Adaptation and adaptability investigation of Improving Parents as Communication Teachers (ImPACT) program for autism spectrum disorder

doi:10.3969/j.issn.1674-8115.2022.09.010

Abstract

Abstract:

Objective ·To adapt and investigate the adaptability of the parent-mediated intervention program “Improving Parents as Communication Teachers (ImPACT)” for autism spectrum disorder (ASD) under the background of Chinese culture. Methods ·There were 4 procedures of adaptation: information gathering, preliminary adaptation design, preliminary adaptation test, and adaptation refinement. In the information collection part, 8 experts (6 pediatrics and 2 psychotherapists) were invited to have 6 focus group discussions, and preliminary adaptation was made in the aspects of language, intervention form, program structure, cultural customs, etc., according to expert suggestions. Then 16 ASD parents were recruited to participate in the ImPACT program after the preliminary adaptation. Adaptative investigation of ImPACT was carried out simultaneously in the preliminary adaptation test stage. Results ·The adaptability investigation results of preliminary adaptation program showed that all parents believed that “the pace of the program was well controlled, and they could follow the rhythm of the therapist to complete the learning of skills”. Among these parents, 66.67% believed that “the course was fully prepared, the explanation was clear, and the goal was clear”, and 33.34% believed that “rich examples were provided to help understand intervention skills” in the learning process. As for the feedback of skill practice homework after each session, 83.33% of parents believed that “homework could be easily completed, and help them better learn intervention skills”, and all parents believed that “comments were timely, and the content of comments could help them answer questions and solve doubts”. The difficulties in mastering, i.e., the 7th session (shaping the interaction), the 6th session (teaching new imitation and play skills), and the 5th session (teaching new communication skills) were further adjusted after discussion with the expert group to make the final plan more convenient for parents to master. Conclusion ·After adaptation and adaptability investigation, a parent-mediated intervention program ImPACT which is more suitable for the families of ASD children in China has been formed.

Key words: autism spectrum disorder (ASD), parent-mediated intervention, ImPACT program, scheme adaptation, adaptability investigation

CLC Number:

R749.94

WU Danping, REN Fang, SHEN Lixiao, XUE Minbo, WANG Junli, LI Fei, XU Mingyu. Adaptation and adaptability investigation of Improving Parents as Communication Teachers (ImPACT) program for autism spectrum disorder[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(9): 1239-1246.

Figures/Tables 5

TrendMD

References 17

1	FRANCESMONNERIS A, PINCUS H, FIRST M. Diagnostic and statistical manual of mental disorders: DSM-V[M]. 5th ed. Arlington: American Psychiatric Association, 2013.
2	SCHREIBMAN L, DAWSON G, STAHMER A C, et al. Naturalistic developmental behavioral interventions: empirically validated treatments for autism spectrum disorder[J]. J Autism Dev Disord, 2015, 45(8): 2411-2428.
3	ZHOU B, XU Q, LI H, et al. Effects of parent-implemented early start Denver model intervention on Chinese toddlers with autism spectrum disorder: a non-randomized controlled trial[J]. Autism Res, 2018, 11(4): 654-666.
4	斯蒂芬·冯·特茨纳, 苏雪云, 肖非. 儿童期自闭谱系障碍的发展、评估与干预: 国际和中国视角[M]. 北京: 光明日报出版社, 2021.
	STEPHEN V T, SU X Y, XIAO F. Development, assessment and intervention of autism spectrum disorders in childhood: international and Chinese perspective[M]. Beijing: Guangming Daily Press, 2021.
5	INGERSOLL B, DVORTCSAK A. Teaching social communication to children with autism: a practitioner′s guide to parent training and a manual for parents[M]. 2nd ed. New York: Guilford Press, 2010.
6	INGERSOLL B, DVORTCSAK A. Including parent training in the early childhood special education curriculum for children with autism spectrum disorders[J]. Top in Early Child Spec Educ, 2006, 26(3): 179-187.
7	INGERSOLL B, WAINER A. Initial efficacy of project ImPACT: a parent-mediated social communication intervention for young children with ASD[J]. J Autism Dev Disord, 2013, 43(12): 2943-2952.
8	INGERSOLL B R, WAINER A L. Pilot study of a school-based parent training program for preschoolers with ASD[J]. Autism, 2013, 17(4): 434-448.
9	BEJARANO-MARTÍN Á, CANAL-BEDIA R, MAGÁN-MAGANTO M, et al. Effect of a focused social and communication intervention on preterm children with ASD: a pilot study[J]. J Autism Dev Disord, 2022, 52(4): 1725-1740.
10	SENGUPTA K, MAHADIK S, KAPOOR G. Glocalizing project ImPACT: feasibility, acceptability and preliminary outcomes of a parent-mediated social communication intervention for autism adapted to the Indian context[J]. Res Autism Spectr Disord, 2020, 76(1): 101585.
11	BARRERA M, CASTRO F G. A heuristic framework for the cultural adaptation of interventions[J]. Clin Psychol, 2006, 13(4): 311-316.
12	WONG R S, TUNG K T S, CHAN B N K, et al. Early-life activities mediate the association between family socioeconomic status in early childhood and physical fitness in early adolescence[J]. Sci Rep, 2022, 12(1): 81.
13	NARZISI A. Phase 2 and later of COVID-19 lockdown: is it possible to perform remote diagnosis and intervention for autism spectrum disorder? An online-mediated approach[J]. J Clin Med, 2020, 9(6): E1850.
14	ILIAS K, CORNISH K, PARK S A, et al. Risk and resilience among mothers and fathers of primary school age children with ASD in Malaysia: a qualitative constructive grounded theory approach[J]. Front Psychol, 2019, 9: 2275.
15	李莉. 上海市自闭症儿童家庭生活质量研究[D]. 上海: 华东师范大学, 2016.
	LI L. Study on the quality of family life of autistic children in Shanghai[D]. Shanghai: East China Normal University, 2016.
16	GHANOUNI P, HOOD G. Stress, coping, and resiliency among families of individuals with autism: a systematic review[J]. Rev J Autism Dev Disord, 2021, 8(3): 389-402.
17	贺成华. 自闭症儿童母亲压力体验的质性研究[D]. 上海: 华东理工大学, 2018.
	HE C H. A qualitative study on the stress experience of mothers of autistic children[D]. Shanghai: East China University of science and technology, 2018.

