The effectiveness of the Early Start Denver Model (ESDM) in a community setting: Relation with maternal sensitivity, child social responsiveness and the moderating role of maternal insightfulness
Yamit Karabelnik
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Abstract
Since social communication impairments are a hallmark of ASD, promoting such impairments and targeting children's responsiveness to- and involvement of social partners are the focus of many early interventions for children with ASD. Children's responsiveness and involvement of their parents are essential to eliciting and maintaining parental synchrony, responsiveness, and sensitivity to the child. Although the benefits of early interventions that include a parent training component on later outcomes of children with ASD have been reported , it has primarily focused on child outcomes and intervention efficacy, without a direct focus on parent-child interactions, the putative mechanism supporting children’s gains. Specifically, changes in children’s responsiveness and involvement of their parents and parental sensitivity have rarely been examined and will therefore be the focus of this study. In addition, since parental insightfulness, the ability to see things from child point of view, helps parents adjust their behavior based on accurate reading of the child's signals, the study will examine the moderating effects of insightfulness
This study will focus on the Parent training component of the Early Start Denver Model (ESDM: Rogers et al., 2012; Rogers et al., 2019), an evidenced based early intervention designed to increase the social participation of young children with ASD and especially focuses on boosting children’s social-emotional, cognitive, and language abilities. Preliminary work has investigated the implementation of the ESDM in Israeli special education preschools operated by Autism Research and Treatment center- Association for children at Risk and demonstrated its effectiveness (Sinai-Gavrilov et al., 2019). However, parental change and improvements in mother-child interaction was not reported, and will therefore be the focus of the proposed study. This study aims to 1. Investigate improvements in mother-child interaction during the ESDM intervention as reflected in in maternal sensitivity and children's responsiveness and involvement. 2. To examine the moderating role of maternal insightfulness on maternal learning and application of intervention strategies. 3. To investigate whether gains in children's responsiveness and involvement of others extend beyond the mother-child context to interactions with an unfamiliar adult.
Eighty children diagnosed with ASD and enrolled in public special education preschools for children with ASD and their mothers will be in the intervention group (ESDM N=40) or in the control group. The control preschools provide treatment as usual which is based on a Multidisciplinary Developmental Intervention (MDI: Sinai-Gavrilov et al., 2020) (N = 40). At the beginning of the school year, parents of participants in both groups will be invited to join the study. After receiving informed consent, pre-treatment child and parent measures will be collected during the first 3 months of the school year (September-November). During the 8 months of intervention, children attend the preschool for 44 hours per week, during which the treatment is delivered. Post-treatment data would be obtained in the last 2 months of the school year (July-August).
Research hypotheses are (1) Mothers in the ESDM group will have higher gains in their sensitivity compared to mothers in the control group. This might be particularly true regarding mothers who are less sensitive at baseline. (2) In the ESDM group, insightful mothers would learn the intervention strategies faster, and will show higher use of intervention strategies compared to non-insightful mothers. (3) Children in the ESDM group, will have more improvements in their involvement of- and responsiveness to their interactional partner, both with their mothers as well as with an unfamiliar adult, compared to children in the control group.
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