Journal of Autism and Developmental Disorders

, Volume 43, Issue 3, pp 540–555 | Cite as

A Parent-Mediated Intervention to Increase Responsive Parental Behaviors and Child Communication in Children with ASD: A Randomized Clinical Trial

  • Michael SillerEmail author
  • Ted Hutman
  • Marian Sigman
Original Paper


Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder. To investigate the underlying causal mechanisms, we conducted a randomized clinical trial of an experimental intervention (Focused Playtime Intervention, FPI) that aims to enhance responsive parental communication (N = 70). Results showed a significant treatment effect of FPI on responsive parental behaviors. Findings also revealed a conditional effect of FPI on children’s expressive language outcomes at 12-month follow up, suggesting that children with baseline language skills below 12 months (n = 24) are most likely to benefit from FPI. Parents of children with more advanced language skills may require intervention strategies that go beyond FPI’s focus on responsive communication.


Autism Randomized clinical trial Parent child communication Language Intervention 



Preparation of this article was supported by CPEA Grant HD35470 from the National Institute of Child Health and Human Development, the M.I.N.D. Institute Research Program, and a PSC-CUNY grant. We gratefully acknowledge the contributions of the parents and children who participated in this study. We also wish to thank the researchers who contributed to this project over the years, especially Agata Rozga, Alma Lopez-Singh, Amanda Chinchilla, Angeline Dijamco DeLaurentis, Cindy Huang, Cynthia Zierhut, Cristina Fernandez, Elia Jimenez, James Earhart, Jenna Mendelson, Joanna Mussey, Laura Espana, Lisa Travis, Liz Lizaola, Lovella Gomez, Michael Bono, Mithi del Rosario, Nuri Reyes, Sarah Clavell, Stephanie Marshall, Stephany Cox, and Tamara Daley. Special Thanks to Paul Yoder and David MacKinnon for their invaluable support and feedback on drafts of this manuscript.

Supplementary material

10803_2012_1584_MOESM1_ESM.pdf (3.8 mb)
#1: Our special play time: Finding ways to improve play time with my young child with autism: Illustrated workbook for parents (unpublished document). Supplementary material 1 (PDF 3875 kb)
10803_2012_1584_MOESM2_ESM.pdf (2.5 mb)
#2: Our special play time: Finding ways to improve play time with my young child with autism: Treatment manual (unpublished manuscript). Supplementary material 2 (PDF 2529 kb)


