The relationship between treatment attendance, adherence, and outcome in a caregiver-mediated intervention for low-resourced families of young children with autism spectrum disorder.
In low-resourced families, caregiver stress and child nonverbal IQ predict lower adherence to caregiver coaching, but those who stick with it see gains in child joint engagement.
01Research in Context
What this study did
The team ran a randomized trial with low-income families of preschoolers with autism.
One group got hands-on caregiver coaching at home. The other sat in group classes.
They tracked how many sessions each family attended and how well they followed the steps.
What they found
Families who came more often and used the steps saw their kids play and share attention better.
Caregiver stress and child nonverbal IQ predicted who stayed in the program.
Stress went up, adherence went down. Lower IQ scores also meant fewer completed sessions.
How this fits with other research
Liao et al. (2025) asked 310 parents of kids with mixed neuro disorders the same question. They found stress and stigma hurt adherence, but family resilience helped. Themba’s trial now shows the same stress link inside a real coaching program.
Davis et al. (2022) tested a similar parent-coaching model. They proved that when parents respond faster and warmer, toddler social skills grow. Themba adds the attendance piece: you need families to show up first.
Pickard et al. (2025) looked at Part C early-intervention sites. Provider fidelity boosted parent strategy use, yet child gains were weak. Themba flips the focus: parent attendance and adherence, not therapist skill, drove child progress.
Why it matters
You can’t coach a parent who isn’t there. Screen for high stress and low nonverbal ability at intake. Offer shorter sessions, flexible times, and stress-reduction tips. Keep families coming and the child gains will follow.
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02At a glance
03Original abstract
Rates of participation in intervention research have not been extensively studied within autism spectrum disorder. Such research is important given the benefit of early intervention on long-term prognosis for children with autism spectrum disorder. The goals of this study were to examine how family demographic factors predicted treatment attendance and adherence in a caregiver-mediated randomized controlled trial targeting core deficits of autism spectrum disorder, and whether treatment attendance and adherence predicted outcome. In all, 147 caregiver-child dyads from a low-resourced population were randomized to in-home caregiver-mediated module or group-based caregiver education module treatment. Treatment attendance, adherence, and outcome (time spent in joint engagement) were the primary outcome variables. The majority of families who entered treatment (N = 87) maintained good attendance. Attendance was significantly predicted by socioeconomic status, site, and treatment condition. Families in caregiver-mediated module reported lower levels of treatment adherence, which was significantly predicted by site, condition, caregiver stress, and child nonverbal intelligence quotient. Dyads in caregiver-mediated module had significantly longer interactions of joint engagement, which was significantly predicted by an interaction between treatment attendance and condition. Overall, the results from this study stress the importance of considering demographic variables in research design when considering barriers to treatment attendance and adherence.
Autism : the international journal of research and practice, 2016 · doi:10.1177/1362361315598634