Field of adaptation	Original program	Detail of preliminary adaptation
Language	English	The researchers in the team who were proficient in both Chinese and English translated the original program and the record sheet to form the first draft of the simplified Chinese version of the program， and checked against the original English version to ensure the consistency between the Chinese version and the original version
Form of intervention	There are 6 sessions （2 h each session） of group therapy， and 6 sessions （1 h each session） of individual therapy. Group therapy alternated with individual therapy once a week	Only group therapy was carried out， but the parents′ skill practice feedback before each group therapy was extended to strengthen the parents′ mastery of the previous skill
Structure of program	Six sessions of group therapy： ① Getting started. ② Focusing on your child and adjusting your communication. ③ Creating opportunity. ④ Teaching new communication skills. ⑤ Teaching new imitation and playing skills. ⑥ Shaping the interaction and moving forward	It was difficult for parents to master two social skills （focusing on your child and adjusting your communication） in the second session， and try to use them in daily life， so that we divided the second session into 2 sessions， which gave parents more time to ask questions and understand the details. The number of group therapy sessions increased from 6 to 7
Cultural custom	The names of people， toys and game scenes in the accompanying videos conformed to the Western cultural environment	Equivalent substitutions were made according to domestic standards and customs to conform to the Chinese context. For example， names like “Johnny” and “Michael” were replaced with “小明（Xiaoming）” and “小芳（Xiaofang）” in the Chinese context； “Wheels on the bus” was replaced with “宝宝巴士（Baby bus）”. Game action “Cool hot water with ice” was replaced with “blow”

Field of adaptation	Original program	Detail of preliminary adaptation
Language	English	The researchers in the team who were proficient in both Chinese and English translated the original program and the record sheet to form the first draft of the simplified Chinese version of the program， and checked against the original English version to ensure the consistency between the Chinese version and the original version
Form of intervention	There are 6 sessions （2 h each session） of group therapy， and 6 sessions （1 h each session） of individual therapy. Group therapy alternated with individual therapy once a week	Only group therapy was carried out， but the parents′ skill practice feedback before each group therapy was extended to strengthen the parents′ mastery of the previous skill
Structure of program	Six sessions of group therapy： ① Getting started. ② Focusing on your child and adjusting your communication. ③ Creating opportunity. ④ Teaching new communication skills. ⑤ Teaching new imitation and playing skills. ⑥ Shaping the interaction and moving forward	It was difficult for parents to master two social skills （focusing on your child and adjusting your communication） in the second session， and try to use them in daily life， so that we divided the second session into 2 sessions， which gave parents more time to ask questions and understand the details. The number of group therapy sessions increased from 6 to 7
Cultural custom	The names of people， toys and game scenes in the accompanying videos conformed to the Western cultural environment	Equivalent substitutions were made according to domestic standards and customs to conform to the Chinese context. For example， names like “Johnny” and “Michael” were replaced with “小明（Xiaoming）” and “小芳（Xiaofang）” in the Chinese context； “Wheels on the bus” was replaced with “宝宝巴士（Baby bus）”. Game action “Cool hot water with ice” was replaced with “blow”

Item	Demographic information
ASD child
Age/year	4.00±0.85
Confirmed the age/year	3.56±0.93
Gender/n （%）
Male	10 （83.3）
Female	2 （16.7）
Only child or not/n （%）
Yes	10 （83.3）
No	2 （16.7）
Language/n （%）
No words	3 （25.0）
Word or phrase	8 （66.7）
Sentence	1 （8.3）
Parent
Age/year	35.1±5.97
Main caregiver/n （%）
Mother	12 （100）
Father	0 （0）
Marital status/n （%）
Married	12 （100）
Single	0 （0）
SES/n （%）
Low	3 （25.0）
Middle	6 （50.0）
High	3 （25.0）

Item	Demographic information
ASD child
Age/year	4.00±0.85
Confirmed the age/year	3.56±0.93
Gender/n （%）
Male	10 （83.3）
Female	2 （16.7）
Only child or not/n （%）
Yes	10 （83.3）
No	2 （16.7）
Language/n （%）
No words	3 （25.0）
Word or phrase	8 （66.7）
Sentence	1 （8.3）
Parent
Age/year	35.1±5.97
Main caregiver/n （%）
Mother	12 （100）
Father	0 （0）
Marital status/n （%）
Married	12 （100）
Single	0 （0）
SES/n （%）
Low	3 （25.0）
Middle	6 （50.0）
High	3 （25.0）