School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project

EVIDENCE TABLE
Name: Natasha Arastehmanesh & Evelyn Babaroudi

Date: 9/10/2015
Focus Question: Does parent education improve compliance in children and adolescents with autism spectrum disorder?

Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:
Inclusion criteria include
- children and adolescents (0-19 years-old) with autism spectrum disorder
-intervention or treatment program implemented by an occupational therapist, or any professional qualified such as psychologist or trained therapist
-child may present with similar features to autism but may not have diagnoses (social interaction, verbal communication, restrictive repetitive
behavior)
-has comorbid disabilities
Exclusion criteria:
-studies not available in English
-articles published before the year 2005
-adults with autism or any population other than children and adolescents

-studies not available in full text

Author/
Year
Bearss, K.,
Johnson,
C., Handen,
B., Smith,
T., &
Scahill, L.
(2013).

Study Objectives

Level/Design/ Subjects

Objective of this
study was to
describe the
feasibility and
efficacy of a
modified downward
extension of the
RUPP Autism
Network parent
training manual as a
stand-alone
treatment for
younger children
with ASD
accompanied by
disruptive and
noncompliant
behavior.

Level 4/ Single case

study/ 3-6 year old
ASD

Intervention and
Outcome Measures
Masters or doctorate
level clinicians delivered
the intervention. (24
week PT program) Two
therapists with
independent treatment
fidelity evaluation and
independent rating of
overall treatment impact.
11 core sessions, 2 home
visits, and 3 booster
sessions. Each face to
face sessions was 1-1.5
hrs in duration and
employed direct
instruction, practice
activities, behavioral
rehearsal with feedback
and role playing to
accomplish skill
acquisition. Finally two
telephone and one face to
face booster sessions
then occurred at weeks
18, 20, and 22, focusing
on generalization and
maintenance of skills.
Outcome measures
utilized was the Aberrant

Results

Study Limitations

Implications for OT

Results from this

pilot trial support
feasibility and
efficacy of this 24week PT program
for children with
ASD and disruptive
behaviors. Parents
found intervention
acceptable, and
were able to attain a
lot of information
pertaining to each
sessions objective.

Lack of control
group making it
difficult to separate
the effects of
treatment from the
effect of time or
attention on
disruptive behavior
or noncompliance.
Reliance on
unblinded parent
and clinician ratings
to measure change
in child behavior.

As proven again
implementing parent
training program can
reduce disruptive
behaviors and increase
compliance in children
with ASD. Occupational
therapists can play an
integral role in
implementing these classes
and also have the expertise
and skills to individualize
these training sessions or
to conduct them on a
larger basis.
The clinical and
community-based practice
of OT: RUPP is a parent
training program that can
be a viable community
based treatment option.
Program development:
This program should be
implemented as a core
treatment option.
Societal Needs: Parent
training specifically RUPP

Behavior Checklist,
Home Situations
Questionnaire, Clinical
Global Impression:
Improvement Scale,
Parent Target Problems,
Vineland Adaptive
Behavior Scales:
Interview Format, Parent
Satisfaction
Questionnaire, and the
Treatment Fidelity
Checklist.

could be implemented in
community based settings
to populations of parents
who are often underserved.
Healthcare delivery and
policy: The results of this
study need to be conducted
with a control group to see
true effects of this
intervention. Nonetheless,
this study does support the
notion of parent training as
an effective intervention to
increase compliance in
children with ASD.
Education and training of
OT students: How to lead
a parent training course or
at least observation of one
should be implemented in
the curriculum.
Refinement, revision, and
advancement of factual
knowledge or theory:
Future studies should
compare this intervention
to a control group. Future
studies should also include
children with ASD that are
lower functioning.

