The objective of the present secondary analysis was to compare two short-term caregiver training interventions or preschool children with autism spectrum disorder (ASD) in the primary outcomes of joint engagement and parent behavior in the context of the home. Participants included 28 caregiver-child dyads who were randomly assigned to receive intervention for three months, either group caregiver education (CEM), or 1:1 individualized caregiver mediated intervention (CMM). Joint engagement and parent behavior was coded from 30-minute home observations at entry, exit, and 3 months post-intervention. The CMM group saw a significant positive treatment effect, with gains in both child-initiated joint engagement and parent behavior ratings. Parent behavior mediated the effect of the individualized intervention on joint engagement. This study is among the first to examine the outcomes of joint engagement and parent behavior in the natural context of the family’s home.

Introduction: Parents of children with autism spectrum disorder (ASD)

consistently report elevated levels of parenting stress. The complexities associated with raising a child with ASD put parents at greater risk, highlighting the importance of understanding potential stressors and protective factors that impact parental wellbeing. As the prevalence of ASD continues to increase, children are being screened and identified at earlier ages. Still, little is understood about parents of children at-risk and the factors associated with parenting stress within this population. The purpose of this study was to examine stress profiles for parents of very young children at-risk, and to examine the working relationship or alliance between parents and early interventionists providing a research based intervention program.

Methods: This study utilized a working alliance framework to examine the association of alliance on lowering parental stress levels over the course of a 12-week parent mediated early intervention project. 66 toddlers at risk for autism were randomized into 12 sessions of a parent-mediated intervention group or 4 sessions of a parent education group. 45 of the 66 participants were included in the current sample. Parenting stress was measured at two

time points pre and post treatment, and working alliance was measured post treatment.

Results: Findings suggest that the caregivers in this study who participated in a parent-mediated intervention for their toddler at-risk reported on average clinical levels of parenting stress, as has been reported by parents of older children with ASD. Findings also showed that caregivers who participated in a parent-mediated treatment condition demonstrated higher alliance than the monitoring group. Alliance was marginally associated with lower parenting stress at the end of treatment.

Conclusion: Future studies should examine alliance and parenting stress in larger samples as alliance could be an important factor in lowering parenting stress for families of at risk toddlers who are engaged in early intervention.

Students with ASD present as unique learners with individual characteristics which may impact their reading performance, particularly related to word reading and comprehension. While a relatively new area of research in reading, students with ASD demonstrate a pattern of below average performance on standardized measures of reading achievement, with comprehension identified as a salient area of deficit. Research remains limited in this area, however, particularly with regard to assessment of the five key areas of reading (phonological awareness, word reading/ decoding, fluency, vocabulary, comprehension). The current study provides an in-depth look at the five key areas of reading for 28 elementary-school students with a confirmed ASD and compares the reading performance of these students with a comparison group of 30 students with SLD who would be expected to show the reverse pattern of performance on reading measures (e.g., deficits in decoding and strengths in comprehension). Additionally, a mixed-methods approach is used in the exploratory examination of student reading behaviors related to comprehension. Findings indicate patterns of strengths and weaknesses for both groups of students across the five key areas, with both groups falling well below expected population norms and benchmarks in phonological awareness, decoding, fluency, and passage comprehension. In contrast, students from both groups excelled on a measure of supported comprehension. Students with ASD performed at higher levels than peers with SLD on measures of word reading and fluency, but not on measures of phonological awareness or decoding. Conversely, students with SLD performed at higher levels than peers with ASD on a measure of listening comprehension, but not on measures of vocabulary, supported comprehension, or passage comprehension. Exploratory investigation revealed that teachers perceived that students with SLD use reading behaviors at a higher rate and with a higher level of proficiency to promote comprehension than peers with ASD. Further, student interviews demonstrated that students who were low comprehenders used fewer and more passive strategies than students who were high comprehenders, regardless of ASD or SLD group membership. Implications for practice and future research are noted.

