In-Home Training for Fathers of Children with Autism: A Follow up Study and Evaluation of Four Individual Training Components
Springerlink.com ( Publisher's URL )
CITATION PDF VIEWER
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/IR00000569/00001
 Material Information
Title: In-Home Training for Fathers of Children with Autism: A Follow up Study and Evaluation of Four Individual Training Components
Physical Description: Journal Article
Creator: Elder, Jennifer
Donaldson, Susan O.
Kairalla, John
Valcante, Gregory
Bendixen, Roxanna
Ferdig, Richard
Self, Erica
Walker, Jeffrey
Palau, Christina
Serrano, Michele
Publisher: Springer
Place of Publication: Springerlink.com
Publication Date: 2010
 Subjects
Genre: serial   ( sobekcm )
 Notes
Abstract: Abstract Literature regarding fathers of children with autism remains sparse, and because mothers are the more common intervening parent, few training methods have focused on fathers. Thus, we sought to evaluate effects of in-home training directed at fathers and their ability to train mothers in the same manner in which they were trained. Fathers were taught four skills commonly associated with in-home training interventions for parents of children with autism: following the child’s lead, imitation with animation, commenting on the child, and expectant waiting. Father skills were evaluated twice a week for 12 weeks during videotaped in-home father–child play sessions. Analyses included visual inspection of graphed data and statistical analyses of father skill acquisition, mother skill acquisition, and child behaviors with both parents. A multivariate repeated measures analysis of 18 dyads revealed significant increases in frequencies of fathers’ imitation with animation, expectant waiting, and commenting on the child. Child initiating rates increased significantly as did frequencies of child non-speech vocalizations. Analysis of mothers revealed significant increases in frequencies of imitation with animation, expectant waiting, and following the child’s lead. Child behaviors had similar results for father and mother sessions. Findings are consistent with those from our first study indicating that fathers can effectively implement skills that promote father–child social interactions and that children respond positively to this approach.
Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Jennifer Elder.
Publication Status: Published
Citation/Reference: Elder, J., Donaldson, S., Kairalla, J., Valcante, G., Bendixen, R., Ferdig, R., et al. (2010). In-Home Training for Fathers of Children with Autism: A Follow up Study and Evaluation of Four Individual Training Components. Journal of Child and Family Studies, 1-9. doi:10.1007/s10826-010-9387-2, PMC Journal
Funding: Publication of this article was funded in part by the University of Florida Open-Access Publishing Fund.
 Record Information
Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: All rights reserved by the submitter.
Resource Identifier: sobekcm - IR00000569_00001
System ID: IR00000569:00001

Downloads

This item is only available as the following downloads:

Published_artice ( PDF )


Full Text

PAGE 1

ORIGINALPAPER In-HomeTrainingforFathersofChildrenwithAutism:AFollow upStudyandEvaluationofFourIndividualTrainingComponents JenniferH.Elder € SusanO.Donaldson € JohnKairalla € GregoryValcante € RoxannaBendixen € RichardFerdig € EricaSelf € JeffreyWalker € ChristinaPalau € MicheleSerrano TheAuthor(s)2010.ThisarticleispublishedwithopenaccessatSpringerlink.com Abstract Literatureregardingfathersofchildrenwith autismremainssparse,andbecausemothersarethemore commoninterveningparent,fewtrainingmethodshave focusedonfathers.Thus,wesoughttoevaluateeffectsof in-hometrainingdirectedatfathersandtheirabilitytotrain mothersinthesamemannerinwhichtheyweretrained. Fathersweretaughtfourskillscommonlyassociatedwith in-hometraininginterventionsforparentsofchildrenwith autism:followingthechild’slead,imitationwithanimation,commentingonthechild,andexpectantwaiting. Fatherskillswereevaluatedtwiceaweekfor12weeks duringvideotapedin-homefather–childplaysessions. Analysesincludedvisualinspectionofgrapheddataand statisticalanalysesoffatherskillacquisition,motherskill acquisition,andchildbehaviorswithbothparents.A multivariaterepeatedmeasuresanalysisof18dyads revealedsignicantincreasesinfrequenciesoffathers’ imitationwithanimation,expectantwaiting,andcommentingonthechild.Childinitiatingratesincreasedsignicantlyasdidfrequenciesofchildnon-speech vocalizations.Analysisofmothersrevealedsignicant increasesinfrequenciesofimitationwithanimation, expectantwaiting,andfollowingthechild’slead.Child behaviorshadsimilarresultsforfatherandmothersessions.Findingsareconsistentwiththosefromourrst studyindicatingthatfatherscaneffectivelyimplement skillsthatpromotefather–childsocialinteractionsandthat childrenrespondpositivelytothisapproach. Keywords Autism Fathers Parenttraining Introduction RecentestimatesfromCentersforDiseaseControland Prevention(CDC)indicatethatasmanyas1in110US childrenarediagnosedwithautismoranautismspectrum disorder(ASD)(CDC2009).Whiledebatecontinuesasto whetherthisreectsmorepublicawarenessand/orbetter diagnosticmeasures,a57%increasefrom2002to2006, anda600%increaseinthelast20yearswarrantsintensiedeffortstoaddressthispopulation’sneeds(CDCMorbidityandMortalityWeeklyReport[MMWR],2009). Particularlyimportantisdeterminingwaystoeffectively treatchildrenwithautismandimprovequalityoflifefor themandtheirfamilies,nowoneofthetopprioritieslisted byNIHandcongressionallymandatedresearchprograms (NIHretrievedOctober5,2009). Amongthevariousprofessionalswhoworkwithchildrenwithautism,ithaslongbeenthoughtthattraining parentstoeducateandmanagetheirchildrencanbean effective,cost-efcientmeasure.Costsavingisparticularly importantasthesefamiliesareoftenfacedwithenormous nancialburdensassociatedwithavarietyofspecialist evaluationsandautism-relatedtreatments.Interestingly, literatureregardingfathersofchildrenwithautismremains sparse,andbecausemothersarethemorecommoninterveningparent,fewtrainingmethodshavefocusedon fathers.Ourclinicalexperiencehasalsoshownthatwhen parentsaretrainedsimultaneously,mothersoftentakelead roleswhilefathersassumebackgroundpositionsorbecome absent,leavingtrainingprimarilytomothers.Thiscan resultininconsistentinterventionimplementation,which maybeveryconfusingtochildrenwithautismwhohave J.H.Elder( & ) S.O.Donaldson J.Kairalla G.Valcante R.Bendixen R.Ferdig E.Self J.Walker C.Palau M.Serrano UniversityofFlorida,101S.NewellRd.,Box100187, Gainesville,FL32610-0187,USA e-mail:elderjh@u.edu 123 JChildFamStud DOI10.1007/s10826-010-9387-2

