Topics in Early Childhood

Special Education
Volume 29 Number 2
August 2009 90-104
Promoting the Social and Communicative © 2009 Hammill Institute on
Disabilities

Behavior of Young Children With Autism 10.1177/0271121409337950

http://tecse.sagepub.com
hosted at http://online.sagepub.com

Spectrum Disorders
A Review of Parent-Implemented Intervention Studies
Hedda Meadan
Illinois State University
Michaelene M. Ostrosky
Hasan Y. Zaghlawan
SeonYeong Yu
University of Illinois at Urbana–Champaign

The purpose of this article is to critically review the literature on parent-implemented interventions aimed at promoting
and enhancing the social and communicative behavior of young children with autism spectrum disorders. Twelve parent-
implemented intervention studies that were conducted, at least in part, in home environments and were published between
1997 and 2007 were identified. Each of these studies is described as a study within a study. A study-within-a-study design
allows researchers to examine (a) the effectiveness of the parents’ implementation of the newly learned strategies and
(b) the influence of parent-implemented strategies on their children’s social and communication skills. All 12 studies
reported positive outcomes for parents and children. Yet closer examination of the research methods used in each study
indicates considerable variability in intervention and data collection strategies. Carefully and critically evaluating this
empirical literature can help researchers, teacher educators, and practitioners as they consider options for interventions and
plan future research efforts that will efficiently and effectively result in positive outcomes for young children with social com-
munication delays. Implications for research and practice are addressed following the literature review.

Keywords: autism spectrum disorder (ASD); disability populations; families; intervention

A utism spectrum disorders (ASD) refers to a wide

spectrum of complex developmental disorders that
typically appear during the first 3 years of life. The three
core features of ASD are impairments in social interac-
tions, impairments in verbal and nonverbal communica-
tion, and restricted and repetitive patterns of behavior
(American Psychiatric Association, 1994). Due to
national trends indicating an increase in the number of
individuals identified with ASD (Centers for Disease
Control and Prevention, 2007), there is growing interest
in developing effective interventions and providing
appropriate social and behavioral support for individuals
with autism in home, school, and community settings
(Kamps et al., 2002).
Researchers suggest that abnormal patterns in the
social and communication development of children with
ASD begin in infancy (e.g., absence of eye contact or
social smile) and that delays, deficits, and atypical social
and communicative characteristics are the core features
of autism (Kohler, Anthony, Steighner, & Hoyson, 2001;
McConnell, 2002). Given the rising number of young
children identified with ASD, it is not surprising that
various interventions are cited in the literature aimed at
supporting the social and communicative development
of children with ASD. In their reviews of the literature,
Koegel (2000) and Rogers (2000) described several
types of interventions that have been shown to improve
the socialization (e.g., peer tutoring) and communication
(e.g., using natural and direct reinforcers) of children
with ASD. Both literature reviews emphasized the
Authors’ Note: Address correspondence to Hedda Meadan, Illinois
State University, Campus Box 5910, Normal, IL 61790; e-mail:
hmeadan@ilstu.edu.

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 Meadan et al. / Parent-Implemented Interventions   91  

