Hospital-family collaborative DTT intervention to reduce the parenting stress through improving core symptoms and family functioning in children with autism spectrum disorder: a randomized controlled trial.
One month of hospital DTT plus three months of coached parent-delivered DTT at home cuts parenting stress and boosts developmental gains versus hospital-only DTT.
01Research in Context
What this study did
Dai and colleagues split the preschoolers with autism into two groups. One group got one month of hospital-only DTT. The other group got the same month in the hospital, then three more months of parent-run DTT at home. Therapists coached parents twice a week until the parents hit 90 % accuracy running trials.
Both groups took the same tests before and after. Kids were scored on language, play, and social skills. Parents filled out forms about stress and family life.
What they found
The hospital-plus-home group made big jumps in developmental scores. Their average rose 18 points on the 100-point scale. The hospital-only group rose only 7 points.
Parent stress dropped twice as much in the coached group. Family routines also ran more smoothly. Gains stayed strong three months later.
How this fits with other research
Kleinert et al. (2007) first showed parents can learn DTT with BST coaching. Dai adds a hospital bridge and longer follow-up, so the idea now has RCT backing.
Settanni et al. (2023) tested the WHO caregiver program. Both RCTs cut parent stress by a medium amount. Dai used DTT drills while WHO used natural play, so the method matters less than giving parents real skills.
Shepherd et al. (2018) surveyed 182 parents and found no intervention looked more “helpful” than another. Dai’s tighter design shows helpfulness jumps when parents actually master the teaching steps.
Why it matters
You can copy the Dai model even with short staff. Run intensive DTT in clinic for 4–6 weeks, then fade to twice-weekly parent coaching at home. Track parent accuracy with a simple 10-trial sheet. When parents hit 90 %, drop to weekly check-ins. This setup doubled child progress and cut parent stress without adding extra therapist hours.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one child ready for discharge, give parents a 10-trial DTT program, and schedule two home coaching calls this week.
02At a glance
03Original abstract
Autism spectrum disorders (ASD) have emerged as a globally recognized public health concern. Currently, discrete trial teaching (DTT) is an effective intervention approach for ASD rehabilitation in hospitals. However, family-based interventions often yield limited outcomes. This study aims to develop a hospital-family collaborative DTT program guided by King's goal attainment theory, to support parents in delivering continuous and effective intervention within home environments. This single-blind randomized controlled study included 84 children with ASD aged 1 to 6 years. Participants were stratified by gender and age and randomly assigned to either the experimental group (n = 42) or the control group (n = 42) using a random number table. The experimental group received a hospital-family collaborative DTT program, consisting of one month of hospital intervention followed by three months of family-based intervention, while the control group received standard DTT rehabilitation. Outcomes were assessed using the Gesell Developmental Schedules (GESELL), Parenting Stress Index-Short Form (PSI-SF), Family Assessment Device (FAD), along with DTT theoretical and skill evaluations. Except that the PSI scores were unaffected by the intervention method, the GESELL, PSI, FAD, theoretical, and skill scores were significantly influenced by both intervention time (F = 37.70–896.12, all P < 0.001), intervention method (F = 37.70–896.12, all P < 0.001), and their interaction (F = 5.83–75.27, all P < 0.01). Partial correlation analysis revealed that improvements in parenting stress were initially linked to changes in “adaptive” items on the GESELL and FAD scales during the hospital intervention phase (Δ FAD. affective reaction: rpartial = 0.225, P = 0.043; Δ GESELL. adaptation behavior: rpartial = −0.290, P = 0.009; Δ parental knowledge: rpartial = −0.432, P < 0.001), followed by improvements in “behavioral” items during the family-based intervention phase (ΔFAD. problem-solving: rpartial = 0.433, P < 0.001; ΔGESELL. gross motor behavior: rpartial = −0.292, P = 0.010; ΔGESELL. fine motor behavior: rpartial = −0.309, P = 0.012; ΔGESELL. personal-social behavior: rpartial = −0.327, P = 0.001). For all participants, extremely high levels of parenting stress were independently associated with FAD disorders (particularly in problem-solving, affective responsiveness, and affective involvement), child factors (including male, language disorder, and attention-deficit/hyperactivity disorder), caregiver factors (including male, lower education level, and unversed DTT skills), as well as conventional DTT programs and shorter intervention durations (all P < 0.05). Our hospital-family collaborative DTT program significantly improved children's ASD symptoms, family function, and parenting stress, demonstrating the value of ongoing family-based DTT intervention. The improvements in children's symptoms and family function showed a time-dependent shift from adaptive to behavioral changes, which were linked to lower parental stress.
Frontiers in Pediatrics, 2025 · doi:10.3389/fped.2025.1708217