The effects of a self-directed telehealth parent training program for children newly diagnosed with autism spectrum disorder in China

Abstract

Parent training (PT) is a prominent approach to supplementing service insufficiency for the population with autism spectrum disorder (ASD), yet barriers such as financial burdens, geographic isolations, and shortage of providers have prevented the dissemination of PT. The use of telehealth in delivering PT has been demonstrated to be a cost-effective means of increasing service reach, which is particularly crucial in low- or middle-income countries (LMICs), such as China. Based on careful adaptations from a preliminary study, the current research is the first randomized controlled trial to evaluate whether a telehealth self-directed PT program would (1) improve parent knowledge, skills, stress and self-efficacy, (2) increase child social communication skills, and (3) be acceptable and feasible to parents in the context of mainland China. A total number of 66 parents of children with newly diagnosed ASD (i.e., confirmed enrollment within three months of formal diagnosis) aged between one and six years were randomly assigned to the intervention group (n = 33) or the waitlist control group (n = 33). An Intention-to-Treat was employed and the small amount of missing data were imputed using multivariate imputation by chained equations (MICE package) in R. Univariate analysis of covariance (ANCOVA) was utilized to examine the efficacy of the program, and estimates of effect sizes were calculated applying formulas of Hedges’ g. Results showed that compared to the waitlist control group, parents in the intervention group reported a significantly higher level of perceived ASD knowledge (F(1, 63) = 70.21, p < .001) and self-efficacy (F(1, 63) = 28.91, p < .001). In addition, parents’ implementation of intervention skills (F(1, 24) = 10.53, p < .01) and children’s social communication behaviors (F(1, 24) = 10.95, p < .01) also significantly increased post-intervention, as compared to the control group. No significant difference in change of parent stress level was found between groups. Estimates of effect size ranged from small to large (i.e., 0.37 to 1.27) for all outcome variables. Parents in the intervention group also reported a high level of usability and acceptability for the clinical content and the technical aspects of the program. Examination of potential moderators showed that site and community services received before intervention were factors that significantly influenced parents’ ASD knowledge, stress, and completion rate. For mediating effects, regression analyses showed that parents’ increased use of prompting and engagement strategies during interaction, and the total fidelity of implementation were significant predictors of improved social-communication behaviors of children in the intervention group. Evaluation of implementation-related factors based on the PRECIS-2 framework resulted in an average score of 3.94 (in a scale of 1–5). The improvements in both parent and child outcomes suggest that this self-directed PT program could be a promising and accessible way to empower families immediately after their child’s diagnosis of ASD within the context of mainland China. The comprehensive and culturally-responsive telehealth training and education framework developed in this study may have the potential for further implementation and dissemination in Chinese societies and other LMICs.