Preliminary Efficacy of Family Implemented TEACCH for Toddlers: Effects on Parents and Their Toddlers with Autism Spectrum Disorder

  • Lauren Turner-BrownEmail author
  • Kara Hume
  • Brian A. Boyd
  • Kirsten Kainz
Original Paper


This study examined the effects of an intervention to support parents and promote skill development in newly diagnosed toddlers with ASD. Participants included 50 children with ASD under 3 and their parents who were randomly assigned to participate in a 6-month intervention, Family Implemented TEACCH for Toddlers (FITT) or 6 months of community services as usual. FITT included 90-min in-home sessions (n = 20) and parent group sessions (n = 4). Results revealed significant treatment effects on parent stress and well-being, with families in the FITT group showing decreased stress and improved well-being over time. While no treatment effects were found for global child measures, there were significant treatment effects on social communication skills.


Early intervention Parent stress Rurality TEACCH 



We are grateful to the families who generously participated in this study and would like to acknowledge the valuable contribution of Samantha Scott, Cassidy Arnold, Laurie Moses, and Amanda Benson to the project. This research was supported in part by grants from the Department of Health and Human Services Maternal Child Health Bureau (R40MC22648) and by the NICHD IDDRC (U54 HD079124).

Author's contributions

LTB, KH, and BAB conceived of the study, participated in its design and coordination and drafted the manuscript; KK performed the statistical analysis and participated in the interpretation of the data. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

Lauren Turner-Brown, Kara Hume, Brian Boyd and Kirsten Kainz declares that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All research activities were approved by our institution’s IRB prior to enrolling participants. Informed consent was obtained from families prior to participation in any research activities.


