Parent coaching of music interventions for children with ASD: A conceptual framework

Parental Demand, Learning, and Satisfaction With Virtual Parent Coaching of Music Interventions

Virtual music therapy services became common during the COVID-19 pandemic and have remained a viable option for communities with access barriers. Parent coaching is a specific intervention where primary caregivers learn evidence-based strategies to support their children's development. Virtual music parent coaching has initial evidence of feasibility for families of autistic children. In this study, we used quantitative and qualitative measures to evaluate an 8-week parent coaching program. Feasibility aspects included parental demand, retention, learning, and satisfaction, interventionist's fidelity to the coaching program, and primary caregiver perspectives of outcomes, challenges, and benefits. Results indicated that caregivers learned about the research opportunity mainly through social media, with much lower response to email invitations. Eleven participants enrolled in the study, but 7 completed the program, for a 64% retention rate. Main reasons to drop out were time constraints and other responsibilities. Parents reported a high level of satisfaction and appropriate learning, as well as meaningful changes in their child's communication, understanding their child better, and valuing the accessibility and flexibility of the virtual modality. An interventionist with limited specialized training in autism but appropriate clinical experience achieved fidelity in the parent coaching model quickly. Caregivers' recommendations for improvement included providing recorded examples of the music and tailoring the written materials to each family. Suggestions for future research and practice include prioritizing social media as recruiting medium, evaluating parental disposition and time availability before initiating the program, considering siblings' needs, investigating cost effectiveness, and emphasizing the interventionist's collaborative approach with the parent.

Social interaction links active musical rhythm engagement and expressive communication in autistic toddlers

Rhythm is implicated in both social and linguistic development. Rhythm perception and production skills are also key vulnerabilities in neurodevelopmental disorders such as autism which impact social communication. However, direct links between musical rhythm engagement and expressive communication in autism is not clearly evident. This absence of a direct connection between rhythm and expressive communication indicates that the mechanism of action between rhythm and expressive communication may recruit other cognitive or developmental factors. We hypothesized that social interactions, including general interpersonal relationships and interactive music-making involving children and caregivers, were a significant such factor, particularly in autism. To test this, we collected data from parents of autistic and nonautistic children 14-36 months of age, including parent reports of their children's rhythmic musical engagement, general social skills, parent-child musical interactions, and expressive communication skills. Path analysis revealed a system of independent, indirect pathways from rhythmic musical engagement to expressive communication via social skills and parent-child musical interactions in autistic toddlers. Such a system implies both that social and musical interactions represent crucial links between rhythm and language and that different kinds of social interactions play parallel, independent roles linking rhythmic musical engagement with expressive communication skills.

Brief Report: Telehealth Music-Enhanced Reciprocal Imitation Training in Autism: A Single-Subject Feasibility Study of a Virtual Parent Coaching Intervention

PURPOSE

Telehealth delivery increases accessibility of parent-mediated interventions that teach parents skills and support autistic children's social communication. Reciprocal Imitation Training (RIT), an evidence-based Naturalistic Developmental Behavioral Intervention (NDBI) focused on imitation skills, a common difficulty in autism, holds promise for telehealth-based parent training. Imitation is also a core component of musical play during childhood and the affordances of musical play/song naturally shape parent-child interactions. We evaluate the feasibility of a music-based, telehealth adaptation of RIT-music-enhanced RIT (tele-meRIT)-as a novel format for coaching parents in NDBI strategies.

METHODS

This single-subject, multiple baseline design study included 4 autistic children (32-53 months old) and their mothers. Parent-child dyads were recorded during 10-min free play probes at baseline, weekly tele-meRIT sessions, and one-week and one-month follow-up. Probes were coded for parents' RIT implementation fidelity, parent vocal musicality, and children's rate of spontaneous imitation.

RESULTS

No parent demonstrated implementation fidelity during baseline. All parents increased their use of RIT strategies, met fidelity by the end of treatment, and maintained fidelity at follow-up. Parent vocal musicality also increased from baseline. Intervention did not consistently increase children's imitation skills. A post-intervention evaluation survey indicated high parent satisfaction with tele-meRIT and perceived benefits to their children's social and play skills more broadly.