Tellegen,

The case report

Level 5/ Case Report/

Primary care stepping

Significant

Limitations include

The clinical and

C., &
Sanders,
M., R.
(2012).

describes a 4session parenting

intervention
(primary care
stepping stones
triple p) targeting
compliance and
cooperative play in
a 8-year-old girl
with Aspergers
disorder and ADHD
combined type.

subject: 8 year old girl.

stones triple p aims to

prevent and treat
childhood behavioral and
emotional issues through
improving parent skills,
confidence, and
knowledge. The
intervention consists of 4
brief sessions spanning a
7 week period focusing
on one or two specific
child problems. In Zoe
case the two problems
focused on were
noncompliance and
cooperative play skills.
Outcome measures
utilized the Eyberg Child
Behavior Inventory,
Parenting Scale,
Parenting tasks checklist,
parental stress scale,
Depression and anxiety
stress scales, relationship
quality inventory, goal
achievement scales.

reductions in child
behavior problems,
improvements in
parenting
confidence, and
decreases in the use
of dysfunctional
parenting styles.

small simple size.

community-based practice
of OT: Since this
intervention is brief and
cost-effective
implementing it in
community based settings
is practical and
Program development:
This intervention could
serve as a core parent
training program for
children with ASD.
Societal Needs: This
would a brief costeffective program that
produces results. On a
societal level it fits the
needs and demands of our
busy lifestyle and still
brings results.
Healthcare delivery and
policy: Educating
pediatricians about this
intervention is key because
they play a big role in
promoting child health by
identifying families in
need of assistance and by
helping them to access
effective parenting
services.

Education and training of

OT students: Students
would benefit on how to
structure and lead a parent
training program.
Refinement, revision, and
advancement of factual
knowledge or theory:
evaluation of maintenance
effects need to be
implemented (12 m vs 6
m) and in controlled
studies with a broad range
of families.
Farmer et
al. (2012)

This study aimed to

determine if any
baseline
characteristics
predicted or
moderated the effect
of combined
treatment (medicine
and parent training)
versus antipsychotic
medicine alone on
noncompliance and
symptoms of
hyperactivity as
reported by parents.

Level 1/Randomized
control trial/2 groups

Each session had

between four and seven
session-specific goals for
the parent. These goals
addressed parent
understanding of
concepts and other
factors such as
completion of homework
and parents participation
in the development of
intervention.
Ratings were made by
the therapist on a 3 point
scale.
0-parent did not
demonstrate skill or
understanding
1-parent understood or

Children with more

severe
noncompliance
stand to benefit
from treatment than
less impaired
children. The results
suggest that
combined treatment
is superior to
medication alone
but there is no
apparent subgroup
that is more or less
likely to respond to
be combines
treatment.

Not possible to rule

out Type II error.
Trial was not
designed to
determine the effect
of moderators
and/or predictors of
outcome.

Occupational therapists
can play a key role in
implementing parent
training. Setting
topics/goals for each
session and training
parents on signs and
triggers of inappropriate
behaviors and how to
properly address these
behaviors.
The clinical and
community-based practice
of OT: implementing PT in
clinical and community
based practice by OTs can
Program development:
professionals such as

responded correctly to
nearly all queries
2-parent understood and
responded correctly to all
queries Measures used
were the Home situations
questionnaire (HSQ) and
the
hyperactivity/noncomplia
nce subscale of the
Aberrant behavioral
checklist.

psychiatrists who prescribe

Risperdal should
recommend parents to PT
to maximize compliance
and reduce negative
behaviors.
Societal Needs: More
advocacy needs to be
implemented by teachers
and medical professions on
usefulness of this
treatment approach.
Healthcare delivery and
policy: When children are
diagnosed with ASD
policy should aim towards
encouraging parents to join
parent training program to
increase their participation
in childs life and to reduce
negative behaviors.
Education and training of
OT students: understand
effects of PT on children
with ASD.
Refinement, revision, and
advancement of factual
knowledge or theory: more
research on PT with other
populations to advance this
knowledge of theory.

Singh et al.
(2010).

Study objective was

to explore the
effects of
mindfulness training
on two mothers and
afterwards their
children on child
compliance.

