Drapalik Krista N, Grodberg David, Ventola Pamela
Center for Autism and Related Disabilities, University at Albany, State University of New York, Albany, NY, United States.
Yale Child Study Center, Yale University, New Haven, CT, United States.
JMIR Pediatr Parent. 2022 Sep 6;5(3):e32520. doi: 10.2196/32520.
Pivotal response treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in autistic individuals.
The aim of this study was to assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health, a telehealth platform that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their autistic children.
Male and female autistic children, aged 2-7 years with single-word to phrase-level speech, and their parents were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Credibility Questionnaire (CCQ) at week 2 and at the study endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at the study endpoint to assess parental expectancies, and treatment acceptability and effectiveness.
Nine of 14 participants completed the study curriculum in the online parent training condition, and 6 of 12 participants completed the control condition. Thus, a total of 58% (15/26) participants across both groups completed the study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ total scores, from 25.38 (SD 3.25) at baseline to 27.5 (SD 3.74) at study endpoint (P=.04); mean CCQ confidence scores, from 6.0 (SD 1.07) at baseline to 6.75 (SD 0.89) at study endpoint (P=.02); and mean CCQ other improvement scores, from 5.25 (SD 0.89) at baseline to 6.25 (SD 1.28) at study endpoint (P=.009). Within the control condition, a modest increase in mean CCQ scores was noted (Confidence, difference=+0.25; Recommend, difference=+0.25; Total Score, difference=+0.50), but the differences were not statistically significant (Confidence P=.38, Recommend P=.36, Total Score P=.43). Among the 11 parents who completed the BIRS at the study endpoint, 82% (n=9) endorsed that they slightly agree or agree with over 93% of the Acceptability factor items on the BIRS.
The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores, as well as strong ratings on the BIRS. This study's small sample size limits the conclusions that can be drawn; however, the PRT MindNest Health platform holds promise to support parents of autistic children who are unable to access traditional, in-person parent-mediated interventions for their child.
关键反应训练（PRT）是一种基于证据且由家长实施的干预措施，旨在改善自闭症个体的社交沟通能力。
本研究的目的是评估通过MindNest Health提供的PRT在线模式的可行性、可接受性和临床效果。MindNest Health是一个远程医疗平台，旨在为大量为自闭症孩子寻求资源的家长提供自主式且引人入胜的在线模块、实时指导和反馈，以及可及的逐步照护服务。
年龄在2至7岁、具有单词到短语水平语言能力的自闭症男童和女童及其家长有资格参与本研究。家庭被随机分配到在线家长培训组或对照组。干预的在线部分包括八个20分钟的在线课程，内容为描述PRT中的家长培训原则。在第1、3、5和8课程之后分别举行了四次1小时的视频会议。家长有1至2周时间完成每门课程。家长在第2周和研究终点完成客户可信度问卷（CCQ），并在研究终点完成行为干预评定量表（BIRS），以评估家长的期望、治疗的可接受性和有效性。
在线家长培训组的14名参与者中有9名完成了研究课程，对照组的12名参与者中有6名完成了研究课程。因此，两组共有58%（15/26）的参与者在研究结束时完成了研究课程。在在线家长培训组中，CCQ总分均值有显著增加，从基线时的25.38（标准差3.25）增至研究终点时的27.5（标准差3.74）（P = 0.04）；CCQ信心得分均值从基线时的6.0（标准差1.07）增至研究终点时的6.75（标准差0.89）（P = 0.02）；CCQ其他改善得分均值从基线时的5.25（标准差0.89）增至研究终点时的6.25（标准差1.28）（P = 0.009）。在对照组中，CCQ得分有适度增加（信心得分，差异 = +0.25；推荐得分，差异 = +0.25；总分，差异 = +0.50），但差异无统计学意义（信心得分P = 0.38，推荐得分P = 0.36，总分P = 0.43）。在研究终点完成BIRS的11名家长中，82%（n = 9）表示他们对BIRS上超过93%的可接受性因子项目略有同意或同意。
在线家长培训组中在线模块的高完成率和视频会议的高参与率证明了这种在线治疗的可行性。CCQ上的高评分、得分的显著改善以及BIRS上的高评分支持了治疗的可接受性。本研究的小样本量限制了可得出的结论；然而，MindNest Health平台有望为那些无法为孩子获得传统的、面对面家长介导干预的自闭症孩子家长提供支持。
