Skip to main content
SpringerLink
Log in

Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Short-term low intensity parent implemented intervention studies for toddlers with autism spectrum disorder (ASD) have found it difficult to demonstrate significantly improved developmental scores or autism severity compared to community treatment. We conducted a randomized comparative intent-to-treat study of a parent implemented intervention to (1) test the effects of an enhanced version on parent and child learning, and (2) evaluate the sensitivity to change of proximal versus distal measures of child behavior. We randomized 45 children with ASD, 12–30 months of age, into one of two versions of parent-implemented Early Start Denver Model (P-ESDM), the basic model, in which we delivered 1.5 h of clinic-based parent coaching weekly, and an enhanced version that contained three additions: motivational interviewing, multimodal learning tools, and a weekly 1.5-h home visit. We delivered the intervention for 12 weeks and measured child and parent change frequently in multiple settings. We found a time-by-group interaction: parents in the enhanced group demonstrated significantly greater gains in interaction skills than did parents in the non-enhanced group. Both interventions were associated with significant developmental acceleration; however, child outcomes did not differ by group. We found a significant relationship between degree of change in parental interaction skill and rate of children’s improvement on our proximal measure. Parents in both groups reported satisfaction with the intervention. These findings suggest that parent skills improved more in the enhanced group than the comparison group. Children in the two groups showed similar improvements. Rate of individual parent learning was associated with greater individual child progress on a measure quite proximal to the treatment, though not on standardized assessments.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Achenbach, T. M., & Rescorla, L. (2000). Manual for ASEBA preschool forms & profiles. Burlington: Research Center for Children, Youth, and Families, University of Vermont.

    Google Scholar 

  • Begg, C. B., & Iglewicz, B. (1980). A treatment allocation procedure for sequential clinical trials. Biometrics, 81–90.

  • Brian, J. A., Smith, I. M., Zwaigenbaum, L., Rogerts, W., & Brysin, S. (2016). The Social ABCs’s caregiver-mediated intervention for toddlers with autism spectrum disorder: Feasibiltiy, acceptability, and evidence of promise from a multisite study. Autism Research, 9(8), 899–912.

    Article  PubMed  Google Scholar 

  • Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., … Varley, J. (2010). Randomized controlled trial of the Early Start Denver Model: A developmental behavioral intervention for toddlers with autism: Effects on IQ, adaptive behavior, and autism diagnosis. Pediatrics, 125(1), e17–e23.

    Article  Google Scholar 

  • Dawson, G., Sigman, M. D., & Rogers, S. J. (2003). CPEA Network Early Intervention Interview (unpublished manuscript).

  • Estes, A., Vismara, L., Mercado, C., Fitzpatrick, A., Elder, L., Greenson, J., … Dawson, G. (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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gengoux, G. W., Berquist, K. B., Salzman, E., Schapp, S., Phillips, J. M., Frazier, T. W., … Hardan, A. Y. (2015). Pivotal response treatment parent training for autism: Findings from a 3-month follow-up evaluation. Journal of Autism and Developmental Disorders, 45, 2889–2898.

    Article  PubMed  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.

    Article  PubMed  Google Scholar 

  • Hanft, B. E., Rush, D. D., & Shelden, M. L. L. (2004). Coaching families and colleagues in early childhood. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Hardan, A. Y., Gengoux, G. W., Berquist, K. L., Libove, R. A., Ardel, C. M., Phillips, J., … Minjarez, M. B. (2015). A randomised controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry, 56(8), 884–892.

    Article  PubMed  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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kasari, C., Siller, M., Huynh, L. N., Shih, W., Swanson, M., Hellemann, G. S., & Sugar, C. A. (2014). Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behavior and Development, 37(4), 711–721.

    Article  PubMed  Google Scholar 

  • Knowles, M. (1973). The adult learner: A neglected species. Houston: Gulf.

    Google Scholar 

  • Lord, C., Luyster, R., Gotham, K., & Guthrie, W. (2012). Autism Diagnostic Observation Schedule—Toddler Module. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychaitry, 63, 694–701.

    Article  Google Scholar 

  • MacDonald, R., Parry-Cruwys, D., Dupere, S., & Ahearn, W. (2014). Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. Research in Developmental Disabilites, 35, 3632–3644.

    Article  Google Scholar 

  • Magiati, I., Tay, X. W., & Howlin, P. (2014). Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clinical Psychology Review, 34(1), 73–86.

    Article  PubMed  Google Scholar 

  • McEachin, J. J., Smith, T., & Ivar Lovaas, O. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 359–359.