PAGE 2

difcultygeneralizingacrossdifferentindividualsorsettings.Moreover,motherswhoareprimarycaretakersoften reportextremestressandadesireformoreinvolvement fromthefather. Resultsfromourrstfathertrainingstudyrevealedthat fatherscouldbetrainedtousetwotheoretically-derived childtrainingskills, imitatingwithanimation and expectant waiting ,andthatthey,inturn,wereempoweredinthisrole andcouldeffectivelytrainmotherstousetheseskills (Elderetal. 2005 ).Wealsomadeseveralimportant methodologicaldiscoveriesthatwereincorporatedintoour recentlycompletedfollow-upstudy,which,inadditionto replicatingourprotocolwith18additionalfamilies,evaluatedeffectsoftwonewtrainingcomponents, following thechild’slead and commentingonthechild .Bothofthese newcomponents,derivedfromsocialinteractiontheory andresearch(DawsonandGalpert 1990 ;Duchan 1989 ; Donnellanetal. 1984 ;Stahmer 1995 ),aredesignedto promoteparent–childsocialreciprocity. TheoreticalFramework First,andstillmostoftenusedtodescribethebi-directionalityofmother-infantinteractions, socialreciprocity is describedastheongoinginteractionalprocessbetweentwo individuals(Calhounetal. 1991 ).Maternalresponsiveness hasbeenexaminedoverseveraldecadesbyanumberof researchers(Ainsworthetal. 1978 ;Barnard 1983 ;Belsky etal. 1984 ;Brazeltonetal. 1974 ;Mundyetal. 1994 ;Siller andSigman 2008 ),andfoundbyalltocorrelatesignicantly withpositivechildoutcomes(e.g.,languagedevelopment, cognitiveandsocialcompetence).Parent–childturn-taking, anothercomponentofsocialreciprocity,isdescribedin severalclassicworksasessentialinchildlanguagedevelopment(Bruner 1973 ;Furrowetal. 1979 ;Snow 1983 ),andit maybeparticularlyimportantforchildrenwithautism,who typicallyhaveseverelanguagedelays(WetherbyandPrizant 2000 ).Othershypothesizedthatparentsofchildrenwith autismmaynotengageinparent–childturn-takingbecause thechilddoesnotrespond(takehisturn)andthus,theparent isnotreinforcedtocontinuetheinteraction(Cunningham etal. 1981 ).Researchersnotethattrainingprogramsfor childrenwithautismaremosteffectivewhentheyaretailoredfortheparticularchild,addresscommunicativeintent ofchildbehaviors,andpromotesocialreciprocitybetween childrenandindividualswithwhomtheyhaveregularcontact(Elder 2002 ;Schopler 1996 ;Koegeletal. 1987 ;Mudfordetal. 2001 ;Mundyetal. 1994 ). ParentTrainingInterventions Overthepast30years,trainingparentstointervenewith theirchildrenwithautismhasbecomeanintegralpartof mosteffectivecomprehensiveinterventionplans.Parents, onceviewedasthecauseoftheirchildren’sproblems,are nowrecognizedforthekeyrolestheycanplayinongoing childtrainingandskillgeneralizationovertime(Elder 2002 ;Marcusetal. 1997;Schreibman 1997 ).Interventions targetingpivotalskillslikejointattentionmayproduce positive,sustaineddevelopmentaleffects(Mundyetal. 1990 ),anditmaybepossibletotrainparentstoeffectively teachtheseimportantskills(Koegeletal. 1999 )during everydayinteractions.Inourworkwecloselyexamined fourindividualparent-traininginterventioncomponents thoughttobelinkedwiththesecoreconstructs:imitating withanimation,expectantwaiting,followingthechild’s lead,andcommentingonthechild. Inareviewofparent-trainingliterature,wefoundfew empiricalstudiesevaluatingparent-trainingmethodsthat addressedtheoretically-linkedpivotalskillsdescribed above.WiththeexceptionofLovaas’( 1987 )work,there wasalsolittlesystematicreplicationofin-homeparenttrainingapproaches.Clearly,aneedexistsforwelldesignedparent-trainingstudiesthatemployappropriate data-collectionstrategies.Manystudiesusecomplicated proceduresthatdiscouragereplicationand‘‘intervention packages’’thatmakeitdifculttoassesseffectsofspecic interventioncomponentsontargetbehaviors.Sincemost studiesreportedareprofessional-directedinterventions, thesearecostly,timeconsuming,intermittentandtake placeoutsidethehome.Theinterventionwedevelopedand replicatedaddressestheseproblems.Itisparent-directed andcanbecontinuouslyimplementedinthehomesetting. FathersasIn-HomeTrainersandGeneralization ofTrainingwithinFamilies Interestinthefather’sroleinchilddevelopmenthas markedlyincreasedoverthepasttwodecades,with researchexpandingonLamb’sseminalwork( 1987 ). TiedgeandDarling-Fisher( 1996 )reportedthathealthy father–childinteractionspositivelyaffectedchilddevelopment.However,BoothandCrouter( 1998 )andDamon ( 1998 )notedthatwhilesomestudiessupportedthispositiveview,othersshowednoclearlydiscerniblepaternal effectsonchilddevelopment.Theseconictingndings arefurthercomplicatedinthecaseoffathersofautistic children,aboutwhomevenlessisknown(Elderetal. 2003 ).Thus,thepurposeofourpriorandrecentlycompletedstudieswastoevaluateeffectsofin-hometraining directedatfathersandtheirabilitytotrainmothersinthe samemannerinwhichtheyweretrained.Inoursecond study,reportedhere,weenrolled18additionalfamilies, andexaminedinmoredetailtwopreviouslytestedandtwo newinterventioncomponentsthoughttopromoteparent– childsocialreciprocity.Specicresearchquestionswere: JChildFamStud123