  1. Abidin, R. R. (1995). Parenting stress index (3rd ed.). Odessa, FL: Psychological Assessment Resource.Google Scholar
  2. Baker-Ericzén, M. J., Brookman-Frazee, L., & Stahmer, A. (2005). Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders. Research and Practice for Persons with Severe Disabilities, 30(4), 194–204. doi: 10.2511/rpsd.30.4.194.CrossRefGoogle Scholar
  3. Beck, A., Hastings, R. P., Daley, D., & Stevenson, J. (2004). Pro-social behaviour and behaviour problems independently predict maternal stress. Journal of Intellectual and Developmental Disability, 29(4), 339–349.CrossRefGoogle Scholar
  4. Boyd, B. A. (2002). Examining the relationship between stress and lack of social support in mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 17(4), 208–215. doi: 10.1177/10883576020170040301.CrossRefGoogle Scholar
  5. Brereton, A., & Tonge, B. J. (2005). Preschoolers with autism: An education and skills training programme for parents. London: Jessica Kingsley Publishers.Google Scholar
  6. Carr, T., Shih, W., Lawton, K., Lord, C., King, B., & Kasari, C. (2015). The relationship between treatment attendance, adherence, and outcome in a caregiver-mediated intervention for low-resourced families of young children with autism spectrum disorder. Autism. doi: 10.1177/1362361315598634.PubMedGoogle Scholar
  7. Carter, A. S., de Martínez-Pedraza, F. L., & Gray, S. A. O. (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. doi: 10.1002/jclp.20634.CrossRefPubMedGoogle Scholar
  8. 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. doi: 10.1111/j.1469-7610.2011.02395.x.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Contopoulos-Ioannidis, D. G., Karvouni, A., Kouri, I., & Ioannidis, J. P. A. (2009). Reporting and interpretation of SF-36 outcomes in randomised trials: Systematic review. British Medical Journal, 338(7687), 1–8. doi: 10.1136/bmj.a3006.Google Scholar
  10. Cripe, J. W., & Venn, M. L. (1997). Family-guided routines for early intervention services. Young Exceptional Children, 1(1), 18–26.CrossRefGoogle Scholar
  11. Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 580–587. doi: 10.1016/j.jaac.2015.04.005.CrossRefPubMedGoogle Scholar
  12. Estes, A., Vismara, L., Mercado, C., Fitzpatrick, A., Elder, L., Greenson, J., & Rogers, S. (2014). The impact of parent-delivered intervention on parents of very young children with autism. Journal of Autism and Developmental Disorders, 44(2), 353–365. doi: 10.1007/s10803-013-1874-z.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., & Pickles, A. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. Lancet, 375(9732), 2152–2160. doi: 10.1016/S0140-6736(10)60587-9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. Ingersoll, B. (2012). Effect of a focused imitation intervention on social functioning in children with autism. Journal of Autism and Developmental Disorders, 42(8), 1768–1773. doi: 10.1007/s10803-011-1423-6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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. doi: 10.1037/a0039080.CrossRefPubMedGoogle Scholar
  17. Kasari, C., Gulsrud, A. C., 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(9), 1045–1056. doi: 10.1007/s10803-010-0955-5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50(3), 172–183.CrossRefPubMedGoogle Scholar
  19. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule, 2nd edition (ADOS-2) manual (Part I): Modules 1–4. Torrence, CA: Western Psychological Service.Google Scholar
  20. Mancil, G. R., Conroy, M. A., & Haydon, T. F. (2009). Effects of a modified milieu therapy intervention on the social communicative behaviors of young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 149–163. doi: 10.1007/s10803-008-0613-3.CrossRefPubMedGoogle Scholar
  21. McGee, G. G., Morrier, M. J., & Daly, T. (1999). An incidental teaching approach to early intervention for toddlers with autism. Journal of the Association for Persons with Severe Handicaps, 24(3), 133–146. doi: 10.2511/rpsd.24.3.133.CrossRefGoogle Scholar
  22. Moh, T. A., & Magiati, I. (2012). Factors associated with parental stress and satisfaction during the process of diagnosis of children with Autism Spectrum Disorders. Research in Autism Spectrum Disorders, 6(1), 293–303. doi: 10.1016/j.rasd.2011.05.011.CrossRefGoogle Scholar
  23. Mullen, E. M. (1995). Mullen scales of early learning: AGS edition. Circle Pines, MN: American Guidance Service.Google Scholar
  24. Murphy, N. A., Christian, B., Caplin, D. A., & Young, P. C. (2007). The health of caregivers for children with disabilities: Caregiver perspectives. Child: Care, Health and Development, 33(2), 180–187. doi: 10.1111/j.1365-2214.2006.00644.x.Google Scholar
  25. National Research Council. (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. In C. Lord & J. P. McGee (Eds.). Washington, DC: National Academy Press.Google Scholar
  26. North Carolina Rural Center. (2016). The Rural Center. Retrieved from
  27. Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Cochrane Database Systematic Reviews, 4, CD009774. doi: 10.1002/14651858.CD009774.pub2.Google Scholar
  28. Osborne, L. A., McHugh, L., Saunders, J., & Reed, P. (2008). Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1092–1103. doi: 10.1007/s10803-007-0497-7.CrossRefPubMedGoogle Scholar
  29. Osborne, L. A., & Reed, P. (2008). Parents’ perceptions of communication with professionals during the diagnosis of autism. Autism, 12(3), 309–324. doi: 10.1177/1362361307089517.CrossRefPubMedGoogle Scholar
