Sibling-Mediated Intervention for Autism

Recruiting at 2 trial locations

Overseen By Katie Castro

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Arizona State University

Disqualifiers: Aggression, Noncompliance, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

40 Participants Needed

Trial Summary

What is the purpose of this trial?

Given the increasing prevalence of autism spectrum disorder (ASD), estimated to be 1 in 68 in the United States alone, ASD has become one of the fastest-growing pediatric concerns. The deficits of children with ASD range across social communication and academic skills. One of the effective interventions that have been used commonly for ASD is the model-lead-test, which includes modeling, prompting children to practice target skills together, and providing children with affirmative feedback or error correction. Previous research has demonstrated that the model-lead-test is successful in teaching different skills for individuals with ASD, including functional, social, and academic skills. The vast majority of the studies had researchers, therapists, or teachers implement the intervention. However, there is clear empirical support and implications for interventions mediated by more familiar persons, such as parents and siblings, which may lead to better effects, maintenance, and generalization due to more practice opportunities in the natural environments. Research has supported the effectiveness of using parents or peers as agents to deliver interventions for individuals with ASD, whereas fewer studies explored the use of siblings to deliver or mediate intervention. As typically developing siblings are an essential part of the daily life of children with ASD, it makes logical extensions to have siblings as mediators to deliver interventions. In the initial findings, the investigators found the typically developing siblings can accurately implement the model-lead-test procedure that improved various skills of their siblings with ASD. This project will extend these findings by examining the efficacy of the sibling-implemented intervention on early literacy (reading) and social reciprocity (conversation and play) of children with ASD as well as the sibling relationship before, during, and after the intervention.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the sibling-mediated intervention treatment for autism?

Research shows that sibling-mediated interventions can be effective for children with autism. Studies found that siblings can successfully learn and use techniques to improve social interactions and communication in children with autism, leading to increased imitation, joint engagement, and contextually appropriate statements. ^{1 2 3 4 5}

Is sibling-mediated intervention for autism safe for participants?

There is no specific safety data available for sibling-mediated interventions for autism, but a review of parent-mediated interventions, which are somewhat similar, found no significant adverse effects, suggesting they are generally safe. ^{5 6 7 8 9}

How is the sibling-mediated intervention treatment for autism different from other treatments?

The sibling-mediated intervention for autism is unique because it involves training siblings to help their brother or sister with autism improve social skills through imitation and engagement activities. This approach leverages the natural sibling relationship to enhance learning and interaction, which is different from traditional therapies that typically involve only parents or professionals. ^{1 2 5 9 10}

Research Team

Chengan Yuan, PhD

Principal Investigator

Arizona State University

Juliet Hart Bartnett, PhD

Principal Investigator

Arizona State University

Erin Rotheram-Fuller, PhD

Principal Investigator

Arizona State University

Eligibility Criteria

This trial is for children with Autism Spectrum Disorder (ASD) who can imitate actions and vocalize, and their typically developing siblings who can read. Both should be able to follow instructions. It's not specified what would exclude someone from this study.

Inclusion Criteria

Typically developing children can sound out and blend letters during reading

Both siblings can demonstrate compliance during instruction

Children with ASD can imitate physical actions and repeat vocalizations, answer common questions, label common objects and actions with adjectives

Exclusion Criteria

Children with aggression towards their siblings and noncompliance during instruction

Children with ASD who can sound out and blend letters

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-Assessment

Pre-assessments for children with ASD, typically developing siblings, and parents to establish baseline measures

5 days

Multiple visits (in-person and virtual)

Intervention

Sibling-mediated intervention with compliance training and intervention phases focusing on early literacy and social reciprocity

3 months

Ongoing sessions (virtual and in-person)

Posttest/Post-intervention

Post-intervention assessments to evaluate changes in skills and social validity

1 week

Multiple visits (in-person and virtual)

Follow-up

Participants are monitored for changes in sibling relationship, self-efficacy, and other outcomes at 3, 6, and 9 months post-intervention

9 months

3 follow-up visits (virtual)

Treatment Details

Interventions

• Sibling-mediated intervention

Trial Overview The study tests a sibling-mediated intervention where the typically developing sibling uses a model-lead-test approach to improve the ASD child's reading and social skills, as well as their relationship.

Participant Groups

Group I: Sibling-mediated intervention Experimental Treatment 1 Intervention

Children with autism will receive explicit instruction from their typically developing siblings

Group II: Treatment as usual/Sibling interaction Active Control 1 Intervention

Children with autism will spend time with their typically developing siblings for 20-30 mins at least three times a week

Who Is Running the Clinical Trial?

Arizona State University

Lead Sponsor

Trials

311

Recruited

109,000+

Findings from Research

The study involved six sibling pairs, including four children with autism, and demonstrated that siblings can effectively learn and implement reciprocal imitation training, leading to increased engagement and imitation in children with autism.

All siblings reported high satisfaction with the intervention, and objective observations showed significant improvements in the children's social interactions, suggesting that sibling involvement can be a valuable approach in autism interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a Sibling-Mediated Imitation Intervention for Young Children with Autism. Walton, KM., Ingersoll, BR.[2023]

The study involved three sibling pairs and demonstrated that normal siblings of autistic children could effectively learn and apply behavior modification techniques, leading to improved learning outcomes for their autistic siblings.

