JMIR Publications

ABSTRACT

Background:

Pivotal Response Treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in individuals with autism spectrum disorder (ASD).

Objective:

To assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their children with ASD.

Methods:

Male and female children, ages 2-7 years old with single-word to phrase-level speech, were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Expectancies Questionnaire (CCQ) at Week 2 and endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at endpoint to assess parental expectancies and treatment acceptability and effectiveness.

Results:

9 of 14 subjects completed the study curriculum in the online parent training condition, and 6 of 12 subjects completed the control condition. A total of 58% subjects completed study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ Total Scores from 25.38 ± 3.25 at baseline to 27.5 ± 3.74 at endpoint (P = .04), mean CCQ Confidence Scores from 6.0 ± 1.07 at baseline to 6.75 ± 0.89 at endpoint (P = .02), and mean CCQ Other Improvement Scores 5.25 ± 0.89 at baseline to 6.25 ± 1.28 at endpoint (P = .009). Within the control condition, a modest increase in CCQ scores existed (Confidence △M = +.25; Recommend △M = +.25; Total Score △M = +.50), but no significant results were found (Confidence P = .38; Recommend P = .36; Total Score P = .43). Out of the eleven parents that completed the BIRS at endpoint, 83% parents endorsed they slightly agree or agree with over 93% of the Acceptability factor items on the BIRS.

Conclusions:

The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores as well as strong ratings on the BIRS. This study’s small sample size limits the conclusions that can be drawn, however, the PRT MindNest Health platform holds promise to support parents of children with ASD who are unable to access traditional, in-person parent-mediated intervention for their child.