Dr. James D. MacDonald's Website
Helping Parents Help Children. Programs for Parents, Therapists & Educators
A one-year study of 25 pre-school children and their parents was conducted at the Nisonger Center at OSU. All children exhibited severe social and communicative delays with marked autistic features including social isolation, self-stimulation, preservation and unconventional functional play. The study involved training parents to develop responsive play relationships that were tailored to enhance the child's social interaction and communication skills. The training involved three phases, education, professional training, and practice in the home.
The education phase introduced parents to developmental information on how children learned to communicate and how parents can be partners in their child's development. Parents used a developmental map similar to the ARM to follow their child's development and learn to focus on appropriate next steps. They were also given readings and practical tutorials that were developmentally targeted to their child. Practical examples of conversation routines were used as models for how parents were to interact From the beginning, parents understood that their child's progress would be their responsibility and not the professional's job.
During the professional training phase, the professional served as teacher and coach for parents who then integrated the program into their daily lives with their children. The professional demonstrated the responsive strategies with the child and coached the parent to become the child's communicating partner, with the help of video training tapes.
The home practice phase involved parents practicing the strategies within regular daily routines and spontaneous events in the home. Parents focused on no more than two goals for the child such as sound imitation and turn taking and no more than two strategies such as matching and balancing. Parents provided simple written diary reports of concerns and progress. The tutorials and practice guides were similar to the ones provided in Volume 2 that follows this book.
The study provided findings in two major arenas, the parent and child profiles before treatment and parallel profiles after treatment. The pre treatment findings addressed the questions: how do preschool ASD children interact and communicate in play with their parents/ How do parents interact and communicate in play with their ASD children. The post-treatment findings describe how parents and children changed after one year of training, based on video taped samples one and two months before and after the program. While no control group was available, the findings were validated by independent evaluations by six uninvolved adults who viewed random samples of the pre and post performances. In over 80 % of the cases, the evaluators judged the children's post performances to be significantly superior to the pre- performances.
The pre treatment findings general indicated the following patterns. The children interacted much less than their parents. The interactions were usually brief and did not last more than one or two turns. There was little evidence of a give and take or reciprocal relationship in the play. The children generally played alone or followed their parent's directions. The parents usually did not join into the children's play but played more of a teacher or regulator role and one of play parnter. Parents often talked in adult's ways far beyond the child's language level. Since most of the children's behavior was nonverbal, it was striking that the parents usually did not enter the child's nonverbal play but appeared to expect the child to enter their verbal world. There appeared to be few joint activity routines in which the child had practice learning to communicate in developmentally possible ways.
Children: After treatment the children played more actively with their parents, rather in the isolated patterns before. Most of the children moved from a generally passive role to a more assertively interactive role. More than half the children demonstrated a habit of turn taking with out prompting. They were staying voluntarily in social contacts and initiating much more than before. While the major gains were increases in interaction, more than half the children began speaking t in the years and were evaluated as having made more than one and a half years progress on communication measures. The children's rate of nonfunctional or "autistic" like behavior decreased as they became more interactive with their parents. About half of the children maintained autistic features as they still improved their interactive life.
Parents: The parents change more in their social play skills than did the children. The generally became more childlike and playful, thus more accessible to the children. Most of the parents learned to match their child in the sense that they acted and communicated more in ways the child could do. They improved considerably in their waiting time since before treatment few parents waited for their children to participate much. The parents also become more responsive in that they usually changed their role from a directive teacher to a play partner who followed the child's lead and made the child the center of the agenda and not their own teaching goals. The video analyses showed strikingly that the parents did much less after the program, which appeared, related to the finding that the child did much more. The parents also became more animated and playful and less rigid and structured as before treatment.
In summary, the study gave us a major video and database from which we further developed the program and refined the treatment strategies on the basis of those strategies that related to increased child interaction. Parents were, by and large, able to implement the program in their homes and reported in surveys that they had learned about their child's development and how to continue supporting it at home.