Post-training assessments showed that the normal siblings made more positive statements and fewer negative statements about their autistic siblings, suggesting enhanced understanding and relationship dynamics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral training for siblings of autistic children. Schreibman, L., O'Neill, RE., Koegel, RL.[2019]

The script-fading procedure effectively increased the number of contextually appropriate statements made by younger siblings with autism, showing lasting improvements even after the scripts were faded.

Typically developing children successfully implemented the script-fading procedure with high fidelity, indicating that they can be effective facilitators in supporting communication skills in their siblings with autism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sibling-Implemented Script Fading to Promote Play-Based Statements of Children with Autism. Akers, JS., Higbee, TS., Pollard, JS., et al.[2020]

In a study of 42 children with Autism Spectrum Disorder (ASD) who received a 3-month parent-mediated intervention, all participants showed significant improvements in symptom severity and adaptive functioning at both 3-month and 18-month follow-ups.

At the 18-month follow-up, 16.7% of the children achieved the 'best possible' outcome, with scores indicating they no longer qualified for an ASD diagnosis, highlighting the effectiveness of early intervention in altering developmental trajectories.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical outcomes of children with ASD - Preliminary findings from a 18 month follow up study. Manohar, H., Kandasamy, P.[2021]

There is a lack of consistent methods for including siblings in interventions designed for individuals with autism spectrum disorder (ASD), despite their occasional involvement in treatment programs.

The review highlights the need for more research on sibling participation in ASD interventions, identifying gaps in current studies and suggesting areas for future exploration to improve outcomes for families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sibling involvement in interventions for individuals with autism spectrum disorders: a systematic review. Shivers, CM., Plavnick, JB.[2021]

In a pilot study involving twin brothers with autism, the child receiving Applied Behavior Analysis (ABA) showed a slight improvement in communication skills, while the child receiving Developmental, Individual-differences, Relationship-based (DIR) intervention experienced a slight decline.

The study highlighted the importance of careful interpretation of the Communication and Symbolic Behavior Scales (CSBS) results when advising parents and students, and it emphasized the need for further research comparing different intervention programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief report: comparative ABA and DIR trials in twin brothers with autism. Hilton, JC., Seal, BC.[2019]

Parent-mediated interventions (PMIs) for children with autism spectrum disorders (ASDs) showed a small but clinically relevant improvement in parent-rated adaptive functioning, although the evidence is of low certainty based on a review of 30 randomized controlled trials involving 1,934 participants.

PMIs may help reduce disruptive behavior in children with ASD, with a moderate certainty of evidence indicating a significant effect, but no clear benefits were found for clinician-rated core symptoms or parental well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parent-Mediated Interventions for Children and Adolescents With Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. Conrad, CE., Rimestad, ML., Rohde, JF., et al.[2021]

Siblings of children with autism spectrum disorder (ASD) reported only slightly elevated levels of behavioral and emotional problems compared to normative data, with no statistically significant differences, suggesting that their experiences may not be as negatively impacted as previously thought.

The study found that higher behavior problems in the child with ASD were linked to decreased warmth and increased conflict in sibling relationships, indicating that while siblings may not have significant emotional issues, their relationships can be affected by the behavior of the child with ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-reported behaviour problems and sibling relationship quality by siblings of children with autism spectrum disorder. Hastings, RP., Petalas, MA.[2022]

Interactions between 18-month-old infants and their older siblings with autism spectrum disorder (ASD) showed higher levels of negativity compared to those with typically developing siblings, indicating potential challenges in these early relationships.

Sibling pairs with an older sister exhibited more positive behaviors, suggesting that gender dynamics may influence the quality of sibling interactions, which could impact the developmental trajectories of both siblings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The early development of infant siblings of children with autism spectrum disorder: Characteristics of sibling interactions. Bontinck, C., Warreyn, P., Van der Paelt, S., et al.[2018]

Children with ASD showed significantly more negative interactions when playing with older siblings compared to younger siblings, indicating that sibling age may influence interaction quality.

Parents reported more negative interactions with their children with ASD during play than when these children interacted with younger siblings, suggesting that the dynamics of play differ based on the partner involved.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Behaviors of Children with ASD during Play with Siblings and Parents: Parental Perceptions. O'Brien, ZK., Cuskelly, M., Slaughter, V.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Evaluation of a Sibling-Mediated Imitation Intervention for Young Children with Autism. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Behavioral training for siblings of autistic children. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Sibling-Implemented Script Fading to Promote Play-Based Statements of Children with Autism. [2020]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Clinical outcomes of children with ASD - Preliminary findings from a 18 month follow up study. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Sibling involvement in interventions for individuals with autism spectrum disorders: a systematic review. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Brief report: comparative ABA and DIR trials in twin brothers with autism. [2019]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Parent-Mediated Interventions for Children and Adolescents With Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. [2021]

8. England pubmed.ncbi.nlm.nih.gov

Self-reported behaviour problems and sibling relationship quality by siblings of children with autism spectrum disorder. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

The early development of infant siblings of children with autism spectrum disorder: Characteristics of sibling interactions. [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Social Behaviors of Children with ASD during Play with Siblings and Parents: Parental Perceptions. [2020]