Little is known about the parenting experiences of autistic mothers, yet there is reason to believe that autistic mothers of non-autistic daughters have a unique set of experiences, especially during their daughters’ adolescence. Mother-daughter relationships are considered to be the closest of all parent-child relationships – however, the nature of parent-child interactions change during adolescence as children seek autonomy from their parents. Furthermore, differences in communication between autistic mothers and their non-autistic adolescent daughters, as proposed by the double-empathy theory of autism, may influence their relationships. The current study aimed to understand the parenting experiences of autistic mothers who have raised or are currently raising non-autistic adolescent daughters. Seven autistic mothers of adolescent (n=5) and adult (n=2) non-autistic daughters participated in semi-structured interviews. Mothers were asked about the strengths and challenges of parenting an adolescent daughter, as well as ways that they communicated with their daughters and guided their social development. An Interpretative Phenomenological Analysis (IPA) approach was implemented when analyzing the data to identify themes related to the lived experiences of autistic mothers. Four superordinate themes were identified: 1) Closeness in relationships, 2) Parenting strengths, 3) Identifying own social challenges, and 4) Building daughters’ social skills. These themes reflected feelings of affection, understanding, and support that characterized mother-daughter relationships (Theme 1) as well as the parenting strengths that mothers described (Theme 2). Mothers reported difficulties in understanding social dynamics (Theme 3) and expressed concerns about their daughters’ social development – however, they were proactive in ensuring that their daughters had opportunities for positive social interactions (Theme 4). This research therefore highlights the strengths of autistic mothers and the loving relationships they have with their daughters. Mothers in the current study also revealed specific challenges, such as interacting with other parents who often ignored or excluded them. Therefore, the current study further emphasizes the need for greater societal awareness, acceptance, and inclusion of the autistic community.

A concerning outcome of many early interventions is that skills gained over the course of treatment are not maintained after the intervention support ends. Particularly for parents who are the target of early interventions, maintenance of taught strategies may be related to a number of factors, including both parent characteristics and subsequent intervention involvement. This study explored parents' use of three specific categories of strategies taught in an early intervention program (communication strategies, engagement strategies, and time spent in dyadic joint engagement) while interacting with their children with autism over time. Participants included 86 dyads who were randomized to either a parent-mediated joint attention intervention (JASPER) in which the specific strategies were taught, or a comparison parent education intervention (PE). Maintenance of strategies learned in the intervention was examined as a function of parents' level of naturally occurring JASPER fidelity pre-treatment. For parents who were randomized to the JASPER condition, parents who displayed high levels of pre-treatment JASPER skills showed better maintenance of communication fidelity and time spent in dyadic joint engagement with their children from exit to follow-up than parents who displayed low levels of pre-treatment strategies. However, parents' level of pre-treatment JASPER strategies was not related to maintenance of communication strategies, engagement strategies, or time in joint engagement for the parent education condition. Second, for the entire sample, maintenance of parent communication fidelity, engagement fidelity, and time in dyadic joint engagement were examined in relation to participation in adult-directed behavioral interventions after program end. Participation in behavioral interventions after exit from the study was associated with more decrease in time spent in dyadic joint engagement during play from exit to follow-up. Findings highlight the importance of a match between intervention models and existing parent skills.

This study was designed to rigorously test, using randomization, a parent-to-parent advocacy mentorship program for parents of children with ASD within a low-income, mostly Latino population. The study design includes randomization to a parent IEP advocacy mentorship or to receive the program materials after intervention. Specifically, this dissertation study addresses the following research questions: RQ1: Does a parent-to-parent advocacy mentorship program for parents of young children with ASD increase their advocacy knowledge (i.e. their rights under IDEA)? RQ2: Does a parent-to-parent advocacy mentorship program for parents of children with ASD increase their family empowerment and family outcomes (i.e. their likelihood to exercise their rights under IDEA)? RQ3: What are the strengths and challenges of implementing a parent-to-parent mentorship program within an urban low-income, mostly Latino context? Therefore, this dissertation study examines the effects of PARENT- a parent-to-parent advocacy mentorship program for parents of children with ASD and other disabilities—on parent empowerment and advocacy knowledge. A total of thirty parent enrolled in the study Parents and were randomly assigned to receive the PARENT intervention or to a CONTROL group. Parents in the PARENT group (n=15) participated in 3 one-on-one meetings (biweekly from January 2018-March 2018) with a community Parent Mentor (PM) at the parent’s home or a public space. RESULTS: There was a statistically significant increase in parents’ IEP advocacy knowledge (i.e. their rights under IDEA) for parents in the PARENT group when compared to the CONTROL group. There were no statistically significant differences between the PARENT group and the CONTROL group for family empowerment or family outcomes. Qualitative interviews were conducted with 9 participants in the PARENT group. These parents reported feeling very grateful for the information they received and found the program to be very effective. Further directions are discussed, such as simplifying the logistics of intervention implementation (e.g., session schedules).

