Study: Autistic Children May Need Fewer Hours of Treatment Than Previously ThoughtParent-Mediated Autism Treatment Leads to Greater Impact, According to New Research

Each year, tens of thousands of parents and caregivers of children with autism spectrum disorder (ASD) face vital decisions: What kind of treatment should my child receive? Who should deliver their care? How many hours of care does my child need to make progress?

A study published yesterday suggests autism care led by parents and caregivers may be more effective than paraprofessional-delivered ABA clinical intervention – and that less intervention may be needed than previously thought. The new data from Catalight challenges long-held assumptions about autism care, with broad implications for how parents, clinicians, policymakers and payers approach intervention decisions.

“We studied the progress of autistic children receiving a common autism treatment delivered by their parents and compared their results with a similar group of children receiving the same treatment delivered by paraprofessionals,” said Lindsey Sneed, PhD, vice president of clinical excellence at Catalight and lead author of the study. “Our data shows that children in the parent- led group made greater gains in their social skills than children in the paraprofessional-led group. Notably, children in both groups made significant progress despite receiving a relatively low amount of treatment – under 9 hours per week, on average.

Published in November’s issue of “Behavior Analysis: Research and Practice,” the study followed 106 families with autistic children ages 3-7 who received Applied Behavior Analysis or ABA – perhaps the most common form of treatment for autism spectrum disorder. ABA is a behavior intervention that aims to help autistic children improve their communication, behavior and social skills by encouraging positive behaviors and discouraging negative behaviors. Children most commonly receive ABA from paraprofessionals but may also receive it from parents who have received training from clinicians.

“Our results shed light on two common myths in autism care,” said Sneed. “First, many people believe Parent-Mediated care is less effective than paraprofessional-led ABA. Our data indicates the reverse may be true. The results we published suggest that many families may wish to consider parent or caregiver-led ABA as the first choice for treatment for their child. The second myth is that autistic children need 20 or 30 hours per week of ABA to make progress. Our research suggests that less than nine hours of treatment per week can lead to significant improvements. Given the shortage of trained autism clinicians and the ongoing increase in autism diagnoses, these results suggest that a shift to more Parent-Mediated ABA and/or lower hours of paraprofessional-led ABA could be a viable means to extend access to care to more families.

Evaluating children’s skills and behavior using standard autism assessment tools, the authors compared baseline scores with scores taken at regular intervals over the course of their treatment, which averaged 20 months per child.

“The improved social skills scores among children receiving parent or caregiver-led ABA could be due to one of several factors,” said Sneed. “Parents who are trained to deliver ABA may end up incorporating the practices into their everyday parenting style; in turn, this may increase their child’s exposure to ABA. In addition, past research has shown that parents and caregivers who deliver ABA themselves develop increased confidence. This may lead them to bring their child into more social situations, which could further help their child develop their social skills.”

Sneed emphasized that each family is different and should choose the treatment plan that best fits their needs. She hoped the results of the paper would encourage parents and caregivers wary of delivering ABA themselves to feel more confident in their ability to deliver the intervention to their child.
“Although many people assume that paraprofessional-led ABA would be more effective, I’m not surprised that the evidence suggests Parent-Mediated ABA is more effective,” said Sneed. “Parents and other caregivers are typically their child’s first and most natural teacher. They are with them during their most pivotal moments of teaching, including mealtimes, their transition to school and bedtime. Incorporating ABA practices into these moments appears to benefit the entire family.”

Families in the study chose whether to receive Parent-Mediated or paraprofessional-led ABA. The authors suggested that future research should include randomized clinical trials to further support the findings of the study.

About the Study
The paper “Evaluating the Effectiveness of Two Models of ABA in a Community-Based Setting for Children With Autism Spectrum Disorder” was published in Behavior Analysis: Research and Practice in November 2023. The lead author is Lindsey Sneed, PhD, of the Catalight Research Institute. The two additional authors are Steven G. Little, PhD, and Angeleque Akin-Little, PhD, of Walden University.