IRIS Educational Media has fulfilled phase 1 of an SBIR grant for the Autism Parent Trainer, a program that uses Applied Behavior Analysis techniques to train parents for helping their children with autism.
We developed and tested a prototype of APT, a telehealth intervention in which videoconferencing technology, Parent Educator-led group sessions, and audio-visual learning assets were used to train and support parents in 1) the acquisition of strategies for managing challenging behavior and teaching life skills to their children based on the principles of Applied Behavior Analysis (ABA), 2) reducing parent stress using practices such as mindfulness, optimism, and clarifying parent values. Targeted toward parents of children with autism aged 4 to 8, APT Phase I consisted of providing training to five separate groups of parents. Each group participated in three videoconference sessions and two individualized web-assisted home practice sessions. The three group sessions were led by Florien Deurloo, an ABA autism specialist and Parent Educator (PE), and Dr. Debra Eisert, an autism specialist and clinical psychologist with a background in Acceptance and Commitment Training. Dr. Meme Hieneman joined each third group session as a special guest to provide additional feedback on the ABA strategies parents were implementing and to present information on how optimism can influence parents’ thoughts and values. APT’s videoconferencing approach relied on Google + Hangouts online videoconferencing platform supplemented by video materials on YouTube and audio materials on SoundCloud. This allowed PEs and participants to see and hear each other and to share audio-visual material during the course of the three 90-minute videoconference sessions. Web-assisted home practice consisted of learning more about ABA, constructing behavior plans to address individual child needs, and learning and practicing more mindfulness and relaxation techniques.
We evaluated the feasibility, usability, and acceptance of the APT prototype using a within-subjects repeated measures pre- and post-training study design. This design evaluates the potential for efficacy by examining changes in user outcomes such as self-efficacy, parental stress, child behavior, and knowledge. The design did not control for potential threats to internal validity, which will be addressed when the complete intervention is tested in the currently proposed Phase II study using a sufficiently powered, large-scale randomized control trial.
We hypothesized that participants completing the APT training would (a) report high levels of consumer satisfaction and usability, (b) exhibit changes in pre-post measures of reported child behaviors, (c) exhibit increases in self-efficacy both generally and with regards to parenting a child with autism, (d) exhibit increases in knowledge about ABA practices, and (e) exhibit decreases in stress.
After exposure to the program and using the practices with their child, parents reported that their child exhibited less hyperactive behaviors, t(15) = 2.95, p < .01, and more prosocial behaviors, t(15) = -3.44, p < .01. Parents demonstrated increases in knowledge about ABA practices, t(15) = -2.60, p < .05. Parents also reported significantly lower stress specific to their child with autism (DCI), t(15) = 2.12, p < .05, and marginal reductions in overall stress (PSS), t(15) =1.81, p = .1. In summary, measures of child behavioral items, parental knowledge, and stress showed the predicted changes at posttest.
The group design allowed PEs to provide useful information to multiple parents, and that the PEs, in turn, were stirred by the intensity of parents’ need. Parents confirmed the premise that behavior is a significant concern for families with children with autism, and that most parents were highly motivated to think about and apply the ABA antecedent-behavior-consequence strategies method to teach their child a new skill. Learning these skills, in turn, reduced parents’ stress level, and their sense of futility. ABA principles were easily taught via the group sessions, and it appears likely that a good proportion of participating parents planned to continue to use the approach. Parents also welcomed instruction in stress management. Some of them already had preferred strategies (exercise, salsa dancing, walking) in place, but as a result of this training many reported that they now used mindfulness as an informal tool before going into stressful situations.
Transcribed open-ended comments from the consumer satisfaction questionnaire included: “I liked the interaction with others and the opportunity to talk through issues and problem solve.” “I appreciated that there was even something out there for parents like me. I needed this and even just the questions made life so much easier for me to express what I am thinking.” “I really liked the homework surveys/behavior plans. It helped break down ideas and think through strategies and ideas.” “I really enjoyed the information on mindfulness, diffusion, and optimism. All of the training I received in the past has just been on ABA principles, and not much to take care of my stress levels.” Parents also expressed wanting training on social/life skills, communication, “surviving meltdowns,” diet, and advocacy.
We were satisfied to learn that parents regarded APT as a training where they learned something new and useful, rather than simply a support group in which one talks over problems. About half of the participants implemented strategies the day following their first video conference. We witnessed a number of breakthroughs. One father from Illinois, whose 7-year old son had meltdowns while shopping, learned to apply antecedents that reduced his child’s reaction to over-stimulation (e.g., wearing headphones and a baseball cap), and was excited to be able to take his son shopping and to doctor visits without having to experience the associated meltdowns. A mother from Michigan, who had never heard of ABA and was on a waiting list for her four-year-old son to receive services, was able to implement strategies from the antecedent-behavior-consequence process to curtail her son’s repetitive behavior during visits to the public library.