PAGE 3

1.Canfathersbetaughttoeffectivelyusefourskill components(imitatingwithanimation,expectant waiting,followingthechild’slead,andcommenting onthechild)duringin-homeplaysessions? 2.Doesfatherimplementationoftheseskillcomponents resultinsignicantdifferencesinthefrequencyof childinitiating,childresponding,childnon-speech vocal,andchildintelligiblewordsduringplay sessions? 3.Canfatherseffectivelytrainmotherstousetheseskill componentsanddoesimplementationoftheseskillsby mothersresultinsignicantdifferencesinthedesignatedchildbehaviors? Methods ParticipantsandSetting Childrenwereincludediftheymetthefollowingcriteria: (a)adiagnosisof‘‘autisticdisorder’’accordingtoDSMIV TRcriteria(AmericanPsychiatricAssociation 2000 ),(b) scoresabovecut-offineachsubscaleoftheAutism DiagnosticInterviewRevised(ADI-R)andAutismDiagnosticObservationSchedule(ADOS),and(c)residence within150milesoftheUniversityofFlorida.Children wereexcludediftheirmedicalhistoriesand/orphysical examinationsindicatedtheyhadphysicalorsensory impairmentsorsignicantmedicalproblems(e.g.,seizure disorders,chronicotitismedia).Afterwritteninformed consentwasprovidedbyparents,children( N = 24)were randomlyassignedtoeitherthestandardinterventionora 6-weekwaitlistcontrolgroup.Eighteenchildren(nineper group)completedtheentireprotocol.Childrenrangedin ageatenrollmentfrom3.07to7.07(mean4.41 1.36) years,andtherewere17malesand1female.Thirteen (72%)wereCaucasian,2(11%)wereAfricanAmerican, and1(6%)eachLatinAmerican,Hispanic,andAsian, reectiveofdemographicsofthenorthcentralFlorida region.Fathersandmothersalsoprovidedinformedconsentforthemselvesandwereincludediftheyexpressed willingnesstobevideotapedwiththeirchildrenandto engageinthetrainingprocess.Exclusioncriteriaforparentsconsistedofanyphysical,majorpsychiatric,orsensoryproblems(e.g.,speechandlanguagedisorders,hearing loss),asnotedintheintakeevaluationthatmightaffect theirabilitytoconducttrainingand/orinteractwith children. Alltrainingandvideotapingsessionstookplacein participants’homes.Videotapingofthechildandone participatingparentoccurredinaroomwherechildren weremostoftenexposedtoinformalfamilyinteractions. Videographersfollowedproceduresdevelopedinourpreviousstudiestominimizeobtrusivenessandparticipant reactivity.Ifchildorparentlefttheplayarea,videotaping andtimingceasedandresumedaftertheyreturned.Ifthey didnotreturn,datawereconsideredunusableandalater sessionwasscheduled.Whilethisdidoccur,itwasrareand usuallyassociatedwiththechildbeingill.Asinourearlier work,studyparticipationwasgenerallywellmaintainedin homesettings.Participantsweremorelikelytokeep scheduledappointmentsandparticipateregularlyathome (comparedtoaclinic)becauseitwasconvenientand requiredlessexpenditureoffamilyresources.Home-based trainingandobservationsalsoprovidedessentialin-depth dataaboutindividualparticipantsinnaturalisticsettings. Instruments Afterobtainingparentconsent,eachchildwasscreened withtheAutismDiagnosticInterview-Revised(ADI-R) andAutismDiagnosticObservationSchedule(ADOS).If initialcriteriaweremet,additionalchilddatawere obtainedwiththeVinelandAdaptiveBehaviorScales. Informationregardingfamilyincomeandparentaleducationwasalsogatheredtodescribeoverallfamilysocioeconomicstatus. AutismDiagnosticInterview-Revised TheADI-R(Lordetal. 1994 )isastandardizedparent interviewforassessingpresenceandseverityofsymptoms. Adiagnosisofautismisestablishedifanindividualscores atorabovethecutoffscoreinthethreeICD-10symptom domains.Atrainedcertiedmemberoftheresearchteam administeredtheADI-Rtotheprimarycaregiver(parent whoreportedspendingthemosttimewiththechild). AutismDiagnosticObservationSchedule TheADOS(Lordetal. 2002 )isasemi-structuredobservationalassessmentadministereddirectlytothechild.Like theADI-R,instrumentvalidityisbasedondiagnosticcriteriaforautismintheDiagnosticandStatisticalManualof MentalDisorders(DSM-IV-R1994)andICD-10symptom domains.ADOSmoduleswereadministeredbyteam memberstrainedandcertiedinitsuse. VinelandAdaptiveBehaviorScales-SurveyForm (Vineland) TheVineland(Sparrowetal. 1984 )isawidelyused measureofadaptivebehaviorsfrombirthtoage18.This semi-structuredinterviewwithaparentoracaregiver JChildFamStud123

