Using Parents as Implementers in a Sibling-Mediated Intervention to Improve Joint Attention in Children with ASD

Abstract

Joint attention is a foundational skill for social and language development in children with autism spectrum disorder (ASD). Peer-mediated interventions, such as Stay, Play, Talk, have been adapted to sibling-mediated interventions as neurodiverse preschool and elementary children spend substantial time in the home setting. By training neurotypical siblings and implementing the intervention in the home setting, sibling-mediated interventions aim to increase the generalization of joint attention skills, promote naturalistic social interactions, and foster meaningful relationships within the family environment. While prior studies have used researchers to train siblings rather than indigenous implementers, such as parents, the current study utilized parents as implementers to train neurotypical siblings in the Stay, Play, Talk intervention. A nonconcurrent multiple baseline design across 5 sibling dyads was used. The current study examined (1) the effectiveness of the intervention on joint attention displayed by children with ASD using visual analysis, (2) the fidelity of parent-led training, (3) the fidelity of sibling implementation following parent training, and (4) parents’ perceptions of the intervention’s alignment with family goals, cultural values, and practicality. Parent training was delivered virtually to enhance accessibility, responding to the growing need for remote intervention following the COVID-19 pandemic. Results indicated that all children with autism increased in joint attention throughout intervention, parents effectively trained the neurotypical siblings to implement the intervention, and all neurotypical siblings used the various strategies of the intervention. All parents reported that the intervention aligned with their family goals and cultural values, highlighting the importance of involving families in intervention. Findings contributed to the literature on sibling-mediated interventions and informed practices for sustainable, family-based support for children with ASD. Implications for clinical and school-based practice and future research are addressed. Keywords: Autism spectrum disorder; sibling-mediated intervention; indigenous implementers; Stay, Play, Talk; social validity; procedural fidelity; joint attention.