The impact of a parent-implemented naturalistic social communication intervention for pre-schoolers on the autism spectrum : a training plus coaching approach : a thesis presented in fulfilment of the requirements for the degree of Masters of Speech and Language Therapy, Massey University, Albany, New Zealand

Abstract

Family-centred approaches are recommended as best practice in the field of early intervention. Interventions that offer training and coaching to parents of pre-schoolers on the autism spectrum are becoming increasingly common, and a growing body of research is examining their impact on child outcomes and parent behaviour. The present study investigates the effects of a training plus coaching intervention in a small sample population to gain preliminary insight into its efficacy. The research sought to answer the following research questions: (1) What impact does a training plus coaching intervention have on parents’ use of naturalistic interactive strategies, with pre-schoolers on the autism spectrum? (2) What is the effect of parent-implemented naturalistic instruction on the acquisition of early social communication skills in pre-schoolers on the autism spectrum? and (3) What are the parents' experiences and perceptions of the intervention? Three parent-child dyads participated in the study. Child-participants presented with a clinical diagnosis of autism spectrum disorder (ASD) and were waiting for services from an early intervention centre. The training plus coaching intervention consisted of four workshops and eight in-home coaching visits. Workshops included purpose-developed training material; parents were provided with education on interaction promoting strategies and implementing complete learning trials (CLTs) informed by literature on Embedded Instruction and Naturalistic Instruction. In-home coaching visits followed a coaching protocol using video feedback informed by several coaching models in the early intervention literature. Through in-home coaching, the parents gained experience in implementing embedded learning opportunities and CLTs, and using interaction promoting strategies. In-situ supports were given during these visits when requested by the parent (e.g., to model strategies or the implementation of CLT components, or to join in the interaction to support the parent in the implementation of these strategies). A single group pre-test/post-test design was adopted for this study. Data was collected though purpose-developed observational coding systems for both parent and child behaviour, parent-completed rating scales and informal verbal feedback from parents. The findings demonstrated that a brief training plus coaching intervention was effective in increasing parents’ use of naturalistic strategies and interaction promoting strategies. Through explicit training and supportive coaching, parents not only gained skill and experience, but also confidence, capacity and empowerment. Findings from this study also showed that parent-implemented naturalistic instruction has the potential to facilitate social communication development in pre-schoolers on the autism spectrum and promotes sustained parent-child interactions. Parent-completed rating scales and parent narratives provided evidence that the training plus coaching intervention was effective and appropriate in improving parent, child and family outcomes.