Exploring best practices, barriers, and supports in family-mediated social communication interventions for children with autism
Pacia, Cressida
Pacia, Cressida
Loading...
Repository DOI
Publication Date
2023-10-02
Type
Thesis
Downloads
Citation
Abstract
Background Best practice guidelines to improve outcomes for children with autism include involving parents in intervention. Parent-implemented interventions (PIIs) have a growing evidence base for teaching social communication skills. PIIs are associated with a range of benefits for parents and children. However, research conducted in a laboratory or university setting does not always translate to meaningful outcomes in the community. Questions remain about factors that impact intervention effectiveness, and families can experience barriers that impede their ability to participate in and benefit from these evidence-based interventions. Aim The aim of this research was to improve family-mediated interventions for autism through identifying characteristics of effective interventions and developing a way to help address barriers and facilitators to family engagement in these interventions. Methods Study 1 was a systematic literature review of family-mediated interventions for young children with autism. Data was extracted with regards to participant and intervention agent characteristics, intervention characteristics, target skills, and collateral outcomes. Treatment effectiveness and research strength were evaluated and synthesized by intervention agent, intervention characteristics, target skills, focused intervention practices (FIPs), and intervention packages. Generalization promotion strategies and outcomes were coded. Study 2 involved a three-stage process to develop the Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS), a tool to help practitioners assess and address variables impacting parent engagement in parent-implemented interventions (PIIs). Stage 1 involved identification of common barriers and facilitators to engagement and the proposal of potential solutions; Stage 2 involved evaluation of the content validity of barrier solution pairings by an expert panel of Board Certified Behaviour Analysts (BCBAs); and Stage 3 involved evaluation of the structure of the PAIRS and its benefits for decision making and day-to-day work with families. Finally, Study 3 utilized a community-based additive treatment design to explore the use of the PAIRS in conjunction with an evidence based PII, Project ImPACT. Two community agencies participated in the study, with one delivering Project ImPACT as part of treatment-as-usual (TAU group) and the other delivering Project ImPACT + PAIRS. Attendance and fidelity of Project ImPACT strategy implementation were compared between groups, and interviews were conducted with parents and providers in the PAIRS group to evaluate social validity. Findings The systematic review (Study 1) found that NDBIs had a growing evidence base as a family-mediated intervention, partial generalization was observed in PIIs and some generalization strategies are under-utilized, and intervention factors such as setting, modality, and dosage had inconclusive effects on intervention outcomes. In Study 2, the expert panel rated the barrier-solution pairings in the PAIRS as relevant, effective, and appropriate, and rated the tool itself as beneficial for decision-making and day-to-day work with families. Finally, in Study 3, attendance in the Project ImPACT program was significantly higher in the PAIRS group compared to the TAU group, while there was no significant difference in fidelity between groups. A qualitative review of the interviews with parents and practitioners provided support for the social validity of Project ImPACT and the PAIRS, and provided insight into the use of the tool for planning, problem-solving, and reflection. Conclusion Overall, the studies in this thesis demonstrate that intervention factors can be adapted to maximize parent engagement. The variable impact of various intervention factors can allow for individualization of these and other relevant factors, while maintaining fidelity to evidence-based intervention packages or FIPs. The present research demonstrates the utility of a systematic, empirical approach to reviewing the literature, developing a practical tool, and conducting community-based research to explore the real-world use of the tool. The PAIRS is thoroughly grounded in the behaviour analytic framework and informed by the existing literature on PIIs and barriers and facilitators to engagement. The findings highlight the importance of using a functional, contextual approach for both child and parent behaviour.
Funder
Publisher
NUI Galway