TABLE 1: OUTCOME MEASURES Parent Measures
Parent Fidelity Behavioral rating during parent-child
interaction (10-min Play and Snack Routine)
Parent Self-Efficacy Parent Sense of Competence Scale
Parenting Stress Family Impact Questionnaire - Negative and
Social Impact subscale items
Positive Perceptions of Child Family Impact Questionnaire -
Positive Impact subscale items
Child Measures
Expressive Language Targets Frequency of language targets during
parent-child interaction
Expressive Vocabulary MacArthur-Bates Communicative Development
Inventory
Functional Communication Vineland Adaptive Behavior Scales-2nd
Edition
(VABS-II) Communication Domain
Social Skills Vineland Adaptive Behavior Scales-2nd Edition
(VABS-II) Social Domain
BACKGROUND
Parent-mediated intervention for children with ASD can improve
both parent and child functioning.
Access to parent-mediated intervention services is often limited
in rural and under-resourced areas.
Telehealth, the provision of health information over the
internet, can increase service access at a reduced cost.
There is growing interest in expanding telehealth to parent
training for ASD, but research is limited and little is known
regarding the relative benefits of self-directed vs.
therapist-assisted models.
OBJECTIVES
Pilot RCT to compare the effect of self-directed and
therapist-assisted formats of ImPACT Online, telehealth-based
parent-mediated intervention on parent and child outcomes.
Comparison of a Self-Directed and Therapist-Assisted Telehealth
Parent Training Intervention for Children with ASD Kate Shannon,
MS, Natalie Berger, MA, Katherine Pickard, MA, Nikki Bonter, MSW,
& Brooke Ingersoll, Ph.D.
Department of Psychology, Michigan State University Supported by
grant #RC063462 from the Department of Defenses Autism Research
Program
METHOD Participants
27 children between 19 and 73 months and their mothers. ASD
diagnoses provided by community providers and confirmed using
DSM-IV-TR
criteria and ADOS-2. Procedure Assessments of child and parent
functioning, and a parent-child interaction were
administered at pre-treatment (see Table 1). Children were
matched on expressive language age on Mullen and randomly
assigned to the self-directed or therapist-assisted group (see
Table 2). Parents in both groups received ImPACT Online for up to 6
months (see Table 3).
Self-directed group: Parents completed 12 internet modules on
their own over the course of 4 months.
Therapist-assisted group: Parents completed 12 internet modules
plus 2, 30-min remote coaching sessions per week from coach for 12
weeks.
Assessments were re-administered at post-treatment. Data
Analysis ITT analysis (missing data was carried forwarded) Mixed
model, repeated-measures ANOVA to compare the effect of
self-directed
and therapist-assisted ImPACT Online on parent and child
outcomes.
CONCLUSIONS Both approaches show promise for increasing parents
use of evidence-based intervention techniques to promote their
childs social communication. The self-directed program was
effective for improving parent fidelity of implementation, parent
self-efficacy, parenting stress, and child language. However,
therapist
assistance via remote coaching provided an added benefit for
improving parent fidelity and some aspects of child language. Gains
in parent positive perceptions of their child and child social
skills were only observed in the therapist-assisted group. A full
scale efficacy trial with a control group is warranted.
Additional research that can identify parents who are most
likely to need remote coaching would assist in the development of a
stepped care model that can increase parent access to
evidence-based services in underserved communities.
Adapted from Project ImPACT (Ingersoll & Dvortcsak,
2010)
TABLE 3: ImPACT ONLINE
TABLE 2: PARTICIPANT CHARACTERISTICS
aMullen Scales of Early Learning
Narrated Slideshow Manual
Self-Check Quiz Video-Based Exercises
Homework Plan Reflection Questions
Video Library Moderated Forum
Self-Directed Interactive Modules
Remote Coaching
RESULTS CHILD OUTCOMES
Main effect of time, F(1, 25)=31.33, p