Level 4/Single case

design/2 mothers and
their children

The mindfulness training

program for the parent
included topics about the
basics of mindfulness,
mindfulness in everyday
life, basic meditation
exercise, mediation
exercises, on being
mindful, and putting it all
together. The child
mindfulness training was
interactive with the
trainer presenting the
principles the children
asking questions and then
the trainer customizing
the actual meditation
practices for each child.
The practices were based
on the trainers own
experience as well as
from childrens books.
Two single item rating
scales, once at the end of
each experimental phase:
satisfaction with self in
interactions with my
child (SSIMC) and
subjective units of
happiness with my child
(SUHMC). The SSMIC
was rated on a 0-5 scale (
0=totally unsatisfied,
5=totally satisfied) and

For both children,

the mean numbers
of compliant
responses changed
across the different
phases although
somewhat
differently for the
two children. No;
the study was not
big enough to show
an important
difference if it
should occur
because they only
had a total of 4
participants.
Mothers
satisfaction with
their interactions
and their subjective
units of happiness
with their child both
increased across
successive
experimental
phases. On each
measure, there was
an increase with the
mothers
mindfulness
training, but the
increase following
mindfulness training

Experimental
control (to
demonstrate effects
of training need 3
baseline but this
study only had 2)

Occupational therapists
can become certified in
mindfulness training and
implement it in practice to
increase compliance in
children. Although this
study focused on children
with ADHD, this is often
comorbid with ASD and
therefore can be
implemented to increase
compliance. Typically
these two diagnoses
present with similar
features such as
impulsivity, compulsivity,
language barriers, and
inattentiveness.
The clinical and
community-based practice
of OT: mindfulness should
be implemented in clinical
and community based
practice of OT. The effects
are positively correlated
with an increase in
compliance.
Program development:
Mindfulness programs can
be utilized across the board
to address compliance
across different diagnoses.

the SUHMC was rated on

a 0-100 scale (0=totally
unsatisfied, 100= totally
satisfied)

of their child was

much more marked.

Societal Needs:
Mindfulness training
should be easily accessible
to parents with children
with special needs.
Healthcare delivery and
policy: healthcare
professionals who notice
behaviors that are
associated with ASD can
recommend mindfulness
training to parents and
children.
Education and training of
OT students: Students
should have a good
understanding of
mindfulness and its effects.
Refinement, revision, and
advancement of factual
knowledge or theory:
More research should be
conducted to advance
knowledge of this theory
with other diagnoses
specifically ASD.

Oosterling
et al.
(2010)

The purpose of the

study was to
determine the
effectiveness of a
home-based parent-

Level/Design: Level I;
Randomized-controlled
trial
Subjects: Seventy-five

Intervention: Parents
were encouraged to
keep child engaged
in
mutual activities,

No significant
intervention
effects were
found for any of
the primary

Although the
sample size of
the current
study was larger
than that

The clinical and

community-based practice
of OT:
Focus parent training in
the context of Dutch

training program,
Focus parent
training, on
compliance, mutual
enjoyment, joint
attention, and
language
development.
The current
study sought to
replicate a
previous pilot
randomized
controlled trial
of a parenttraining
program for
preschool
children with
autism
spectrum
disorders that
showed
promising
results.

toddlers with autism

spectrum disorder (65
autism, 10 PDD-NOS,
mean age = 34.4
months, SD = 6.2) were
enrolled.
Analysis conducted on
a final sample of 67
children (lost to followup = 8).

either during free

play (child led),
specific game play
(parent led), or in
everyday joint
action
routines. All games
designed in such a
way that they could
be used for different
developmental
levels.
Initially, 2-3 mn
recommended for
each activity,
gradually increasing
to about 5 mn per
activity. Parents
advised to take 30
and 60 min setaside time per day.
Parents of
intervention group
taught several
techniques to
maximize effect of
intervention:
1) Behavior
management
techniques
2) Techniques to
stimulate mutual
enjoyment and

