A study conducted by researchers at the Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) and colleagues at the University of Washington and the Center for Telepsychology has shown that an interactive, web-based training can help parents of children with autism spectrum disorders (ASD) use proven strategies to improve their child’s participation in daily home routines as well as reduce parental stress.
The study, “Enhancing interactions during daily routines: A randomized controlled trial of a web-based tutorial for parents of young children with ASD,” was published online in January in Autism Research.
Authors were Dr. Zachary Warren, Amy Swanson, and Lisa Wallace (TRIAD); Drs. Lisa Ibañez and Wendy Stone (University of Washington); and Dr. Ken Kobak (Center for Telepsychology, Madison, Wisconsin).
“Even though we’ve made good progress in establishing evidence-based practices for treating young children with ASD, there’s been a lag in implementing those practices in communities,” said Zachary Warren, Ph.D., one of the study’s lead authors. Warren is associate professor of Pediatrics, Psychiatry & Behavioral Sciences, and Special Education, and TRIAD executive director.
“States often lack sufficient numbers of early interventionists, especially in rural areas, and many providers have insufficient training to implement ASD-specific services,” Warren said. “Teaching young children with ASD within the context of daily routines in their own homes—and using a web-based interactive tutorial to coach parents in how to do this—is a promising and pragmatic approach to addressing child and family needs.”
The tutorial focused on daily routines such as bath time, meal and snack times, bed time, and play time, all of which are important to family daily life while at the same time providing a rich context for parents to engage with their children in ways that will support their child’s social and emotional development. In view of behavioral challenges for young children with ASD, these daily times often are times of stress for parents.
“Teaching parents how to use evidence-based strategies while interacting with their children with ASD as they’re engaged in familiar daily routines increases the likelihood of their use,” said co-author Amy Swanson, M.A., TRIAD research and training coordinator. “And because these routines are predictable and occur daily, there are lots of opportunities for repetition and practice—which reinforces learning for children and parents,”
A web-based tutorial approach offers multiple advantages compared with traditional instructional methods, Swanson said. Advantages include 24-hour accessibility, standardization of training, self-paced, home-based, cost-effective, and addresses barriers such as transportation/travel and need for child care, as well as insufficient numbers of ASD early interventionists, especially in rural areas.
The goals of this study were to examine the efficacy of this interactive, web-based parenting tutorial for improving children’s engagement in daily routines (i.e., proximal outcomes) as well as to improve children’s social communication and parenting efficacy and stress (i.e., broad outcomes).
Study participants were parents of children with ASD between 18 and 60 months who were randomly assigned to the Tutorial group (n = 52) or the Control group (n = 52).
The research team found that parents who used the tutorial reported less parenting stress, felt better about their parenting skills, and reported better child social interactions compared to parents who did not use the tutorial. Outcomes were assessed using self/parent-report measures only because the study was conducted remotely.
Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial.
“This tutorial may be especially helpful for families who have limited access to services, since it can be completed at home,” Swanson said.
The tutorial has three main sections. The first section introduces material, e.g., defines home routines and provides tips for establishing routines. The second section describes and illustrates four daily routines—bath time, snack time, play time, and bed time—and includes general information and individualized content. The third section consists of “toolbox” modules that describe specific, evidence-based behavioral strategies shown to enhance children’s cooperation and participation in routines.
The tutorial allows for individualization by providing a “menu” of the four daily routines, so that parents can choose a specific activity within that routine that they would like to improve and provides them with behavioral strategies for improving their child’s participation during the selected part of the routine. Parents are then taught the strategies through a combination of didactic instruction, video examples, interactive quizzes, and animations.
According to co-author Lisa Wallace, M.S., CCC-SLP, TRIAD speech-language pathologist and one of the primary developers of the on-line training, “One of the great features of the tutorial is that all the video examples are of real families interacting with their children with ASD in the home environment. This can make it easier for parents taking the tutorial to relate to the material and strategies suggested.”
The project was the culmination of over 10 years of work by the study’s authors.
“Although this study extends earlier pioneering research using web-based technology with families of children with ASD, it is the first to use a randomized control design—the ‘gold standard’ for research—with a relatively large sample,” Warren said. “In summary, our findings suggest that the approach of a web-based interactive tutorial may be for some parents a promising and accessible way for improving parent-child interactions and empowering parents of children with ASD.”
Link here to view an online training example from the tutorial.
This study was funded by the National Institute of Mental Health and the Department of Health and Human Services, under Small Business Innovation Research (SBIR) Grant No. R44MH086936, which was awarded to the Center for Psychological Consultation (Kenneth Kobak, PI).
Ibanez, L. V., Kobak, K., Swanson, A., Wallace, L., Warren, Z., & Stone W. L. (2018). Enhancing interactions during daily routines: A randomized controlled trial of a web-based tutorial for parents of young children with ASD. Autism Research, Jan. 7, 2018 [Epub ahead of print).
Jan Rosemergy is VKC director of Communications and Dissemination.