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Title: Efficacy of a Parent-Mediated Intervention for One-Year-Olds at-Risk for Autism (Early Development Project-2)

Purpose: To assess the efficacy of an early intervention program called Adaptive Responsive Teaching in improving developmental outcomes and ameliorating symptom severity among one-year-olds at-risk for autism spectrum disorders (i.e., “autism”).
Setting: The research was carried out in 6 counties in central North Carolina, with assessments conducted in local communities and the intervention provided in children’s homes.

Population: Our sample of 87 randomized children/families was drawn from the population of one-year-olds > 2500 grams at birth in our catchment area, with the restriction that English was a primary language in the home. Families of children who scored at high-risk for autism on a screening tool called the First Year Inventory (Baranek et al., 2003) were invited to participate. Racially our sample of child participants was 69% White, 21% African-American/Black, 2% Asian, and 8% multi-racial. The highest education levels of the primary caregivers were: 15% high school degree or less, 18% associate’s degree, vocational program, or some college, 28% baccalaureate degree, and 39% graduate degree.

Intervention tested: We tested a parent-mediated, home-based intervention called Adapted Responsive Teaching (ART), which is based on the Responsive Teaching curriculum (Mahoney & MacDonald, 2007). ART targets pivotal behaviors (i.e., early behaviors linked to the later development of more complex functions) in two key domains of social-communication and sensory-regulatory functions. An interventionist met with families for approximately 30 1-hour home visits over a period of 6-8 months to provide them with information, demonstration, and coaching on the use of responsive teaching strategies to promote targeted pivotal behaviors for their child. Responsive teaching strategies emphasize reciprocity, contingency; shared control, positive affect, and matching the child’s developmental level and behavioral style. Family action plans were formulated at the end of each session to promote the use of ART by parents during daily, routine interactions with their child.

Comparison condition: ART was compared to a condition called “Referral to Early Intervention and Monitoring (REIM) in which families of eligible children are referred to community services for early intervention, with monthly monitoring via phone calls from the research staff.
Primary research method: We used randomized assignment to group, with an equal probability of assignment to ART or REIM. Assessors and coders involved in pre- and posttest measures were blind to group assignment.

Measures and key outcomes: We used a battery of assessments to evaluate pre- and post-intervention performance on our key outcomes of (1) social-communication and sensory-regulatory pivotal behaviors targeted in ART, (2) broader development and adaptation, and (3) autism symptom severity. In addition, we measured changes in parent responsiveness as a postulated mediator, and initial child developmental quotient (DQ) and parent stress as postulated moderators of outcomes.

Data analytic strategy: We used an intent-to-treat strategy in our analyses to report our per protocol findings for this study. ANCOVAs were be used to evaluate the effects of ART on our primary outcomes, as well as the postulated moderating effects of initial child DQ and parent stress. A path analytic approach was used to test whether changes in parent responsiveness mediated outcomes. (Manuscript under review as of September, 2016.)

NOTE: The data collected in conjunction with this project are currently being used to address a variety of additional research questions through secondary data analysis.

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Contact Person

Linda Watson (Lwatson@med.unc.edu)

Website Address

https://www.med.unc.edu/ahs/pearls/research/early-development-project

Investigators and Key Personnel

Linda R. Watson Elizabeth R. Crais Grace T. Baranek Lauren Turner-Brown J. Steven Reznick Linn Wakeford