Many studies have documented the importance of emotional knowledge for later social competence in typical children (e.g., Denham, 1986; Dunn & Cutting, 1999; Schultz, Izard, Ackerman, & Youngstrom, 2001). However, less is known about the factors that lead to the development of these skills, or the growth trajectories of these skills in children with developmental disabilities. The aims of this longitudinal study were: (1) to examine the specificity and uniqueness of emotional understanding and expression in atypical populations, and (2) to identify if joint attention skills in early development are predictive of greater emotional understanding and increased positive reported expression of emotions at an older age. The initial sample consisted of 135 children: 37 with a diagnosis of an autism spectrum disorder (ASD), 66 with Down syndrome (DS), and 32 with other developmental delays (DD). At entry children were rated on initiations and responses to joint attention at a mean age of 3.17 years. At follow-up, 122 of the original children were assessed again, at a mean age of 10.7 years, on emotional labeling, identification, expression, and empathy. The ASD group had a lower rate of responding to joint attention at entry. Diagnostic group differences were also found for the DD group, with more negative expressed emotions as rated by parents, but there were no difference in teacher report of negative expressed emotions in the classroom. The DS group performed significantly worse on a number of expressive measures: labeling of negative emotions, identification of both positive and negative emotions, and empathy to a positive vignette. However, when given the same tasks receptively, the DS group did not perform significantly different than the other two diagnostic groups. Early initiations of nonverbal joint attention gestures predicted greater parent reported positive emotional expression, holding diagnostic groups constant with a coefficient of determination equal to .224. These results suggest that improvements in joint attention at a young age may have long-term consequences for later expressive affect in children with developmental disabilities. These data are consistent with other research that has found concurrent associations between joint attention and positive affect (Kasari et al., 1990) and increases in positive affect due to joint attention training (Lawton & Kasari, 2012).

Very little is known about language and communication development in minimally verbal children with autism, especially those who remain minimally verbal past the age of five. This population is rarely reported on in research and although there is evidence that some children do learn to speak after the age of five, we lack information on the course and characteristics of their language development. Studies that do include this population generally focus on discrete incremental language skills without addressing broader communication and pragmatic skills. Due to the fact that communication and social deficits are both inherent to a diagnosis of autism, an examination of not only what discrete language skills are acquired but how those skills are used in communicative interchanges is relevant. Research on communication development in typically developing children includes attention to early pragmatic and interchange level language use. Information and methods from this body of literature can be used to guide our exploration of similar abilities in minimally verbal children with autism as they become more competent communicators over time. This study examined the interchange level communication development of 42 children with autism over the course of a six-month play and engagement based communication intervention. Communication interchanges between interventionists and children with autism were observed and characterized at seven time points over six months. Interchanges were coded for frequency, length and communicative function, as well as who (adult or child) initiated each interchange. Communication repair was examined in depth, documenting attempts, success rates and strategies employed by participants. Children were observed to engage in communication interchanges for a variety of communicative functions and these interchanges increased over the course of intervention in terms of frequency, length and the proportion initiated by the child. Children's level of joint engagement at the beginning of the study was positively related to their use of long interchanges over time. 55% of the participants were observed to repair at least once during the study. Most of these repairs were successful and children used a variety of strategies.