importance of parent-implemented interventions and the Carefully and critically evaluating this empirical litera-
magnitude of social and communicative gains that par- ture can help researchers, teacher educators, and practi-
ents could accomplish with their children. Koegel also tioners as they consider options for interventions and
noted the importance of individualizing interventions to plan future research efforts that will efficiently and
adjust for contextual family variables and the develop- effectively result in positive outcomes for young chil-
ment of culturally and linguistically sensitive interven- dren with social communication delays. Following the
tion plans. literature review, implications for research and practice
Teaching children in their natural environments is an are addressed.
important component of early intervention approaches and
recommended practices in early childhood special educa-
Literature Review Method
tion (Dunlap, Ester, Langhans, & Fox, 2006; Dunst,
Hamby, Trivette, Raab, & Bruder, 2000; McCollum &
Articles related to parent-implemented interventions
Hemmeter, 1997; Sandall, Hemmeter, Smith, & McLean,
for young children with ASD were identified through the
2005). Natural environments and daily routines are pre-
ERIC and PsycINFO databases. Along with autism,
ferred intervention settings for children with a range of
autism spectrum disorders, and pervasive developmental
abilities (Kashinath, Woods, & Goldstein, 2006). McWilliam
disorder, various combinations of keywords related to
(2000) pointed out that the successful experiences of fami-
parents (e.g., parents, caregivers, mothers, fathers) and
lies and therapists when teaching children in natural envi-
social and communication skills (communication, lan-
ronments is what led to the adoption of more naturalistic
guage, social behavior) were used. Additional articles were
approaches and policies in teaching young children.
identified from the reference lists of articles retrieved
Many of the 1 million infants and young children who
from the databases and from review articles and book
receive special education services (U.S. Department of
chapters (i.e., ancestral methods). The search was limited
Education, 2005) spend most of their waking hours at
to peer-reviewed journals; therefore, books, disserta-
home with their parents. Therefore, it is important to col-
tions, and other publications that were not peer reviewed
laborate with parents in selecting and implementing
are not included in the literature review. The criteria for
strategies that can be used to enhance children’s social
inclusion in the review were as follows: (a) at least one
and communication skills. Researchers have demon-
child in the study had ASD or PDD; (b) at least one child
strated repeatedly that parents are able to learn new
in the study was between the chronological age of
strategies and implement them accurately (e.g., Dunlap
infancy through 6 years; (c) the article was published in
et al., 2006; Kashinath et al., 2006), highlighting the
a peer-reviewed journal between 1997 and 2007 and
importance of home-based programs. Koegel (2000)
included an intervention study; (d) parents worked directly
noted that parent education programs requiring parents
with their children as the trainers (i.e., parent-implemented
to set aside specific time in their schedules to work one-
intervention); (e) data on the parent-implemented inter-
on-one with their children increase parent stress levels.
ventions were collected, at least in part, in the natural
Therefore, Koegel suggested that intervention programs
environment (i.e., the children’s homes); and (f) the
be designed to fit within families’ routines and schedules
children’s target behaviors focused on social and/or com-
so that children receive ongoing opportunities for skill
munication skills. All articles were carefully reviewed to
development throughout the day in their natural environ-
verify that they met the inclusion criteria.
ment, thus decreasing parental stress levels. McWilliam
(2000) supported this approach, emphasizing that posi-
tive child outcomes are realized when family members
Results
provide multiple opportunities for children to practice
skills between weekly therapy sessions.
Participants
Different types of parent-implemented programs have
been developed to promote the social and communicative Twelve articles were identified that met the criteria
behavior of young children with disabilities, including established for this review. The total number of children
young children with ASD. The purpose of this article is with ASD or PDD who participated in these intervention
to critically review the literature on parent-implemented studies was 105 (22 girls and 83 boys), and their ages
interventions aimed at promoting and enhancing the ranged from 20 months to 9 years. At least 85 of the
social and communicative behavior of young children children were younger than 6; in a number of studies, the
with ASD or pervasive developmental disorder (PDD). ages of some children were not specified. The total
92   Topics in Early Childhood Special Education
number of parents who implemented social and/or com-
municative interventions with their children was 110; at
least 52 of the parents were mothers and 28 were fathers
(the remaining participants were identified simply as
parents).
Research Method
Research design. Out of the 12 identified research
articles, 8 used single-subject design to examine the
research questions. In one study (Mahoney & Perales,
2003), statistical analysis of pre- and postintervention
data was used to examine the effectiveness of the inter-
vention, whereas another study (Drew et al., 2002) used
a randomized control trial to compare two intervention
models. In two studies (Elder, Valcante, Yarandi, White,
& Elder, 2005; Rogers et al., 2006), single-subject
design and group analysis methods were implemented to
compare two interventions.
A study within a study. Parent-implemented interven-
tion studies can be viewed or characterized as a study
within a study. In the first study, parents are taught new
strategies (e.g., strategies such as modeling and role
playing are used by researchers to teach parents new
skills such as following the child’s lead or imitating the
child’s verbal and nonverbal initiations), and parent edu-
cation is the independent variable. Parent behavior (e.g.,
parents’ use of the strategies) is the dependent variable.
In the second study, children are taught new skills by
their parents, and the independent variable is the training
or teaching the parents implement (e.g., parents’ use of
specific strategies with their child). The dependent vari-
able is the child’s behavior (e.g., imitation, verbalization,
nonverbal initiation). A study-within-a-study design
allows researchers to examine (a) the effectiveness of the
parents’ implementation of the newly learned strategies
and (b) the influence of parent-implemented strategies on
the children’s social and communication skills. Table 1
includes information about the 12 identified studies,
using this framework of a study within a study.
Reliability, generalization, social validity, and fidelity.
In Table 2, information about reliability, generalization,
social validity, and fidelity for each study is presented.
All studies, except for 1 (Drew et al., 2002), reported
inter-rater reliability measures (ranging from 62%-
100%). However, only a few studies collected reliability
data on both parent and child behaviors, and most
researchers gathered reliability on children only. The
most frequent generalization measures reported in the
reviewed studies were generalization across time (i.e.,
maintenance) and settings (e.g., location and routines).
Social validity data were reported in 7 of the 12 studies.
In all of these studies, parents were asked to complete a
short satisfaction questionnaire. Nine of the reviewed
studies reported some type of fidelity of implementation
measure (e.g., using a procedural checklist). Only 2 of
the studies (Kashinath et al., 2006; Rogers et al., 2006)
reported assessing the fidelity of both the parent educa-
tion and parents-as-trainers components.
Research Purpose
Each of the 12 articles can be categorized into one of
three types of research. Four articles included compara-
tive studies (Charlop-Christy & Carpenter, 2000; Drew
et al., 2002; Moes & Frea, 2002; Rogers et al., 2006).
Four articles included an evaluation of a specific inter-
vention (Elder et al., 2005; Ingersoll & Gergans, 2007;
Mahoney & Perales, 2003; Seung, Ashwell, Elder, &
Valcante, 2006). The remaining 4 studies evaluated the
effectiveness and generalization of an intervention
(Jones, Carr, & Feeley, 2006; Kaiser, Hancock, &
Nietfeld, 2000; Kashinath et al., 2006; Symon, 2005).
The following section describes each of the different
types of studies.
Comparative studies. Moes and Frea (2002) com-
pared the effects of functional communication training
(FCT) and the effects of contextualized FCT (C-FCT; the
researchers individualized FCT to meet each family’s
strengths and concerns based on a family interview) on
the challenging behaviors of children with autism. Three
families who had 3-year-old children with autism par-
ticipated in parent education. A multiple-baseline design
across participants was used. The design included four
phases: (a) baseline, (b) FCT, (c) C-FCT, and (d) follow-
up. Results showed that children’s challenging behavior
decreased and their functional communication increased
following the C-FCT intervention. In addition, self-
report questionnaire data indicated that parents’ ratings
of sustainability of the intervention package increased
from the FCT-only condition to the C-FCT condition.
The researchers concluded that C-FCT not only is com-
patible with FCT but also is important for and valued by
families. The researchers emphasized that family con-
texts (i.e., family support, patterns of social interaction)
should be considered in assessment and intervention
planning.
In another comparative study that focused on modify-
ing an existing intervention, Charlop-Christy and
 Table 1
Description of the Reviewed Studies
Participants Method
Purpose and Research
Citation Method Children With ASD Parents Independent Variable Dependent Variable Results