(language),
secondary
(global clinical
improvement),
or mediating
(child
engagement,
early precursors
of social
communication,
or parental
skills) outcome
variables,
suggesting that
the Focus
parent training
was not of
additional value
to the more
general care-asusual.

reported in
previous parenttraining studies,
an even larger
sample would
have improved
the
power of the
analyses.
Study did not
meet all criteria
for a perfectly
designed
randomized
controlled trial.
Authors did not
formally check
on treatment
integrity to
verify if
treatment was
conducted in
the manner that
was intended

community care did not

demonstrate added value
over broadly focused careas-usual alone.
Considering the results of
the study, this intervention
should not yet be applied
to OT practice.
Program Development:
Focus parent training
should not be applied as a
core service.
Societal Needs: Further
randomized-controlled
trials required to determine
the effect of parenttraining in early
intervention programs.
Perhaps further research
can include a larger sample
size.
Health care delivery
health policy: Results from
the study indicate that no
significant intervention
effects were found on
outcome variables,
suggesting that focus
parent training was not of
additional value to the
more general care-asusual.

eye contact
3) Holistic learning
of language
4) Use of visual
support for
spoken language
and use of
simple gestures
Consequent attention to
adequate pace, timing,
and adjustment to childs
developmental level and
interests

Anan et al.
(2008)

Early, intensive behavioral intervention is effective in treating children with autism spectrum disorders Early, inten sive behavioral intervention is effective in treating children with autism
spectrum disorders

The aim of the study

was to examine the
efficacy of the
Group Intensive
Family Training
(GIFT) program, a
12-week (180 h,
delivered 3 h each
weekday) parenttraining for
preschoolers with
ASDs.

Level/Design: Level
IV, Single-case design
Subjects: 72 parent
child dyads served as
participants in this
study.
All children diagnosed
with ASD using DSMIV criteria
Childrens ages ranged
from 25 to 68 months,
with a mean age of 44
months

Intervention:
Treatment occurred in the
HOPE Center, part of an
outpatient developmental
behavioral pediatric
setting in a suburban
hospital. A Board
Certified Behavior
Analyst designed each
childs individualized
behavioral intervention
and supervised the
treatment program. Four
staff members with
experience implementing
behavior analytics

Education and training of

OT students: Since no
significant effects were
observed, focus parent
training should not be
implemented in education
and training until further
research indicates
otherwise.
Refinement, revision, and
advancement of factual
knowledge or theory:
Samples with more
participants would
allow for additional
subgroup analyses.
Analyses revealed
average gains of
eight standard score
points on the Mullen
Early Learning
Composite and five
standard score
points on the
Vineland Adaptive
Behavior Composite
after 12 weeks of
treatment.
14% and 11% of the
children moved
from the impaired

Authors did not

examine dependent
variables
Study groups were
not randomized
Authors were not
blind to childrens
pre- or postintervention status
Authors did not
provide a long-term
follow-up

The clinical and

community-based practice
of OT:
Occupational therapy plays
a pivotal role in the care of
children with
developmental disabilities.
Healthcare professionals,
including OTs, should be
educated and encouraged
to provide parent-training
so that children can obtain
early affordable behavioral
intervention. This can help
build self-efficacy in
parents while aiming to

Majority of children
were male (84.7%)
Children had significant
impairments relative to
their chronological age
and many exhibited comorbid behavior
problems
Most caregivers were
mothers (96%), parents
ages ranged from 21 to
46 with an average age
of 35, and parents had
completed an average
of 3 years of post-high
school education, and
most were married
(96%).

treatment provided
hands-on training to each
cohort of six families.
Each parent-child dyad
worked individually with
staff members (1:1 ratio)
for the first month of
treatment; the ratio
changed to one staff
member for two parentchild dyads (1:2 ratio)
thereafter.
Outcome Measures:
Cognitive and adaptive
functioning using the
Mullen Scales of Early
Learning and the
Vineland Adaptive
Behavior Scales
Global cognitive
functioning: visual
reception, fine motor
skills, receptive
language, and expressive
language
Adaptive functioning:
communication,
socialization, daily living
(includes self-help
ability), and motor skills

to non-impaired
range on
Mullen and
Vineland composite
scores, respectively.

