A Contextual Intervention Adapted for Autism Spectrum Disorders: A Pilot Study With Single-Subject Design

Abstract

Objective The current study aims to investigate the feasibility and effectiveness of Contextual Intervention Adapted For Autism Spectrum Disorders (CI-ASD) in occupational performance of developing ASD children and their mothers' self-efficacy. This intervention includes three components of mothers' coaching, children's sensory processing patterns, and social support of mothers. It is presented through group training sessions and individual coaching sessions using reflective questions and discussions for mothers. This intervention helps mothers to find ways to achieve their therapeutic goals. Materials & Methods This is a single-subject pilot study with ABA interrupted time-series design. The study was conducted on three mothers of children with ASD referred to Navid-e-asr rehabilitation center in Tehran, Iran in spring 2017. The participants were selected based on the inclusion criteria (children aged 3-10 years and having at least one sensory processing problem, mothers with a school diploma or higher and having sufficient ability to understand and speak Persian). We conducted the study for 18 weeks in three stages. At the first stage (baseline), the participants received Treatments As Usual (TAU) for 4 weeks. During the intervention (stage 2), besides TAU, the participants received CI-ASD for 10 weeks, including two sessions of group training for one week and 9 sessions of individualized coaching for 9 weeks. At stage 3 (follow-up), the participants received TAU again for 4 weeks. The intervention was performed by occupational therapists with 20 years of experience in the field of pediatric rehabilitation. Measurements were performed at four phases: before stage 1 (pre-test 1), after stage 1 (pre-test 2), after stage 2 (post-test), and after stage 3 (follow-up). We measured the child's occupational performance by the Canadian occupational performance measure and goal attainment scaling questionnaires. The mothers' self-efficacy was measured by the parent self-efficacy measure. We conducted a semi-structured interview after completing the intervention period to explore the acceptability of treatment and participants' experiences. The data are reported in the form of tables, graphs, and visual analysis of different stages of research. Results Two of three mothers showed considerable improvement in terms of children's occupational performance (13, 14, 22, 26 and 12, 12, 23, 29), satisfaction with children's occupational performance (13, 17, 22, 25 and 7, 7, 23, 29), goal attainment (-6, -6, +2, +6 and -6, -6, +2, +6), and parental self-efficacy (50, 53, 57, 57 and 44, 43, 49, 55). The improvement continued up to 4 weeks after the intervention. Two mothers found CI-ASD highly acceptable. The mother who left the study after 3 coaching sessions probably had difficulty in understanding and accepting CI-ASD. Conclusion CI-ASD is an acceptable intervention for children with ASD and their families. Further research is needed to determine the effectiveness of CI-ASD and identify the characteristics of families who may benefit from this intervention.