Charlop-Christy & –To examine the 3 boys 3 parents Parent training: Parent behavior: Parent behavior:
Carpenter (2000) efficacy and use of Age: 6-9 years –Parents received training in incidental –Parents had to reach a –Parents made relatively few
modified incidental teaching, MITS, and discrete trial criterion for using the errors during the treatment
teaching sessions procedures. Training consisted of procedure. conditions (5%-10% of total
(MITS) and compare instruction, modeling, and feedback from –Number of errors made trials in each condition).
the MITS, incidental the experimenter. by the parents using Child behavior:
teaching, and discrete –Once the parents had implemented the each procedure. –MITS led to a better acquisition
trial procedure correctly on 5 consecutive trials, Child behavior: and generalization than other
–An alternating they were considered to have reached the –Imitation interventions (incidental
treatments design criterion for learning the teaching method. –Spontaneous speech teaching and discrete trial).
comparing the 3 Parents as trainers: –Incorrect verbal –This study demonstrated that
treatment conditions –Parents used MITS, incidental teaching, and response parents could use the MITS to
and a multiple discrete trial procedures with their children. teach and promote
baseline design across –Each procedure was implemented for at generalization of their
children least five 1-week intervals or until children’s spontaneous speech.
generalization was displayed.
Drew et al. (2002) –To compare a parent- –Parent-training Parents Parent training: Parent behavior: Parent behavior:
training intervention group (11 boys, (including –Consultant model with parent acting as the –No data on parent use –No data reported
focusing on joint 1 girl) fathers) everyday therapist. A speech and language of strategies taught in Child behavior:
attention and joint –Local services therapist visited the parents every 6 weeks the training were –At follow-up, children in the
engagement with group (8 boys, 4 for a 3-hour session. collected. parent-training group
locally available girls) –Training sessions focused on behavior –Data from Parent Stress understood slightly more words
services only Mean age: 23 management, social pragmatic approach for Index were included. than did children in the
–Randomized control months joint attention, nonverbal social Child behavior: comparison group. According
trial communication, and language. –Language to parent reports, more children
Parents as trainers: comprehension and in the training group moved
–Parents completed an activity checklist production from being nonverbal to having
every 3 months, which included the number –Nonverbal single-word or phrase speech.
of hours of therapist and parent –Symptom severity
interventions the children received.
Activities for each 6-week period were
designed to take 30-60 minutes of “set
aside” time and to be incorporated into
everyday routines.

(continued)

93
94
Table 1 (continued)
Participants Method
Purpose and Research
Citation Method Children With ASD Parents Independent Variable Dependent Variable Results

Elder, Valcante, –To evaluate the effects 14 boys, 4 girls 18 fathers Parent training: Parent behavior: Parent behavior:
Yarandi, White, & of an in-home training Age: 24 to 84 –Researcher trained the fathers to use –Imitating with –Increases in fathers’ I/A and
Elder (2005) program on fathers of months imitating/animating (I/A) and expectant animation EW
children with autism Mean age: 56.7 waiting (EW) methods; booster sessions –Expectant waiting –Increases in fathers’ responding,
–Single-subject design months (videotaped vignettes and graphed data) –Responding to child but no difference in fathers’
to evaluate were provided. –Initiating initiating
intervention Parents as trainers: Child behavior: Child behavior:
component effects in –Fathers used I/A for 8-10 sessions and EW –Initiating –Increases in children’s initiating
individual participants in the following 8-10 sessions. –Responding and vocalizing
and group analysis to –14-22 sessions (including baseline) over a –Vocalizations –No difference in children’s
assess the external 10- to 12-week period responding
validity of the
intervention
Ingersoll & Gergans –To assess the 2 boys, 1 girl 3 mothers Parent training: Parent behavior: Parent behavior:
(2007) effectiveness of Age: 31-42 –Mothers were taught to use RIT twice a –Mothers’ use of RIT –All mothers showed increases
parent-implemented months week for 10 weeks in a clinic setting strategies (modeling, in their correct implementation
Only generalization reciprocal imitation (manual, modeling, and practice with prompting and of imitation training procedure.
in the home training (RIT) with feedback). reinforcement) Mothers generalized their use
young children with Parents as trainers: Child behavior: of the imitation training
ASD –Mothers used RIT strategies with their –Spontaneous object procedure to their homes.
–Single-subject, children. and/or gesture Child behavior:
multiple-baseline imitation –All children increased their use
design conducted of spontaneous imitation. They
across participants and maintained and generalized
across behaviors their imitation skills to their
homes.
Jones, Carr, & –To extend joint 2 boys 3 parents Parent training: Parent behavior: Parent behavior:
Feeley (2006) attention skills that Age: 2 year 2 (2 mothers, No information No data provided No data provided
were taught by months; 3 years 1 father) Parents as trainer: Child behavior: Child behavior:
Only the 2nd teachers to children’s –Parents taught joint attention (i.e., respond Joint attention skills: –The 2 children acquired joint
study in the series interactions with their and initiate) using prompting and pivotal responding and attention with their parents in
of 3 studies parents response training (PRT) strategies (skills initiating the home and community as or
included parents –Clinical extension of were taught by teachers to the same more quickly than they did
as trainers. skills already acquired children in Study 1). with the teachers in Study 1.
–Parents used the same set of toys and –Children demonstrated an
routines from Study 1. expanded use of both
–Parents expanded joint attention to novel responding and initiating to
stimuli and naturally occurring activities. novel stimuli, including
–Parents were asked to provide at least 5 additional toys, pictures, and
expansion opportunities per week. routines.

(continued)
 Table 1 (continued)
Participants Method
Purpose and Research
Citation Method Children With ASD Parents Independent Variable Dependent Variable Results

