Telehealth Intervention Coaching for Fathers | Organization for Autism Research

Research Review

In November, OAR’s Board of Directors authorized funding for six new applied autism research studies in 2021. These new grants, totaling $240,000, bring OAR’s total research funding to more than $4.4 million since 2002. This study is supported by funds from OAR’s Changing Lives Fund. This is the third of six previews to be featured in The OARacle this year.

There is strong evidence that early, high-quality language input from parents contributes to strong communication outcomes among autistic children, yet few parent-coaching interventions have involved fathers. Given that fathers are increasingly involved in child rearing and that high-quality father engagement is related to improved child development outcomes, effectively involving fathers in interventions could expand service offerings and improve social communication outcomes for autistic children.

Fathers play an important role in early language input and are often primary play partners for their children. Aligning intervention strategies with father–child interaction styles may improve parent fidelity and treatment efficacy. Considerable evidence indicates coaching parents to increase responsiveness, which refers to use of affectively positive and contingent reactions to children’s communication and acts of play, can result in improved language skills for autistic children.

In this OAR-funded two-year study, Michelle Flippin, Ph.D., CCC-SLP, an assistant professor in communicative disorders at the University of Rhode Island, will pilot a telehealth coaching program for fathers designed to improve social communication skills for autistic children. The study’s goals are to:

  • Determine the positive outcomes of a responsive parent coaching intervention designed for fathers to improve child social communication skills.
  • Identify the parent and child characteristics associated with the father’s use of the targeted strategies and the child’s gains in joint engagement and communication skills.
  • Understand how fathers’ perceived implementation successes and challenges impact the use of strategies and intervention outcomes.
Methodology

Dr. Flippin will recruit 12 autistic children between the ages of 3 and 5 and their fathers. Prior to participating, the research team will administer assessments of the children to capture their baseline language skills, adaptive skills, and sensory profile. Fathers will complete a demographic survey, parental stress measure, and the Broad Autism Phenotype Questionnaire. Fathers must have resided with the child since the child’s birth to participate.

Dr. Flippin, a licensed speech-language pathologist with 18 years of experience working with autistic children and their families, developed an online coaching model for the study. She will coach participating fathers to use two verbal strategies (follow-in comments, follow-in directives) and two play strategies (physical play, object play). For each targeted strategy, the coaching and feedback loop will include seven steps:

  1. Clinician creates ‘‘buy in’’ with the father.
  2. Clinician describes targeted strategy and rationale for using the strategy.
  3. Clinician provides a model of the strategy.
  4. Father completes implementation plan.
  5. Father implements strategy during father-child session.
  6. Father completes reflection log.
  7. Clinician and father review performance data and problem solve, with booster lessons as needed.

Instructional sessions for the first target strategy will continue until the participating father achieves three consecutive sessions above baseline. Instruction will then begin on the next strategy and continue across the four targeted strategies.

Evaluation

The research team will examine group data for all 12 father-child participants to evaluate overall performance and to identify associations between pre-intervention parent and child characteristics and father uptake and use of the four targeted strategies.

Parent characteristics include:

  • Socioeconomic status
  • Parental stress
  • Broad autism phenotype

Child characteristics include:

  • Autism severity
  • Adaptive skills
  • Language skills
  • Sensory profile

In addition, Dr. Flippin will collect data so that she can examine pre- and post-changes in adult word count, child vocalizations, and father-child conversational turns.

The research team will interview fathers at the completion of the intervention to assess their belief systems, expectations, achieved goals and outcomes, and problem-solving strategies. Soliciting fathers’ input on which strategies are most feasible for them and effective for their child may increase parent adherence to using such techniques, which would improve child social communication outcomes.

Outcomes

By providing a better understanding of how to overcome the barriers to effectively involving fathers in intervention, this study has the potential to expand service offerings for autistic children. Furthermore, the study data on the pre-intervention characteristics associated with more frequent strategy use by fathers and improved child social communication outcomes will identify factors that lead to stronger parent uptake and increased child joint engagement and communication skills so that interventions can be tailored to parents’ and children’s specific needs. Using a telehealth model enables more parents to participate in the coaching program, allowing for the capability to deliver parent interventions that can be used by both parents.

The results of the proposed study will bridge significant gaps in research and clinical practice in communication intervention for autistic children by providing treatment evidence from an intervention optimized for fathers. As a result, effective father communication coaching may one day be widely available for clinicians to offer as a stand-alone treatment or supplemental support for in-home, clinic, or school-based speech-language services for autistic children.


Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.


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