    PubMed  Google Scholar 

  • McWilliam, R. A. (2010). Routines-based early intervention. In Supporting young children and their families. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. New York: Guilford Press.

    Google Scholar 

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

    Google Scholar 

  • Prochaska, J. O., Redding, C. A., & Evers, K. E. (1997). The transtheoretical model and stages of change. In K. Glanz, F. M. Lewis & B. K. Rimer (Eds.), Health behavior and health education (pp. 60–84).

  • Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.

    Article  PubMed  Google Scholar 

  • Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. New York: Guilford Press.

    Google Scholar 

  • Rogers, S. J., Dawson, G., & Vismara, L. A. (2012a). An early start for your child with autism: Using everyday activities to help kids connect, communicate, and learn. New York: Guilford Press.

    Google Scholar 

  • Rogers, S. J., Dawson, G., Zierhut, C., Winter, J., McCormick, C., & Holly, E. (2013). The PATH curriculum checklist for young children with autism. (unpublished document).

  • Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., … Dawson, G. (2012b). 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 & Adolescent Psychiatry, 51(10), 1052–1065.

    Article  Google Scholar 

  • Rogers, S. J., & Vismara, L. A. (2013). P-ESDM parent coaching fidelity measure (unpublished document).

  • 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.

    Article  Google Scholar 

  • Sigman, M., Ruskin, E., Arbeile, S., Coronoa, R., Dissanayake, C., Esponosa, M., … Zierhut, C. (1999). Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays. Monogrpah of the Society for Research in Child Development, 64(1), 1–114.

    Article  Google Scholar 

  • 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(2), 77–89.

    Article  PubMed  Google Scholar 

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales: (Vineland II), survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.

    Google Scholar 

  • Swinkels, S. H., Dietz, C., van Daalen, E., Kerkhof, I. H., van Engeland, H., & Buitelaar, J. K. (2006). Screening for autistic spectrum in children aged 14 to 15 months. I: The development of the Early Screening of Autistic Traits Questionnaire (ESAT). Journal of Autism and Developmental Disorders, 36(6), 723–732.

    Article  PubMed  Google Scholar 

  • Vismara, L., Colombi, C., & Rogers, S. J. (2009). Can one hour per week of therapy lead to lasting changes in young chidlren with autism? Autism, 13, 93–115.

    Article  PubMed  Google Scholar 

  • Vismara, L., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment. https://doi.org/10.1155/2012/121878.

    Article  PubMed  PubMed Central  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 

  • Wetherby, A. M., & Prizant, B. M. (2002). Communication and symbolic behavior scales: Developmental profile. Baltimore: Paul H. Brookes.

    Google Scholar 

Download references

Acknowledgments

This study was supported by Autism Speaks Grants #8089 (Rogers) #8376 (Estes) and by the Children’s Miracle Network (Rogers). Conflicts of interest for Rogers, Dawson, and Vismara involve royalties from publications and lectures related to the Early Start Denver Model. Thanks to children and families involved and to Gayna Guidici, Diane Larzelere, and Ehoua Vue for formatting the manuscript.

Author information

Author notes

  1. L. Vismara

    Present address: Emory University, Atlanta, GA, USA

Authors and Affiliations

  1. University of California Davis MIND Institute, Sacramento, CA, USA

    S. J. Rogers, L. Vismara, C. Zierhut, M. Rocha & M. Talbott

  2. University of Washington, Seattle, WA, USA

    A. Estes, J. Munson & J. Greenson

  3. Duke University, Durham, NC, USA

    G. Dawson

  4. University of California, Los Angeles, Los Angeles, CA, USA

    C. Sugar, D. Senturk & F. Whelan

Authors
  1. S. J. Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Estes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Vismara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Munson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Zierhut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Greenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Dawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Rocha
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Sugar
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D. Senturk
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. F. Whelan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Talbott
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SJR, LV, AE, and GD conceived of the study, participated in its design and coordination and drafted the manuscript; CZ, LV, JG, MR, and SJR managed the treatment arm of the study and provide the interventions; JM, JG, and MT participated in the design of the study, and performed the measurement and data management; JM, DS, CS, and FW participated in the design of the study and performed the statistical analysis; All authors helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to S. J. Rogers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rogers, S.J., Estes, A., Vismara, L. et al. Enhancing Low-Intensity Coaching in Parent Implemented Early Start Denver Model Intervention for Early Autism: A Randomized Comparison Treatment Trial. J Autism Dev Disord 49, 632–646 (2019). https://doi.org/10.1007/s10803-018-3740-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-018-3740-5

Keywords

Search

Navigation