A recent study published in the Journal of Early Intervention looked at the feasibility and effectiveness of Responsive Teaching (RT) with Saudi Arabian mothers and their children diagnosed with autism. RT is a relationship-based early intervention curriculum that was developed by study author, Gerald Mahoney of Case Western Reserve University.
“Since parenting stress and depression tend to be particularly high among parents of children with autism (as reported in the United States) and could potentially interfere with parent participation," Mahoney told us, "we wanted to determine whether our observations could be generalized to the Saudi Arabian culture.”
RT has been reported to be effective at enhancing the cognitive, communication and social emotional functioning of young children with disabilities by teaching their parents to engage in highly responsive interactions during routine activities with their children.
“Parental responsiveness is targeted by this type of intervention because this is one of the main parenting qualities that child development research literature has consistently reported to contribute to the early development of all children," Mahoney told us, "including children with significant disabilities including autism."
Dr. Turki Alquraini, a professor at King Saud University in Riyadh, Saudi Arabia asked Mahoney if he might be able to replicate this intervention in Saudi Arabia because of the need to provide cost-effective early childhood intervention services to parents and preschool aged with autism.
“Dr. Alquraini and I subsequently wrote a grant to support a two-year pilot project to examine the feasibility of this intervention with Saudi mothers and their preschool-aged children with autism,” Mahoney told us.
Despite the fact that evaluations showed that RT had been implemented effectively not only in the U.S., but in Turkey and South Korea as well, Mahoney said he and his colleagues had significant reservations as to whether this might be effective for Saudi Arabian mothers and families.
Saudi Arabian mothers have limited direct involvement in their children’s developmental intervention as there is a general acceptance of a medical model of treatment which asserts that developmental intervention services should only be implemented directly by trained professionals, such as teachers, psychologist, pathologists, and occupational therapists.
Also, research suggests that Saudi Arabian parents tend to be authoritarian in their style of interacting their children, and do not emphasize the type of parental responsiveness emphasized by RT.
“This raised the concern that parents might have difficulty with RT in so far as it encouraged a style of parenting that appeared to be in conflict with general descriptions of parenting in Saudi Arabia,” Mahoney told us. “We hypothesized there would be a large number of parents who either refused to participate in this intervention, or when participating in this intervention would fail to follow through with recommended intervention procedures.”
Researchers conducted a randomized control trial with 28 mothers and their preschool children with autism. One half of the sample received RT, while the other half received treatment as usual. RT interventionists were college-educated Saudi women who had no previous experience providing early intervention services.
The intervention was implemented weekly in parents’ homes for a four-month period of time. Pre-and post-measures of children’s language development and social functioning, as well as pre-and post-measures of mother's depression and parenting stress were collected at the beginning and completion of intervention. Parent-child interaction was assessed at the completion of intervention.
“The developmental improvements observed for children in the RT group were 44 per cent greater for social development and 37 per cent greater for language development than the improvements observed for children in the control group,” Mahoney told us. “Parents who participated in RT became significantly more responsive and affective with their children than control group mothers.”
In addition, the mother's ability to participate in RT was not impeded by their level of depression or parenting stress at the beginning of intervention. Rather, participation in RT resulted in substantial decreases in parental depression and stress symptoms.
The percentage of RT parents experiencing clinical levels of depression declined from 77 per cent to 15 per cent, while clinical levels of parenting stress declined from 100 per cent to 31 per cent. This contrasted with control group mothers who made no changes in parenting stress or depression.
“Given the cultural and treatment delivery issues identified, we thought that only a small percentage of the parents and children who participated in this study would have benefited from RT," Mahoney told us. "Yet, every one of the parents and children who participated made dramatic improvements. This was particularly surprising since our Saudi Arabian research team had limited training and experience delivering this intervention to parents.”
In addition, noted Mahoney, their sample of parents of children with autism experienced much higher levels of parenting stress and depression than what has been reported for parents in the U.S.
“We were surprised that this did not impede parents from participating in RT,” Mahoney told us. “Even more surprising, was the apparent effect RT appeared to have in mitigating the stress and depression parents were receiving since U.S. literature suggests that these types of psychosocial problems tend to persist throughout the early years of their children’s lives.”
Although this was only a small pilot study, Mahoney said results are important because they add to the accumulating evidence that relationship-based, developmental interventions such as RT provide an effective treatment for addressing the language and social development of young children with autism.
“Since this type of intervention can be provided at a fraction of the cost of many of the more intensive developmental interventions currently being used with children with autism,” Mahoney told us, “these results point to a feasible mechanism that countries that have yet to develop extensive service systems can use to address the needs for early intervention services for young children with autism and their parents.”
Patricia Tomasi is a mom, maternal mental health advocate, journalist, and speaker. She writes regularly for the Huffington Post Canada, focusing primarily on maternal mental health after suffering from severe postpartum anxiety twice. You can find her Huffington Post biography here. Patricia is also a Patient Expert Advisor for the North American-based, Maternal Mental Health Research Collective and is the founder of the online peer support group - Facebook Postpartum Depression & Anxiety Support Group - with over 1500 members worldwide. Blog: www.patriciatomasiblog.wordpress.com