Autism is a neurodevelopmental disorder characterized by deficits in social reciprocity, verbal and nonverbal communication, and behavior. It is among the most prevalent of all developmental disabilities, with an estimated prevalence of 1 in 110. Early detection and intervention has been shown to improve long-term outcomes, including language functioning, cognitive/developmental skills, and social and adaptive behavior, preventing a cascade of effects that result from early deficits impacting later functioning. From a public health perspective, early intervention may also ultimately reduce the considerable lifetime cost and service system demands. Unfortunately, there is a gap between our knowledge of effective intervention strategies and the availability of these resources, due in part to a critical shortage of professionals trained in these interventions. One way to bridge this gap is to teach parents how to utilize these techniques in their daily interactions with their children. Learning effective ways of interacting with a child with autism is critical both for improving long term outcomes for the child in terms of remediation of the core deficits associated with the disorder, as well as reducing the stress on the caregiver. One such program recently developed ("Enhancing Interactions") provides individualized instruction to caregivers with children under 3 years old with autism. The program consists of 12 sessions and has the dual goals of improving interactions and parenting effectiveness while at the same time improving the core deficits and long term outcomes in the child. Based on empirically validated techniques, the sessions are unique in that the clinicians go the child's home to observe problematic behaviors in real time, and model in vivo different teaching strategies with the child and coach the parents as they implement the strategies themselves. While the program has been highly successful, its ability to provide help to those needing it is limited due to the lack of trained clinicians to provide such services. One way to increase the accessibility to this program is through the use of web-based technologies. In phase I we developed a prototype of a web-based interactive tutorial for caregivers of young children with autism designed to a) teach parents how to promote their child's development in the core deficit areas, b) help parents understand and improve challenging behaviors their child may demonstrate, and c) reduce caregiver stress through more effective interactions. It emphasizes everyday situations as opportunities for learning, including common home routines and community activities and contains videotaped illustrations (modeling) of the techniques taught in research-based intervention settings. Both feasibility and user satisfaction was demonstrated with the Phase I prototype. Phase II will develop the complete tutorial and evaluate its efficacy in a diverse sample of 100 parents recruited from early intervention and school based intervention programs, U.S. Military Family Intervention programs, autism clinics, and direct to parent recruitment.
Early intervention in autism improves long-term outcomes, however few clinicians are trained in these interventions. This study will utilize a web-based tutorial to empower parents to administer these interventions directly to their children during their daily interactions. Web access makes this training more widely accessible, and if effective, will improve the long-term outcomes for the child, reduce caregiver stress, and from a public health perspective, may ultimately reduce the considerable lifetime cost and service system demands associated with providing autism care to individuals with autism and their families.