# Optimizing Outcomes through Sequencing Parent-Mediated Interventions for Young Children with Autism

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2023 · $649,963

## Abstract

PROJECT SUMMARY
Despite advances in early identification of and intervention for children with autism spectrum disorders (ASD),
the long-term outcomes for children with ASD remain variable. As many as 40% of children with ASD are
minimally verbal at 9 years of age, and 75% of adults with ASD have persistent social communication (SC)
difficulties. Furthermore, as many as 70% of children with ASD have a co-occurring diagnosis of disruptive
behavior (DB) disorder. Parents play an important role in SC development and in the prevention of and
intervention for DB. As such, the overarching goal of the proposed study is to: (a) determine how best to
sequence two parent-mediated interventions: an SC intervention (Project ImPACT, Improving Parents as
Communication Teachers) and a DB intervention (Parent Training for Disruptive Behavior) and (b) examine
moderators and mediators of intervention outcomes. While evidence of efficacy and feasibility exist for both of
these interventions individually, an adaptive intervention approach that considers and optimizes both
interventions has not been evaluated. This type of adaptive intervention approach may be particularly needed
in parent-mediated interventions due to the cost, burden, and complexity of teaching parents to use multiple
intervention strategies. To determine the optimal intervention sequence that considers parent moderators and
parent use of intervention strategies, we propose a sequential, multiple assignment, randomized trial (SMART)
design in which we will initially randomly assign 184 children with ASD, between 18 and 36 months of age, to
receive either the SC or DB intervention. Following each respective manualized, 12-week intervention (first-
stage intervention; SC or DB), the interventionist will measure the parents' use of intervention strategies. At
this point, all parents will be re-randomized before starting the second-stage intervention. Second-stage
intervention decisions are designed to be responsive to parents' implementation of the first-stage intervention
strategies. That is, parents who are implementing the first-stage intervention strategies with high fidelity (high
implementers) will be re-randomized to receive the same intervention at a lower frequency (Reduce) or to
receive the other intervention (Switch). Parents who are implementing the first-stage intervention strategies
with low fidelity (low implementers) will be re-randomized to receive the same intervention with an additional
parent instructional method, such as modeling and in-vivo coaching or video feedback (Augment) or to receive
the other intervention (Switch). After 24 weeks of intervention (12 weeks for first stage, 12 weeks for second
stage), we will assess child SC skills, child DB, and family life participation in everyday activities. We will also
measure parent-child joint engagement continually during intervention to examine the extent to which joint
engagement mediates intervention outcomes. The proposed resea...

## Key facts

- **NIH application ID:** 10675042
- **Project number:** 5R01DC020457-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Megan Y Roberts
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $649,963
- **Award type:** 5
- **Project period:** 2022-08-01 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10675042

## Citation

> US National Institutes of Health, RePORTER application 10675042, Optimizing Outcomes through Sequencing Parent-Mediated Interventions for Young Children with Autism (5R01DC020457-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10675042. Licensed CC0.

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