Kaiser, Hancock, & –To examine the effects 6 boys 6 mothers Parent training: Parent behavior: Parent behavior:
Nietfeld (2000) of parent-implemented Age: 2.5-5 years –45-minute training twice a week in a clinic 7 aspects of parent –All parents showed increases in
enhanced milieu Mean age: 42 setting implementation of correct use of milieu teaching.
Only a few teaching (EMT) on months –Parents learned naturalistic language training were –Parents learned EMT
sessions at the end social communication intervention strategies using handouts, measured. procedures and generalized and
of intervention skills of children with videotape clips, role-playing, and Child behavior: maintained their use across
were conducted at autism demonstration. –Social communication settings and time.
home. –Single-subject, –Training continued until the parent met skills Child behavior:
multiple-baseline criteria (80% correct use of technique) or –Expressive and –All children showed increases in
design across parent- until 24 sessions were completed. receptive their total use of target behaviors
child dyads Parents as trainers: communication (prompted plus unprompted).
–Parents used environmental arrangement, –Linguistic complexity –All children’s spontaneous
responsive interaction, and milieu teaching target use increased.
procedures with their children. –Children demonstrated positive
changes in social communication
across settings and measures.
Kashinath, Woods, & –To examine the effects 4 boys, 1 girl 5 mothers Parent training: Parent behavior: Parent behavior:
Goldstein (2006) of facilitating Age: 2-6 years –60-90 minutes twice a week ranging 5-6 –Parent use of the target –All parents showed increases in
generalized use of months. Parents learned 2 teaching teaching strategies their frequency of use of target
teaching strategies by strategies using handouts, videotape clips, Child behavior: strategies.
parents of children modeling, and practice, and discussion. –Child communication –All parents generalized the use of
with autism within Parents as trainers: outcomes teaching strategies across routines.
daily routines Parents used teaching strategies during Child behavior:
–Multiple-baseline identified routines (arranging the –All children showed increases
design across teaching environment, natural reinforcement, in the frequency of their
strategies imitating contingently, modeling, or specific communication targets
gesture/visual cuing). subsequent to intervention.
Mahoney & Perales –To investigate the 12 boys, 8 girls 20 mothers Parent training: Parent behavior: Parent behavior:
(2003) effectiveness of Mean age: 32 –Parents learned responsive teaching (RT) –Following through with –Parents improved in responsiveness
relationship-focused months strategies the family action plan and affect but did not make
intervention on the –Weekly 1-hour intervention over 1-year that contained changes in achievement
social and emotional period recommended orientation, and directiveness.
well-being of children Parents as trainers: intervention activities –Parents reported that they
with autism –Parents used RT strategies with their –Maternal Behavior successfully followed through
–Pretest/posttest children Rating Scale with the family action plan for
without a control Child behavior: more than 50% of the sessions.
group –Infant Toddler Social Child behavior:
Emotional Assessment –Children’s social interactive
–Behavior Scale behaviors increased in
–Child Behavior Rating attention, persistence, interest,
Scale cooperation, initiation, joint
–Temperament and attention, and affect.
Atypical Behavior Scale –After the intervention children
were less detached, had fewer
problems in self-regulation, and
were more socially reactive.

95
(continued)
96
Table 1 (continued)
Participants Method
Purpose and Research
Citation Method Children With ASD Parents Independent Variable Dependent Variable Results
Moes & Frea (2002) –To evaluate 2 boys, 1 girl 3 mothers Parent training: Parent behavior: Parent behavior:
contextualized Age: 3 years –Mothers were taught to implement the FCT –Fidelity of –Parents reached 80% criteria on
functional treatment package using modeling, direct implementation fidelity of treatment (no
communication instruction, and feedback. (mothers started using specific data are provided).
training (FCT) in the –In the contextualized FCT (C-FCT) the strategies after –Self-report questionnaire indicated
routines of 3 families condition modifications were made to the reaching 80% criteria that parents’ ratings of
–A multiple-baseline FCT. on fidelity) sustainability of the intervention
design across –Families were seen 1-2 times per week –Self-report on the package increased from the FCT-
participants during assessment and intervention phases. sustainability of the only condition to the C-FCT
Parents as trainers: intervention package condition.
–Mothers were asked to complete daily Child behavior: Child behavior:
teaching sessions and reinforce their –Tantrum behavior –During C-FCT problem behavior
children’s functional communication. (aggression and reached near zero levels and
disruptions) functional communication
–Functional responses continued to show an
communication increasing trend similar to the
response trend in the FCT condition only
(not individualized for each
family).
–The reductions in challenging
behaviors and increased use of
functional communication were
observed in the generalization
probes and follow-up sessions.
Rogers et al. (2006) –To examine 2 models 10 boys (5 in each 10 parents and Parent training: Parent behavior: Parent behavior:
of intervention for condition) trainers –12 weekly 1-hour sessions with therapists. –Parent implementation –No data provided
developing speech in Age: 20-65 Parents in both treatments were coached in of intervention was Child behavior:
young children with months specifics to practice each week, were taught monitored via parent –8 of 10 children demonstrated
ASD: Denver Model to keep data, and handed their data in to report. functional, spontaneous use of
and PROMPT their therapists. Child behavior: 5 novel words or more by the
–Single-subject design Denver Model: Parent was present and active –The number of novel completion of treatment.
(A-B-A) across 10 in therapy session. words and/or –Gains in integration of verbal
participants PROMPT: Parents observed the entire approximations and nonverbal communication
treatment session via video and then were produced were reported in both models.
given target for daily intervention. –The number of novel
Parents as trainers: phrases produced
Denver Model: –Standardized
Parents were asked to spend 45 minutes each assessments of cognitive
day implementing the children’s treatment and language
objective. functioning, adaptive
PROMPT: Parents were asked to spend 30 behavior, and autism
minutes each day implementing the symptoms
children’s treatment objective.

(continued)
 Table 1 (continued)
Participants Method
Purpose and Research
Citation Method Children With ASD Parents Independent Variable Dependent Variable Results

Seung, Ashwell, –To examine the 6 boys, 2 girls 8 fathers Parent training: Parent behavior: Parent behavior:
Elder, & Valcante efficacy of in-home Age: 4-7 years –Fathers were taught how to use expectant –The ratio of the number –No difference between fathers
(2006) father training on the waiting first and then imitation with of parents’ utterances to and mothers in learning skills
verbal communicative animation. the number of designed to promote social
outcomes of children –Fathers were asked to use the strategies with children’s utterances reciprocity
with autism their children and received additional –The number of parents’ –The number of imitation
–Retrospective analysis booster sessions (reviewing video clips of verbal imitation behaviors increased after
of some of the data the interactions and discussion of the behaviors intervention.
collected by Elder performance) Child behavior: Child behavior:
et al. (2005) Parents as trainers: –The number of single- –The number of single-word
–Fathers used imitation with animation word utterances utterances increased.
(Intervention 1) and expectant waiting produced –Children produced a greater
(Intervention 2) during 15-minute play –The number of different variety of words in the
sessions with their children. words produced intervention.
–The frequency of –Children’s responses to parents’
children’s verbal questions increased but were
responses to their not statistically significant.
parents’ questions
Symon (2005) –To evaluate the 3 boys 3 mothers Parent training: Parent behavior: Parent behavior:
generalized effects of Age: 2-5 years (primary –5 hours per day over 5 consecutive days, for –Fidelity of –All parents showed mastery of
an intensive parent caregivers) total 25 hours, in a clinic setting implementation for the PRT skills, and they
education program for 1 father –Mothers were taught to use PRT (manual, primary and significant generalized their skills into
children with ASD (significant modeling, practice). caregivers home settings.
–Nonconcurrent caregiver) –Mothers were not taught how to train Child behavior: –The skills spread from primary
multiple-baseline 2 service significant caregivers. –Assessment of caregivers to significant
design providers Parents as trainers: functional verbal caregivers.
(significant –Mothers used PRT with their children utterances and Child behavior:
caregivers) –Primary caregivers were asked to provide appropriate behaviors –The children’s functional verbal
videotape segments of the children with the language and appropriate
primary caregivers and the significant behaviors improved during
caregivers. interaction with their primary
caregivers, and these gains
transferred to interactions with
their significant caregivers.