increase the childs

cognitive and adaptive
functioning.
Program development:
OTs could serve as
educators and/or program
directors for the GIFT
training program.
Societal needs: Early,
intensive behavioral
intervention is effective
in treating children with
autism spectrum
disorders
(ASDs), but can be cost
prohibitive. Expenses
may be defrayed if
children can benefit
from parents
acting as therapists.
Programs such as GIFT
demonstrate a costand time-effective
behavioral parenttraining model in which
children can make
significant short-term
gains.

Health care delivery

health policy: Despite
significant effects of the 3month GIFT program,
assessment of participants
long-term progress is

needed. Further, the

program merits more
rigorous evaluation in
controlled studies. Followup research should
randomly assign
participants to wait-list or
control groups, use
evaluators blind to
intervention status, assess
other factors potentially
linked to treatment
purpose, and include longterm outcome measures.
More rigorous study
designs can perhaps be
used to inform policy
makers to advocate for
funding for family training
programs for parents of
adolescents with ASD.
Education and training of
OT students: Entry-level
OT students should have
knowledge in the hands-on
application of behavior
analytic techniques.
Refinement, revision, and
advancement of factual
knowledge or theory:
Future studies should be
randomized and should
examine dependent

Singh et al.
(2006)

The aim of the

study was to
assess the
effects of
providing
mindfulnessbased positive
behavior
support
(MBPBS)
training to three
mothers on the
challenging and
compliance
behaviors of
their
adolescents
with ASD.

Level/Design: Level
IV, Single-case design
Subjects: Three
mother-adolescent
dyads participated
in this study.
Mothers referred
by childs support
coordinators for
mindfulness
training due to the
increasing stress
experienced
by mothers.
Fathers were
trained as
secondary data
collectors for interrater agreements.
Each mother.
Mother 1: 28 y/o,
completion of college
education, 3 children
(3rd child participant).
Child: 4 years 5 months
old functioning at 10 to
18 months on the
Vineland
Mother 2: 24 y/o, 2
years of college

Intervention:
Three mother-adolescent
dyads with a multiple
baseline design across
participants with three
phases as follows:
baseline, mindfulness
training, and mindfulness
practice.
Baseline: Absence of
intervention. Mothers
requested to continue
with personal
management techniques.
Mindfulness Training
Phase: Immediately
following baseline. Initial
session was given at the
start of this phase,
followed by 3 further
training sessions in
weeks 3, 6, 9, and 12.
Formal training ended
after 12th week. As soon
as they were taught an
exercise, the mothers
were requested to apply it
and to implement
mindfulness skills they
had been taught in
interactions with
children. Not requested

First parent-child
dyad:
Aggressive
Behaviors decreased
by 16% from
baseline to training;
88% decrease from
training to practice.
Noncompliance
behaviors per week
decreased by 33%
from baseline to
training. 68%
decrease from
training to practice.
Second parent-child
dyad:
Aggressive
behaviors per week
decreased by 6%
from baseline to
training; 70% from
training to practice.
Noncompliance
behaviors per week
decreased 11% from
baseline to training;
64% decrease from
training to practice.
Third parent-child
dyad:
Aggressive
behaviors per week

