Comparison of the efficacy of parent-mediated NDBIs on developmental skills in children with ASD and fidelity in parents: a systematic review and network meta-analysis.
Train parents in a clear sequence: ImPACT first for fidelity, ESDM next for language and motor, then higher-intensity PRT for broad social gains.
01Research in Context
What this study did
The team looked at 32 randomized trials of parent-led NDBIs. These were PRT, ESDM, and ImPACT.
They used network meta-analysis to rank each model. They checked child skills and parent fidelity.
All studies had kids under six with ASD. Parents got coaching, then ran sessions at home.
What they found
All three models helped kids gain language, play, and social skills.
ImPACT gave the fastest parent-fidelity wins. ESDM boosted language and motor skills next. PRT, when dosed higher, gave the broadest social-language gains.
The data say: start simple, then layer up.
How this fits with other research
van Noorden et al. (2022) showed that a quick group class plus 1:1 ESDM coaching works. The meta-analysis now pools that trial and says ESDM is solid for language.
Bradshaw et al. (2017) proved parent PRT helps toddlers talk. The 2024 review adds that higher-intensity PRT keeps paying off into the preschool years.
ACruz-Montecinos et al. (2024) pushed NDBI even younger with Baby JASPER for 12-22-month infants. The new review did not cover infants, so Baby JASPER extends the idea downward.
Gerow et al. (2018) reviewed parent FCT for behavior reduction. The NDBI review focuses on skill building, not problem behavior, so the two reviews sit side-by-side.
Why it matters
You can now plan parent training like a staircase. Week 1: teach ImPACT to lock in parent fidelity. Month 2: add ESDM targets for words and play. Month 4: ramp up PRT dose for peer-ready social skills.
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02At a glance
03Original abstract
Recently, studies on behavioral interventions for autism have gained popularity. Naturalistic Developmental Behavior Interventions (NDBIs) are among the most effective, evidence-based, and widely used behavior interventions for autism. However, no research has been conducted on which of the several NDBI methods is most effective for parents and children with autism spectrum disorders. Therefore, we conducted a network meta-analysis to compare the specific effects of each type of parental-mediated NDBI on children’s developmental skills and parent fidelity. PubMed, Embase, Cochrane Library, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), CINAHL, and Wanfang databases were searched from inception to August 30, 2023. A total of 32 randomized controlled trial studies that examined the efficacy of different NDBIs were included. Parents of children with ASD who received Pivotal Response Treatment (PRT) reported significant improvements in their children’s social skills (SUCRA, 74.1%), language skills (SUCRA, 88.3%), and parenting fidelity (SUCRA, 99.5%). Moreover, parents who received Early Start Denver Model (ESDM) reported significant improvements in their children’s language (SMD = 0.41, 95% CI: 0.04, 0.79) and motor skills (SMD = 0.44, 95% CI: 0.09, 0.79). In terms of the efficacy of improving parent fidelity, the results showed that the Improving Parents as Communication Teachers (ImPACT) intervention significantly improved parent fidelity when compared with the treatment-as-usual group (TAU) (SMD = 0.90, 95% CI: 0.39, 1.42) and the parental education intervention (PEI) (SMD = 1.10, 95% CI:0.28, 1.91).There was a difference in parent fidelity among parents who received PRT(SMD = 3.53, 95% CI: 2.26, 4.79) or ESDM(SMD = 1.42, 95% CI: 0.76, 2.09) training compared with PEI. In conclusion, this study revealed that parents can achieve high fidelity with the ImPACT intervention, and it can serve as an early first step for children newly diagnosed with ASD. It also showed that parent-mediated ESDM is effective in improving language and motor skills for children with ASD and can be used as part of the second stage of parent training. Parent-mediated PRT can also be used as a third stage of parent training with sufficient training intensity to further improve language, social, and motor skills. The online version contains supplementary material available at 10.1186/s12887-024-04752-9.
BMC Pediatrics, 2024 · doi:10.1186/s12887-024-04752-9