97
98
Table 2
Description of Reliability, Generalization, Social Validity, and Fidelity in the Reviewed Studies
Citation Reliability Generalization and Maintenance Social Validity Fidelity

Charlop-Christy & Inter-rater reliability –Children’s generalization of spontaneous speech –Parent satisfaction questionnaires were given at –Parents as trainers: Data were
Carpenter (2000) (range 90%-97%) across persons and settings was assessed with the end of each treatment week. collected about parent-implemented
probes at the end of each 1-week treatment –Questions assessed the ease of implementation in interventions (e.g., procedural errors).
period. the home and the treatment’s utility in promoting
–Follow-up data involving modified incidental spontaneous speech.
teaching training were collected for 1 child
during weeks 3, 4, and 5 of treatment.
Drew et al. (2002) Not reported Not reported Not reported Not reported
Elder et al. (2005) Inter-rater reliability Not reported –Parent satisfaction questionnaire was given at the –Parents as trainers: Data were
(range 77.7%-89.9%) end of the study. collected on fathers’ use of the
–The median rating for overall parental satisfaction targeted teaching strategies.
with the program was 5.0 (the highest possible
rating).
Ingersoll & Gergans Inter-rater reliability –Children’s behaviors were assessed twice at home Parent satisfaction survey was given at the end of –Parents as trainers: Data were
(2007) (Cohen’s Kappa range during baseline and at the end of treatment. the study to rate parents’ level of agreement with collected on parents’ use of the
.64-.99) –Follow-up data were collected 1month after positive statements about the program. All targeted teaching strategies.
treatment. statements were rated with an agreement level of
6.3 or higher on a 7.0 scale.
Jones et al. (2006) Interobserver reliability –Children’s behaviors were assessed with novel Not reported Not reported
(range 92%-100%) stimuli (e.g., toys and pictures) and routines.
–Parents were asked to implement at least 5
expansion opportunities per week.
–Maintenance data were collected.
Kaiser et al. (2000) Interobserver reliability –Parents’ use of strategies was assessed in an –Parent satisfaction questionnaire was given at the –Parents as trainers: Data were
(mean of parent untrained setting (the home) across 3 sessions at end of the study. collected on parents’ use of the
behaviors 90.3%; the end of baseline and 3 sessions at the end of –On a 5-point scale, the mean rating for 13 scaled targeted teaching strategies.
mean of child intervention. items for the 6 parents was 4.96.
behaviors 82.1%) –Children’s language skills were assessed at home. –All 6 parents rated their overall satisfaction with
–Follow-up data were collected across 3 sessions at the interventions (on a 1-5 scale).
the end of the 6-month period.

(continued)
 Table 2 (continued)
Citation Reliability Generalization and Maintenance Social Validity Fidelity

Kashinath et al. Interobserver reliability –Parents’ behaviors were assessed in untrained –Parent satisfaction questionnaire was given at the –Parent training: Treatment fidelity was
(2006) (average for parent contexts/routines twice weekly. end of the study. monitored during each home visit.
strategy use 87%- –Once strategy use was observed in an untrained –Questions addressed the utility of embedding the –Parents as trainers: Data were
89%; average for routine for 3 consecutive sessions, the second intervention within routines, the most useful teaching collected on parents’ use of the
child objectives 89%- intervention strategy was introduced. approach, the usefulness of teaching strategies that targeted teaching strategies.
91%) were introduced, and the applicability of the teaching
strategies across different activities.
–The mean score of parents’ perceptions was 3.8,
with 4 being the most favorable score.
Mahoney & Perales Interobserver reliability Not reported Not reported –Parents reported on their use of the
(2003) (range of reliability for strategies.
Maternal Behavior –Parents’ interaction styles with
Rating Scale 56%- children were measured pre- and
60%) postintervention.
Moes & Frea (2002) Interobserver reliability –Children’s behavior was assessed in untrained –Family interviews were conducted at the –Parents as trainers: Fidelity-of-
(percentages were routines. completion of the study. implementation checklist was
not specified) –Follow-up probes were conducted at 2-month –Detailed information regarding the caregiving completed by an observer on parents’
intervals for 1 year after the training was demands associated with the target routines, use of the strategies.
completed. individual family member needs for support, and
communication goals and social interactions families
would like to achieve within those routines emerged.
Rogers et al. (2006) Interobserver reliability –Parents reported on children’s words in the home. Not reported –Parent training: Fidelity rating systems
(range of kappas for –Follow-up data were collected 3 months following were used.
children’s behavior the completion of the study. –Parents as trainers: Parent
.62-.92) implementation of the intervention
models was monitored via parent
report.
Seung et al. (2006) Inter-rater reliability –Maintenance data were collected. Not reported Not reported
(agreement rate on –Positive changes either decreased or remained the
language same from intervention to maintenance except for
transcription 93%) the production of different words, which
continued to improve.
Symon (2005) Inter-rater reliability –Generalization of the strategies taught to primary Not reported –Parents as trainers: Data were
(range for parent caregiver and to other caregiver was assessed. collected on parents’ use of the
behavior 71%-100%; –Follow-up data were collected at 2 weeks and 1 targeted teaching strategies.
range for children’s month following the completion of the study.
behavior 74%-100%)

