Parent-Mediated Home-Based Behavioural Intervention for a Preschool Child with Autism Spectrum Disorder: A Single-Case Intervention Study

Abstract

Background: Parent-mediated behavioural interventions have become an evidence-based and cost-effective intervention for developmental outcomes in children with Autism Spectrum Disorder (ASD). Studies on individualised home-based parent training (IHP) programs in the Indian setting, however, have been scarce, especially for preschool children with mild intellectual disability. Allowing parents to be primary interventionists can increase the intensity and sustainability of early intervention and improve child outcomes in natural home environments.
Objective: This case study aimed to assess the effectiveness of a 16-week parent-mediated behavioural intervention for improving developmental functioning, adaptive behaviour, severity of autism symptoms, sitting tolerance, imitation skills and following simple one-step instructions in a preschool child with a diagnosis of mild intellectual disability and mild ASD.
Method: A single case pre & post test design with baseline behavioural recordings was used. One mother was given weekly 45 minute sessions with a clinician who worked on behaviour management strategies, such as environmental restructuring, functional behaviour analysis, modelling, prompting and systematic use of primary and differential reinforcement. Progress in behaviour was monitored on a daily basis at home using daily monitoring sheets. Developmental outcomes were measured by Developmental Screening Test (DST), adaptive functioning was measured by Vineland Social Maturity Scale (VSMS) and autism severity was measured by Indian Scale for Assessment of Autism (ISAA). Baseline and 4-weekly behavioural targets were assessed, and standardised reassessed at 16-weeks.
Results: In all targeted behaviours, there was improvement over time. These included improved sitting tolerance from some 10sec to 4- 5 min; was able to imitate simple motor tasks and, with minimal cues, was able to listen to verbal instructions and act on them. The intervention resulted in improvement of the Developmental Quotient (DST: 51 to 60), Social Quotient (VSMS: 54 to 58), and reduction in the autism severity (ISAA: 102 to 88) as demonstrated by the standardized assessments.
Conclusion: There is a positive effect of structured parent-mediated behavioural intervention, which can lead to meaningful observable changes in developmental functioning, adaptive behaviour, and autism symptom severity in young children diagnosed with ASD when delivered regularly in a home setting, as suggested in this case study. The model of evidence-informed early intervention services via the parent as primary interventionist is feasible, low cost, and culturally relevant and could expand access to these services in resource-limited contexts.