News and Knowledge

In October, OAR’s Board of Directors authorized funding for six new applied autism research studies in 2018. These new grants, totaling $176,090, bring OAR’s total research funding to over $3.6 million since 2002. This is the third of six previews to be featured in The OARacle this year.

Access to specialized services for individuals with autism spectrum disorder (ASD) is limited and unevenly distributed in low- and middle-income countries. Despite global initiatives to promote awareness and early identification of ASD and build capacity for services, significant barriers and disparities in access to care continue to be identified. Using internet/mobile health interventions is one alternative that enables cost-effective service delivery to areas that may not otherwise have access.

Study Goal and Researchers

“Parent-Mediated Mobile Health Intervention for Children with Autism Spectrum Disorder in Peru” is an OAR-funded study that aims to validate the use of technology to improve the health and well-being of children with ASD. Three researchers will lead the study:

• Robert Gilman, professor, Bloomberg School of Public Health, Johns Hopkins University
• Mirko Mimic, professor, Cayetano Heredia Medical School, University of Peru
• Michael Powers, director, Center for Children Special Needs, and assistant clinical professor of Psychology, Yale Child Study Center and the Yale School of Medicine

Study Format

The researchers plan to implement a low-cost internet/mobile health technology in Peru to train local trainers who will in turn train parents and family members of children with ASD on therapy based on applied behavior analysis (ABA). They hypothesize that the intervention will improve functional and behavioral outcomes in affected children.

Parents and children will be recruited through existing centers and specialized schools that provide services to individuals with ASD. At least 60 parents of children with ASD will be recruited for a control group and a group that will receive the intervention.

A U.S.-based clinical training team with expertise in applied behavior analysis will provide training for the community trainers in broad-based ABA teaching principles via the internet. They will emphasize three pivotal skills: evoking requests, promoting appropriate social engagement, and initiating positive child-parent interaction. All modules will be delivered over approximately three months with ongoing technical support from the clinical training team and an additional month allotted for booster sessions to ensure content mastery. The modules will cover:

1. ASD and its impact on learning
2. Introduction to applied behavior analysis
3. Building positive interactions
   1. Behavior-specific praise
   2. Reducing negative commentary
   3. Building neutrality
4. Promoting engagement
   1. Initiating interactions
   2. Maintaining interactions
   3. Following other-led activities
5. Evoking requests
   1. Finding learning opportunities
   2. Common areas of request: requests for attention from people, activities, items; requests to terminate attention from people, activities, items; requests for help
   3. Modeling and prompting requests
6. Monitoring progress

Trainer mastery of content pre- and post-training will be evaluated through quizzes given at the end of each module. Mastery will be defined as achieving a score of 90 percent or better on quizzes at the end of training modules. Following the delivery of the teaching modules, the trainers will then participate in a final evaluation, which will include observation of each trainer as they demonstrate target skills while working with their fellow trainers.

The trainers will then work directly with parents in community settings to develop the targeted pivotal skills for use with their children. Data on the three pivotal skills will be collected with video recordings of three 5-minute long parent-child play sessions, carried out at one of the clinics collaborating with the study. Data will also be collected via video four and eight weeks after the intervention to assess for skill maintenance. Impact of parent training on the family system will be measured by pre- and post-assessments. A post-implementation evaluation at the end of the project will assess parent satisfaction.

Outcomes

While the main purpose of this study is to investigate the efficacy of building capacity among national trainers to deliver intervention content to parents of children with ASD, the research team will also monitor changes in child-specific engagement and functional communicative requests.

The outcomes from this project will inform a larger proposed project. If the study outcomes are positive, then the training can potentially be used in other countries and places where access to services is limited.

Increasing access to services via internet/mobile health technology would open the door for even more people with ASD and their families to receive evidence-based treatment and facilitate engagement and communication with children with ASD.