The first few years of life are an important period for communication and language development. Even before the emergence of spoken language, typically-developing children engage in communicative interchanges with caregivers through gaze, directed facial expressions, gestures, and vocalizations. These early communicative interchanges with caregivers set the stage for later linguistic, psychosocial, and emotional development (Cohen, 2010).
Communication and language impairments are a central feature of autism spectrum disorder (ASD). Deficits in reciprocal and nonverbal communication are necessary criteria for diagnosis (American Psychiatric Association, 2013). Communication challenges are often one of the first concerns reported by parents whose children later receive an ASD diagnosis (Kozlowski, Matson, Horovitz, Worley, & Neal, 2011). Moreover, the severity of communication challenges in infants and toddlers with ASD predicts later autism symptom severity (Lobban-Shymko, Im-Bolter, & Freeman, 2017). This suggests that language is an important skill to target through early intervention, as improvements in language have the potential to alter the long-term course of development.
There is a strong empirical base supporting the importance of early intervention for promoting children’s receptive and expressive language skills (Zwaigenbaum et al., 2015). One evidence-based intervention for promoting language development among toddlers as young as twelve months is the Early Start Denver Model (ESDM; Rogers & Dawson, 2010). The ESDM is a manualized, early intensive behavioral intervention (EIBI) that is typically administered through one-on-one therapist-led instruction. It is administered during the first few years of life to capitalize on neural plasticity and the critical period for linguistic development (Dawson & Zanolli, 2003).
Unfortunately, families often face several barriers when trying to access EIBI services for their children. Intensive interventions are time-consuming, tend to have long waitlists, and can be very costly (Shattuck & Grosse, 2007). To address these barriers, recent research has focused on teaching parents the skills they need to act as their children’s interventionists in the home and community. Since parents spend time with their children every day and in multiple contexts, the benefits of the intervention are likely to generalize across situations and persist beyond the intervention time frame (McConachie & Diggle, 2007). Additional support for parent-mediated interventions comes from knowledge that parental behaviors, including sensitivity to children’s cues, are strong predictors of children’s nonverbal and verbal language abilities (Siller & Sigman, 2002).
A modified, parent-delivered version of the traditional, therapist-led ESDM (P-ESDM) resulted in significant gains on the PATH Curriculum Checklist, a measure that assesses a wide range of skills, including receptive and expressive language, joint attention, and social interaction with adults (Rogers et al., 2019). The P-ESDM consisted of 12 consecutive 1.5-hour sessions with intervention topics that include increasing child attention and motivation; using sensory social routines; enhancing nonverbal communication; and building imitation skills.
Recently, the Center for Autism in Albany, NY implemented an accelerated 6-week, group-format parent training program based on the manualized P-ESDM (Fox, 2017). Sessions took place twice per week for 60-90 minutes and followed the standardized session outlines provided in An Early Start for your Child with Autism by Rogers, Dawson, and Vismara (2012). A group format was selected due to previous work suggesting its success in promoting parenting skills while simultaneously fostering social support among families (Stahmer & Gist, 2001). Parents were randomized to either an immediate treatment group (n = 5) or delayed treatment control group (n = 5). The parents who participated in the program had children who ranged in age from 21 to 42 months. Nine of the target children in the study had diagnoses of ASD, while one child had an older sibling with ASD and was therefore at high genetic risk for the disorder.
From pre- to post-treatment, parents in the immediate treatment group showed qualitative gains in their children’s expressive language. While children whose parents were in the delayed treatment group remained stagnant during the waitlist period, they also showed a qualitative increase in expressive language from pre- to post-treatment. Parents in both groups showed reliable increases in narration of their children’s play. Parent narration of play has been shown to be directly related to the development of spoken language (Tamis-Lemonda, Bornstein, & Baumwell, 2001). Additionally, parent knowledge of ASD and the ESDM curriculum increased significantly and parents reported a high level of satisfaction with the program.
In line with our goal of increasing the feasibility and accessibility of the ESDM for families in the Capital Region, the University at Albany Center for Autism is currently offering a 12-week version of the group-format parent training program described above. This community-based program is being provided at no cost to parents of five male children between the ages of 24 and 46 months with ASD. Prior to the start of the program, parents and their children completed several assessments, including the Autism Diagnostic Observation Schedule, Second Edition (Lord et al., 2012), a five-minute non-standardized play interaction, and the MacArthur-Bates Communicative Development Inventory (Fenson et al., 2007). Parents and their children will also complete the assessments following completion of the program to evaluate improvements in child communication and parent skill acquisition. Weekly 60-minute sessions involve didactic presentations of the intervention topic as well as opportunities for parents to troubleshoot difficulties encountered while implementing the previous week’s skill at home.
Additional research on the efficacy of parent training interventions is clearly needed, but the findings outlined here, as well as in recent review articles (e.g., Nevill, Lecavalier, & Stratis, 2018), suggest that they are a promising approach for improving communication skills in children with ASD during a sensitive time in development.
Anna Milgramm, BA, is a Graduate Assistant at the University at Albany Center for Autism and Related Disabilities. Stephanie A. Fox, PhD, is a Psychology Postdoctoral Fellow at the Carolina Institute for Developmental Disabilities at the University of North Carolina at Chapel Hill. Kristin V. Christodulu, PhD, is Director, and Erica Davis, LMSW, is a Training Program Coordinator at the University at Albany Center for Autism and Related Disabilities.
For more information about this research, contact Anna Milgramm at amilgramm@albany.edu and visit https://www.albany.edu/autism.
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