Bibliographic Details
| Title: |
Treatment mechanism of the WHO caregiver skills training intervention for autism delivered in community settings. |
| Authors: |
Settanni, Michele, Suma, Katharine, Adamson, Lauren B., McConachie, Helen, Servili, Chiara, Salomone, Erica |
| Source: |
Autism Research: Official Journal of the International Society for Autism Research; Jan2024, Vol. 17 Issue 1, p182-194, 13p |
| Abstract: |
This study examined the mechanism of effect of the WHO Caregiver Skills Training (CST) through secondary analysis of a pilot RCT conducted in community settings. Participants were 86 caregivers (77% mothers) of children with ASD (78% male, mean age: 44.8 months) randomized to CST (n = 43) or treatment as usual (n = 43). The primary outcomes, measured at baseline (t1), immediately post‐intervention (t2), and 3 months post‐intervention (t3), were derived from the coding of caregiver‐child free play interactions with the Brief Observation of Social‐Communication Change (BOSCC) and the Joint Engagement Rating Inventory scale (JERI). At t3 positive treatment main effects had been observed for caregiver skills supportive of the interaction and for flow of the interaction (JERI), albeit only non‐significant changes in the expected direction for child outcomes: autism phenotypic behaviors (BOSCC), joint engagement and availability to interact (JERI). This study tested the theory of change of CST, hypothesizing that the intervention would lead to an improvement on all child and dyad outcomes through an increase in the caregiver skills supportive of the interaction. Serial mediation analyses revealed that the effect of the intervention was significantly influenced by change in caregiver skills. Participation in the intervention led to notable increases in caregiver skills at t2 and t3, which subsequently contributed to improvements at t3 in flow of the interaction, autism phenotypic behavior, joint engagement, and availability to interact. We confirmed our a priori hypothesis showing that change in caregiver skills significantly mediated the effect of treatment on the dyad primary outcome, as well as on the other child outcomes that had shown non‐significant changes in the expected direction. Implications for intervention design and policy making in the context of public health services are discussed. Lay Summary: Community‐implemented caregiver‐mediated interventions are commonly used with children with autism spectrum disorder under age 5, but few studies have examined their effective mechanism (i.e., the processes responsible for changes in the clinical outcomes). This study examined the mechanism of a recently developed intervention, the WHO Caregiver Skills Training (CST), within a randomized controlled trial carried out in the community. The trial had shown positive intervention effects on parent skills supportive of the interaction and for fluent interaction between the child and caregiver, but less strong changes in the expected direction for child autism characteristic behaviors, joint engagement and availability to interact. The current study tested the hypothesis that CST works by increasing the parent's skills in support of the interaction, which in turn can lead to improved outcomes. We found that caregivers who received the CST intervention improved significantly more in their interaction skills with the child, and this led to a significant improvement on all joint interaction and child outcomes, including those which did not show a main effect of the intervention. This study shows that an acceptable and feasible open access community‐implemented caregiver‐mediated intervention can lead to a sustained improvement in the quality of the caregiver–child interaction through enhancing the caregiver's interaction skills. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |
