Skip to main content
SpringerLink
Log in

Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT

Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Cite this article

Abstract

This pilot RCT compared the effect of a self-directed and therapist-assisted telehealth-based parent-mediated intervention for young children with ASD. Families were randomly assigned to a self-directed or therapist-assisted program. Parents in both groups improved their intervention fidelity, self-efficacy, stress, and positive perceptions of their child; however, the therapist-assisted group had greater gains in parent fidelity and positive perceptions of child. Children in both groups improved on language measures, with a trend towards greater gains during a parent–child interaction for the therapist-assisted group. Only the children in the therapist-assisted group improved in social skills. Both models show promise for delivering parent-mediated intervention; however, therapist assistance provided an added benefit for some outcomes. A full-scale comparative efficacy trial is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2000). DSM-IV. Diagnostic and statistical manual of mental disorders 4th edition TR. Arlington, VA: American Psychiatric Publishing.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  • Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38(4), 196–205.

    Article  PubMed  Google Scholar 

  • Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS one, 5(10), e13196.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baggett, K. M., Davis, B., Feil, E. G., Sheeber, L. B., Landry, S. H., Carta, J. J., & Leve, C. (2010). Technologies for expanding the reach of evidence-based interventions: Preliminary results for promoting social-emotional development in early childhood. Topics in Early Childhood Special Education, 29(4), 226–238.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bitterman, A., Daley, T. C., Misra, S., Carlson, E., & Markowitz, J. (2008). A national sample of preschoolers with autism spectrum disorders: Special education services and parent satisfaction. Journal of Autism and Developmental Disorders, 38(8), 1509–1517.

    Article  PubMed  Google Scholar 

  • Campbell, N. C., Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F., et al. (2007). Designing and evaluating complex interventions to improve health care. British Medical Journal, 334, 455–459.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carter, A. (2009). Stability and individual change in depressive symptoms among mothers raising young children with ASD: Maternal and child correlates. Journal of Clinical Psychology, 65(12), 1270–1280.

    Article  PubMed  Google Scholar 

  • Donenberg, G., & Baker, B. L. (1993). The impact of young children with externalizing behaviors on their families. Journal of Abnormal Child Psychology, 21(2), 179–198.

    Article  PubMed  Google Scholar 

  • Fenson, L., Dale, P. S., Reznick, J. S., Bates, E., Thal, D., & Pethick, S. (1994). Variability in early communicative development. Monographs of the Society for Research in Child Development, 59, 1–173.

    Article  PubMed  Google Scholar 

  • Fenson, L., Marchman, V. A., Thal, D., Dale, P. S., Reznick, J. S., & Bates, E. (2006). MacArthur-Bates communicative development inventories: User’s guide and technical manual 2. Baltimore, MD: Brookes Publishing.

    Google Scholar 

  • Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65(6), 591–598.

    Article  PubMed  Google Scholar 

  • Gibaud-Wallston, J., & Wandersmann, L. P. (1978). Development and utility of the parenting sense of competence scale. Washington: John F. Kennedy Center for Research on Education and Human Development.

    Google Scholar 

  • Gros, D. F., Morland, L. A., Greene, C. J., Acierno, R., Strachan, M., Egede, L. E., & Frueh, B. C. (2013). Delivery of evidence-based psychotherapy via video telehealth. Journal of Psychopathology and Behavioral Assessment, 35(4), 506–521.

    Article  Google Scholar 

  • Gustke, S. S., Balch, D. C., West, V. L., & Rogers, L. O. (2000). Patient satisfaction with telemedicine. Telemedicine Journal, 6(1), 5–13.

    Article  Google Scholar 

  • Hamad, C. D., Serna, R. W., Morrison, L., & Fleming, R. (2010). Extending the reach of early intervention training for practicitioners: A preliminary investigation of an online vurriculum for teaching behavioral intervention knowledge in autism to families and service providers. Infants and Young Children, 23(3), 195–208.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hayes, S., & Watson, S. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum. Journal of Autism and Developmental Disorders, 43(3), 629–642.

    Article  PubMed  Google Scholar 

  • Ingersoll, B., & Berger, N. I. (2015). Parent engagement with a telehealth-based parent-mediated intervention program for children with ASD: Predictors of program use and parent outcomes. Journal of Medical Internet Research, 17, e227.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ingersoll, B., & Dvortcsak, A. (2010). Teaching social communication: A practitioner’s guide to parent training for children with autism. New York: Guilford Press.

    Google Scholar 

  • Jang, J., Dixon, D. R., Tarbox, J., Granpeesheh, D., Kornack, J., & de Nocker, Y. (2012). Randomized trial of an eLearning program for training family members of children with autism in the principles and procedures of applied behavior analysis. Research in Autism Spectrum Disorders, 6(2), 852–856.

    Article  Google Scholar 

  • Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36(4), 567–589.

    Article  PubMed  Google Scholar 

  • Karst, J., & Hecke, A. Van. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 5(3), 247–277.

    Article  Google Scholar 

  • Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554–563.

    Article  PubMed  PubMed Central  Google Scholar 

  • Keen, D., Couzens, D., Muspratt, S., & Rodger, S. (2010). The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence. Research in Autism Spectrum Disorders, 4(2), 229–241.

    Article  Google Scholar 

  • Kobak, K. A., Stone, W. L., Wallace, E., Warren, Z., Swanson, A., & Robson, K. (2011). A web-based tutorial for parents of young children with autism: Results from a pilot study. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 17(10), 804–808.

