Mechanism of Developmental Change in the PLAY Project Home Consultation Program: Evidence from a Randomized Control Trial.
Monthly DIR-style parent coaching in the living room cut autism social-affect severity scores by making moms warmer and less bossy.
01Research in Context
What this study did
Mahoney et al. (2016) ran a true experiment. Families were picked by lottery for PLAY coaching or for regular care.
Once a month a coach came to the home. She showed parents how to follow the child’s lead, share joy, and talk less like a teacher.
Kids were preschoolers with autism. The team filmed moms and kids before and after to see if mom got warmer and if child social scores moved on the ADOS.
What they found
Parents in PLAY used more smiles, waiting, and copy-cat play than control parents.
Because mom changed, kids looked longer, shared toys more, and scored lower on the social-affect part of the ADOS. Less severity, more fun.
How this fits with other research
Solomon et al. (2007) tried the same PLAY plan first, but with no control group. Gerald’s 2016 RCT now trumps that pilot. It proves the gains were from PLAY, not just time.
Schertz et al. (2018) also coached parents of toddlers at home and saw social gains. Both studies say the same thing: warm, responsive parents equal more social kids.
Smit et al. (2019) added extra bells and whistles to parent coaching yet saw no extra child gains. Their mixed result lines up with Gerald: parent skill can rise even when child test scores stay flat, so use real-world social measures like the ADOS.
Why it matters
You do not need forty hours at a table. One home visit a month that trains parents to be playful and less bossy can soften autism social scores. Start with teaching joy, then layer on demands. Film a five-minute play clip, score parent warmth, and set one smile-and-wait goal for next month.
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02At a glance
03Original abstract
This investigation is a secondary analysis of data from a randomized control trial of the PLAY Home Consultation Intervention Program which was conducted with 112 preschool children with Autism Spectrum Disorders and their parents (Solomon et al. in J Dev Behav Pediatr 35:475-485, 2014). Subjects were randomly assigned to either a community standard (CS) treatment group or to the PLAY Project plus CS Treatment (PLAY). PLAY subjects received monthly parent-child intervention sessions for 1 year during which parents learned how to use the rationale and interactive strategies of the Developmental, Individual-differences, Relationship-based (DIR) intervention model (Greenspan and Weider in The child with special needs: encouraging intellectual and emotional growth. DeCapo Press, Cambridge, MA, 1998) to engage in more responsive, affective and less directive interactions with their children. This investigation examined whether PLAY intervention effects on parents' style of interacting with their children as well as on children's social engagement mediated the effects of PLAY on children's autism severity as measured by ADOS calibrated severity scores. Regression procedures were used to test for mediation. There were two main findings. First the effects of PLAY on children's social engagement were mediated by the increases in parental responsiveness and affect that were promoted by PLAY. Second, the effects of PLAY on the severity children's Social Affect disorders were mediated by changes in parental responsiveness and affect; however, the effects of Responsive/Affect were mediated by the impact these variables had on children's social engagement. Results are discussed in terms of contemporary models of developmental change including the developmental change model that is the foundation for DIR.
Journal of autism and developmental disorders, 2016 · doi:10.1007/s10803-016-2720-x