Parent-Mediated Interventions With Children With Autism Spectrum Disorder: A Systematic Review

PURPOSE: Children with autism spectrum disorder (ASD) have difficulties in occupational performance areas such as play, feeding, and family and peer engagement. Parent-mediated interventions capitalize upon the expert knowledge of caregivers, who can implement therapeutic strategies within daily activities. Parent-mediated interventions create a unique opportunity to provide intervention in an environmentally relevant context, focusing on meaningful occupation for the both the parent and child. The goal of this systematic review is to determine if parent-mediated interventions are effective for increasing occupational performance for children diagnosed with ASD.

DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), an evidence-based reporting standard, was used to guide execution and reporting of the systematic review (Moher, Liberati, Tetzlaff, & Altman, 2009).

METHOD: Following the PRISMA guidelines, a broad search of academic databases (e.g., PubMed, CINAHL, and OTseeker) was conducted using search terms related to ASD, parent, caregiver, and intervention. Inclusion criteria for the studies were that the child needed to have a diagnosis of ASD with no co-occurring conditions and the intervention needed to occur in the United States and meet the basic criteria for a parent-mediated intervention (interventionist modeling of strategies, parent coaching, provision of feedback, and family and child individualization). Initially, a total of 355 articles were reviewed by title and abstract. Seventy-seven of those articles met inclusion criteria and were selected for full-text review. Sixteen articles were included in the final synthesis. Methodological quality of included articles was evaluated using the American Occupational Therapy Association’s (AOTA’s) level of evidence criteria. All five levels were considered for inclusion.

RESULTS: Using AOTA’s levels of evidence, 10 articles were categorized as Level I, three as Level III, and three as Level IV. Overall, parent-mediated interventions for children with ASD had the strongest evidence to support improving social communication and moderate evidence to support reducing autism symptom severity. Limited available research and variable study designs, varying outcome measurement tools, and limited evidence minimized the ability to determine if parent-mediated interventions were effective for other outcomes such as feeding, independent functioning, play, and behavior.

CONCLUSION AND IMPACT STATEMENT: Parent-mediated interventions can be effective for increasing occupational performance related to social communication and decreasing autism symptom severity. Many outcomes in this review, although not always overtly occupational in nature, were related to basic skills that may be considered building blocks for successful engagement in social and developmental occupations. A decrease in autism symptom severity, coupled with improvements in social communication, may enable a child to form relationships with peers and increase participation in school-based occupations. Future research should focus on occupation outcomes and other barriers to participation for children with ASD, such as sensory processing challenges.

Occupational therapists (OTs) are well suited to deliver and further develop parent-mediated interventions due to our expertise in development, coaching skills, and family-centered goal setting and interventions. With the increased need for occupational therapy services for children with ASD, parent-mediated interventions may allow for occupational therapy practitioners to provide comprehensive support for a greater number of families and children in an environmentally relevant context. Technology may also provide a medium for OTs to integrate parent-mediated interventions in geographically remote locations where services may otherwise not be available.

References

Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83, 554–563. http://doi.org/10.1037/a0039080

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-implemented social intervention for toddlers with autism: An RCT. Pediatrics, 134, 1084–1093. http://doi.org/10.1542/peds.2014-0757