van Noorden Lauren E, Sigafoos Jeff, Waddington Hannah L
School of Education, Victoria University of Wellington, Wellington, New Zealand.
Adv Neurodev Disord. 2022;6(4):473-493. doi: 10.1007/s41252-022-00264-8. Epub 2022 May 30.
Early intervention can improve the outcomes of young autistic children, and parents may be well placed to deliver these interventions. The Early Start Denver Model (ESDM) is a naturalistic developmental behavioral intervention that can be implemented by parents with their own children (P-ESDM). This study evaluated a two-tiered P-ESDM intervention that used a group parent coaching program, and a 1:1 parent coaching program. We evaluated changes in parent use of the ESDM and parent stress, as well as child engagement, communication, and imitation.
Seven autistic or probably autistic children (< 60 months old) and their parents participated. A multiple-baseline design was used to compare individual changes between Baseline 1, Group Coaching (Tier 1), Baseline 2, and 1:1 Coaching (Tier 2). Parent and child behaviors were analyzed from weekly videos and graphed. Parenting stress was measured.
All parents improved in their use of ESDM strategies after the Tier 1 intervention. Changes in parent fidelity during Tier 2 were mixed, but all parents maintained higher than baseline levels of fidelity. Six parents demonstrated above 75% ESDM fidelity in at least one session. There were positive changes in parent stress levels pre- post-intervention. Positive results were found for most children's levels of engagement, imitation, and communication. There were significant positive relationships between parent fidelity and both child engagement and child functional utterances.
Group P-ESDM is a promising approach for improving parent fidelity and some child outcomes. Future randomized and controlled studies of group P-ESDM, using standardized outcome measures, are warranted.
The online version contains supplementary material available at 10.1007/s41252-022-00264-8.
早期干预可改善年幼自闭症儿童的预后，而家长可能非常适合实施这些干预措施。早期丹佛模式（ESDM）是一种自然主义的发展行为干预方法，家长可以与自己的孩子一起实施（家长实施的ESDM，即P-ESDM）。本研究评估了一种两级P-ESDM干预措施，该措施采用了团体家长指导计划和一对一家长指导计划。我们评估了家长对ESDM的使用变化、家长压力，以及儿童的参与度、沟通能力和模仿能力。
七名自闭症或疑似自闭症儿童（年龄小于60个月）及其家长参与了研究。采用多基线设计来比较基线1、团体指导（第1级）、基线2和一对一指导（第2级）之间的个体变化。通过每周的视频对家长和儿童的行为进行分析并绘图。测量育儿压力。
在第1级干预后，所有家长在ESDM策略的使用上都有改进。第2级干预期间家长的忠实度变化不一，但所有家长的忠实度都维持在高于基线的水平。六名家长在至少一次课程中表现出高于75%的ESDM忠实度。干预前后家长压力水平有积极变化。大多数儿童在参与度、模仿能力和沟通能力方面都取得了积极成果。家长忠实度与儿童参与度和儿童功能性话语之间存在显著的正相关关系。
团体P-ESDM是提高家长忠实度和改善一些儿童预后的一种有前景的方法。未来有必要使用标准化的结局指标对团体P-ESDM进行随机对照研究。
在线版本包含可在10.1007/s41252-022-00264-8获取的补充材料。
