Contextual Intervention Adapted For Autism Spectrum Disorder: Pilot ‎Research Using Single Subject Design

Objectives: The current study investigated the potential acceptability and effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) in developing children’s participation and mothers’ parenting self efficacy. Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) involving contextually reflective occupational therapy combines 3 elements: parent coaching, child’s sensory processing patterns, and social support of parents. Intervention sessions comprised group parents training and (individualized) coaching sessions, which reflective questions and discussions with mothers support them in identifying best plans to achieve their therapeutic goals. Method: In this pilot research, we employed a single subject, A-B-A interrupted time series design across 3 participants (3 mothers of children with the diagnosis of Autism Spectrum Disorders) reffered to Navid-e-asr rehabilitation center in Tehran, in spring of 2017. The participants were selected among families who have children with diagnosis of Autism Spectrum Disorders, ages 3-10 years and had at least one sensory pattern outside typical range based on the Short Sensory Profile II. Recruitment was based upon parent reports, Short Sensory Profile II data, demographic questionnaires and informed consents. The mothers’ education participated in this research were diploma or above diploma, and they could understand and speak Persian very well. We conducted the study for eighteen weeks in 3 phases. During baseline period or phase 1, the participants received treatments as usual (TAU) for 4 weeks. During intervention period or phase 2, the participants received Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) for 10 weeks, 1 week group parents mothers training (two sessions) and 9 weeks individualized coaching sessions (1 session per week), in addition to treatments as usual (TAU). During phase 3 or follow up, participants received only treatment as usual (TAU) for 4 weeks. The intervention therapist and coach was an occupational therapist, with 20 yrs. of clinical experience in pediatric rehabilitation implemented CI-ASD sessions during the study. In this pilot research, we administered outcome measures four times: prior to the study before phase 1 (pre- intervention1), after phase 1 (pre- intervention2), after phase 2 (post- intervention) and, after phase 3 (follow- up). We measured child participation by Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), and parental self efficacy by Parent Self Efficacy Measure (PSEM). We conducted semi-structured interviews after completing the intervention period to explore acceptability of treatment and participants’ experiences of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). We used visual inspection of graphed data to identify variations between phases. Results: Two of three participants )two mothers( completed the program and described growth in children occupational performance (COPM1)  [13, 14, 22, 26] and [12, 12, 23, 29], satisfaction of occupational performance (COPM2) [13, 17, 22, 25] and [7, 7, 23, 29], goal attainment (GAS)  [-6, -6, +2, +6] and [-6, -6, +2, +6], and parental self efficacy (PSEM) [50, 53, 57, 57] and [44, 43, 49, 55]. Two participants (mothers) found Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) highly acceptable. Data showed development in occupational performance (COPM1), satisfaction of occupational performance (COPM2), goal attainment (GAS) and parental self efficacy (PSEM) continued after 4 weeks follow up. One of three participant (one mother) had difficulty accepting Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) and left the study after 3 coaching sessions. Conclusion: On the report of two participants, Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) was acceptable to deliver and may show promise as an intervention for children with the diagnosis of Autism Spectrum Disorders and their families. Further research is needed to determine the effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). Since one family did not accept the Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD), it would be useful to identify characteristics of families who may benefit most from this intervention.