PAGE 4

assessesadaptive(reallife)skillsincommunication,daily living,maladaptivebehavior,andsocialization.Itiscommonlyusedinautismresearchbecauseitoffersoverall areasofdecitsinindividualswithautismanddimensional metricationofahallmarkdecit,socialization(social competence;Volkmaretal. 1997 ).Allinstruments describedabovehavewell-establishedpsychometric properties. MeasurementofDependentVariables DirectObservationofParentandChildBehavior ResearchAssistants(RAs),whosuccessfullycompleted extensivebehavioralcodingtraining,videotaped15min eachoffather–childandmother–childin-homeplaysessions.Therst5minwere‘‘settlingin’’andnotcoded;in thefollowing10min,codersvideotapedoccurrencesof parentandchildreciprocitybehaviors.Codersworked independentlyandbehavioralfrequencycountswere determinedbynumberofoccurrencescountedduringthe 10-minsession.Codingandanalysisoftargetbehaviors werefacilitatedwiththewidelyusedcomputerized ObserverProgram,whichalloweddatatobeenteredinto computers,labeledandorganized,andstoredinalarger desktopcomputerwithnetworkaccess.Throughoutthe researchprotocolthePI,whotaughttheinterventions,was notinvolvedinthecodingprocess,andcoderswerenot toldwhichinterventionswerebeingtaught.Toevaluatefor possibleraterdrift,asecondratercoded20%ofrandomly selectedvideotapedsessions.Interraterscoresrangedfrom 0.71to1.0,withameanof0.83.First,theteamcoded frequenciesofthefourfatherskillcomponents:imitating withanimation,expectantwaiting,followingthechild’s lead,andcommentingonthechild.Theteamalsocoded frequencyofthesameskillcomponentsforthemothers. Childinitiating,childresponding,childnon-speech vocalizations,andintelligiblewordswerealsocodedfor boththefather–childandmother–childsession. DescriptionofIndependentVariable(Father-Training Intervention) RationaleforSpecicTrainingComponents Inearlierresearchandclinicalwork,manyparentsverbalizedtheydidnotknowhowtoplaywiththeirchildrenduring playsessions.Parentseithersatpassivelyoraggressively triedtodirectinteractions,notallowingchildrensufcienttimetorespond(Elder 1995 ).Therstintervention, ‘‘imitating/animating,’’wasdesignedtoaddresstheseconcernsbypromotingbasicturn-takingplayinteractions. Enhancedwithspecicvideotapedexamplesandwritten directionsaboutfollowingthechild’sleadinplay,fathers wereinstructedtoattendtoandimitatetheirchildren’s vocalizationsand/oractionsinananimatedmanner.Asin ourearlierwork,parentsreportedthatimitatingthechildren was‘‘fun’’andhelpedthemrelaxduringplaysessions. ‘‘Expectantwaiting’’continuedtobemoredifcultto employ,asitrequireswaitingforchildresponses.Thus,we continuedtoteach‘‘imitating/animating’’rst,followedby ‘‘expectantwaiting.’’Inourpriorstudywealsoobservedthat evenwithinstructionemphasizingwaitingforthechildto initiate,fatherandmotherinitiatingdidnotdecreasesignicantlyacrossconditionsandthatmanyparentsreliedon directivequestioning.Toaddressthisinthecurrentstudy,we addedanothercomponenttospecicallyteachfathersto commentonthechild’sverbalizationsandactions,rather thanquestion. Figure 1 providesanoverviewofPI-fathertraining sessions,father-conductedtrainingsessions,andvideotapingdatacollectionsequence.Asnoted,therewerethree PI-fathertrainingsessions:introducingandteaching ‘‘imitating/animating’’and‘‘followingthechild’slead’’in playinterventions(Session1),introducingandteaching ‘‘expectantwaiting’’and‘‘commentingonthechild’’ (Session2),andcombiningthefourstrategies(Session3). FollowingPI-fathertraining,fathersimplementedwhat theylearned.Eachtimeaninterventionwasintroducedby fathers,anewconditionwasestablished(I-III). ConditionI:FathersUseInterventionItoTeachImitating/ Animating Oncepre-evaluationdatawereanalyzedforfather–child dyads,therstauthor(PI)usedfather–childvideotaped Enrolled and randomly assigned to standard intervention or wait list control group  Videotaped baseline sessions until stable  4-6 sessions for standard intervention group 16-18 sessions for wait list control group Condition I: Imitating/Animating and Following Child’s Lead (1) PI trained father, (2) 2 father-child sessions videotaped, (3) computer feedback session,* (4) 2 father-child sessions videotaped, (5) father instructed to train mother in Intervention I. Condition II: Expectant Waiting and Commenting vs. Questioning (1) PI trained father, (2) 2 father-child sessions videotaped (3) computer feedback session,* (4) 2 father-child sessions videotaped, and (5) father instructed to train mother in Intervention II. Condition III: Combining All Strategies (1) PI trained father, (2) 2 father-child sessions videotaped, (3) computer feedback session,* (4) 2 father-child sessions videotaped, and (5) father instructed to train mother in Intervention III. Fig.1 Sequenceofexperimentalconditions* JChildFamStud123

