Autism Spectrum Disorder Clinical Trial
Official title:
Social ABCs for Toddlers With Signs of Autism Spectrum Disorder: RCT of a Parent-Mediated Intervention
The Social ABCs is an innovative parent-mediated intervention for toddlers with confirmed or suspected Autism Spectrum Disorder (ASD). The intervention draws on what is known about core, early emerging impairments in ASD, and on evidence-based Pivotal Response Treatment (PRT) and associated parent training programs for enhancing development in children with ASD. Completion of a comprehensive pilot study set the stage for a randomized control trial (RCT) of the Social ABCs. The purpose of this RCT is to evaluate the efficacy of the Social ABCs intervention program on improving spoken language skills and positive parent-child emotion sharing in toddlers with signs of or a diagnosis of ASD.
With funding from Autism Speaks (2007-10), the investigators have developed and conducted a
pilot evaluation of an autism-specific intervention for toddlers with ASD. The Social ABCs,
developed by the investigators, is an innovative parent-mediated intervention for toddlers
with confirmed or suspected ASD. The Social ABCs draws on what is known about core, early
emerging impairments in ASD, on evidence-based Pivotal Response Treatment (PRT) and
associated parent training programs for enhancing development in children with ASD, and on
the literature on effective parent training programs for at risk infants. The investigators
also draw on their demonstrated success implementing a province-wide PRT-based early
intervention program for preschoolers with ASD, and developing effective brief training in
PRT for parents of newly diagnosed children with ASD.
The Social ABCs intervention incorporates the principles and procedures of Applied Behaviour
Analysis (ABA), represented in the natural language paradigm of PRT, supplemented by those of
Responsive Parenting. Targets of intervention focus on two areas of early impairment in ASD -
functional spoken language and positive parent-child emotion sharing.
Data are collected from both parents and children. Measures of key targeted child behaviours
(i.e., vocal responsivity and initiations) and shared positive emotion are coded from videos
of child-parent play interactions recorded in the family home on 3 separate days at each of 3
time points: (1) study entry (Baseline/ pre-Training), (2) Post-Training (Week 12) and (3)
Follow-up (Week 24). For each time point, data coded from the videos of child-parent
interactions are averaged across 2 days to increase the probability that they are
representative of the key child targets and parent variables under study (i.e., that they do
not represent either a particularly "good" or "bad" day).
To provide a strong test of generalization of child learning, the same measures of functional
behaviours are coded from videos of child-examiner play interactions recorded in the family
home on 2 separate days at Follow-up; this examiner is blind to treatment group, not trained
in PRT, and is unfamiliar to the child. Standardized child measures are collected at study
entry and Week 24. These include the Autism Diagnostic Observation Schedule, Autism
Observation Scale for Infants, Mullen Scales of Early Learning - AGS Edition, Preschool
Language Scale-4, and Vineland Adaptive Behavior Scales, 2nd ed. Child and parent
questionnaires are also completed at these time points. For both the Treatment group and the
Control group, a Service Log is completed to record the services and interventions in which
the child is currently participating. This Service Log is updated throughout the duration of
the family's participation in our trial. A child and family's data is considered "useable" as
long as the child is enrolled in the study up to and including week 4. If a child and family
drop out of the study for any reason prior to their completion of week 4, we will not
consider their data to be useable.
The 6-month Social ABCs parent-mediated intervention consists of 3 months of in-home live
parent coaching and a 3-month period during which the parent implements the strategies with
no further coaching. Parents implement the procedures in vivo, as they play with and follow
routines of daily life with their toddlers. Research Trainers train parents using positive
teaching procedures in which feedback and suggestions focus on parents' strengths (i.e.,
correct or close-to-correct implementation of the intervention procedures). The 3-month
parent training program consists of 8 consecutive weeks of "Active Training" followed by 4
consecutive weeks of "Consultation and Refresher". During the 8-week "Active Training" phase,
individual 1.5-hour sessions are provided three times on separate days in Week 1, twice on
separate days in Week 2 and once in each of Weeks 3-8, for a total of 11 training sessions.
Parents are provided with written modules that form the Social ABC's Intervention Manual,
through which they are led by their Research Trainer. Each visit begins with a discussion of
the module and intervention targets. For the remainder of the session, parents implement the
procedures with their child, while receiving feedback (in vivo coaching) from their Trainer.
During the 4-week "Consultation and Refresher" phase (Weeks 9-12), parents are contacted
weekly by their Trainer via telephone/ email to trouble-shoot specific issues as needed, and
the Trainer makes 2 home visits (Weeks 10 and 12) in which additional video recordings of in
vivo coaching are taken.
For the control group, treatment is that typically provided by local services (e.g., visits
from a community early interventionist/speech and language pathologist; see Eligibility
Criteria). Upon completion of Week 24, the control group is offered the same intervention
received by the experimental group.
Primary Aims and Hypotheses:
(1) It is predicted that, relative to controls, toddlers in the Social ABC's (experimental)
treatment group will show greater post-training and follow-up changes in functional speech
(i.e., responsivity and initiations) and positive emotion sharing with their caregiver.
Secondary Aim: It is predicted that (1) parents in the treatment group will achieve fidelity
of implementation, and (2) the experimental group will also show greater gains than the
control group on standardized measures of receptive and expressive language. Exploratory
Aims: Investigators predict that (1) post-training and follow-up child gains in shared
positive emotion will be related to high levels of parental (facial) positive emotion, (2)
post-training and follow-up child gains in functional vocalizations will be a) moderated by
better receptive language at baseline, and b) related, in the experimental group, to parents'
fidelity of PRT implementation post-training.
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