An adaptive parent-mediated intervention to improve outcomes for autistic children

About This Grant

Project Summary There is clear evidence that early intervention benefits autistic children’s short- and long-term development. However, the rising autism prevalence is overwhelming the public health system’s capacity. As a result, many autistic children cannot access timely diagnostic and intervention services. Self-directed telehealth interventions (i.e., online programs that parents can complete via computer, tablet, or mobile device, without provider coaching or feedback) offer parents a way to gain evidence-based strategies that they can implement with their children without having to navigate barriers such as long intervention waitlists and high cost. However, parent engagement with the program, and child outcomes, in existing self-directed interventions vary widely, and little is known about which families can benefit from low- vs. high-support interventions. The proposed sequential multiple assignment randomized trial (SMART) will evaluate an adaptive, parent- mediated, telehealth intervention that teaches basic principles of autism intervention with varied levels and types of support. 340 parent-child dyads will be initially randomized to either a self-directed intervention (OPT- In-Early) or OPT-In-Early with automated support. Parent engagement with OPT-In-Early and comprehension of intervention content will be monitored over a 1-month period. At that point, parents with “low engagement” (i.e., parents who either did not use the intervention or did not demonstrate learning of key concepts) will be re- randomized to either individual or group clinical support, with a goal of increasing engagement with the intervention and ultimately improving child outcomes. Multi-method, longitudinal assessments will be used to rigorously evaluate implementation and outcomes. Child outcomes will include assessment of key developmental domains that are impacted by autism. This research is significant because it will be the first time a self-directed telehealth intervention for autism is optimized for greatest engagement. This proposal is aligned with NIMH’s Strategic Plan Goal 4.2, to improve mental health by expediting adoption and implementation of an evidence-based intervention. This study will generate the evidence necessary to implement an adaptive intervention at-scale, thereby increasing the capacity of the existing public health system to offer tailored and cost-effective interventions to young autistic children and their families.