ASD Parent Trainer: Online Coaching for Parents of Children With Autism
Phase: NA
Conditions: Autism Disorder
Sponsor: IRIS Media Inc

 
 
 
 
 
ASD Parent Trainer: Online Coaching for Parents of Children With Autism 
NCT02469870 
Study Protocol and Analysis Plan 
3/2/17 
 

Study Protocol and Analysis Plan 
We employed a mixed-model repeated measures, randomized group design to evaluate the PR 
and TR programs, examining changes over time both within and across the programs, assessing 
whether there were improvements in each program.  All research was conducted online. 
Participants were recruited nationally. Eligible parents had to (a) have access to necessary 
technology (i.e., computer with camera and microphone, high-speed Internet connection, and a 
mobile device with current operating system) and (b) speak English. Parents had to have at least 
one child who (a) had a medical diagnosis or special educational eligibility of ASD, (b) was 
between 3 – 8 years old, (c) lived in the home of the participating parent, and (d) engaged in 
challenging behavior that interfered with at least one family routine. Eligible participants 
completed informed consent online. Parents were assigned to either the PR or TR condition 
using block randomization.  
Measures 
 
To evaluate changes over time both within and between programs, we assessed family 
quality of life; parenting stress, behaviors, and knowledge; and child behavior (adaptive and 
maladaptive) using parent report measures. Additionally, at T3 we examined parents use of and 
satisfaction with the programs. The measures described in the following sections were used. 
Quality of Life. The Family Quality of Life survey (FQOL; Summers et al., 2005) is a 
25-item measure for families raising a child with intellectual or developmental disabilities. The 
measure includes domains of parenting, emotional well-being, physical/material well-being, and 
disability-related supports using a 5-point scale with responses ranging from (1) very dissatisfied 
to (5) very satisfied. In the current study we used the mean FQOL scores for analyses, which 
demonstrated excellent internal reliability (alpha = .91 at pretest). 

Parenting Stress. The Parental Stress Scale (PSS; Berry & Jones, 1995) was developed 
to assess stress of parenting stress, and contains 18 items representing both positive and negative 
parenthood components. In the current study, it demonstrated strong internal reliability (alpha = 
.90 at all three time points), so all analyses used parents’ mean scores.   
Parenting Practices. The Parenting Scale (PS; Arnold, O’Leary, Wolff, & Acker, 1993) 
and the Bangor Mindful Parenting Scale (BMPS; Jones et al., 2014) were administered. The PS 
is a 30-item scale with three subscales (laxness, over-reactivity, and hostility). The BMPS is a 
15-item instrument designed to measure parental mindfulness measuring five domains: 
observing, describing, acting with awareness, nonreactivity, and nonjudgement. For the current 
study, we used the overall mean for the PS (alpha = .77 at pretest) and total mindful parenting 
score on the BMPS (alpha = .85 at pretest). To measure parental knowledge, we developed a 20-
item multiple choice/true-false test (alpha = .47 at pretest). The test included items related to 
principles of ABA and routine-based intervention strategies, as well as five questions on 
mindfulness practice because that content was included in the PR program.   
 
 Child Behavior. This was measured with the Strengths and Difficulties Questionnaire–
Parent Report (SDQ-P; Goodman, 1997) and the Scales of Independent Behavior-Revised (SIB-
R; Bruininks, Woodcock, Weatherman, & Hill, 1996). The SDQ is a 25-item parent-report 
version of a behavioral screening questionnaire. It assesses both positive and negative behaviors 
in the following domains: conduct problems, inattention-hyperactivity, emotional symptoms, 
peer problems, and pro-social behavior. The SBI-R is a 40-item scale that measures 14 areas of 
adaptive behaviors and 8 areas of maladaptive behaviors. The current study analyzed means of 
the total difficulty scale (alpha = .80 at pretest) and the adaptive (alpha = .92 at pretest) and 

maladaptive behaviors (alpha = .90 at pretest) subscales of the SIB-R, as well as the internalizing 
and externalizing subscale of the SDQ.     
 
Consumer satisfaction was evaluated using a 9-item, 6-point Likert scale asking about the 
participants’ use and satisfaction with the programs. The consumer satisfaction items were 
combined into a single measure with strong internal reliability (alpha = .93). Responses to open-
ended questions in the consumer satisfaction instrument were subjected to a thematic analysis by 
two separate reviewers. The responses were analyzed by compiling topics and identifying 
emergent themes using inductive content analysis. Two authors worked independently to develop 
core themes and then met to review their lists. Conflicts were discussed until consensus was 
reached.  
 
