dimensions using the Maternal Behavior Rating Scale: Responsiveness, Affect, Achievement Orientation and Directiveness. Results indicated that the kinds of experiences that children received varied significantly across the three instructional models. However, there were no significant differences in the impact of these instructional models on children's rate of development. Regression analyses indicated that children's rate of development at the end of intervention was significantly related to their parents' style of interaction but was unrelated to the type of instructional model they received.

PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation model, in combination with usual community services (CS), to improve parent-child interaction, child development, and autism symptomatology in young children with autism spectrum disorders (ASDs) compared with CS only. METHODS: Children (N = 128) with autism or PDD-NOS (DSM-4 criteria) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were randomized in two 1-year cohorts. Using videotape and written feedback within a developmental framework, PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction. CS included speech/language and occupational therapy and public education services. Primary outcomes included change in parent-child interactions, language and development, and autism-related diagnostic category/symptoms. Secondary outcomes included parent stress and depression and home consultant fidelity. Data were collected pre- and post-intervention. RESULTS: Using intent-to-treat analysis (ITT), large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales. Child language and developmental quotient did not differ over time by group, although functional development improved significantly. PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule (ADOS). PLAY caregivers' stress did not increase, and depressive symptomatology decreased. Home consultants administered the intervention with fidelity. CONCLUSIONS: PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents' stress/depression. ADOS findings must be interpreted cautiously because results do not align with clinical experience. PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents.

Interactions between Turkish mothers and preschool children with autism.

This study explored the relationship between Turkish mothers' style of interaction and the engagement of their preschool-aged children with autism. Data were collected from fifty mother-child dyads in which all children had diagnoses of autism. Video recordings of mother-child interaction were analyzed using the Turkish versions of the Maternal Behavior Rating Scale and the Child Behavior Rating Scale (O. Diken, 2009 ). Similar to mothers from Western countries, Turkish mothers tended to engage in highly directive interactions with their children. However, a cluster analysis revealed considerable variability in mothers' style of interaction. This included a directive nonengaged style, a directive/achievement-oriented style, and a responsive style of interaction. Children's level of engagement was associated with differences in mothers' style of interaction. Children were least engaged with directive/nonengaged mothers and most engaged with responsive mothers. However, children's engagement was only associated with their mothers' responsiveness, not with their directiveness. Results are discussed in terms of their implications for early intervention.

Effectiveness of responsive teaching with children with Down syndrome.

A randomized control study was conducted to evaluate Responsive Teaching (RT) with a sample of 15 Turkish preschool-aged children with Down syndrome (DS) and their mothers over a six-month period of time. RT is an early intervention curriculum that attempts to promote children's development by encouraging parents to engage in highly responsive interactions with them. Subjects were randomly assigned to treatment conditions: the control group consisted of standard preschool classroom services; the RT group received bi-weekly RT parent-child sessions in addition to standard services. RT mothers made significantly greater increases in their Responsiveness and Affect as wellas decreases in Directiveness than control group mothers. There were also significant group differences in children's interactive engagement and development. Children in the RT group improved their developmental quotient scores by an average of 47% compared to 7% for children in the control group. Results are described in terms of the effects of parental responsive interaction on the developmental functioning of children with DS.