Caregiver-mediated intervention for low-resourced preschoolers with autism: an RCT

Abstract

Objectives: To compare 2 short-term, community caregiver training interventions for preschool-aged children with Autism Spectrum Disorder who had low resources. Low resource was defined by the US Department of Housing and Urban Development low-income index or 1 "indicator," (e.g., Medicaid eligibility). Child outcomes focused on joint engagement, joint attention, and play.

Methods: Participants included 112 families of a child who had Autism Spectrum Disorder who met criteria for being low-resourced and who were randomly assigned to 1 of 2 3-month interventions, group caregiver education or individualized caregiver-mediated intervention (CMM). Children were assessed for social communication skills pre- and post-treatment, and followed up at 3 months.

Results: All children improved in joint engagement and initiating joint attention, with significantly greater improvement by the CMM group. Outcomes on play skills were mixed, with improvement of symbolic play for the CMM group and no change in functional play skills. Joint engagement maintained over time for the CMM group, and initiating joint attention maintained for both groups over time.

Conclusions: This study is among the first randomized trials comparing 2 active interventions with a large sample of low-resourced families. Results suggest improvements in core autism deficits of joint engagement, joint attention, and symbolic play with relatively brief, caregiver-mediated interventions, but additional support is necessary to maintain and generalize these gains over time.

Keywords: autism; early intervention; joint attention; parent-child interactions.

Copyright © 2014 by the American Academy of Pediatrics.

Figures

FIGURE 1

Recruitment flow diagram.

FIGURE 2

Primary aim: predicted time in joint engagement across groups and time for children who have average mental age (24.85 months).

FIGURE 3

Secondary aim: predicted rate of initiating joint attention across groups and time for children who have average mental age (24.85 months).