    Article  Google Scholar 

  • Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & Van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158.

    Article  PubMed  Google Scholar 

  • Krebs, P., Prochaska, J. O., & Rossi, J. S. (2010). Defining what works in tailoring: A meta-analysis of computer tailored interventions for health behavior change. Preventive Medicine, 51(3–4), 214–221.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuhn, J., & Carter, A. (2006). Maternal self-efficacy and associated parenting cognitions among mothers of children with autism. American Journal of Orthopsychiatry, 76(4), 564–575.

    Article  PubMed  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H, Jr, Leventhal, B. L., DiLavore, P. C., & Rutter, M. (2000). 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(3), 205–223.

    Article  PubMed  Google Scholar 

  • McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice, 13, 120–129.

    Article  PubMed  Google Scholar 

  • Moher, D., Schulz, K. F., Altman, D. G., & Consort Group. (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. The Lancet, 357(9263), 1191–1194.

    Article  Google Scholar 

  • Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: AGS.

    Google Scholar 

  • National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press.

    Google Scholar 

  • Nefdt, N., Koegel, R., Singer, G., & Gerber, M. (2009). The use of a self-directed learning program to provide introductory training in pivotal response treatment to parents of children with autism. Journal of Positive Behavior Interventions, 12(1), 23–32.

    Article  Google Scholar 

  • Nieuwboer, C. C., Fukkink, R. G., & Hermanns, J. M. A. (2013). Online programs as tools to improve parenting: A meta-analytic review. Children and Youth Services Review, 35(11), 1823–1829.

    Article  Google Scholar 

  • Phaneuf, L., & McIntyre, L. L. (2011). The application of a three-tier model of intervention to parent training. Journal of Positive Behavior Interventions, 13(4), 198–207.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 2411–2428.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (2005). Vineland II: Vineland adaptive behavior scales. Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Spek, V., Cuijpers, P., Nyklícek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine, 37(3), 319–328.

    Article  PubMed  Google Scholar 

  • Steever, M. (2011). Stepped care and e-health: Practical applications to behavioral disorders. In W. T. O’Donohue & C. Drapper (Eds.), Autism. New York, NY: Springer.

    Chapter  Google Scholar 

  • Symon, J. B. (2005). Expanding interventions for children with autism: Parents as trainers. Journal of Positive Behavior Interventions, 7(3), 159–173.

    Article  Google Scholar 

  • Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R., & Yoder, P. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 52(3), 643–652.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thomas, K. C., Ellis, A. R., McLaurin, C., Daniels, J., & Morrissey, J. P. (2007a). Access to care for autism-related services. Journal of Autism and Developmental Disorders, 37(10), 1902–1912.

    Article  PubMed  Google Scholar 

  • Thomas, K. C., Morrissey, J. P., & McLaurin, C. (2007b). Use of autism-related services by families and children. Journal of Autism and Developmental Disorders, 37(5), 818–829.

    Article  PubMed  Google Scholar 

  • United States Department of Education, Office of Planning, Evaluation, and Policy Development. (2010). Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. Washington, DC: Author.

    Google Scholar 

  • Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal of Autism and Developmental Disorders, 43(12), 2953–2969.

    Article  PubMed  Google Scholar 

  • Vismara, L. A., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment, 2012, 121878.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wainer, A. L., & Ingersoll, B. R. (2013). Disseminating ASD interventions: A pilot study of a distance learning program for parents and professionals. Journal of Autism and Developmental Disorders, 43(1), 11–24.

    Article  PubMed  Google Scholar 

  • Wainer, A. L., & Ingersoll, B. (2015). Increasing access to an ASD imitation intervention via a telehealth parent training program. Journal of Autism and Developmental Disorders, 45, 3877–3890.

    Article  PubMed  Google Scholar 

  • Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-implemented social intervention for toddlers with autism: An RCT. Pediatrics, 134(6), 1084–1093.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wootton, R. (2012). Twenty years of telemedicine in chronic disease management—an evidence synthesis. Journal of Telemedicine and Telecare, 18(4), 211–220.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This project was supported by CDMRP Grant: #W81XWH-10-1-0586. The first author receives royalties from the sale of the manual that was adapted for use in the online tutorial. Royalities are donated to the research. We thank the families who participated in this study.

Author Contributions

BI conceived of the study, participated in its design and coordination and drafted the manuscript; ALW, NIB, and KEP performed the measurement and participated in its design and coordination and helped to draft the manuscript. NB performed the measurement and participated in the study’s coordination. All authors read and approved the final manuscript.

Author information

Author notes

  1. Allison L. Wainer

    Present address: Rush University Medical Center, Chicago, IL, USA

Authors and Affiliations

  1. Department of Psychology, Michigan State University, 316 Physics Rd., East Lansing, MI, 48824, USA

    Brooke Ingersoll, Allison L. Wainer, Natalie I. Berger, Katherine E. Pickard & Nicole Bonter

Authors
  1. Brooke Ingersoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allison L. Wainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalie I. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine E. Pickard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicole Bonter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brooke Ingersoll.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ingersoll, B., Wainer, A.L., Berger, N.I. et al. Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT. J Autism Dev Disord 46, 2275–2284 (2016). https://doi.org/10.1007/s10803-016-2755-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-016-2755-z

Keywords

search

Navigation