PAGE 5

baselinesessionstoteachfatherstorecognizechildinitiations,followchild’sleadinplay,andapplytheintervention‘‘imitating/animating.’’Motherswerenotpresent duringfathertraining.Aftertraining,fatherswere instructedtoimmediatelybeginusingInterventionIin everydayinteractionswiththeirautisticchildren.Skill acquisitionwasassessedviavideotapeduringfather–child playsessionstwotimesaweekfortwoconsecutiveweeks. Fatherswereinstructedtousetheinterventioncomponent withtheirchildfor3–4daysbeforebeingvideotaped again.Theresearchteamuseddatafromthesesessionsto determinenumberofopportunitiesforusingtheinterventionandhowoftenfathersrespondedtotheseopportunities.ThePIdiscussedthesendingswithfathersand determinediftheywerereadytoadvancetothenext conditionorifremediationwasindicated.Motherswere videotapedduringeachhomevisitaswell.Father–child andmother–childsessionsremainedseparate,andorderof videotapingwascounterbalancedacrosssessions.Asinthe baselinephase,childrenweregivenbreaksbetweenall sessions. Attheendofeachinterventioncondition,fatherswere instructedtoteachmothersinthesamemannertheywere taught.Thisincludeduseofwrittenmaterialsandvideotapedparent–childsessions.ThePI wasnot directly involvedinthemothertrainingprocessbutremained availabletofathersfortelephoneand/orweb-basedconsultation.Eachparentwasgivenaccesstoaweb-based discussionforumforprivateconsultationwitharesearcher asneeded. ConditionII:FathersUseInterventionIItoTeach CommentingandExpectantWaiting PriortocollectingdatainConditionII,fatherswereasked totrainmothersinInterventionIandtobeginusing InterventionII,themselves.Datacollectionmethodsof child/parentbehaviorswereidenticaltoConditionI.PIfathertrainingofInterventionIIinvolvedtwostrategies: ‘‘expectantwaiting’’(signalingchildforadesiredactionor wordandwaitingexpectantlyaminimumof3-sfora response)and‘‘commentingonthechild,’’insteadof askingquestions,amorecommonparentalbehavior.From ourpreviousworkwenotedthatevenwheninstructedto discontinueInterventionI,somefathershadalready incorporateditintotheirdailyfather–childinteractions, anditwasunrealistictoexpectthemto‘‘unlearn’’theskills set.Therefore,inthecurrentstudyfathersdecidedwhether tocontinueusingInterventionIwithoutovertinstruction, andInterventionIusewasdocumentedthroughoutall conditions.AsinConditionI,theresearchteamuseddata obtainedfromthersttwovideotapedsessionsinConditionIItodeterminenumberofopportunitiesforusingthe interventionandhowoftenfathersrespondedtothese opportunities.Theparenttrainer(PI)discussedndings withfatherstodetermineiftheywerereadytoadvanceto thenextconditionorifboostertrainingwasindicated.If videotapesshowedafatherwasnotusingthestrategiesas instructed,ateammembermadeonesubsequenthomevisit toprovideadditionalinstructionandencouragement,andto answerquestions.Atleasttwomorevideosessionswere thenconductedtoensurethefatherwasusingthestrategies beforeaskinghimtoinstructthemotherandmovetothe nextintervention. ConditionIII:FathersUseCombinedInterventionsIandII Inthistrainingsessionfathersviewedfather–childvideotapesanddata,andreceivedadditionalinstructionregardingcombiningbothpreviouslylearnedstrategies.Training wasindividualized,basedonassessmentdata,thechild’s progress,andexpressedneedsoffathers.Datacollection wasidenticaltoConditionsIandII. Insummary,eachfamilywasvideotapedtwiceaweek for8–12weeks.Therangeinweeksreectseachfamily’s uniquenessregardingneedfortraining,familyillness,and/ orlast-minutelmingsessioncancellations.Variationwas accountedforinstatisticalanalysisofgroupeddata. DataAnalysis Twotypesofanalyseswereused.Therstinvolvedvisuallyanalyzingindividualparent–childgraphstodetermine ifbaselinedatawerestablepriortoimplementinginterventioncomponents.Thisisacustomaryapproachusedin single-subjectexperimentalresearchdesigns(Hersenand Barlow 1987 ).Baselinesofstandardinterventionandwait listcontrolgroupswereevaluatedtodetermineifthere werechangesinlevelsandtrendsthatcouldbeattributable tofactorsotherthanspecictraininginterventions.The secondandmainanalysisinvolvedrepeatedmeasures ANOVAtostudypotentialgroupwisechangesinbehaviorsovertheconditionsofinterest;SASversion9.1.3(SAS Institute,Cary,NC)wasused.Toreducevariability,individualsessionfrequencieswererstaggregatedbycondition,withaggregatevaluesusedintheanalysis.Thesingle groupapproachusestheparticipant’smeanbaseline behaviorscoresashis/herowncontrolsanddetermines whether,onaverage,thereisachangeoverthechronologicalconditionsofinterest.Advantagesofthedesignare thatissuessuchasparticipantselectionandmatching becomeirrelevant,andeveryparticipatingfamilyreceives theintervention. AtConditionI,fathersweretaught‘‘imitating/animating’’and‘‘followingthechild’slead.’’Themultivariatetest JChildFamStud123

PAGE 6

ofinterestwaswhethertherewasachangefrombaseline, onaverage,atanyfollow-upperiod(allConditions).At ConditionII,fathersweretaught‘‘expectantwaiting’’and ‘‘commentingonchild.’’Hence,themultivariatetestof interestwaswhethertherewasachangefrombaseline,on average,atIIorIII.Testsformotherbehaviormirrored thoseusedforfathers.Multivariatetestsforchildresponses lookedforachangefrombaselinetoanyfollow-upperiod inthestudy.Inordertofurtherexaminelocationsand magnitudesofchange,follow-up t -testsexaminingchange frombaselinetospecicconditionswerealsoperformed. Results Visualanalysesofbaselinedataforboththestandard intervention( n = 9)andwaitlistcontrolgroups( n = 9) revealednodiscernabletrendsindicatingtheinuenceof confounds(e.g.,participantreactivitytodatacollectors, environmentalfactors)priortotheintervention. Themainanalysisinvolvedgroupeddataacross18 childrenandtheirparents.RepeatedmeasuresANOVA resultsforfathersessionsarepresentedinTable 1 and visuallydepictedinFig. 2 ;resultsformothersessionsare presentedinTable 2 andvisuallydepictedinFig. 3 FatherBehaviors Signicantchangesinfather imitating/animating rates werefoundfrombaselinetothethreeconditions(overall p \ 0.001).Follow-upanalysisconrmedthemeanratefor imitating/animating increasedfrombaselinetoeachfollow-upcondition( p \ 0.001ateachcondition).Nosignicantoverallchangeoccurredfrombaselinefor followingthechild’slead (overall p = 0.089);however, follow-upexploratoryanalysisshowedapossibleincrease frombaselinetoConditionI( p = 0.015).Signicant changesinfathers’ expectantwaiting rateswerefound frombaselinetothenaltwoconditions(overall p = 0.013).Follow-upanalysisconrmedthemeanrate Table1 Father–childdyadfrequencies( n = 18) BehaviorVariablesBaselineConditionIConditionIIConditionIII Fp ImitatewithanimationM1.921.421.319.519.72 \ 0.001 SD0.43.82.72.6 Followchild’sleadM1.32.52.22.32.620.089 SD0.30.50.40.6 ExpectantwaitingM0.50.57.57.55.740.013 SD0.30.22.42.0 CommentonchildM24.027.631.728.54.900.022 SD2.72.93.03.2 ChildinitiatingM16.022.728.129.84.150.025 SD2.23.55.55.5 ChildrespondingM21.218.521.721.50.33 [ 0.2 SD4.45.35.14.5 Childnon-speechvocalsM23.429.833.330.54.240.023 SD2.33.73.22.4 ChildintelligiblewordsM40.951.846.844.50.65 [ 0.2 SD11.015.211.312.6 ImitatewithAnimation,FollowChild’sLead,andchildbehaviorfrequenciesweretestedaschangefromBaselinetoanyofthethreeConditions; ExpectantWaitingandCommentingonChildweretestedaschangefromBaselinetoeitherConditionIIorConditionIII 0 5 10 15 20 25 30 35Behavior frequenciesBaselineCondition ICondition IICondition IIICondition Father SkillsImitate/Animate Follow Lead Expectant Waiting Comment on Child Fig.2 Fatherskillacquisitionandchildbehaviorsfrombaseline throughconditionIII JChildFamStud123

