Moving towards a more ecologically valid model of parent-implemented interventions in autism.

Early intervention is critical for improving the long-term outcomes for children with autism (National Research Council, 2001). Training parents and other caregivers of young children with autism to implement treatment has been identified as a potential way to improve access to evidence based interventions during the critical early years Our field has a long history of successfully teaching parents to increase communication and other skills in their children with autism in research settings using primarily single-subject or quasi-experimental designs. Several recent studies that include randomized trials have shown very promising results for teaching parents of very young children with autism to integrate evidence-based strategies into daily routines with positive effects on core However, many other trials evaluating the effectiveness of parent-implemented interventions have failed to demonstrate the large effects seen in studies of therapist-implemented interventions (Carter et al., 2011; Green et al., 2010; Rogers et al., 2012). A recent meta-analysis comparing studies of parent-and clinician-implemented interventions for children with autism found significantly greater improvements in clinician-implemented studies with small to no effects in parent-implemented studies (Nahmias and Mandell, 2014). The disparity in outcomes between parent-implemented and clinician-implemented interventions may result from a variety of factors. First, manualized parent-implemented autism interventions can be complex and require extensive training and expertise to be implemented with high levels of fidelity (Rogers et al., 2012). Second, parents also have difficulty reaching the high levels of intensity typically provided in clinician-implemented trials, due to the many competing demands for their time. Third, parent-implemented interventions typically are designed to improve the child's play, imitation, and communication skills, with outcomes measured using standardized assessments after relatively brief periods of time (Carter et al. These standardized assessments may not capture improvements in these domains as well as the more specific measures usedin single-subject studies. Developing outcome measures that capture meaningful change is a critical failure of the field and has led funders like the Simons Foundation to prioritize this area of research (http://www.