The Effects and Mechanism of Parent Intervention for Autism Sprectrum Disorder

The ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) is a semi-structured, standardized assessment of communication, social interaction, play, and restricted and repetitive behaviors. The Comparison Score is a standardized metric used to compare autism severity across different modules and ages. The Comparison Score ranges from 1 to 10, with higher scores indicating greater severity of autism spectrum-related symptoms (worse outcome).

The SRS-2 is a 65-item caregiver-completed rating scale that measures the severity of autism spectrum symptoms as they occur in natural social settings. Each item is scored on a 4-point Likert scale ranging from 0 (Never True) to 3 (Almost Always True). The Total Raw Score is calculated by summing the scores of all 65 items. The total raw score ranges from 0 to 195, with higher scores indicating greater severity of social impairment (worse outcome).

Mean Oxygenated Hemoglobin (Oxy-Hb) concentration in the Prefrontal Cortex (PFC) collected while the child engages in a standardized play task with their parent. Higher concentration indicates greater activation.

Participants view a battery of 3 paired paradigms presenting simultaneous social and non-social stimuli. The index is calculated as the percentage of total fixation duration spent on Social Areas of Interest (AOIs) divided by the total fixation duration on both Social and Non-social AOIs. Formula: (Duration on Social / (Duration on Social + Duration on Non-social)) * 100. The score is averaged across the 3 paradigms. Values range from 0 to 100%. Higher scores indicate a stronger preference for social stimuli.

The ABAS-II (Adaptive Behavior Assessment System, Second Edition) measures adaptive skills across the lifespan. It provides a General Adaptive Composite (GAC) score and three composite domain scores: Conceptual, Social, and Practical. These are reported as age-adjusted Standard Scores. The standard score range is 40 to 160 (Mean = 100, SD = 15). Unlike symptom scales, higher scores indicate better adaptive functioning (better outcome).

Structural MRI data (T1-weighted) is collected during natural sleep. The metric reported is the Gray Matter Volume in specific Regions of Interest (ROIs) related to social processing.

Data is preprocessed using standard pipelines (e.g., FreeSurfer). Values are reported in cubic millimeters ($mm^3$).

The CSQ is a 21-item self-report measure used to assess the impact of caring for a child with emotional or behavioral disorders. It evaluates three domains: Objective Strain, Subjective Internalized Strain, and Subjective Externalized Strain. Items are rated on a 5-point scale ranging from 1 (Not at all a problem) to 5 (Very much a problem). The Total Score is calculated by summing the scores of all 21 items. The total score ranges from 21 to 105, with higher scores indicating higher levels of caregiver strain (worse outcome).

he PSOC is a 17-item self-report scale assessed on a 6-point Likert scale. It comprises two subscales: Satisfaction (9 items, reflecting the parent's motivation and frustration) and Efficacy (8 items, reflecting the parent's perceived competence and problem-solving ability). Items in the Satisfaction dimension are reverse-coded so that higher scores reflect greater satisfaction. The Total Score is the sum of all 17 items, ranging from 17 to 102. Subscale scores range from 9-54 (Satisfaction) and 8-48 (Efficacy). Higher scores indicate higher parenting self-esteem and better coping capability (better outcome).

The RBS-R is a caregiver-rated questionnaire designed to measure the breadth and severity of repetitive behaviors in individuals with autism. It typically consists of 43 items grouped into six subscales (Stereotyped, Self-injurious, Compulsive, Ritualistic, Sameness, and Restricted Behavior). Each item is rated on a 4-point Likert scale ranging from 0 (Behavior does not occur) to 3 (Behavior occurs and is a severe problem). The Total Raw Score is the sum of all 43 items, ranging from 0 to 129. Higher scores indicate greater severity of repetitive behaviors (worse outcome).

he Social Communication Checklist is a psychometrically validated measure designed for the Project ImPACT intervention (Wainer, Berger, & Ingersoll, 2017). It assesses child progress across four domains: Social Engagement, Expressive Communication, Receptive Communication, and Imitation/Play. Items are scored on a frequency scale: 1 (Rarely/Not yet), 2 (Sometimes), and 3 (Frequently). (Note: Specific items 32-36 have weighted scoring for verbal/non-verbal strategies). The Total Score is the sum of all item scores, ranging from 70 to 215. Higher scores indicate better social communication skills (better outcome).

Raw scores for the Social Affect (SA) and Restricted and Repetitive Behavior (RRB) domains, as well as the Overall Total Score. The specific algorithm (Module 1 "Few to No Words", Module 1 "Some Words", Module 2 "Younger than 5", or Module 2 "Older than 5") is determined by the participant's age and language level. Scores are summed, with higher scores indicating greater severity of autism spectrum-related symptoms (worse outcome). Scale Ranges: Social Affect (SA): 0 to 21, Restricted and Repetitive Behavior (RRB): 0 to 8, Total Score: 0 to 29 (Note: Maximum possible scores vary slightly by the specific algorithm used, but fall within these ranges.)

Mean Oxy-Hb concentration in the PFC collected while the child plays with a therapist (unfamiliar adult). Used to assess generalization of social brain response.

Mean Oxy-Hb concentration in the PFC collected while the child plays alone (non-social condition). Serves as a control condition for social tasks.

Calculated as the percentage of discrete fixation counts directed towards Social AOIs relative to the total number of fixations on both stimuli types. Formula: (Count on Social / Total Count) * 100. Averaged across the 3 paradigms. Values range from 0 to 100%.

Resting-state functional MRI is collected during natural sleep to assess intrinsic brain organization. The metric is the Functional Connectivity strength (Fisher's z-transformed correlation coefficient) within the Default Mode Network (DMN) or between social brain regions. Values range from -1 to 1 (approximate, after transformation). Higher values indicate stronger functional synchronization between regions.

Assessed in the intervention group only.Parent fidelity is assessed by trained independent observers using the Project ImPACT Fidelity Checklist. The scale evaluates the parent's competence in five intervention domains: 1) Focus on the Child, 2) Adjust Communication, 3) Create Opportunities, 4) Teach New Skills, and 5) Shape the Interaction. Each domain is rated on a 5-point Likert scale ranging from 1 (Low Fidelity/Ineffective) to 5 (High Fidelity/Effective). The Total Score is reported as the Mean Score across all applicable items/domains. The range is 1 to 5. Higher scores indicate higher fidelity and competence in delivering the intervention (better outcome).

Assessed for the intervention group only. Completed by the teacher/interventionist to validate skill acquisition for the Project ImPACT intervention.It assesses child progress across four domains: Social Engagement, Expressive Communication, Receptive Communication, and Imitation/Play. Items are scored on a frequency scale: 1 (Rarely/Not yet), 2 (Sometimes), and 3 (Frequently). (Note: Specific items 32-36 have weighted scoring for verbal/non-verbal strategies). The Total Score is the sum of all item scores, ranging from 70 to 215. Higher scores indicate better social communication skills (better outcome).