CONCLUSION

Implementing tele-meRIT is feasible. Although tele-meRIT additionally involved coaching in incorporating rhythmicity and song into play interactions, parents achieved fidelity in the RIT principles, suggesting one avenue by which music can be integrated within evidence-based parent-mediated NDBIs.

Integrated parent-child music classes for preschoolers with and without autism: Parent expectations and experiences

Integrated recreational programs designed to support neurodiverse children and their families are important vehicles for community participation. In this mixed-methods study, we investigated the mechanisms by which parent-child music classes for autistic and neurotypical children can support community participation. Parents of autistic (n = 33) and typically developing (TD; n = 28) preschoolers were interviewed about their expectations for and experiences of participating in a 12-week psychoeducational parent-child music program. Parents completed ratings of momentary affect and social connection, and researchers coded children's behavioral engagement during classes at multiple time points throughout the program. Primary motivations for enrolling in an integrated music class included children's interest in music and opportunities for child socialization. Parent-focused reasons were less frequently endorsed as primary motivations for participation. Yet, momentary ratings indicated that music classes supported parents' affect regulation and social connection with other parents at the level of individual classes and across the program. These in-class experiences were echoed by interviews following program completion, which additionally highlighted the use of new parenting strategies through the musical activities. Since parental emotional experiences of activities, supportive community relationships, and parenting confidence are all linked with increased community participation, integrated music classes may support participation and satisfaction with community experiences.

Parent-Child Nonverbal Engagement During Read Versus Sung Book-Sharing in Preschoolers with and without ASD

Providing natural opportunities that scaffold interpersonal engagement is important for supporting social interactions for young children with Autism spectrum disorder (ASD). Musical activities are often motivating, familiar, and predictable, and may support both children and their interaction partners by providing opportunities for shared social engagement. We assessed multiple facets of nonverbal social engagement - child and caregiver visual attention and interpersonal movement coordination - during musical (song) and non-musical (picture) book-sharing contexts in caregiver-child dyads of preschoolers with (n = 13) and without (n = 16) ASD. Overall, children with ASD demonstrated reduced visual attention during the book sharing activity, as well as reduced movement coordination with their caregivers, compared to children with typical development. Children in both diagnostic groups, as well as caregivers, demonstrated greater visual attention (gaze toward the activity and/or social partner) during song books compared to picture books. Visual attention behavior was correlated between children and caregivers in the ASD group but only in the song book condition. Findings highlight the importance of considering how musical contexts impact the behavior of both partners in the interaction. Musical activities may support social engagement by modulating the behavior of both children and caregivers.

Parental Responsiveness During Musical and Non-Musical Engagement in Preschoolers with ASD

BACKGROUND

Parent-child play interactions offer an important avenue for supporting social development in children with autism spectrum disorder (ASD). Musical play is a natural and ubiquitous form of parent-child play. As a familiar, reinforcing, and predictable activity, musical play may support parent-child interactions by scaffolding children's attention to the play activities, while also providing parents with a familiar and accessible context to promote parental responsiveness. However, musical play may also impede interactions due to its sensory and repetitive components.

METHOD

12 parent-child dyads of preschoolers with ASD were video-recorded during a ten-minute play session that included musical and non-musical toys. Interactions were coded for parent and child musical engagement, as well as parental responsiveness.

RESULTS

Parent-child dyads varied in their amount of musical engagement during play, which was not related to children's language level. Overall, parents showed similar levels of responsiveness to children's play across musical and non-musical activities, but type of parental responsiveness differed depending on the play context. Parents provided significantly more physical play responses and significantly fewer verbal responses during musical vs. non-musical engagement with their child.

CONCLUSIONS

There are substantial individual differences in children with ASD's musical engagement during a parent-child free play. Children's musical engagement impacted type of parental responsiveness, which may relate to the familiarity, accessibility, and sensory nature of musical play/toys. Results suggest that musical play/toys can both support and hinder different types of parental responsiveness with implications for incorporation of musical activities into interventions.