Is Caregiver Use of Strategies to Support their Young Autistic Children Associated with Caregiver or Child Characteristics?

Abstract

Introduction: Caregiver-child interactions are vital for the cognitive, emotional, and social communicative development of young children. In low- and middle-income countries (LMIC), and other settings with inadequate health resources to cater for autistic individuals, caregiver-mediated interventions have shown potential to address the vast unmet needs of those who need autism care. Over the last decade, there has been a significant increase in research output on the use of caregiver-mediated interventions in autism care, however, there is little knowledge to whether caregiver and child characteristics affects the caregivers’ use of intervention strategies during caregiver-child interactions. With this existing research gap, it is imperative to study the association of the caregiver and child characteristics with the caregiver’s use of strategies to support the social communication abilities of their young autistic children in a LMIC. Study Aim: Determine the association between caregiver and child characteristics with the caregiver’s use of strategies to support the social communication development of their young autistic children. Methods: This is a sub-study of the parent study, Autism Caregiver Coaching in Africa (ACACIA), conducted in the Centre for Autism Research in Africa (CARA) at the University of Cape Town, South Africa. This sub-study utilized an exploratory, cross-sectional design. At study enrollment, baseline data of the caregiver-child dyads was obtained, and a 6-minute video of the caregiver and child interaction was recorded and coded using the Parent-Early Start Denver Model fidelity scale (P-ESDM). The measures included participant sociodemographic questionnaire, Caregiver Strain Questionnaire, Autism Observational Diagnostic Schedule – 2nd Edition (ADOS-2), and P-ESDM scale. A sociodemographic risk score was conceptually developed for data analysis. Scatterplots, and linear regression analyses were used to determine the association between four explanatory variables of interest (sociodemographic data, Caregiver Strain, ADOS-2 comparison score, Sociodemographic Risk Score), and the outcome variable (P-ESDM total fidelity score). Unadjusted analyses included a single explanatory variable, adjusted included all four variables of interest. Results: 41 participants caregiver-child dyads enrolled into the study, and 39 caregiver-child dyads had all the baseline data available. Among the 41 caregivers, the mean age was 38.8 years, and most (35/41, 85.4%) were females. For the 41 children, the median age at study enrolment was 59 months, and most (35/41, 85.4%) were males. There was no evidence of an association between caregiver strain and fidelity or between the sociodemographic risk score and fidelity. However, there was an indication of a negative association with child age at enrollment (Adjusted: 0.31 units per month; 95% CI: 0.03, 0.6) and a negative association with autism severity (Adjusted: 3.1 units per 1-unit increase in severity score 95% CI: 1.2, 5.1) in unadjusted and adjusted analyses. Conclusion: The result showed that prior to initiation of caregiver-coaching interventions in ACACIA study, there was no evidence that the sociodemographic risk score and caregiver strain affects the caregiver’s use of strategies. Instead, the significant factors were the autism-related behaviors and the child’s age at enrollment, of which both factors have a negative association with caregiver’s use of strategies at baseline. As caregiver-mediated interventions emerge as a crucial tool for addressing the unmet needs of autism care in LMIC and other low-resource settings, understanding and leveraging the factors that influence caregivers’ use of strategies is essential in supporting the social communication development of autistic children.