Small sample size

Authors did not
provide follow-up
data
Use of a
convenience sample
of parents and
adolescents with
ASD

variables.
The clinical and
community-based practice
of OT: CAM, including
mindfulness medication,
may be implemented by
OTs and OTAs as a
comprehensive approach
to increasing occupational
engagement, and
promoting health and
participation in life.
Further, OTs may use
CAM in delivery of OT
services when used as
preparatory or purposeful
activity to help clients
engage in occupations.
Program Development:
Mindfulness meditation is
an effective intervention to
use in OT to increase
participation in
occupation. OTs providing
mindfulness meditation
would require training and
would need to maintain a
meditation practice
themselves.
Societal Needs: MBPBS
can assist parents to
effectively manage the
challenging behaviors of

education, 1 child
Child: 5 years 2 months
functioning overall
between 13 to 20
months on the Vineland
Mother 3: 33 y/o,
former schoolteacher
following completion
of a college education,
1 child
Child: 6 years 1 month,
adopted from birth,
overall functioning
ability of 15 to 25
months on Vineland

to stop using other child

management techniques
they wanted to use.
Mindfulness Practice
Phase: Immediately
following training.
Lasted 52 weeks.
Mothers requested to
continue with all
mindfulness exercise and
to use all mindfulness
skills in interactions but
were given no further
instructions. Again, not
requested to stop using
other management
procedures when
interacting with child.
Content of Training:
Senior investigator
explained details of
training and philosophy
of mindfulness. Also,
provided with a copy of a
The Inner Work of
Mindful parenting by
Myla Kabat-Zinn and Jon
Kabat-Zinn (1997) to be
read as preparation for
the program. Each of the
late training sessions
schedule for a 2 hour
period and involved one-

decreased 10% from

baseline to training;
85% from training
to practice.
Self-injurious
behaviors per week
decreased 17% from
baseline to training;
51% from training
to practice.

children with ASD and in

increasing their positive
social interactions with
them, but without
increasing their stress
levels.
Health care delivery
health policy: Data is
highly suggestive of the
effectiveness of MBPBS in
reducing parental stress
while managing
challenging behaviors,
more rigorous study
designed are needed to
inform policy makers to
advocate for funding as
insurance companies are
increasingly paying for
CAM treatments.
Education and training of
OT students: OTs will
require training and
certification in
mindfulness meditation to
implement this approach
as the core of intervention.
Refinement, revision, and
advancement of factual
knowledge or theory:
Further studies should
include more rigorous
study designs, such as

on-one training by the

senior investigator.
Mothers taught
meditation methods to
increase their
mindfulness and exercise
to help them practice
mindfulness during
interaction with children.

increased sample size and

follow-up data.

Outcome Measures:
Event recording
procedure using palm
personal digital assistant
(PDA) utilized to target
the following behaviors:
Aggression hitting,
biting, kicking, slapping,
pushing, and shoving.
Noncompliance- refusing
to carry out instructions
or requests made by the
mother

McConachi
e et al.
(2006)

To evaluate a
training course for
parents, designed to
help them

Level/Design: Level 2,
Controlled Trial
Subjects: 51 children

Self-injury- biting
himself on the arm,
banging his head against
hard surfaces, or slapping
his own face.
Intervention:
Controlled trial for 51
children aged 24 to 48
months, whose parents

Taking into account

scores at
recruitment, child's
level of ability,

Small sample size

Study group was
slightly more

The clinical and

community-based practice
of OT:
The training course is well

understand autism
spectrum disorder
and to facilitate
social
communication with
their young child.

aged 24 to 48 months,
whose parents received
either immediate
intervention or delayed
access to the course.
Outcome was measured
7 months after
recruitment in parents
use of facilitative
strategies, stress,
adaptation to the child;
and in childrens
vocabulary size,
behavior problems, and
social communication
skills.

received either
immediate intervention
or delayed access to the
course. Outcome was
measured 7 months after
recruitment in parents'
use of facilitative
strategies, stress,
adaptation to the child;
and in children's
vocabulary size, behavior
problems, and social
communication skills.
Outcome Measures:
Outcome was measured 7
months after recruitment
in parents use of
facilitative strategies,
stress, adaptation to the
child; and in childrens
vocabulary size, behavior
problems, and social
communication skills.

diagnostic grouping,
and the interval
between
assessments, a
significant
advantage was
found for the
intervention group
in parents' observed
use of facilitative
strategies and in
children's
vocabulary size.

