Internet-Based, Parent-Implemented Early Intervention for Children with ASD
by Wendy Hoke
The rise in diagnosed cases of autism and autism spectrum disorder (ASD) is widely known, with the Centers for Disease Control and Prevention (CDC) estimating that one in 68 children is diagnosed in the United States. For boys, this rate drops to one in 42. ASD represents a broad spectrum of individuals with differing capabilities and support needs, but all people diagnosed with ASD have deficits in social interaction and communication. With the rising prevalence, parents of children with ASD and the people who support these families (e.g., researchers, teachers, early interventionists) experience greater challenges to meet the need for services to help children with ASD.
A recent article in the Journal of Early Intervention reviewed a study that assessed the potential for using parent coaching and training on communication skills to improve the outcomes of ASD children. Using the Internet for communication has the potential to connect early intervention professionals (EI) to greater numbers of parents who can be trained in EI techniques. The study researchers reported their results in the March issue of the journal. Below is a brief review of their premise and conclusion.
Naturalistic Teaching Strategies
Social communication skills are crucial to social success, academic achievement, and quality of life outcomes, such as self-determination, interpersonal relationships, and social inclusion. Therefore, interventions that help to support the development of effective social communication skills are critical services for children with ASD. Naturalistic strategies and milieu language interventions are effective strategies for enhancing the social communication skills of children with ASD.
Naturalistic strategies have been shown to be especially effective when teaching communication skills to children with ASD and other types of developmental disabilities because they can be easily integrated into everyday routines in the home and community. Communication partners can utilize the techniques as learning opportunities arise throughout the day and across differing environments, thus giving the child repeated practice that can lead to additional skills.
With the rise in children with ASD, the need to offer effective interventions and give families access to early interventions has grown. Developing innovative models of early intervention delivery is a crucial avenue for research, particularly for families that have limited access to EI services. As children with ASD spend much of their day with parents or caregivers, training those parents or caregivers in early intervention techniques is a logical method of ensuring delivery of those interventions throughout daily routines. The purpose of the study was to determine the effectiveness of a coaching and training program designed towards parental implementation of naturalistic teaching strategies and child communication skills utilizing a telepractice service delivery method.
The researchers adapted and modified procedures and materials from the Parent-Implemented Communication Strategies (PiCS) program, which is an in-person, face-to-face method that teaches parents on the use of naturalistic teaching techniques to improve their child’s social communication skills. However, in this study, the researchers coached and taught the parents from a distance over the Internet. They sought to answer three main research questions, which are paraphrased here:
1. Is there a relationship between an Internet-based program teaching these techniques to parents and the actual parental implementation of the new skills?
2. Is there a relationship between the parental implementation of the newly gained skills and their child’s communication skills?
3. How do parents rank the validity of the procedures, goals and outcomes of a program delivered via the Internet from a distance?
The researchers used a training program that had five components. The first component provided an overview of the proposed intervention. Second, the coach reviewed flowcharts and handouts with the parent on each of the strategies. Third, for each strategy, the coach shared her computer screen over Skype with the parent to view a video example of another parent utilizing the teaching strategy with a child. Fourth, after training in the teaching strategies, the coach and parent collaborated on the creation of an action plan. Fifth, the coach listened to and addressed any of the parent’s concerns and questions.
The participants were three mother/child dyads, and the program included training, video of the interactions, feedback, coaching and assessments. The results appeared mixed with varying degrees of quality in implementation and outcomes, although each child showed some improvements. The researchers included lengthy discussions addressing some of the subjective elements of the study to assess the validity of distance learning as accurately as possible.
Implications for Practice
While the research findings proved to be less than compelling, the study showed that telepractice and distance coaching has the potential to become a valid service delivery option with further development. EI practitioners can capitalize on this method of delivery to either supplement in-person services or replace them outright. Specific to this one study, EI service providers may wish to adapt or adopt the PiCS method to deliver coaching and training to parents who want to use naturalistic communication strategies to promote language development in their child. The researchers identified several barriers to making telepractice an effective method for delivering services including access to high-speed Internet, time availability, familiarity with the technology, and personal motivation to participate. The challenge for EI service providers is that many of the families in need of these services are most likely the same families without the prerequisite conditions.
The researchers concluded that the study added to the existing evidence that supports parental coaching and training in intervention techniques that can improve the communication skills of their child. Specifically, the study provided evidence supporting early intervention training in naturalistic strategies. In addition, the researchers concluded that coaching and training parents using videoconferencing, Skype, and other Internet-based methods proved to be an effective method of service delivery. EI service providers should be encouraged to add telepractice delivery models to enhance services for their clients.
Relias Academy offers parents of children with ASD resources that will give them a deeper understanding of the disorder with its Family Plan course package, which includes five online learning courses targeted for families.