PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial

Abstract

Objective: To evaluate the effectiveness of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation model, in combination with usual community services (CS), to improve parent-child interaction, child development, and autism symptomatology in young children with autism spectrum disorders (ASDs) compared with CS only.

Methods: Children (N = 128) with autism or PDD-NOS (DSM-4 criteria) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were randomized in two 1-year cohorts. Using videotape and written feedback within a developmental framework, PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction. CS included speech/language and occupational therapy and public education services. Primary outcomes included change in parent-child interactions, language and development, and autism-related diagnostic category/symptoms. Secondary outcomes included parent stress and depression and home consultant fidelity. Data were collected pre- and post-intervention.

Results: Using intent-to-treat analysis (ITT), large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales. Child language and developmental quotient did not differ over time by group, although functional development improved significantly. PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule (ADOS). PLAY caregivers' stress did not increase, and depressive symptomatology decreased. Home consultants administered the intervention with fidelity.

Conclusions: PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents' stress/depression. ADOS findings must be interpreted cautiously because results do not align with clinical experience. PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents.

Trial registration: ClinicalTrials.gov NCT01768806.

Conflict of interest statement

Disclosure: Small Business Innovation Research (SBIR) grants, sponsored by the NIMH, are administered through business entities to support research in technological innovation and dissemination. Therefore, all SBIR principle investigators if they are directly involved in the grant have a financial conflict of interest. R. Solomon, the principle investigator of the study, was involved in the design of the study, wrote the first draft of the manuscript and was involved in the decision to submit the article. To limit his bias, R. Solomon was assiduously excluded from evaluation of outcomes, data collection, or data analysis, all of which were done independently at Michigan State University under the auspices of L. A. Van Egeren, a senior level researcher and director of the Community Evaluation and Research Collaborative. The only involvement with data occurred when the data collected at Easter Seals sites were deidentified at the “central office” in Ann Arbor and sent on to Michigan State University for analysis. R. Solomon received no other funds outside of the grant (such as honoraria, consultant fees, etc) before or during the grant. G. Mahoney received a fee for consulting as an original part of the grant protocol. The remaining authors declare no conflict of interest.

Figures

Figure 1

Participant enrollment and retention.