Autistic children often experience difficulties with language and communication development (Tager-Flushberg et al., 2005). Early intervention (EI) is an integral and highly efficacious tool to target and promote optimal development in this population (Zwaigenbaum et al., 2015). By targeting specific developmental needs at an early stage, EI offers an opportunity to build foundational skills that set the stage for long-term success. A commonly utilized form of EI is naturalistic developmental behavioral interventions (NDBI) (Tiede & Walton., 2019). NDBIs use behavioral strategies to teach skills in a developmentally appropriate sequence (Schreibman et al., 2015), and substantial evidence suggests these interventions promote language development in autistic children (Crank et al., 2021). NDBIs serve as a reliable and effective intervention for addressing the language development challenges often faced by these children.
The Early Start Denver Model (ESDM; Rodgers et al., 2012) is an evidence-based NDBI that integrates behavioral and developmental principles to enhance social communication skills in autistic toddlers. The efficacy of ESDM is well-documented in traditional one-on-one, in-person settings, with research consistently highlighting significant improvements in children’s cognitive and language development (Fuller et al., 2020). However, limited research focuses on the intervention’s effectiveness when delivered via a virtual, group-based modality. Due to the sudden halting of in-person services during the COVID-19 pandemic, the University at Albany’s Center for Autism and Related Disabilities (CARD) adapted the ESDM program to be delivered in a virtual group setting for caregivers of autistic children.
This virtual group program was designed to follow a 12-week caregiver coaching group format. The program focused on providing caregivers with knowledge and tools to support their child’s communication and social development through ESDM-related topics such as imitating, following their child’s lead, engaging in social routines, supporting joint attention skills, and scaffolding their child’s play levels. In order to adapt to the virtual group-based setting, two main modifications were made. Caregivers were given 20-minute pre-recorded didactic videos weekly, which outlined the session topic, to watch prior to group. The videos then served as the basis for the 60-minute virtual sessions led by a program leader. These sessions provided caregivers an opportunity to review module strategies and brainstorm in-home applications for use with their children. Additionally, by implementing a train-the-trainer model, the program aimed to empower caregivers with the confidence and skills to apply evidence-based strategies at home, effectively increasing intervention hours for their child. By incorporating both virtual and group-based modifications, the program sought to address gaps in service availability.
Program effectiveness was measured by assessing parental stress, family empowerment, and overall family quality of life. These assessments were completed pre- and post-intervention. Parents also reported on the program’s satisfaction and acceptability. As of yet, 20 caregivers have completed the program at CARD. Based on a recent analysis, the program demonstrated significant changes in parental stress, family empowerment, and family quality of life. Additionally, 100% of caregivers reported high satisfaction with the program and indicated that they would recommend the program to others. 72% of caregivers strongly agreed that they and/or their child benefited from the program and indicated that they felt more informed about important social/communication targets for their child’s intervention.
These encouraging findings indicate that this virtual, group-based adaptation of an ESDM-based caregiver program is both effective and well-received by families. The results from this pilot program underscore the potential of virtual interventions to address the diverse needs of families, driving significant progress in both child development and overall family well-being.
This article was authored by Hanna Kent, B.S., Dan Magin, M.A., and Krista Drapalik, M.A., graduate assistants; Erica Davis, LMSW, training program coordinator; Melissa Rinaldi, Ph.D., clinical investigator; and Kristin Christodulu, Ph.D., director, at the Center for Autism and Related Disabilities at the University at Albany. For more information on programming and training opportunities at the Center for Autism and Related Disabilities at the University at Albany, please visit www.albany.edu/autism.
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