  1. Adamson, L. B., Bakeman, R., Deckner, D. F., & Romski, M. A. (2009). Joint engagement and the emergence of language in children with autism and Down syndrome. Journal of Autism and Developmental Disorders, 39, 84–96.PubMedCrossRefGoogle Scholar
  2. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.Google Scholar
  3. Akhtar, N., Dunham, F., & Dunham, P. J. (1991). Directive interactions and early vocabulary development: The role of joint attentional focus. Journal of Child Language, 18, 41–49.PubMedCrossRefGoogle Scholar
  4. Anderson, S. R., Avery, D. L., DiPietro, E. K., Edwards, G. L., & Christian, W. P. (1987). Intensive home-based intervention with autistic children. Education and Treatment of Children, 10, 352–366.Google Scholar
  5. Baker, J. K., Fenning, R. M., Crnic, K. A., Baker, B. L., & Blacher, J. (2007). Prediction of social skills in 6-year-old children with and without developmental delays: Contributions of early regulation and maternal scaffolding. American Journal on Mental Retardation, 112, 375–391.PubMedCrossRefGoogle Scholar
  6. Baker, J., Messinger, D., Lyons, K. K., & Gantz, J. (2010). A pilot study of maternal sensitivity in the context of emergent autism. Journal of Autism and Developmental Disorders, 40, 988–999.PubMedCrossRefGoogle Scholar
  7. Bono, M. A., Daley, T., & Sigman, M. (2004). Relations among joint attention, amount of intervention and language gain in autism. Journal of Autism and Developmental Disorders, 34, 495–505.PubMedCrossRefGoogle Scholar
  8. Breitborde, N. J. K., Srihari, V. H., Pollard, J. M., Addington, D. N., & Woods, S. W. (2010). Mediators and moderators in early intervention research. Early Intervention in Psychiatry, 4(2), 143–152.PubMedCrossRefGoogle Scholar
  9. Carpenter, M., Nagell, K., & Tomasello, M. (1998). Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monographs of the Society for Research in Child Development, 63(4), 1–176.CrossRefGoogle Scholar
  10. Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52(7), 741–752.PubMedCrossRefGoogle Scholar
  11. Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Lawrence Erlbaum Associates.Google Scholar
  12. Collins, J. (2004). Education techniques for lifelong learning: Principles of adult learning. RadioGraphics, 24(5), 1483–1489.PubMedCrossRefGoogle Scholar
  13. Collins, L. M., Schafer, J. L., & Kam, C. M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6, 330–351.PubMedCrossRefGoogle Scholar
  14. Copple, C., & Bredekamp, S. (2009). Developmentally appropriate practice in early childhood programs serving children from birth through age 8 (3rd ed.). Washington, DC: National Association for the Education of Young Children.Google Scholar
  15. Coyne, L., Low, C. M., Miller, A. L., Seifer, R., & Dickstein, S. (2007). Maternal empathic understanding of their toddlers: Associations with maternal sensitivity and depression. Journal of Child and Family Studies, 16, 483–497.CrossRefGoogle Scholar
  16. Demers, I., Bernier, A., Tarabulsy, G., & Provost, M. (2010). Maternal and child characteristics as antecedents of maternal mind-mindeness. Infant Mental Health Journal, 31(1), 94–112.CrossRefGoogle Scholar
  17. Dunst, C. J., & Trivette, C. M. (2009). Let’s be PALS: An evidence-based approach to professional development. Infants and Young Children, 22(3), 164–176.CrossRefGoogle Scholar
  18. Early Child Care Research Network, N. I. C. H. D., & Duncan, G. J. (2003). Modeling the impacts of child care quality on children’s preschool cognitive development. Child Development, 74, 1454–1475.CrossRefGoogle Scholar
  19. Enders, C. K. (2010). Applied missing data analysis. New York: Guilford.Google Scholar
  20. Fitzmaurice, G. M., Laird, N. M., & Ware, J. H. (2004). Applied longitudinal analysis. New York: Wiley.Google Scholar
  21. Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239.PubMedCrossRefGoogle Scholar
  22. Graham, J. W., Olchowski, A. E., & Gilreath, T. D. (2007). How many imputations are really needed? Some practical clarifications of multiple imputation theory. Preventive Science, 8(3), 208–213.CrossRefGoogle Scholar
  23. Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., et al. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet, 375, 2152–2160.CrossRefGoogle Scholar
  24. Harris, S., Kasari, C., & Sigman, M. D. (1996). Joint attention and language gains in children with Down syndrome. American Journal on Mental Retardation, 100, 608–619.PubMedGoogle Scholar
  25. Hutman, T., Siller, M., & Sigman, M. (2009). Mothers’ narratives regarding their child with autism predict maternal synchronous behavior during play. Journal of Child Psychology and Psychiatry, 50(10), 1255–1263.PubMedCrossRefGoogle Scholar
  26. Kasari, C., Gulsrud, A., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40, 1045–1056.PubMedCrossRefGoogle Scholar
