Early Joint Attention and Social Communication: A Telepractice Parent-Mediated Intervention
STUDY ONE ABSTRACT: Compared to neurotypical children, children presenting with ASD or ASD risk spend a fraction of time jointly engaged with their parents during play routines. When children and parents spend more time together jointly engaged in synchronous interactions, children reportedly also make gains in social initiations and spoken language production. Targeted early intervention can recalibrate a child’s developmental course, and inclusion of early intervention targets specific to ASD risk factors including joint attention skills and social motivation is especially important – as is including parents in the early intervention alliance. Thus, utilizing parents’ attunement as a mechanism of change for a child’s attention, interests, and behavior is a well-established means of early intervention in the field of ASD. Identified barriers to parent-mediated interventions have included parents’ required time commitment and distance from trained coaches which have prompted the development of more accessible remote parent-coaching interventions and consolidated online training modules. Empirical studies with telepractice based interventions targeted at language growth and parent training on ASD risk factors indicate feasibility and positive parent perceptions. Since the understanding of how and why these intervention programs are promising effective tools remains limited, the current study evaluated how specific processes of parent-child engagement support child social communication growth in the context of the Partnership for Education and Social Communication Education (PEASCE) intervention, a novel telepractice PMI. Mothers of children aged 12-48 months with, or at-risk for, ASD (n =6) received individualized coaching for 16 weeks on strategies to scaffold joint attention and social motivation through engaged play activities and daily routines. Comparison of pre- and post- intervention measures with t-tests confirmed improvements in each factor of the proposed expanded elicited bootstrapping theory model including child social motivation, child joint attention, parental language input, and child language skills. Findings of the current study suggest the PEASCE intervention was an effective and feasible resource for improving the quality of parental language input and strengthening social skill and language outcomes of children diagnosed with ASD and for those with early red flags for ASD. Results also provide initial support for future testing of mediation pathways in the proposed expanded elicited bootstrapping theory model with a larger sample size. STUDY TWO ABSTRACT: Parents and young children naturally engage in a responsive feedback cycle of “serve and return”, thereby fostering effective social and communication skills and promoting growth in neural architecture. However, children with neurodevelopmental disorders such as autism spectrum disorders (ASD) demonstrate atypical social reciprocity as early as infancy, which often impedes parent-child behavioral harmony and contributes to bidirectional adverse outcomes. Parent-mediated intervention (PMI) programs are an evidence-based practice strategy for improving developmental trajectories of children with or at-risk for ASD, but limited interventions to date have investigated changes in both behavioral and emotional synchrony over time. Since parent-child dyadic synchrony encompasses co-regulation of both behavior and emotions, the current study evaluated patterns of change in affect, responsiveness, and dyadic synchrony in the context of the Partnership for Education and Social Communication Education (PEASCE) intervention program, a novel telepractice PMI. Mothers of children aged 12-48 months with, or at-risk for, ASD (n =6) received individualized coaching for 16-weeks on strategies to scaffold joint attention and social motivation through engaged play activities and daily routines. Each week parents were asked to share a five-to-ten-minute video of at-home play for coach review and feedback; videos were also utilized for post-hoc observational coding using the Parent-Child Interaction System coding schemes for responsiveness, positive affect, negative affect, reciprocity, conflict, and cooperation. A series of within-subjects repeated measures ANOVAs indicated changes in several outcomes over the course of PEASCE, with the greatest strength of change observed for parent responsiveness, child responsiveness, parent positive affect, child negative affect, parent-child reciprocity, and parent-child cooperation. Findings of the current study suggest the PEASCE early intervention was an effective and feasible intervention for improving an array of parent and child coordinated engagement behaviors, specifically with children diagnosed with ASD and with early red flags for ASD such as joint attention delays. The results promote expanded implementation of telepractice PMI programs targeting both behavioral and emotional synchrony for children presenting with early ASD risk regardless of diagnostic status.
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