In the largest study of its kind, researchers have demonstrated that toddlers with autism clearly benefit when their parents receive training in strategies that promote social communication. The benefits were modest when parents attended a weekly class. The toddlers gained significantly more skills when therapists visited their homes and worked with their parents, one on one, two or three times a week.
“This study shows how valuable parents can be in implementing intensive interventions for their toddlers with autism spectrum disorder,” comments developmental pediatrician Paul Wang, Autism Speaks senior vice president for medical research. (Dr. Wang was not directly involved in the study.) “Intensive, individual training for parents may be especially important for helping younger children such as the toddlers in this study.”
The new findings, by researchers at Florida State University, build on the growing scientific evidence that training parents is an effective investment of time and resources. Last week, researchers reported on the gains seen in 2- to 6-year-olds with autism after their parents took classes in Pivotal Response Training. (Read more about that study, likewise funded by Autism Speaks, here.) The goal of both studies was to evaluate whether parents could effectively augment, not replace, autism therapy delivered by trained professionals.
Classes versus in-home instruction
In the new study, researchers evaluated and compared the benefits of two, nine-month, parent-led intervention programs as part of Florida State’s Early Social Interaction Project. The project's goals are to develop and evaluate early intervention programs for toddlers with autism and their families.
The researchers randomly assigned the parents of 82 toddlers (ages 16 to 20 months) affected by autism to either attend a weekly class or receive two or three in-home tutoring sessions each week.
The instruction focused on strategies that promote social communication. Social communication involves the use of eye gaze, facial expression, gestures and sounds to communicate. The intervention strategies also encouraged understanding of new words and learning how to use toys, tools and other objects. Children with autism tend to have learning difficulties in these areas.
Parents were encouraged to use the strategies with their children, 20 to 25 hours a week, during the course of daily living. This included not only playtime, but also meals, personal care and family chores. The parents also learned how to encourage social communication outside the home – for example, on a trip to a playground, grocery store or restaurant.
At the end of the nine-month study, parents completed questionnaires and examiners evaluated the children’s social communication skills. Importantly, the examiners did not know to which of the two groups each child belonged.
Both groups of children showed overall gains in social communication and word use. However, the children of the parents who received individual, in-home training showed substantially greater progress.
In addition, the children whose parents received individual training made significant overall gains in understanding others (receptive language). By contrast, the children of the parents who took weekly classes showed no gains, on average, in this area.
Finally, more of the parents who received individual training reported that their children improved in daily living skills. By contrast, more of the parents who took the classes reported that their children lost such skills.
“We’ve come up with a treatment model that can teach parents to support their child’s learning during everyday activities,” says lead researcher Amy Wetherby. Dr. Wetherby directs the Autism Institute at Florida State University’s College of Medicine. “We’ve tested a model that any early intervention system should be able to offer to all families of toddlers with autism. It’s affordable, and it’s efficient.”
Adds Dr. Wang: "Most of the children in this study had relatively strong language, even at baseline. It will be important to see if the approach can be successfully extended to children whose communication skills are not as strong to begin with."
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