Early intervention for children with autism: parental priorities.

Introduction

It has been recognised for some time that early intervention for children with disabilities should not only focus on child outcomes but must also recognise the integral role families play in the development of their child (Bailey et al., 1998). Services that support families have frequently been discussed in terms of their family-centredness, and research has focused on identifying critical dimensions of family-centred practice (Allen & Petr, 1996; Bailey et al., 1998; Begun, 1996; Dunst, Trivette & Deal, 1994; Keen & Knox, 2004; Knox et al., 2000; Murray, 2000; Turnbull & Turnbull, 2001). Fundamental to a family-centred approach is the importance of matching early intervention support with the unique characteristics of each child and family (Bailey et al., 1990). As stated by Dunst et al. (1994), 'the greatest impact on child, parent, and family functioning is most likely to occur when interventions are based upon the needs, aspirations, and desires a family considers important' (p. 9).

Bailey et al. (1990) referred to the matching of intervention support to family ecology as 'goodness-off-it'. The concept was adapted and applied to the development and implementation of behaviour support plans by Albin et al. (1996), who referred to this matching process as 'contextual fit'.

Some authors have argued that behaviour support plans that may be technically sound but lack good 'contextual fit' could be rejected by families, implemented inaccurately, or not sustained over time (Lucyshyn et al., 2002). Some research has suggested that enhancing 'contextual fit' by embedding strategies within family routines can lead to improved intervention outcomes. Moes and Frea (2000), for example, found that behavioural interventions, when developed in collaboration with families, lead to more favourable results. They compared two intervention approaches for children. In the contextualised intervention, an intervention was developed based on family routines and professional collaboration to guide implementation. The prescriptive intervention was based on a treatment package that parents were trained to implement. Contextualised intervention led to greater reductions in challenging behaviour and increases in on-task behaviour.

Another process thought to contribute to good 'contextual fit' is the identification of parental priorities and preferences in relation to intervention goals. Given that a good 'contextual fit' is said to be achieved when behaviour support plans reflect family goals and values (Lucyshyn et al., 2002), assessment of parental priorities and preferences would seem central to any intervention planning with families. Parental participation in educational goal-setting for students with disabilities through development of individual education plans (IEPs) is now a widely-adopted intervention strategy. The involvement of parents in IEPs and the commitment of services to the IEP process varies widely within and between countries. In Australia and New Zealand, administrative requirements may direct teachers to prepare IEPs; however, teachers are not legally compelled to do so (Ashman & Elkins, 2002).

The importance of understanding and incorporating parental priorities within early intervention services is well-recognised (Sperry et al., 1999). However, few early intervention programs described in the literature have demonstrated how their programs have been derived from parental priorities for children with Autistic Spectrum Disorder (ASD). More frequently, parental input is sought and accommodated into structured programs where professionals have determined program content and goals (Dempsey & Carruthers, 1997; Iovanne et al., 2003). Identifying and incorporating intervention goals across home and early childhood settings is essential, however, if children with ASD are to gain the most from their early intervention experiences. Children with ASD frequently have difficulty generalising skills learned in one setting to another setting or context (Drasgow, Halle & Phillips, 2001). Early childhood educators are in an ideal position to participate in the process of goal identification and prioritisation with families and, through this process, to use the concept of 'contextual fit' to address selected goals within their early childhood settings. In this way, goals may be shared across settings, but implementation of the goals can be tailored to the routines and opportunities within each setting.

The Canadian Occupational Performance Measure (COPM) (Law et al, 1998) is used to identify priorities for therapy and to document the client's self-rating of occupational performance and satisfaction. It is embedded in an understanding of client- and family-centred practice (Hannah & Rodger, 2002; Law, Baptiste & Mills, 1995) and the Canadian Model of Occupational Performance, which highlights the importance of the …