Abstract | Summary | Original Article

Parent-mediated early intervention for young children with autism spectrum disorder.

Diggle T., McConachie HR, Randle VRL

(Cochrane Review) In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.

Question: How effective in producing positive parent and child outcomes are parent- mediated interventions with young children with autism?

Background: The evidence is in — early intervention makes a big difference to the future functioning of young children with autism spectrum disorders. The problem is that with current funding levels, many children wait for up to two years for a place in an early intervention centre. That’s a long time for a small child, especially one who needs early intervention in order to have the best start. If we can’t do anything right now to reduce the waiting lists, we need to know if interventions carried out by parents are effective in improving children’s skills.

The following is a summary of a systematic review that looked at this problem. It is important because it looked at both the children’s skills and whether there were improvements in the parents’ stress levels as they learned new ways of teaching their children.

Data Sources: Using the terms "child" or its synonyms, "autism" or its synonyms, "parent" or its synonyms, and "intervention" or its synonyms the authors searched the following databases to find studies that might answer their question: The Cochrane Controlled Trials Register, MEDLINE, EMBASE, PsycINFO, CINAHL, Dissertation Abstracts International, Social Science Abstracts, Sociological Abstracts, Linguistics and Language Behavior Abstracts, National Research Register, and LILACS.

The search was not restricted by language.

They also searched bibliographies of systematic and non-systematic reviews and the reference lists of key articles. The Journal of Autism and Developmental Disorders and the Journal of Child Psychology and Psychiatry and Allied Disciplines were hand searched.

Study Selection:

Types of Studies: Randomized controlled trials and quasi-randomized controlled trials were found and assessed. Studies had to include a comparison group of children who received no treatment, were on a waiting list for treatment, or who had been allocated to a comparison intervention.

Types of Participants: The children taking part in the studies were between 1 year and 6 years 11 months and had been diagnosed as having autism, Asperger Syndrome, Pervasive Developmental Disorder (PDD), or PDD not otherwise specified.

Types of Interventions: The interventions had to have a specific training component for parents to help them better manage their children’s autism-related problems. Interventions that emphasized parental involvement when there was also a teacher or professional component to it were included if the hours of parental input were at least equivalent. The parent training could be on a group or individual basis. The authors excluded interventions that were drug-based, were dietary interventions, or surgical procedures.

Types of Outcome Measures: Child-related tests of specific skills that were measured pre/post treatment and in both the intervention and comparison groups were included. The particular outcomes were progress in child language, positive change in behaviour, and a positive change in the parents’ behaviour toward the child. Secondary outcomes were parental confidence and reduction in parental stress levels.

Data extraction: Using a specially designed form, the authors noted the study locations, the methods used, the diagnosis and severity of the participants, and the type, duration, and intensity of the interventions.

Main Results: Only two studies met the inclusion criteria and because their populations and methods differed considerably and their numbers were small, it was not possible to combine them and analyze their results together. The results are reported separately for each study.

Child Outcomes: The Jocelyn study looked at community day care vs. day care plus parent training. The study favoured the parent plus day care as determined by the language component of the Early Intervention/Preschool Development Profile (EI/PDP). Although the results were statistically significant, they may not be clinically significant, that is, have an effect on the day-to-day functioning of the child. Other measures that did not show a difference were the independent raters’ assessments of the child using the Autism Behavior Checklist, and on the cognitive component of the Early Intervention/Preschool Development Profile.

The Smith study compared parent training in a treatment program to intensive treatment by professional staff. The intensive treatment group had statistically significant IQ gains and language development. These were measured on standard scales. Those measures that depended upon parent or teacher report did not show a statistically significant difference between the two groups.

Parent Outcomes: In the Jocelyn study, the only outcome to reach statistical significance was in the Parent training group, where the knowledge about autism of both mothers and child care workers increased. More of the positive findings, whether reaching statistical significance or not, were in the parent training group, including those related to parental stress. The results that favoured the day care only group were related to the fathers’ reports of stress and the fathers’ outcomes in the Family Assessment Measure.

In the Smith study, parental stress was significantly reduced in the intensive treatment group.

Conclusions: There may be a role for parent-provided interventions, but better research is needed to demonstrate whether it is as effective as treatment provided by professionals.

The two included studies were:

Jocelyn LJ, Casiro OG, Beattie D, Bow J, Kneisz J.

Treatment of children with autism: A randomized controlled trial to evaluate a care-giver based intervention program in community day-care centers. Journal of Developmental & Behavioral pediatrics 1998; 19(5): 326-334.

Smith T, Groen AD, Wynn JW.

Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation 200; 105(4): 269-285.