Editorial: One Good Thing (Sometimes) Leads to Another: Demonstrating Mechanistic Connections Between Parent and Child Outcomes in a Community Implementation Autism Trial

TY - JOUR

T1 - Editorial

T2 - One Good Thing (Sometimes) Leads to Another: Demonstrating Mechanistic Connections Between Parent and Child Outcomes in a Community Implementation Autism Trial

AU - Charman, Tony

N1 - Funding Information: Disclosure: Dr. Charman has received grant or research support from the Medical Research Council (UK), the National Institute for Health Research, Horizon 2020, and the Innovative Medicines Initiative (European Commission), Autistica, Epilepsy Research UK, the Baily Thomas Charitable Fund, the Charles Hawkins Fund, and the Waterloo Foundation. He has served as a consultant to F. Hoffmann?La Roche and Servier. He has received royalties from Sage Publications and Guilford Publications. The author has reported no funding for this work. Funding Information: Disclosure: Dr. Charman has received grant or research support from the Medical Research Council (UK), the National Institute for Health Research , Horizon 2020 , and the Innovative Medicines Initiative (European Commission), Autistica , Epilepsy Research UK , the Baily Thomas Charitable Fund, the Charles Hawkins Fund, and the Waterloo Foundation . He has served as a consultant to F. Hoffmann–La Roche and Servier. He has received royalties from Sage Publications and Guilford Publications. Publisher Copyright: © 2020 American Academy of Child and Adolescent Psychiatry Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3

Y1 - 2021/3

N2 - This is an important study for several reasons and shows a positive way forward for the design, execution, and analysis of intervention trials in the autism field. Brookman-Frazee et al.1 present a novel analysis demonstrating that their community training program, An Individualized Mental Health Intervention (AIM HI), which has been shown to improve behaviors that challenge in young children with autism,2 also leads to improvements in parental sense of competence (but not caregiver strain). This is in line with a limited number of other recent studies that have addressed the same issue.3,4 The present report adds to our knowledge in at least 2 important ways; both investigating the mechanisms of how these outcomes might come about. First, the study demonstrates that implementation of the training during the period of intervention, specifically, continuity across treatment sessions and the effectiveness with which a therapist pursued teaching a caregiver skill, mediated improvements in parental sense of competence at the end of treatment. Of note, these process or fidelity implementation ratings were blind coded by naïve raters trained to reliability on video-recorded sessions, an example of the high-quality methodology valued by expert trialists. Second, the authors not only show that changes in parental sense of competence during the intervention are associated with reductions in child behaviors that challenge at the end of the treatment period, they also conducted a formal mediation analysis that further demonstrates that changes in parental sense of competence during the treatment period are related to improvements in child outcomes at 12 and 18 months, long after the intervention period itself. There have long been calls highlighting the value of such mechanistic analysis to get “maximum value” from the precious resource of intervention trials,5 but these have only rarely been taken up in the autism intervention field.6

AB - This is an important study for several reasons and shows a positive way forward for the design, execution, and analysis of intervention trials in the autism field. Brookman-Frazee et al.1 present a novel analysis demonstrating that their community training program, An Individualized Mental Health Intervention (AIM HI), which has been shown to improve behaviors that challenge in young children with autism,2 also leads to improvements in parental sense of competence (but not caregiver strain). This is in line with a limited number of other recent studies that have addressed the same issue.3,4 The present report adds to our knowledge in at least 2 important ways; both investigating the mechanisms of how these outcomes might come about. First, the study demonstrates that implementation of the training during the period of intervention, specifically, continuity across treatment sessions and the effectiveness with which a therapist pursued teaching a caregiver skill, mediated improvements in parental sense of competence at the end of treatment. Of note, these process or fidelity implementation ratings were blind coded by naïve raters trained to reliability on video-recorded sessions, an example of the high-quality methodology valued by expert trialists. Second, the authors not only show that changes in parental sense of competence during the intervention are associated with reductions in child behaviors that challenge at the end of the treatment period, they also conducted a formal mediation analysis that further demonstrates that changes in parental sense of competence during the treatment period are related to improvements in child outcomes at 12 and 18 months, long after the intervention period itself. There have long been calls highlighting the value of such mechanistic analysis to get “maximum value” from the precious resource of intervention trials,5 but these have only rarely been taken up in the autism intervention field.6

UR - http://www.scopus.com/inward/record.url?scp=85101092686&partnerID=8YFLogxK

U2 - 10.1016/j.jaac.2020.12.005

DO - 10.1016/j.jaac.2020.12.005

M3 - Editorial

C2 - 33310160

AN - SCOPUS:85101092686

SN - 0890-8567

VL - 60

SP - 338

EP - 339

JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

IS - 3

ER -