PAGE 7

for expectantwaitingi ncreasesfrombaselinetoeachofthe twonalconditions( p = 0.011and p = 0.003,forIIand III,respectively).Signicantchangeswerealsofoundfor fathers’ commentingonthechild ratesfrombaselinetothe naltwoconditions(overall p = 0.022).Follow-upanalysisconrmedthatthemeanratefor commentingonthe child increasesfrombaselinetoConditionII( p = 0.005) andthattheeffectispossiblydiminishedinConditionIII ( p = 0.11). MotherBehaviors Signicantchangesinmother imitating/animating rates werefoundfrombaselinetothethreeconditions(overall p \ 0.001).Follow-upanalysisconrmedthatthemean ratefor imitating/animating increasedfrombaselineto eachoftheconditions( p \ 0.001ateach).Therewasalso asignicantoverallchangefrombaselinefor followingthe child’slead (overall p = 0.006).Follow-upanalysis showedasignicantincreasefrombaselinetoConditionII ( p = 0.034)butdidnotshowsignicantchangestothe othertwoconditions( p [ 0.2and p = 0.068forIandIII, respectively).Signicantchangesinmothers’ expectant waiting rateswerefoundfrombaselinetothenaltwo conditions(overall p = 0.005).Follow-upanalysisconrmedthemeanratefor expectantwaiting increasedfrom baselinetoeachofthetwonalconditions( p = 0.007and p = 0.008forIIandIII,respectively).Signicantchanges werenotfoundformothers’ commentingonthechild rates frombaselinetothenaltwoconditions(overall p [ 0.2). Follow-upexploratoryanalysisdidnotndpotentiallysignicantchangesfrombaselinetoeitherConditionIIorIII. ChildBehaviors,FatherandMotherSessions Childbehaviorfrequencieswereanalyzedforbothfather andmothersessions,withsimilarresults.Signicant overallchangesfrombaselinewerefoundin childinitiating (overall p = 0.025forfathersessionsand p = 0.009 Table2 Mother-childdyadfrequencies( n = 18) ResponseVariablesBaselineConditionIConditionIIConditionIII Fp ImitatewithanimationM3.59.813.713.211.77 \ 0.001 SD0.91.61.51.6 FollowleadM1.51.32.33.96.170.006 SD0.30.20.30.5 ExpectantwaitingM1.00.92.33.97.700.005 SD0.40.30.71.1 CommentonchildM26.228.532.332.50.91 [ 0.2 SD3.52.83.34.5 ChildinitiatingM16.322.026.727.55.620.009 SD2.43.74.24.3 ChildrespondingM20.320.315.817.22.140.107 SD3.33.03.03.2 Childnon-speechvocalsM22.731.031.428.25.430.010 SD2.22.52.93.1 ChildintelligiblewordsM45.154.251.348.61.35 [ 0.2 SD12.813.514.813.6 ImitatewithAnimation,FollowChild’sLead,andchildbehaviorfrequenciesweretestedaschangefromBaselinetoanyofthethreeConditions; ExpectantWaitingandCommentingonChildweretestedaschangefromBaselinetoeitherConditionIIorConditionIII 0 5 10 15 20 25 30 35Behavior frequenciesBaselineCondition ICondition IICondition IIICondition Mother SkillsImitate/Animate Follow Lead Expectant Waiting Comment on Child Fig.3 Motherskillacquisitionandchildbehaviorsfrombaseline throughconditionIII JChildFamStud123