Participants were sent T1 approximately one week prior to accessing the Learning 
Management System (LMS), which housed both programs. Parents were notified to which group 
they were randomly assigned upon completion of T1. Participants were sent T2 six weeks after 
T1, and T3 was sent 4 weeks later. Honorarium checks in the amount of $50 were mailed within 
four weeks of each survey completion. Participants who did not attend any PR sessions were not 
sent T2 or T3.  
Program Descriptions 
 
Both programs focused on ABA within the context of typical family routines. The 
content guided parents to identify target routines and behaviors of concern, learn about the 
patterns that may be affecting their children’s behavior, and develop strategies to prevent 
problems, teach skills, and manage access to reinforcement. The LMS courses were divided into 
modules that included videos, written summaries of each video, fillable forms and other 
exercises to guide parents through activities to support the intervention process with their 

children, and resource materials including links to relevant websites. The parents were expected 
to complete homework for each module.  Parents were given access to the courses for the 
duration of the study and technical support was available.  
Teaching Routines. Teaching Routines was entirely self-directed. The program included 
eight modules with videos for each ranging 3 – 5 minutes in duration. The topics were 
antecedent-behavior-consequence method, creating task analyses, antecedent-based strategies, 
communication, reinforcement, teaching methods, and overcoming obstacles. Participants were 
assigned six activities using fillable forms and provided additional resources including examples, 
a glossary of terms, and a list of websites. No feedback was given to the parents apart from the 
automated completion responses. The participants were given access to the TR LMS for the 
duration of the study, but post and follow-up assessments were completed at 6 and 10 weeks 
(i.e., same as the PR condition).  
 
Practiced Routines. Practiced Routines was a facilitated program. It was organized into 
four modules that included a total of seven videos ranging from 3-13 minutes each. The topics 
overlapped with those in the TR program, but included more explicit information on function-
based strategies, as well as mindfulness practice. Participants were assigned six fillable forms, 
and provided supplemental data collection tools. Additional resources focused on mindfulness 
and PBS within family routines. Eighteen brief guided audio meditations were available to 
participants via the Practiced MindTM mobile application. The meditations focused on bringing 
the parents’ awareness to both internal and external experiences and helping them act 
intentionally. 
 
When participants were assigned to PR, they were grouped based on their availability and 
assigned to one of five parent educators. Parents were encouraged to attend a brief “tech check” 

(via WebEx) to test their computer (e.g., webcam, video) and Internet connection. The parent 
educators contacted participants prior to and between three weekly online meetings via email or 
phone, not exceeding a total of 10 minutes per participant to check on their progress and respond 
to questions. The online meetings were held using WebEx video conferencing software with 
small groups of parents (M = 3.7; range = 1 – 5) per cohort. They lasted between 1.5 and 2 hours, 
with most approaching 2 hours. Meetings were organized using PowerPointTM presentations and 
session guides. A technology support specialist was available during the meetings for assistance.  
Treatment Integrity. Because TR was self-directed, it was not necessary to evaluate 
treatment integrity beyond ensuring that the participants were able to log on to the platform and 
access all resources consistently. Specific provisions, however, were implemented in PR to 
ensure that the parent educators were consistent in delivery. Parent educators were master’s and 
doctoral level professionals experience in behavioral intervention with children with ASD and 
their families. They were provided with training that involved selected readings on positive 
behavior support and mindfulness, review of the LMS resources, and instruction on facilitating 
the sessions and using the online meeting system and LMS.  
Fidelity checks were conducted for 34% of the sessions. The fidelity checklist included 
items on content and parent participation. Fidelity for content ranged from 90-100% (M = 99%). 
Fidelity for participation ranged from 53-100% (M = 94%). Interrater reliability was conducted 
for 38% of sessions assessed by a second observer. Reliability was evaluated on an item-by-item 
basis, dividing the number of agreements by agreements plus disagreements and multiplying by 
100 to obtain a percentage. Reliability was 87.5% for the content and 97.5% for participation. 
Dosage was measured as the percent of components (e.g., videos, forms, supplemental resources) 
accessed by the participants.  

Data Analysis 
Change was evaluated over time within condition using repeated-measures t-tests. To 
address hypotheses predicting differential change in outcome measures between condition over 
time we used analysis of covariance (ANCOVA) models that allow for examination of cross-
sectional effects and mean adjusted outcomes. The ANCOVA models (adjusted for baseline 
scores) were used for analyses of change in the outcome measures at posttest and follow-up.