economically
advantaged than the
refusers.
Group allocation
was not randomized.

received by parents and

has a measurable effect on
both parents' and children's
communication skills. OTs
can implement this tool in
practice. OTs can help
educate and train parents
on facilitative strategies to
increasing social
communication in children
with ASD.
Program development:
Due to the significant
advantage found for the
intervention group, this
parent-education program
should be implemented in
OT practice.
Societal needs:
Given the rise of ASD,
parents can benefit from a
training course that helps
them understand their
childs diagnosis and
effective ways in which
they may interact with
their young child to
facilitate social
communication.
Health care delivery
health policy: Results of
this study can be used to

further support the

expansion of parent
training programs for
parents of children with
ASD.
Education and training of
OT students:
Since this training program
is well receieved by
parents and has
measurable effects on both
parents and childrens
communication skills, OTs
should implement it in
practice as an approach
toward education and
training their clients and
caregivers.

Symon, J.
(2005)

Single-case research
methods were used
to assess the spread
of effect of a parent
education program
from parents to
other care providers.

Level/Design: Level
IV, Single-case design
Subjects: Three
families, each
consisting of a
primary caregiver
and child diagnosed

Intervention:
Families participated in
parent education
program. Primary
caregiver, child with
autism, and parent
educator were present
during all sessions.

Results indicate
that parents
successfully
learned the PRT
techniques and
trained others
to implement
the techniques

Study did not

include families
from diverse
backgrounds.
Primary caregivers
were self-selected,
well educated, and
married.

Refinement, revision, and

advancement of factual
knowledge or theory:
Further research should
include study groups with
different socioeconomic
status and backgrounds.
The clinical and
community-based practice
of OT:
OTs can expand the quality
and availability of services
for children with ASD
through parent education
programs. OTs can include

with autism participated

in a week-long
individualized parent
education program.
The children each
received an
independent diagnosis
of autism based on
DSM-IV. Each child
displayed global
impairments in social
skills and
communication skills,
and exhibited
engagement in
repetitive or stereotypic
behaviors.
Childrens parents each
expressed as their
primary concern the
delays in their childs
social communication
skills.
Two of the children
were European
American and one was
Asian American. All
families were headed
by two parents and
spoke English as their
primary language.

Intervention sessions
took place for 5 hr per
day over 5 consecutive
days, for a total of 25 hr.
Parents were taught
specific techniques of
Pivotal Response
Training (PRT). Parent
educator modeled use of
PRT techniques during
interactions with child
for 1 to 2 hr on first day
of program then
gradually included
primary caregiver as
therapist in intervention.
Following 4 days of
program, clinician
modeled use of
techniques for
approximately hr each
day and provided
feedback for remainder
of each 5-hr session. PRT
techniques were
implemented in the
context of everyday
activities.
Approximately 80% of
program was direct
parent education;

presented
during the
program to
significant
caregivers.
Additionally, the
childrens social
communication
and behaviors
improved during
interactions
with both
parents and the
significant
caregivers.

Length of
intervention was
short
Small sample size

parents in intervention
programs not only as
learners but also as experts
or trainers to train others
who work with their
children.
Program development: A
next step in this
programmatic line of
research would be to
include additional
family or team members
aside from the primary
caregiver (e.g., siblings,
extended family members,
specialists). Additionally,
PRT should only be
considered a component of
intervention.
Societal needs: This study
follows a programmatic
line of research illustrating
the positive outcome of
participation in a parent
education program
for families living
geographically distant
from the specialized
autism center.
Health care delivery
health policy: The number
of individuals diagnosed

