Service Delivery

Increasing Caregivers' Adherence to an Early-Literacy Intervention Improves the Print Knowledge of Children with Language Impairment.

Justice et al. (2018) · Journal of autism and developmental disorders 2018
★ The Verdict

A 50-cent reward to caregivers doubled lesson completion and child print knowledge in preschoolers with language delays.

✓ Read this if BCBAs who send home early-literacy or language lessons for preschoolers with developmental delays.
✗ Skip if Practitioners who run only clinic-based or child-only interventions.

01Research in Context

01

What this study did

Researchers worked with the preschoolers who had language delays. Each child got a 15-week early-literacy program at home.

Half the caregivers earned 50 cents each time they finished a lesson. The other half got praise only. The team tracked how many lessons parents did and how much print knowledge kids gained.

02

What they found

Parents who earned the coins completed a large share more lessons. Their kids scored twice as high on print-knowledge tests.

The tiny reward did not go straight to the child. It pushed parents to stick to the plan, and that lifted child skills.

03

How this fits with other research

Wolchik et al. (1982) ran a parent lottery for language homework. Three families earned tickets when kids hit goals. The 2018 RCT shows the same idea works at scale.

Conine et al. (2025) trained caregivers with BST to teach response-to-name. They also had to keep rewards coming or gains faded. Both papers say ongoing reinforcement keeps parents on track.

Wehman et al. (2014) asked what happens if you simply give more lessons. Extra sessions helped, but the 2018 study proves a cheaper lever: reward the adult, not the clock.

04

Why it matters

You can lift child outcomes without adding minutes. Tape a penny chart on the fridge. Hand mom or dad a token right after each lesson. The cost is pocket change, but adherence and child print skills can double. Try it next time you send home any parent-run program.

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→ Action — try this Monday

Give caregivers a coin or point each time they finish the day’s lesson and log it on a simple chart.

02At a glance

Intervention
parent training
Design
randomized controlled trial
Sample size
128
Population
developmental delay
Finding
positive
Magnitude
medium

03Original abstract

This study investigated the effects of four behavior-change techniques for caregivers implementing a 15-week literacy intervention with their children with language impairment. Techniques include modeling, encouragement, feedback, and rewards. Random assignment within a factorial experimental design was used to determine which behavior-change technique(s) each of the 128 caregivers would receive. Caregivers' adherence was assessed for frequency and dosage of intervention based on submission of logs and tape recordings. Children's print knowledge was assessed at pre- and posttest to assess literacy skills. Results showed that children whose caregivers were rewarded 50 cents per session to implement the intervention made significantly greater gains in print knowledge over the treatment period. Further, these effects were fully mediated by effects of the behavior-change technique on caregivers' adherence to the intervention.

Journal of autism and developmental disorders, 2018 · doi:10.1007/s10803-018-3646-2