PAGE 8

formothersessions)and childnon speechvocalizations (overall p = 0.023forfathersessionsand p = 0.010for mothers).Follow-upanalysisforchildinitiatingshowed signicantincreasesfrombaselinetoallthreeconditions forfather/mothersessions(all p \ 0.03).Follow-upanalysisfor non speechvocalizations showedsignicant increasesfrombaselinetoeachofthethreeconditionsfor fathersessions(all p \ 0.03)andthersttwoconditions formothersessions(both p \ 0.01forIandII, p = 0.08 forIII).Overallchangesfrombaselinewerenotsignicant forchildresponse( p [ 0.2forfathers; p = 0.11for mothers)orfor intelligiblewords (both p [ 0.2).Exploratoryfollow-upanalysisfoundonlyonepotentialchange frombaselineforthesetwomeasuresacrossmother/father sessions:childuseofintelligiblewordsfrombaselineto ConditionIincreasedby9.2onaverage( p = 0.047)in mothersessions. Discussion Asdiscussedintheintroductorysection,thefourindividual trainingcomponentsarelinkedtosocialinteractiontheory anddesignedtopromotesocialreciprocitybetweenparents andchildrenwithautism.Asinourpreviouswork,we notedthatpriortoin-hometraining,fathersandmothers infrequently,andinsomecasesnever,usedstrategiesof imitatingthechildwithanimation and expectantlywaiting forachildresponse.AfterfathersweretrainedbythePI andmothersweretrainedbyfathers,bothgroupseffectivelyusedthesestrategiesanddemonstratedsignicant increasesinfrequency.Anecdotalreportsindicatedthat parentsviewedtherststrategyas‘‘fun’’andwereableto incorporateitintotheirdailyparent–childinteractions. Whileparentswereabletolearnandusethe expectant waiting strategy,theyreporteditwassometimesdifcultto waitforchildresponsesfortheinstructedminimumof3s. Differencesoccurredinhowoftenfathersandmothersused theothertwostrategies, followingthechild’slead and commentingonthechild .Mothersused commentingonthe child moreoftenthanfathersduringbaseline,andperhaps thatiswhytheydidnotdemonstratethesamesignicant increasesasfathersfollowingtraining.Mothersdid,however,showasignicantincreaseinuseof thechild’slead whilefathersdidnot.Reasonsforthisndingareuncertain.Childresponsesweresimilarforbothparentsinthat sessionswitheachshowedsignicantincreasesinboth initiating and non speechvocalizations .Thisndingis particularlyimportantsinceahallmarkfeatureofautismis impairedsocialinitiating,andnon-speechvocalizations (pre-speech‘‘babble’’)oftenprecedeintelligiblespeech. FathersinthisstudyweretrainedbythePIand instructedtotrainmothers,whohadnotrainingotherthan this.Toourknowledge,oursaretherststudiestotestthis approach.Inbothstudiesfathersdemonstratedtheycould learnthestrategiesandtrainmothers.Mothers,inturn, effectivelylearnedfromfathersasdemonstratedbytheir abilitytoimplementthesestrategies.Furtherstudyis neededtodetermineifthisapproachisanefcaciousmeansofsolicitingandmaintainingfatherinvolvement. Resultsofthisandourpriorstudyindicatethatidentifyingandimplementingstrategiesdesignedtopromote socialreciprocityinparentsandchildrenwithautismisa valuableapproachandwell-acceptedbyparticipating families.Afthaimofthisstudy,notdiscussedinthis article,wasthedevelopmentofawebsitetoinformfamiliesandreinforcetraining(Ferdigetal. 2009 ).Awebassistedapproachalsoshowspromiseandwillbeempiricallyevaluatedinfutureresearch.Wehaveprovidedevidenceindicatingthatfather-directedtrainingiseffective andaddressesavarietyoffamilyandchildneeds.Although labor-intensive,wealsonotedthatcollectingvideotaped dataovernumeroussessionsratherthansinglepreand post-interventionisveryimportantbecausebehavioral variabilityinchildrenwithautismoftenoccurs.Visually analyzingbaselinedatafromthewaitlistcontrolgroup alsohelpeddiscernthattreatmenteffectswerefromthe interventions,notmerelyfromattentionto,orpresenceof, investigators.Asineverynewareaofinquiry,more researchisneededtofurthervalidatefamily-focused,inhomeinterventionsinchildrenwithautismaswellasother relateddisorders.Acknowledgments Wewishtoacknowledgetheparticipating familiesandchildrenwhohavegainedouradmirationandtheeditorialassistanceprovidedbyPamelaSelby,M.S.,M.A.Theresearch wasfundedbyaR01fromtheNationalInstituteofNursingResearch. RichardFerdigisnowatKentStateUniversity. OpenAccess Thisarticleisdistributedunderthetermsofthe CreativeCommonsAttributionNoncommercialLicensewhichpermitsanynoncommercialuse,distribution,andreproductioninany medium,providedtheoriginalauthor(s)andsourcearecredited.ReferencesAinsworth,M.,Blehar,M.,Waters,E.,&Wall,S.(1978). Patternsof attachment:Apsychologicalstudyofthestrangesituation (5th ed.).HillSDale,NJ:Erbaum. AmericanPsychiatricAssociation.(2000). Diagnosticandstatistical manualofmentaldisorders (Revised4thed.).Washington,DC: Author. Barnard,K.(1983).Thecasestudymethod:Aresearchtool. Journal ofMaternalChildNursing,8 (1),36. Belsky,J.,Rovine,M.,&Taylor,D.G.(1984).ThePennsylvania infantandfamilydevelopmentproject,III:Theoriginsof individualdifferencesininfant-motherattachment:Maternaland infantcontributions.[Article]. ChildDevelopment,55 (3),718– 728.doi: 10.1111/1467-8624.ep12422856 JChildFamStud123

