None listed
Conditions
Brief summary
The early start Denver model (ESDM) is a routines-based naturalistic developmental behavioural intervention for young children with or at risk for autism spectrum disorder. There is emerging evidence to suggest that less than ten hours per week of ESDM therapy delivered by trained professionals may improve outcomes for young children with ASD. There is also evidence to suggest that, while ESDM parent coaching is generally successful in teaching most parents to implement the ESDM techniques with a high level of fidelity, increased parent use of these techniques does not always lead to increases in all outcomes for their children with ASD.. There does not appear to be any research investigating whether the addition of a few hours a week of ESDM delivered by trained professionals leads to an improvement in child outcomes above and beyond the child improvements at the end of ESDM parent coaching. The main aim of this study is to evaluate the effectiveness of ESDM parent coaching followed by low-intensity direct ESDM therapy for improving imitation, expressive language, and joint engagement for young children with, or at risk for, ASD. Specifically, the study aims to answer the following four research questions 1. Is 90 min a week of ESDM parent coaching over 12 weeks effective in enabling parents to implement ESDM intervention procedures with fidelity? 2. Does 90 min a week of ESDM parent coaching over 12 weeks produce an increase in imitation, expressive language, and joint engagement for young children with ASD? 3. Does 2 hours a week of therapist implemented ESDM intervention (direct ESDM therapy) for 12 weeks produce an increase in imitation, expressive language, and joint engagement for young children with ASD, whose parents have previously received ESDM parent coaching? 4. Do parents find the procedures used in the ESDM parent coaching and the ESDM therapist implemented interventions to be understandable, reasonable, efficient and effective? It is hypothesised that the parents' implementation of the ESDM techniques will improve following the parent coaching and that children's imitation, expressive language, and joint engagement will improve during both the parent coaching and direct therapy interventions. It is also hypothesied that parents will find both interventions understandable, reasonable, efficient, and effective.
Interventions
The Early Start Denver Model (ESDM) is a routines-based naturalistic developmental behavioural intervention for children with, or at risk for ASD under the age of 5. See Rogers and Dawson's (2010) manual: Early Start Denver Model for young children with autism for more information. This intervention will involve 90 minutes per week of ESDM parent coaching delivered to parents of children with ASD by a therapist who is trained in the ESDM parent coaching for 12 weeks. This will be followed by two
The Early Start Denver Model (ESDM) is a routines-based naturalistic developmental behavioural intervention for children with, or at risk for ASD under the age of 5. See Rogers and Dawson's (2010) manual: Early Start Denver Model for young children with autism for more information. This intervention will involve 90 minutes per week of ESDM parent coaching delivered to parents of children with ASD by a therapist who is trained in the ESDM parent coaching for 12 weeks. This will be followed by two 1-hour weekly sessions of ESDM direct therapy delivered by trained therapists for 12 weeks. All sessions will take place in parents' homes. The materials used during the intervention will be those that are typically available in each family's home, in addition to a range of age appropriate toys (listed in the ESDM manual). ESDM parent coaching sessions will have the following format: 1) Greeting- the therapist will greet the parent and gather any data that the parent may have collected; 2) Progress report- the parent and therapist will discuss the focus for the previous week, how well this approach worked for the child, and the main focus for the current week (will not occur in week 2); 3) Warm up activity- the parent will interact with the child using the previous week’s techniques (data collected in this phase, will not occur in week 2), 4) Reflection on warm up- the therapist and the parent will jointly reflect on the warm-up activity; 5) Topic discussion- the parent will decide whether the therapist will cover a new topic or further discuss the previous week’s topic, 6) Activity 2- the parent will practice the techniques from the topic discussion; 7) Reflection on Activity 2; 8) Activity 3- the parent will practice the techniques from the topic discussion in a different activity; 9) Reflection on Activity 3; 10) Planning for following week (will not occur in Week 12). During each hour long ESDM therapy session the child's goals will be embedded into the therapist’s play with the child and will taught by applying the following behaviour analytic teaching principles: (a) the delivery of learning opportunities at least every 30s, (b) delivery of clear antecedents, (c) the use of reinforcement, and (d) the use of instructional strategies such as prompting, shaping, chaining, and fading. At the beginning of each session, the therapist will greet the child and then allow him or her to verbally or non-verbally (e.g. leading the adult to the activity or object, pointing) choose the first activity, either by presenting a limited choice of two options or allowing the child to choose any toy or activity. Teaching will occur through the use of two types of routines: sensory social routines, in which the therapist will play with the child without an object (e.g. songs, chase, tickles), or using special sensory objects that the child did not operate (e.g. balloons, bubbles, shaving foam); and joint activity routines, in which the therapist and the child will play together with an object (e.g. blocks, books, balls). Throughout these routines, the therapist will maintain a positive affect, employ strategies to maximise the child’s motivation (e.g., offering choices, following the child’s lead, and being sensitive and responsive to all attempts at communication), and make conscious attempts to attract and maintain the child’s attention to her face, voice, and actions. When the therapist determines that there are no more learning opportunities during the chosen activity, the child seems bored, or the child initiates finishing an activity, the therapist will instruct the child to tidy up and, once the child had done so, he or she will select a new activity. Sessions will be terminated after one hour or when the therapist determines from the child’s behaviour that he or she no longer wants to continue.
Sponsors
Hannah Waddington
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
1 Years to 5 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for participating in this study are: (a) the child is under the age of 5 years (60 months) at the start of the study; (b) the child has a clinical diagnosis of ASD or meets criteria for an ASD diagnosis based on an assessment using the autism diagnostic observation schedule (Lord et al., 2012); (c) the participating parent/caregiver provides consent to allow videotaping of their interactions with the child,
Exclusion criteria
(a) the child does not have another serious or specific medical, genetic, neurological or sensory condition (e.g., Down syndrome, fragile X), (b) the child is not receiving intensive early intervention of any type at any time during the study, and (c) the participating parent/caregiver has been involved in no more than one other autism specific parent training/support programme and is not currently involved in any other parent training programmes during the present study.
Outcome results
None listed