An Examination of an Adaptive Parent-Mediated Intervention delivered via Telehealth for Toddlers `At Risk' of Autism Spectrum Disorder in the United Arab Emirates.
Citation:
Alhejailan, Rasha, An Examination of an Adaptive Parent-Mediated Intervention delivered via Telehealth for Toddlers `At Risk' of Autism Spectrum Disorder in the United Arab Emirates., Trinity College Dublin, School of Psychology, Psychology, 2024Download Item:
Abstract:
Best practice in interventions for children below the age of three years with
suspected or confirmed autism diagnosis is to include behavioural and developmental
approaches as early as possible, and ensure active involvement of parents (e.g.,
Zwaigenbaum et al., 2015). Naturalistic Developmental Behaviour Interventions
(NDBIs) is an evidence-based approach that integrates the principles of both Applied
Behaviour Analysis and developmental science (Schreibman et al., 2015). A crucial
element in the success of early intervention, especially for toddlers, is parental
involvement. Parent-mediated intervention is an approach whereby professionals
support parents in fostering their child’s learning and development, by embedding
intervention strategies across natural everyday activities (Wetherby et al., 2018).
Despite strong evidence supporting the importance of early intervention in increasing
positive outcomes, there are major barriers to accessing services. Utilising a telehealth
model in the delivery of parent-mediated intervention, can potentially narrow the service-
need gap. Given the heterogeneity of Autism clinical presentation, and the diversity
within families and cultures, recent recommendations support a novel adaptive, ‘stepped
care’, approach in delivering intervention (Lord et al., 2021). In the United Arab
Emirates, Autism research and service provisions are still at their infancy, and there
continues to be a gap between policy and practice, despite recent efforts of policy makers.
The aim of the current research programme was to explore the introduction of a
contextually fit, adaptive parent-mediated NDBI delivered via telehealth to parents of
toddlers ‘at risk’ of autism in the UAE.
In Chapter 1, an overview of the evidence base for early intervention in young
children with Autism Spectrum Disorder is provided, including NDBIs, parent-mediated
approaches, and the utilisation of telehealth. The barriers to accessing early intervention,
and the resulting service-need gap are illustrated, specifically within the context of the
United Arab Emirates.
Chapter 2 describes early experiences from a pilot trial of a bilingual NDBI
intervention program, conducted via telehealth during the COVID-19 pandemic, which
informed the development of bilingual (Arabic and English) online learning modules
based on the Early Start Denver Model, and the adaptation and translation of outcome
measures to evaluate the intervention.
Chapter 3 describes the outcomes from a pilot study conducted to examine the
feasibility of individual and group-based coaching of parent mediated NDBI delivered via
telehealth to parents of toddlers ‘at risk’ of Autism in the UAE. Outcomes support the
initial feasibility and acceptability of the provided intervention, as well as a reported
improvement in parent knowledge, and parent reported child outcomes. A discussion of
the challenges and limitations of the study highlight the importance of an adaptive,
‘stepped care’, approach that takes into account the diversity and variability of parent
needs and preferences.
Chapter 4 investigates the implementation of an adaptive parent-mediated NDBI
delivered via telehealth, adopting a Sequential Multiple Assignment Randomised Trial
design. Reported outcomes support the feasibility and acceptability of the adaptive
intervention. Utilising a rapid measure of response to intervention halfway through the
intervention program was shown to be useful in identifying ‘slow responders’ to
intervention. Subsequently augmenting intervention for slow responders with parent-
coaching was shown to lead to a more positive outcome, including improved parent
knowledge; decreased burden of autism on family experience; parent reported
improvement in social engagement, communication, and play; and improved parent
response to intervention. In Chapter 5, qualitative data from post-intervention semi-
structured interviews are collated and analysed, and emerging themes related to parents’
opinions on the characteristics of the program, and their perceptions and attitudes towards
intervention are described. Parents’ perceptions of the strengths and limitations of the
intervention, as well as identified facilitators and barriers in implementation are
discussed.
Chapter 6 describes the process of developing and tailoring implementation
strategies based on the barriers and facilitators identified in Chapter 5, utilising the EPIS
framework. The implementations strategies are discussed within the context of the recent
Lancet recommendations for ‘stepped care’ model for interventions in Autism (Lord et
al., 2021).
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https://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:ALHEJAIRDescription:
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Author: Alhejailan, Rasha
Advisor:
Healy, OlivePublisher:
Trinity College Dublin. School of Psychology. Discipline of PsychologyType of material:
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