PAGE 9

Booth,A.,&Crouter,A.C.(Eds.).(1998). Meninfamilies:Whendo theygetinvolved?Whatdifferencedoesitmake? Mawhaw,NJ: LawrenceErlbaumAssociates. Brazelton,T.,Koslowski,B.,&Main,M.(1974).Theoriginsof reciprocity.Theearlymother-infantinteraction.InM.Lewis& L.Rosenblum(Eds.), Theeffectoftheinfantonthecaregivervol 1 (pp.49–76).NewYork:Wiley. Bruner,J.S.(1973).Fromcommunicationtolanguage:Apsychologicalperspective. Cognition,3 ,255–287. Calhoun,M.,Rose,T.,Hanft,B.,&Sturky,C.(1991).Social reciprocityinterventions:Implicationsfordevelopmentaltherapists. PhysicalandOccupationalTherapyinPediatrics,11 ,45– 56. Cunningham,C.E.,Reuler,E.,Blackwell,J.,&Deck,J.(1981). Behavioralandlinguisticdevelopmentsintheinteractionsof normalandhandicappedchildrenandtheirmothers. Child Development,52 ,62–70. Damon,W.,&Eisenberg,N.(1998). Handbookofchildpsychology: Social,emotional,andpersonalitydevelopment (5thed.).New York:Wiley. Dawson,G.,&Galpert,L.(1990).Mothers’useofimitativeplayfor facilitatingsocialresponsivenessandtoyplayinyoungautistic children. DevelopmentandPsychopathology,2 ,151–162. Donnellan,A.,Mirenda,P.,Mesaros,R.,&Fassbender,L.(1984). Analyzingthecommunicativefunctionofaberrantbehavior. JournaloftheAssociationfortheSeverelyHandicapped,9 ,201– 212. Duchan,J.(1989).Evaluatingadults’talktochildren:Assessingadult attunement. SeminarsinSpeechandLanguage,10 ,17–27. Elder,J.H.(1995).In-homecommunicationinterventiontrainingfor parentsofmultiplyhandicappedchildren. ScholarlyInquiryfor NursingPractice,9 ,71–92. Elder,J.H.(2002).Currenttreatmentsinautism:examiningscientic evidenceandclinicalimplications. JournalofNeuroscience Nursing,34 (2),67–73. Elder,J.H.,Valcante,G.,Won,D.,&Zylis,R.(2003).Effectsofinhometrainingforculturallydiversefathersofchildrenwith autism. IssuesinMentalHealthNursing,24 (3),273–295. Elder,J.H.,Valcante,G.,Yarandi,H.,White,D.,&Elder,T.H. (2005).Evaluatingin-hometrainingforfathersofchildrenwith autismusingsingle-subjectexperimentationandgroupanalysis methods. NursingResearch,54 (1),22–32. Ferdig,R.E.,Amberg,H.G.,Elder,J.H.,Donaldson,S.A., Valcante,G.,&Bendixen,R.(2009).Autismandfamily interventions:TheuseoftheInternettotrainfathersofautistic children. InternationalJournalofWeb-basedLearningand TeachingTechnologies,4 (3),55–69. Furrow,D.,Nelson,K.,&Benedict,H.(1979).Mothers’speechto childrenandsyntacticdevelopment:Somesimplerelationships. JournalofChildLanguage,6 (3),423–442.doi: 10.1017/ S0305000900002464 Hersen,M.,&Barlow,D.(1987). Single-caseexperimentaldesign: Strategiesforstudyingbehaviorchange .NewYork:Pergamon Press. Koegel,L.,Koegel,R.,&Dunlap,G.(1999). Positivebehavioral support .York,PA:TheMaplePress. Koegel,R.L.,O’Dell,M.,&Koegel,L.K.(1987).Anatural languageparadigmfornonverbalautisticchildren. Journalof AutismandDevelopmentalDisorders,17 (2),187–200. Lamb,M.E.(1987). Thefather’srole:Cross-culturalperspectives HillSDale,NJ:LawrenceErlbaumAssociates. Lord,C.,Rutter,M.,DiLavore,P.C.,&Risi,S.(2002). Autism diagnosticobservationschedulemanual .LosAngeles:Western PsychologicalServices. Lord,C.,Rutter,M.,&LeCouteur,A.(1994).Autismdiagnostic interview-revised:Arevisedversionofadiagnosticinterviewfor caregiversofindividualswithpossiblepervasivedevelopmental disorders. JournalofAutismandDevelopmentalDisorders, 24(5),659–685.doi: 10.1007/BF02172145 Lovaas,O.(1987).Behavioraltreatmentandnormaleducationalan intellectualfunctioninginyoungautisticchildren. Journalof ConsultingandClinicalPsychology,55 (1),3–9. Marcus,L.,Kunce,I.,&Schopler,E.(1997).Workingwithfamilies. InD.J.Cohen&F.R.Volkmar(Eds.), Handbookofautismand pervasivedevelopmentaldisorders (2nded.,pp.631–649).New York:Wiley. Mudford,O.C.,Martin,N.T.,Eikeseth,S.,&Bibby,P.(2001). Parent-managedbehavioraltreatmentforpreschoolchildrenwith autism:SomecharacteristicsofUKprograms. Researchin DevelopmentalDisabilities,22 (3),173–182. Mundy,P.,Sigman,M.,&Kasari,C.(1990).Alongitudinalstudyof jointattentionandlanguagedevelopmentinautisticchildren. JournalofAutismandDevelopmentalDisorders,20 (1),115– 128.doi: 10.1007/BF02206861 Mundy,P.,Sigman,M.,&Kasari,C.(1994).Jointattention, developmentallevel,andsymptompresentationinyoung childrenwithautism. DevelopmentandPsychopathology,6 389–401.doi: 10.1017/S0954579400006003 Schopler,E.(1996). Parents’survivalmanual:Aguidetocrisis resolutioninautismandrelateddevelopmentaldisorders .New York:Plenum. Schreibman,L.(1997).Theoreticalperspectivesonbehavioral interventionforindividualswithautism.InD.J.Cohen&F. R.Volkmar(Eds.), Handbookofautismandpervasivedevelopmentaldisorders (2nded.,pp.920–933).NewYork:JohnWiley &Sons. Siller,M.,&Sigman,M.(2008).Modelinglongitudinalchangeinthe languageabilitiesofchildrenwithautism:Parentbehaviorsand childcharacteristicsaspredictorsofchange. Developmental Psychology,44 ,1691–1704. Snow,C.E.(1983).Sayingitagain:Theroleofexpandedand deferredimitationsinlanguageacquisition.InK.E.Nelson (Ed.), Children’slanguage (Vol.4,pp.29–58).HillSDale,NJ: LawrenceErlbaumAssociates. Sparrow,S.,Balla,D.,&Cicchetti,D.(1984). Vinelandadaptive behaviorscales .CircleInes,MN:AmericanGuidanceService. Stahmer,A.C.(1995).Teachingsymbolicplaytochildrenwith autismusingpivotalresponsetraining. JournalofAutismand DevelopmentalDisorders,25 ,123–141. Tiedge,L.B.,&Darling-Fisher,C.(1996).Fatherhoodreconsidered: Acriticalreview. ResearchinNursingandHealth,19 (4),471– 484. Volkmar,F.,Klin,A.,&Cohen,D.(1997).Diagnosisandclassicationofautismandrelatedconditions:Consensusandissues.In D.J.Cohen&F.R.Volkmar(Eds.), Handbookofautismand pervasivedevelopmentaldisorders (2nded.,pp.5–40).New York:Wiley. Wetherby,A.M.,&Prizant,B.M.(2000). Autismspectrum disorders:Atransactionaldevelopmentalperspective .Baltimore,MD:Brookes. JChildFamStud123


University of Florida Home Page
© 2004 - 2011 University of Florida George A. Smathers Libraries.
All rights reserved.

Acceptable Use, Copyright, and Disclaimer Statement
Powered by SobekCM