99
100   Topics in Early Childhood Special Education
Carpenter (2000) compared the effects of modified inci-
dental teaching sessions (MITS), discrete trial, and tradi-
tional incidental teaching with three boys with autism.
Using an alternating treatment design along with a multiple-
baseline design across children, changes in the boys’
verbalizations were assessed. Results indicated that par-
ents learned each targeted teaching strategy and made
relatively few errors during the treatment conditions. In
addition, MITS led to better acquisition and generaliza-
tion than the two other procedures. The authors noted that
the stronger acquisition of MITS could be because this
strategy was “designed to incorporate those aspects of
both incidental teaching and discrete trial that facilitate
acquisition” (p. 109). In addition, MITS incorporated
many factors typically associated with generalization
(i.e., loose training, multiple exemplars), leading to gen-
eralization of target behaviors by all three participants.
In contrast to the two studies described earlier, the
next two studies (Drew et al., 2002; Rogers et al., 2006)
compared two very different interventions. Rogers et al.
compared two communication interventions: the Denver
Model (which merges behavioral, developmental, and
relationship-oriented interventions) and PROMPT
(Prompts for Restructuring Oral Muscular Phonetic
Targets; a neurodevelopmental approach for speech pro-
duction disorders). After randomly assigning 10 verbal
boys with autism to each treatment approach, parents
were taught skills by therapists in clinic settings and
encouraged to practice the strategies with their children
on a daily basis at home or in other natural settings.
Results revealed that 8 of the 10 children demonstrated
functional and spontaneous use of at least five novel
words by the completion of treatment. Children who
participated in both models showed some gains in the
integration of verbal and nonverbal communication (i.e.,
imitation, functional play), and the researchers reported
that the parents “followed through at some level at
home” (p. 1021).
In a pilot study, Drew et al. (2002) conducted a ran-
domized control trial to compare a parent education
intervention with locally available services. Twenty-four
young children with autism and their parents were ran-
domly assigned to either a parent education group or a
local-services-only group. The parent education sessions
focused on behavior management, joint attention, non-
verbal social communication, and language. A speech
and language therapist conducted a weekly 3-hour session
with the parent group for 6 weeks. The local services
group received typical early intervention home-based ser-
vices. According to the authors, “There was some evi-
dence that the parent training group made more progress
in language development than the local services group”
(p. 266); however, the authors also highlighted the limi-
tations to their study (e.g., reliance on parent report for
child outcome data, lack of fidelity of implementation
data).
Evaluation studies. Four studies were designed to
evaluate the effects of specific interventions. Mahoney
and Perales (2003) investigated the effectiveness of a
relationship-focused intervention on the social emotional
behavior of 20 young children with ASD. The relation-
ship-focused intervention had numerous predefined or
pivotal intervention objectives, which address global
developmental behaviors (i.e., attachment, cooperation,
empathy, self-regulation). Mothers and children partici-
pated in individualized weekly sessions conducted in
their homes or in center-based settings. Comparison of
pre- and postintervention data revealed that mothers
altered their interaction styles, and children’s social
interaction behavior and social emotional functioning
improved significantly from pre- to postintervention.
In three other evaluation studies, parents were taught
to imitate their children in order to increase communica-
tion and social behaviors. Ingersoll and Gergans (2007)
examined the effectiveness of a parent-implemented
intervention on the object (e.g., action with toys) and
gestural (e.g., body movement) imitation skills of three
young children with ASD. Two boys and one girl and
their mothers participated in this study. The intervention
phase was conducted in a clinic setting, and follow-up
data were gathered in home settings. The reciprocal imi-
tation training included three phases: (a) increasing
mother-child reciprocity using contingent imitation;
(b) increasing object imitation by modeling, prompting,
and praising; and (c) increasing gestural imitation by
modeling, prompting, and praising. Ingersoll and
Gergans found that the mothers learned to use the inter-
vention strategies and used them in both clinic and home
settings. In addition, the three children demonstrated
increases in both object and gestural imitation.
In one of only two naturalistic studies that specifically
focused on fathers, Elder et al. (2005) evaluated the
effects of an in-home program on the acquisition of skills
by fathers of 18 young children with autism. The com-
munication skills of the children also were evaluated.
Parent education consisted of two components: (a) expect-
ant waiting, during which the father was taught to prompt
the child to communicate (e.g., “say ball”) and then wait
at least 3 seconds for a response, and (b) imitation with
animation, whereby the father was taught to imitate his
child’s behavior using an exaggerated affect or lively