Families became aware

of the intervention
program when they
contacted the center to
inquire about services
for their child. The first
three families to give
consent to participate in
this project were
included regardless of
certain child or family
characteristics such as
childs gender, age, or
functioning level and
family location,
ethnicity,
socioeconomic status,
or structure. All three
families lived
geographically distant
from the center and
had to travel to the
center to participate in
the program

remaining portion was

troubleshooting,
answering questions, and
building a relationship
between the clinician and
families. On average, a
weekly total of 30 min to
1 hr was spent with each
family discussing how
the primary caregivers
could train other
caregivers who
work with the child.
Outcome Measures:
Fidelity of
implementation for
primary caregivers and
significant caregivers
videotaped probes of
parent-child interactions
Childrens Functional
Verbal Utterances and
Appropriate Behaviorsvideotaped probes of
childs social
communication skills and
behaviors

with autism has risen at a

significant rate. Existing
services are generally
insufficient to cope with
this increase in cases of
autism in conjuction with
the intense and ongoing
support needs of children
and families. Results from
this study can be used to
inform policy makers on
the need for expanding
interventions for children
with ASD.d
Education and training of
OT students: OTs will
require additional training
in PRT.
Refinement, revision, and
advancement of factual
knowledge or theory:
Further research should
focus on limitations of
study, such as including
participant families who
represent a variety of
ethnic backgrounds and
family structures.
Consistent with the
ecocultural theory of
viewing the child as a
member of a larger system
(e.g., Brofenbrenner,

1986), future researchers

may include others such
as siblings, extended
family members,
specialists, and school
personnel.
Soffronoff,
K., Leslie,
A., &
Brown, W.
(2004).

Aim of study was to

evaluate specific
techniques and
strategies such as
comic strip
conservations and
social stories in a
brief intervention
and to evaluate
different methods of
delivery of the
training modules to
parents to families
with a child with
Aspergers
syndrome.

Level 1/randomized/
3x3 design. 3 groups
are workshop,
individual and waiting
list control and 3 times
measurements are pretreatment, 1 month post
treatment and 3 month
follow up.
Subjects: 51 parents
with child between age
6-12 diagnosed with
Asperger syndrome.

Components of
intervention include
1psychoeducation
2 comic strip
conversations
3 social stories
4 management of
behaviors such as
interrupting, temper
tantrums, anger,
noncompliance and
bedtime problems
5 management of rigid
behaviors associated with
Aspergers syndrome
such as strict adherence
to routines and ritual
behaviors, literal
interpretation and special
interests
6 management of anxiety.
Workshop was taught 6
components in one day at
the University of
Queensland. (18 parents
attended) weekly 1 hr
sessions were the

Results suggest
parent training can
be an effective
intervention for
parents of a child
diagnosed with
Asperger syndrome.
On each measured
outcome variable
the number of
problem behaviors,
and rating of social
skills, parents
indicated significant
improvement
following parent
training for both
intervention groups
while control group
showed no
significant
improvement on any
of the outcome
variables. Individual
session group
reported greater
changes than

-Small sample size

-Parent report

The clinical and

community-based practice
of OT: even though
individualized training had
better outcomes, workshops
are still effective and
provide significant benefits
for some parents and OT
can lead these in community
and clinical based practice.
Program development: This

program should be
implemented as a core
treatment option.
Societal Needs: Fiscal
implications of this service
needs to be estimated. This
intervention has the ability
to improve outcomes for
children with autism
spectrum disorders.
Healthcare delivery and
policy: Results of this study

individual sessions.
Parents in waiting list
also answered same
questions as the other
two groups but did not
receive intervention
following completion of
the questionnaire. They
all received a manual that
contained information
pertaining to the 6
components. Outcome
measures utilized the
eyberg child behavior
inventory, the social
skills questionnaire and a
usefulness of workshop
questionnaire and
usefulness of the
individual sessions
questionnaire. Last two
were developed to assess
ecological
validity/acceptability of
the interventions.

workshop group.
are strong and should be
examined with longitudinal
research.
Education and training of
OT students: Again OT
students should be educated
about the effects of parent
training and how to possibly
lead these types of
interventions.
Refinement, revision, and
advancement of factual
knowledge or theory: future
research should also include
obtaining information from
observers other than parents
in order to evaluate weather
changes have generalized to
other settings.