Group Social ABCs: Early Intervention for Toddlers With Suspected ASD
Condition: Autism Spectrum Disorder; Autism
MeSH terms: Autistic Disorder; Autism Spectrum Disorder
Study type: Interventional

Summary: 
      The Social ABCs is an evidence-based, developmentally informed, caregiver-mediated
      behavioural intervention for toddlers with suspected or confirmed Autism Spectrum Disorder
      (ASD). It is based on principles of Pivotal Response Treatment (PRT, grounded in Applied
      Behavioural Analysis), and responsive parenting. The two key targets of this program are
      functional verbal communication and positive caregiver-child affect sharing. This
      intervention takes place in the context of play and daily routines, and in all contexts is
      made to be fun.

      In both a pilot study and a recently completed randomized control trial, toddlers whose
      caregivers received training in the Social ABCs intervention showed significant gains in
      early language development (both responsivity and initiations), increased child smiling
      (mediated by parent smiling), and a trend toward increased social orienting (one important
      manifestation of social attention).

      In an effort to make the Social ABCs more feasible for community service providers to provide
      this intervention to higher number families, an abbreviated version of the Social ABCs
      intervention is being offered in a mixed group/individual format in a clinic setting. The
      primary goal of this pilot project is to assess feasibility of this abbreviated program in
      the novel format and setting. The secondary goal is to train clinical service providers to
      facilitate this intervention, thus introducing the program into community practice.
    

Detailed description: 
      The Social ABCs intervention was developed to meet the need for evidence-based, feasible, and
      sustainable interventions for toddlers with emerging ASD. Unlike other more comprehensive
      programs, the Social ABCs selectively targets only two key developmental areas (i.e.,
      functional spoken language and positive affect). These domains were selected in order to
      promote developmental progress in areas thought to be central at this developmental stage in
      ASD. By targeting only two core domains, this program maximizes feasibility and portability
      (i.e., reduces resource demand) while effecting meaningful change with potential for
      collateral effects in untargeted, but related, areas.

      Bolstered by evidence of acceptability, feasibility, and promise from a pilot study, the
      Social ABCs was subsequently evaluated in a large two-site RCT, demonstrating the efficacy of
      this caregiver-mediated intervention for toddlers with suspected or confirmed ASD. This study
      found child-level increases in vocal responsiveness, vocal initiations, child and parent
      smiling, and a trend toward increased social orienting in toddlers with suspected or
      confirmed ASD. Findings also demonstrated that caregivers attained fidelity relatively
      quickly, rated the intervention as highly acceptable, reported increased feelings of
      self-efficacy, and did not report increased stress associated with the burden of learning and
      providing the intervention.

      Although the original Social ABCs model has demonstrated positive outcomes for children and
      their caregivers, it requires a large time commitment from both the Social ABCs coach and the
      family. Because of this, only a small number of children can receive the intervention at any
      given time in the original program. Given the urgent need for access to early interventions
      in ASD, a modified version of the Social ABCs ("Group Social ABCs") will be piloted and
      evaluated in order to increase access for more families in the community than the existing
      Social ABCs model. This new model has been carefully adapted to reach more families without
      sacrificing the meaningful aspects of the program.

      In the Group Social ABCs project, the Social ABCs intervention itself remains the same as
      previous versions in terms of targeted skills, content, the parent coaching manual, and
      evaluation of fidelity and child responsivity. The difference is specifically in the delivery
      format. While the standard Social ABCs model was designed to be delivered exclusively in
      families' homes over a 12-week period, the Group Social ABCs model is shortened to 6 weeks
      and incorporates group informational sessions at Holland Bloorview along with some
      individualized live coaching sessions that also occur in clinic. By condensing the length of
      the program, incorporating group sessions, and offering this as a clinic-based program, the
      researchers hope to provide an intervention that is comparable in efficacy but able to reach
      a larger number of children than the original model.

      Specifically, a Social ABCs coach will facilitate the intervention to small groups of 3-5
      parents at a time in a clinic setting*, rather than the family's home. This new format allows
      the program to be completed in 6 weeks, versus the current 12-week model, and also offers the
      potential benefit of creating a parent support network within the program. Parents will still
      get live, one-on-one coaching for strategies to use with their child over the course of the
      program.

      *In response to the 2020 global COVID-19 pandemic, study activities including both the group
      didactic and individual coaching sessions have shifted to an online format, with sessions
      being completed virtually. The protocol, delivery schedule, and session design remain the
      same. Baseline and follow-up data collection take place via mail and recorded video
      teleconference.

      This project is highly relevant to early intervention, and thus outcomes, for children with
      ASD. This study has the potential to validate a model that will increase access to the Social
      ABCs for a greater number of families than the original program and will be more accessible
      to busy families who may not have had time for the original program. This means families who
      would otherwise not be able to access early intervention will now be able to participate.

      The primary objective of this pilot study is to understand the impact of the Social ABCs in a
      condensed group format on child and caregiver outcomes, such as children's vocal
      communication, children's shared smiling with a caregiver, and caregiver implementation
      fidelity. The secondary objective is to identify any differences in the current project from
      previous Social ABCs findings. This may include child and/or caregiver outcomes as well as
      caregiver feelings of satisfaction with the Social ABCs training.

      The primary hypothesis predicts that vocal responsivity to caregiver prompts will increase
      over the course of training. Secondary hypotheses predict the following will increase over
      the course of the training: child-initiated vocalizations, positive emotion sharing with a
      caregiver, orienting to caregiver, and caregiver fidelity of implementation.
    

Intervention name(s): Group Social ABCs
Intervention type(s): Behavioral
Intervention description(s): Social ABCs coach will facilitate the intervention to small groups of parents in a clinic setting, rather than the family's home. This new format allows the program to be completed in 6 weeks, versus the current 12-week model, and also offers the potential benefit of creating a parent support network within the program. Parents will still get live, one-on-one coaching for strategies to use with their child over the course of the program.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Social ABCs; Early Intervention; Autism Spectrum Disorder (ASD); Toddler; Pivotal Response Treatment (PRT); Group Intervention; Parent-Mediated; Caregiver-Mediated; Social Communication; Positive Affect; Social Smiling; Social Orienting; Naturalistic Developmental Behaviour Intervention; NDBI; Autism; Early Identification