  30. Osborne, L. A., & Reed, P. (2010). Stress and self-perceived parenting behaviors of parents of children with autistic spectrum conditions. Research in Autism Spectrum Disorders, 4(3), 405–414. doi: 10.1016/j.rasd.2009.10.011.CrossRefGoogle Scholar
  31. Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28(1), 25–32.CrossRefPubMedGoogle Scholar
  32. Peterson, C. A., Luze, G. J., Eshbaugh, E. M., Jeon, H. J., & Kantz, K. R. (2007). Enhancing parent-child interactions through home visiting: Promising practice or unfulfilled promise? Journal of Early Intervention, 29(2), 119–140.CrossRefGoogle Scholar
  33. Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Systematic Reviews, 10, CD009260. doi: 10.1002/14651858.CD009260.pub2.Google Scholar
  34. Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., & Dawson, G. (2012). Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1052–1065. doi: 10.1016/j.jaac.2012.08.003.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Rush, D., & Sheldon, M. (2011). The early childhood coaching handbook. Baltimore, MD: Brookes Publishing.Google Scholar
  36. Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of Joint Attention Mediated Learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28(2), 249–258. doi: 10.1016/j.ecresq.2012.06.006.CrossRefGoogle Scholar
  37. 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(8), 2411–2428. doi: 10.1007/s10803-015-2407-8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Selby, J. V., Beal, A. C., & Frank, L. (2012). The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. Journal of the American Medical Association, 307(15), 1583–1584. doi: 10.1001/jama.2012.500.CrossRefPubMedGoogle Scholar
  39. Seltzer, M. M., Greenberg, J. S., Hong, J., Smith, L. E., Almeida, D. M., Coe, C., & Stawski, R. S. (2010). Maternal cortisol levels and behavior problems in adolescents and adults with ASD. Journal of Autism and Developmental Disorders, 40(4), 457–469. doi: 10.1007/s10803-009-0887-0.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Stahmer, A. C. (2007). The basic structure of community early intervention programs for children with autism: Provider descriptions. Journal of Autism and Developmental Disorders, 37(7), 1344–1354. doi: 10.1007/s10803-006-0284-x.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Stahmer, A. C., Collings, N. M., & Palinkas, L. A. (2005). Early intervention practices for children with autism: Descriptions from community providers. Focus Autism Other Developmental Disabilities, 20(2), 66–79. doi: 10.1177/10883576050200020301.CrossRefGoogle Scholar
  42. Stahmer, A. C., & Mandell, D. S. (2007). State infant/toddler program policies for eligibility and services provision for young children with autism. Administration and Policy in Mental Health, 34(1), 29–37. doi: 10.1007/s10488-006-0060-4.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Stahmer, A. C., & Pellecchia, M. (2015). Moving towards a more ecologically valid model of parent-implemented interventions in autism. Autism, 19(3), 259–261.CrossRefPubMedGoogle Scholar
  44. Stone, W. L., Coonrod, E. E., Pozdol, S. L., & Turner, L. M. (2003). The Parent Interview for Autism-Clinical Version (PIA-CV): A measure of behavioral change for young children with autism. Autism, 7(1), 9–30. doi: 10.1177/1362361303007001017.CrossRefPubMedGoogle Scholar
  45. Stone, W. L., & Hogan, K. L. (1993). A structured parent interview for identifying young children with autism. Journal of Autism and Developmental Disorders, 23(4), 639–652. doi: 10.1007/BF01046106.CrossRefPubMedGoogle Scholar
  46. Valicenti-McDermott, M., Lawson, K., Hottinger, K., Seijo, R., Schechtman, M., Shulman, L., & Shinnar, S. (2015). Parental stress in families of children with autism and other developmental disabilities. Journal of Child Neurology, 30(13), 1728–1735. doi: 10.1177/0883073815579705.CrossRefPubMedGoogle Scholar
  47. Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 Physical and Mental Health Summary Scales: A users’ manual. Boston: The Health Institute.Google Scholar
  48. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.CrossRefPubMedGoogle Scholar
  49. Welterlin, A., Turner-Brown, L. M., Harris, S., Mesibov, G., & Delmolino, L. (2012). The home TEACCHing program for toddlers with autism. Journal of Autism and Developmental Disorders, 42(9), 1827–1835. doi: 10.1007/s10803-011-1419-2.CrossRefPubMedGoogle Scholar
  50. 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. doi: 10.1542/peds.2014-0757.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. doi: 10.1007/s10803-014-2351-z.CrossRefPubMedGoogle 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. doi: 10.1097/TLD.0b013e318227fde4.CrossRefGoogle Scholar
  53. Zaidman-Zait, A., Mirenda, P., Duku, E., Szatmari, P., Georgiades, S., Volden, J., et al. (2014). Examination of bidirectional relationships between parent stress and two types of problem behavior in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1908–1917. doi: 10.1007/s10803-014-2064-3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lauren Turner-Brown
    • 1
    Email author
  • Kara Hume
    • 2
  • Brian A. Boyd
    • 3
  • Kirsten Kainz
    • 2
  1. 1.Department of Psychiatry/TEACCH Autism ProgramUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Frank Porter Graham Child Development InstituteUniversity of North Carolina at Chapel HillCarrboroUSA
  3. 3.Department of Allied Health SciencesUniversity of North Carolina at Chapel HillChapel HillUSA

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