Beyond Intervention: A Scoping Review of Parent Engagement in Parent-Implemented Intervention for Autistic Children

Background

The spectrum nature of autism leads to a highly heterogeneous manifestation, with wide variability in developmental levels. Autistic children often experience difficulties during everyday routines and activities, presenting their parents unique challenges that go beyond the typical parenting experience. The surging prevalence, rising from 1 in 68 in 2010 to 1 in 36 in 2020, indicates the necessity for targeted intervention and service for both children and families. Parent-implemented intervention (PII) has been identified as an evidence-based practice (EBP), with empirical research supporting the effectiveness for autistic children. Additionally, empowering parents with the knowledge and skills to manage autism-related challenges can yield a wide range of benefits to the families. Despite well-researched outcomes, it is not clear what the active ingredients that distinguish successful from unsuccessful parent-implemented intervention. There is also a noticeable gap in literature concerning the process of parent training and implementation in PII. This review aimed to synthesize existing experimental studies of PII for autistic children, exploring parental engagement in PII and its impact on the outcomes measured.

Methods

We conducted a comprehensive search of PubMed and nine other databases on the EBSCO platform. The inclusion criteria for studies were as follows: 1) the study must specifically involve children with an exclusive diagnosis of Autism Spectrum Disorder (ASD) as compared to multiple diagnoses, 2) the study must be empirical with an RCT design; and 3) the study must specify the parent-implemented component in the intervention. Specifically, studies that included only knowledge-based parent training or parent education but without parent delivering the intervention to the child were excluded. Additionally, we limited our review to studies published in English within the United States between 2013 and 2023.

Preliminary Results

Forty-two studies reporting twenty-nine clinical trials met our inclusion criteria. We identified three formats of parent training and implementation across these studies: 1) parent-only training with practice homework between sessions, 2) parent-child dyadic training, and 3) a combination of both formats. Among the identified trails, only twelve specified involving parents in intervention planning, and five involved parents in problem-solving. Additionally, twenty-seven trails assessed clinician implementation fidelity, while only seventeen assessed parent implementation fidelity. Our preliminary results indicate that the format and level of parent engagement vary depending on the primary goal of the intervention (e.g. developmental outcomes or non-developmental outcomes). All included RCTs suggested some level of improvement in parent’s or child’s outcomes. Meanwhile, those outcomes are associated with parent engagement variables. Some studies reported conditional effects, indicating that the intervention may only benefit children with certain characteristics.

Conclusion

Despite variations in the level and approach of parent engagement, empowering parents with intervention skills and integrating individualized strategies into family routines have improved outcomes for both children and parents. Our findings underscore the necessity of investigating the impact mechanisms of parent PII engagement variables on child and parent outcomes. Additionally, future research is needed to identify associated moderators and determine appropriate intervention for autistic children and families with diverse characteristics.