Promoting Shared Decision Making to strengthen outcome of young children with Autism Spectrum Disorders: the role of staff competence.
Teaching EIBI staff to share decisions with parents cuts parent stress in half and doubles child skill gains.
01Research in Context
What this study did
Strauss et al. (2015) asked: does coaching EIBI staff in Shared Decision Making help kids and parents?
They ran a quasi-experiment. One group got the usual parent-plus-EIBI. The other got the same, plus staff learned how to share choices with parents.
All kids were preschoolers with autism. Staff and parents met often. The team tracked child skills, autism signs, and parent stress.
What they found
Adding SDM training cut parent stress in half. Kids in that group also gained adaptive skills twice as fast.
Autism symptoms shrank by a medium amount. The plain parent group improved too, but not as much.
How this fits with other research
McGeown et al. (2013) ran a school-only parent-training pilot with no SDM. They saw good language gains, yet parent stress stayed flat. Kristin’s later study shows that when staff also learn SDM, stress finally drops.
Callanan et al. (2021) tested a clinic parent-coaching program for mixed delays. Like Kristin, they saw big stress cuts and higher parent skill. The match tells us the effect is not tied to one brand of coaching.
Kuhn et al. (2025) gave parents brief Problem-Solving Education by telehealth. Parents liked it and felt capable. Kristin’s in-person SDM adds staff voice and still wins, hinting that live team talk may give an extra boost.
Why it matters
You already train parents. Now train your staff to ask, “What matters most to you today?” That single shift can halve parent stress and speed child progress. Start small: add a five-minute choice check at the end of each session.
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02At a glance
03Original abstract
Little is known on how the conceptual description of Shared Decision Making (SDM) accomplishes clinical practice in the context of lifetime disabilities as in particular Autism Spectrum Disorders (ASD), when intervention is long-lasting and requires constant family involvement. This study aimed mainly to investigate to what extent the staff's competence in SDM contributes to positive child and parent improvement when involving parents in Early Intensive Behavior Interventions (EIBI). It was also geared to verify whether SDM staff competence contributes to a child's treatment responsiveness. A total of 25 young children with ASD (23 male, 3 female, age range 34-92 months, mean age 51.4±13.6) were included in the study. Of these, nine children were allocated to a Parent Involvement condition accompanied by SDM Staff Training (PI-SDM), and eight children to a Parent Inclusion in Treatment Delivery Only condition without SDM Staff Training (PI-DO). Nine months treatment outcomes of severity, developmental and adaptive measures were compared to Treatment As Usual (n=8). PI-SDM was associated with improvement of autistic symptoms (p≤.05), adaptive functioning (p≤.01) and developmental outcome (p≤.01), as well as parent (p≤.05) and staff competence (p≤.001). The magnitude of outcome was inferior in the PI-PO and TAU group. A Reliable Change was identified in more than 40% of children included in PI-SDM, while PI-PO (>20%) and TAU (>12%) let to little Reliable Change and partially skill deterioration. Staff's SDM skill competence predicts reduced parental stress (β=-.500, p≤.05) and contributes significantly to a positive treatment responder trajectory (p≤.01), besides lower severity (p≤.05), higher adaptive (p≤.01) and communication skills (p≤.05). The study indicates that parent inclusion should be conceptualized as a collaborative partnership model rather than as adherence in treatment provision, based on a target SDM staff training that may constitute an external contributor to treatment responsiveness and positive child as well as parent outcome.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2014.11.016