Examining a stepped-care telehealth program for parents of young children with autism: a proof-of-concept trial.
A short, stepped telehealth course lets parents run RIT at home and boosts child social communication.
01Research in Context
What this study did
Wainer and her team ran a 15-week telehealth program for parents of toddlers and preschoolers with autism.
Parents learned Online Reciprocal Imitation Training (RIT) through stepped-care video calls.
The study used a randomized design and compared the telehealth group to usual care.
What they found
Parents in the telehealth group used RIT skills better and felt more confident.
Their children showed clearer social communication than kids who got usual care.
Imitation scores and family life quality did not change, but parents liked the program.
How this fits with other research
Rollins et al. (2019) already showed telehealth coaching can protect parent skills under stress.
Togashi et al. (2023) later copied the telehealth model but taught manding instead of imitation and still saw gains.
Bhana et al. (2023) extended the idea by adding family photos to the calls and also lifted parent communication.
Why it matters
You can teach parents RIT without making them drive to clinic.
The stepped-care format keeps costs low while still giving personal feedback.
Try opening your next parent training with a short video module, then move to live Zoom coaching only if they need it.
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02At a glance
03Original abstract
Intervention during the first years of life for children with autism spectrum disorder (ASD) may have the strongest impact on long-term brain development and functioning. Yet, barriers such as a shortage of trained professionals contribute to significant delays in service. The goal of this proof-of-concept study was to explore strategies that support timely and equitable deployment of ASD-specific interventions. This 15-week, randomized proof-of-concept study explored the acceptability of a digital parent mediated intervention online reciprocal imitation training (RIT; a naturalistic developmental behavioral intervention) and compared it to a treatment as usual (TAU) control on parent and child outcomes. Eligible children were between 18 and 60 months, met the cutoff for ASD on the Autism Diagnostic Observation Schedule-2nd Edition and demonstrate significant social imitation deficits. Primary outcomes include the acceptability of RIT (Scale of Treatment Perceptions) and the feasibility of the Online RIT digital intervention (online RIT attributes). Secondary outcomes included parent fidelity (RIT parent fidelity form) and parental self-efficacy (Early Intervention Parenting Self-Efficacy Scale). Exploratory outcome measures included child social communication (Social Communication Checklist), child imitation skills (Unstructured Imitation Assessment), and family quality of life (Beach Center Family Quality of Life Scale). Twenty participants were randomized in a 1:1 fashion. The acceptability and feasibility of RIT and the Online RIT digital intervention were rated highly. Among the secondary outcomes, there were significant group differences in parent fidelity (p < .001) and self-efficacy (p = .029). On exploratory outcomes, there were group differences in child social communication (p = .048). There were no significant group differences in imitation ability (p = .05) or family quality of life (p = .22). There are several limitations with this study, including the small sample size as well as lack of data on enactment and website engagement. This study was not able to address questions related to which variables predict program engagement and treatment response, which will be critical for determining which families may benefit from such a stepped-care delivery model. Overall, the Online RIT program delivered in a stepped-care format shows strong acceptability and holds promise as an innovative delivery model. Trial registration ClinicalTrials.gov, NCT04467073. Registered 10 July 2020- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04467073
Molecular Autism, 2021 · doi:10.1186/s13229-021-00443-9