  27. Koren-Karie, N., & Oppenheim, D. (1997). The insightfulness assessment coding manual. In Unpublished manuscript, Center for Research in Child Development. University of Haifa, Israel.Google Scholar
  28. Koren-Karie, N., Oppenheim, D., Dolev, S., Sher, E., & Etzion-Carasso, A. (2002). Mother’s insightfulness regarding their infants’ internal experience: Relations with maternal sensitivity and infant attachment. Developmental Psychology, 38(4), 534–542. doi: 10.1037/0012-1649.38.4.534.PubMedCrossRefGoogle Scholar
  29. Landry, S. H., Smith, K. E., & Swank, P. R. (2006). Responsive parenting: Establishing early foundations for social, communication, and independent problem-solving skills. Developmental Psychology, 42, 627–642.PubMedCrossRefGoogle Scholar
  30. Landry, S. H., Smith, K. E., Swank, P. R., Assel, M. A., & Vellet, S. (2001). Does early responsive parenting have a special importance for children’s development or is consistency across early childhood necessary? Developmental Psychology, 37, 387–403.PubMedCrossRefGoogle Scholar
  31. Lord, C., & Bishop, S. L. (2010). Autism spectrum disorders: Diagnosis, prevalence, and services for children and families. SRCD Social Policy Report, 24(2), 1–27.Google Scholar
  32. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.PubMedCrossRefGoogle Scholar
  33. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.PubMedCrossRefGoogle Scholar
  34. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.PubMedCrossRefGoogle Scholar
  35. MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Erlbaum.Google Scholar
  36. McDuffie, A., & Yoder, P. (2010). Types of parent verbal responsiveness that predict language in young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 53, 1026–1039.PubMedCrossRefGoogle Scholar
  37. Mullen, E. M. (1995). Manual for the Mullen Scales of Early Learning. Circle Pines, MN: American Guidance.Google Scholar
  38. Oppenheim, D., & Koren-Karie, N. (2002). Mothers’ insightfulness regarding their children’s internal worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23, 593–605.CrossRefGoogle Scholar
  39. Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Computational tools for probing interaction effects in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31, 437–448.CrossRefGoogle Scholar
  40. Rogers, S. J., & Vismara, L. A. (2008). Empirically supported comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37, 8–38.Google Scholar
  41. Sandall, S., Hemmeter, M. L., Smith, B. J., & McLean, M. E. (2005). DEC recommended practices: A comprehensive guide for practical application in early intervention/early childhood special education. Missoula, MT: Division for Early Childhood.Google Scholar
  42. Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7(2), 147–177.PubMedCrossRefGoogle Scholar
  43. Seibert, J. M., Hogan, A. E., & Mundy, P. C. (1982). Assessing interactional competencies: The Early Social-Communication Scales. Infant Mental Health Journal, 3, 244–258.CrossRefGoogle Scholar
  44. Sheinkopf, S. J., & Siegel, B. (1998). Home based behavioral treatment of young autistic children. Journal of Autism and Developmental Disorders, 28, 15–23.PubMedCrossRefGoogle Scholar
  45. Siller, M., & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32, 77–89.PubMedCrossRefGoogle Scholar
  46. Siller, M., & Sigman, M. (2008). Modeling longitudinal change in the language abilities of children with autism: Parent behaviors and child characteristics as predictors of change. Developmental Psychology, 44, 1691–1704.PubMedCrossRefGoogle Scholar
  47. Smith, C. B., Adamson, L. B., & Bakeman, R. (1988). Interactional predictors of early language. First Language, 8, 143–156.CrossRefGoogle Scholar
  48. Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269–285.PubMedCrossRefGoogle Scholar
  49. Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72, 748–767.PubMedCrossRefGoogle Scholar
  50. Trivette, C., Dunst, C., Hamby, D., & O’Herin, C. (2009). Characteristics and consequences of adult learning methods and strategies. (Winterberry Research Syntheses Vol. 2, No. 2). Asheville, NC: Winterberry Press.Google Scholar
  51. Warren, S. F., Brady, N. C., Sterling, A. M., Fleming, K., & Marquis, J. (2010). The effects of maternal responsivity on the language development of children with fragile X syndrome. American Journal on Intellectual and Developmental Disability, 115, 54–75.CrossRefGoogle Scholar
  52. Woods, J. J., & Brown, J. A. (2011). Integrating family capacity-building and child outcomes to support social communication development in young children with autism spectrum disorder. Topics in Language Disorders, 31(3), 235–246.CrossRefGoogle Scholar
  53. Yoder, P., & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49, 698–711.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesUSA
  2. 2.Psychology DepartmentHunter College of The City University of New YorkNew YorkUSA

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