movement. Using single-subject methodology and tradi-
tional group analysis, data revealed that fathers acquired
and implemented the skills taught. Fathers demonstrated
significant increases in imitation with animation during
both conditions. Children demonstrated increases in ini-
tiating, but surprisingly, significant increases were not
observed in children’s rates of responding.
In another study that focused on fathers’ use of imita-
tion, Seung et al. (2006) conducted a retrospective
analysis of some of the data collected by Elder et al.
(2005). Eight of the original 18 families who partici-
pated in the Elder et al. study gave permission for their
videotapes to be reexamined. Seung and colleagues
focused on the efficacy of a parent education program
on the verbal behavior of eight young children with
ASD. The authors found that in addition to the fathers
learning the strategies, children demonstrated increases
in their use of one-word utterances and in the number of
different words they used from baseline to intervention.
However, changes in the children’s verbal communica-
tion from baseline to intervention were not statistically
different.
Evaluation and generalization studies. Four of the 12
identified studies examined the effectiveness of parent-
implemented interventions and, in addition, looked at gen-
eralization of the intervention. Jones et al. (2006) conducted
three studies focusing on joint attention skills of children
with autism (only the second study met all inclusion criteria
for the current literature review and therefore is included in
this review). In the first study, teachers were trained in dis-
crete trial instruction and pivotal response training (PRT)
strategies to increase the joint attention skills of five young
children with autism. In the second study, the parents of two
of the five children from Study 1 were taught to extend their
children’s joint attention skills learned in Study 1 to differ-
ent toys and routines. The authors reported that the children
acquired joint attention skills with their parents as quickly,
or more quickly, than they did with their teachers in
Study 1. As a result of the parent-implemented intervention,
the two target children demonstrated improvements in their
frequency of responding and initiating joint attention. The
children also generalized their responding and initiating to
novel stimuli, including new toys, pictures, and routines.
Study 3 included secondary analyses of data from Studies 1
and 2, with a focus on additional dependent measures and
the social validity of the intervention.
In another evaluation and generalization study, Symon
(2005) evaluated the generalized effects of a train-the-
trainer model by assessing whether the communication
and social interaction skills of three preschool boys
Meadan et al. / Parent-Implemented Interventions   101  
improved during time spent with newly trained caregiv-
ers. Using a nonconcurrent multiple-baseline design to
evaluate the spread of effects, parent-child interactions
along with the child’s interactions with another caregiver
were evaluated. Results showed that parents mastered
PRT techniques and generalized their skills into home
settings. In addition, a spread of effects was realized as
other caregivers acquired the PRT skills, and child out-
comes (appropriate behavior and increased social com-
munication skills) were observed during interactions
with both parents and other caregivers.
In two additional studies, researchers evaluated an
intervention and the generalization of intervention effects
to different settings or routines. Using single-subject
methods, six mothers were taught to use enhanced milieu
teaching (EMT) in a study by Kaiser et al. (2000). By
combining a responsive conversational style with prompt-
ing and modeling strategies, EMT addresses several criti-
cal components necessary to build social communication
skills for young children with autism. Although training in
this naturalistic language intervention approach occurred
in a university-based clinic setting, generalization and
maintenance sessions were conducted in home settings.
Data revealed that the mothers learned to use EMT and
generalized their use of the strategies to home settings. In
addition, preschoolers demonstrated increases in prompted
and spontaneous use of target words.
To examine generalization across routines, Kashinath
et al. (2006) not only assessed generalization but also
programmed for generalization. These researchers exam-
ined whether using a routine-based intervention would
facilitate parents’ use of teaching strategies at home. The
researchers also investigated whether parents were able
to generalize the use of the teaching strategies to a novel
routine and how the routine-based intervention affected
children’s communication skills. The researchers fol-
lowed general case principles (Horner, Sprague, &
Wilcox, 1982) in an attempt to program for generaliza-
tion while emphasizing the contextual fit between parent
strategies, child communication goals, and the identified
routines. Using a multiple-baseline design across teach-
ing strategies, positive changes in parental strategy use
and increases in child communication outcomes were
observed for all five dyads.
Conclusions, Limitations,
and Implications
Three types of studies were found that address the
topic of home-based parent-implemented interventions
102   Topics in Early Childhood Special Education
to support the development of social and communication
skills by young children with ASD or PDD (compara-
tive, evaluation, and evaluation with generalization com-
ponent). Overall, a review of these studies using a
study-within-a-study framework revealed positive results
both for parents and children. All 12 teams of researchers
reported that parents were able to learn and implement
new strategies with their young children in natural envi-
ronments. In addition, all research teams reported that
parents’ positive behavior changes resulted in positive
changes in children’s target behaviors.
In the past, parent-focused interventions typically
have occurred during very structured situations in clinic
or home settings (Kashinath et al., 2006); however, all of
the reviewed studies included a component within natu-
ral settings and routines in the home environment. The
data from these 12 studies support those of other
researchers who have stressed that parents can learn new
strategies and use them with their children in natural
environments to realize positive changes in children’s
social and communication skills (Koegel, 2000). The
next step needed to translate this research to parents is to
develop and disseminate more “parent-friendly” materi-
als that describe these evidence-based intervention strat-
egies in jargon-free language and that are readily
available for parents to use with their young children.
Although some materials for families were developed
for specific interventions (e.g., PRT), many parents do
not know about these materials or do not have appropri-
ate training or feedback systems to implement them
appropriately. In addition, there is an urgent need to
teach current and future educators and other profession-
als (i.e., speech language pathologists, behavior special-
ists) how to share research-based strategies with families
so that more families can support their children’s skill
development in natural environments.
Although the 12 studies that were reviewed focused
on home-based parent-implemented interventions, these
studies represent a wide range of (a) research questions
(e.g., comparisons between different interventions,
assessing the effectiveness of a single intervention),
(b) research methodologies (e.g., single-subject design,
group design), (c) dependent variables measured for
children (e.g., imitation, joint attention, responding), and
(d) type of parent-implemented strategies and the theo-
retical framework underlying these strategies (e.g., FCT
and incidental teaching, behavioral and cognitive frame-
works). Due to the limited number of studies that met the
criteria for inclusion and the variability across investiga-
tions, generalization of the findings from these 12
reviewed studies is limited. In addition, although we
included only home-based interventions, we used a
broad definition of home-based in that we included stud-
ies in which generalization was done at home even if the
intervention was conducted in a clinic setting (e.g.,
Kaiser et al., 2000).
When critically evaluating research studies, certain
questions must be addressed, including (a) Does the
implemented intervention have strong scientific support?
(b) Was the intervention implemented correctly (i.e.,
fidelity of implementation measures)? (c) Does the
research method control for external and internal valid-
ity? (d) Are the outcomes positive and important? (e) Are
the outcome data reliable (i.e., reliability measures)?
(f) Are the outcomes generalized (i.e., generalization and
maintenance measures)? and (g) Are the goals, proce-
dures, and outcomes socially or clinically important (i.e.,
social validity measures). In addition, researchers who
use a study-within-a-study framework should collect
data both on parent and child behaviors, for it is not
enough to document parent behavior change if child
behavior is not realized as well.
The information provided in Tables 1 and 2 reveals con-
siderable differences across researchers on the information
provided. Although all 12 reviewed studies reported posi-
tive outcomes, a closer evaluation of these studies reveals
considerable strengths and weaknesses. For example, only
a few of the studies included complete information on
important variables such as fidelity of implementation and
generalization, resulting in less strength for the studies that
did not report on these variables.
It is also important to note that the intervention strate-
gies highlighted in the studies reviewed in this article
varied in their scientific support. A few of the interven-
tions have been evaluated and replicated by several teams
of researchers and seem to have strong scientific support
(e.g., applied behavior analysis, incidental teaching, FCT),
whereas other strategies have been evaluated only in lim-
ited number of studies, and therefore their scientific sup-
port is limited. Further research is needed on potentially
promising parent-implemented interventions that have
limited, but positive, empirical support. In addition, most
of the studies reviewed did not include information about
other services and therapies the participating children
received during the intervention, and therefore it is diffi-
cult to pinpoint the influence of these variables on the
outcomes of the parent-implemented interventions.
Studies with small sample sizes are common in the
area of family research; however, generalization of the
results of these studies is limited. Sample size in the 12
studies reviewed ranged from 2 to 20 children. Large-
scale studies are needed to identify factors that are
related to the success of a particular intervention. Large-
scale studies will require researchers to collaborate

across university boundaries and would benefit from
federal funding for behavioral research centers that sup-
port the implementation of large-sample studies. In addi-
tion, it is important to study the effectiveness of
parent-implemented strategies by parents and other fam-
ily members from diverse cultural, linguistic, economic,
and social backgrounds. More studies where fathers are
the primarily interventionists also are needed.
Six of the reviewed studies assessed social validity by
surveying parents’ satisfaction at the end of the interven-
tion. Researchers need to carefully plan for and investi-
gate the social validity of an intervention. In his seminal
piece, Wolf (1978) suggested three levels of social valid-
ity that continue to be relevant today: (a) the social sig-
nificance of the goals, or the importance of the goals for
society; (b) the social appropriateness of the procedures,
or the acceptability of the intervention by consumers; and
(c) the social importance of the effect or consumers’ sat-
isfaction with the results of the intervention. In addition,
procedures such as social comparison and subjective
evaluation can be used to evaluate social validity (Kazdin,
1977). In the social comparison method, the behavior of
the participant before (i.e., goals) and/or after (i.e., out-
comes) the intervention is compared with the behavior of
a normative group (e.g., typically developing children),
and the intervention used is compared to other interven-
tion procedures with the same goals. In the subjective
evaluation method, the opinions of others are assessed to
determine whether the intervention goals, procedures,
and outcomes are important and meaningful. For exam-
ple, the behavior of the participant would be evaluated by
experts or by significant others who are familiar with the
participant to determine whether the goals of the inter-
vention are important, the procedures are acceptable, and
the changes are meaningful. As mentioned above, only 7
of the 12 reviewed studies included social validity mea-
sures. However, in these studies, only one indicator of
social validity was measured: parent satisfaction. Parents
were given a satisfaction questionnaire at the end of the
intervention, which included questions related to the pro-
cedures used and outcomes. Although parent satisfaction
is important, it is not a sufficient measure of social valid-
ity. Additional social validity measures, including social
comparison methods, are needed in the area of parent-
implemented interventions. Investigations that systemati-
cally address social validity are clearly needed as
researchers design and implement intervention studies
focusing on the social communication skill development
of young children with ASD.
Other methodological issues to be considered by future
researchers include the assessment of fidelity of imple-
mentation and generalization. Only limited information
Meadan et al. / Parent-Implemented Interventions   103  
related to fidelity of implementation was provided in
most of the reviewed studies. Most of the researchers
who presented fidelity data collected information on the
parents’ use of the new strategy. Data were collected by
observing parent behavior (e.g., Elder et al., 2005), com-
pleting fidelity checklists (e.g., Moes & Frea, 2002), or
gathering parent report data on the use of the strategy
(e.g., Mahoney & Perales, 2003). Only two studies
(Kashinath et al. 2006; Rogers et al., 2006) reported on
the fidelity of parent education; this type of information
should be included in all studies. Because fidelity of
implementation is a very important variable in the evalu-
ation of the effectiveness of an intervention, it should be
routinely measured and clearly described by researchers.
In addition, although a few of the studies included gener-
alization data on parent and child behavior, it is important
to plan and program for generalization and not just assess
it (Kashinath et al., 2006). Further research on parent-
implemented interventions should include strategies that
support the generalization of skills.
Findings from this review reiterate what is often recom-
mended by intervention researchers—the need for addi-
tional replications of promising intervention strategies,
with diverse families, by other research teams. Ample
studies exist in the literature to demonstrate the success of
various interventions with young children with ASD or
PDD, when implemented by teachers, therapists, and
other professionals. Families must be recruited as partners
and interventionists to achieve positive outcomes for
young children with ASD and PDD. As McWilliam
(2000) emphasized, a few hours of therapy each week
does not result in the type of developmental gains for chil-
dren compared to those achieved by teaching families
intervention strategies and encouraging them to take
advantage of the “teachable moments” they have with
their children in home and community environments.
Researchers are encouraged to take advantage of
many parents’ interest in and motivation to work with
their children to support learning and development. As
experts on their children, parents can assist professionals
in designing high-quality, individually appropriate inter-
ventions, with the potential to make the interventions
more efficient and effective. When parents assume the
role of interventionists, there is an increased likelihood
that they will follow up with their children on the newly
learned skills and encourage them to continue to improve
their skills. As more parents become knowledgeable
about different evidence-based strategies, these parents
can serve as mentors to other families, thus spreading
information on recommended practices to additional
families with children with ASD and PDD who are in
need of this knowledge and these skills.
104   Topics in Early Childhood Special Education
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Hedda Meadan, PhD, is an assistant professor of special education at
Illinois State University. Her current interests include social and com-
munication behavior of young children with disabilities.
Michaelene M. Ostrosky, PhD, is a professor of special education
at the University of Illinois at Urbana–Champaign. Her research in-
terests focus on young children’s social emotional competence and
challenging behavior.
Hasan Y. Zaghlawan, MS, is a doctoral candidate at the department of
special education at the University of Illinois at Urbana–Champaign.
His research interests focus on early social and communication de-
velopment of young children with autism and challenging behaviors.
SeonYeong Yu, MA, is a doctoral student at the department of special
education at University of Illinois at Urbana–Champaign. Her cur-
rent interests include peer relationships and friendship development
of young children with disabilities.
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