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Trial registered on ANZCTR

Registration number

ACTRN12622001139763

Ethics application status

Approved

Date submitted

15/08/2022

Date registered

18/08/2022

Date last updated

28/07/2024

Date data sharing statement initially provided

18/08/2022

Type of registration

Prospectively registered

Titles & IDs

Public title

The effect of participating in the Let's Play programme on social engagement and interaction between autistic children and their parents

Scientific title

The effect of participating in the Let's Play programme on social engagement and interaction between autistic children and their parents: A between groups, randomised controlled trial

Secondary ID [1]

Nil

Universal Trial Number (UTN)

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Autism Spectrum Disorder

Child social communication difficulties

Parent stress

Condition category

Condition code

Mental Health

Autistic spectrum disorders

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

The Let's Play programme is designed to teach caregivers the value of play and give them a repertoire of techniques they can apply in everyday routines to positively impact their child’s development. The Let's Play techniques are developed to help build children’s communication, social reciprocity, shared attention, imitation, emotion regulation, planning, and problem solving skills during caregiver-child interactions. The Let’s Play programme focuses on three target areas: (1) caregivers’ play skills, (2) caregivers’ communication strategies, and (3) the well-being of the family.

The programme draws on the Developmental Individual-Differences Relationship Model (DIR: Greenspan, 2000; Greenspan & Weider, 1999) and the Routines-Based Intervention (RBI; McWilliam, 2010; McWilliam et al., 2020), as well as Joint Action Routines (Ratner & Bruner, 1978), Vygotsky’s (1978) Zone of Proximal Development, guided participation (Rogoff, 2003), Rush and Shelden’s (2020) adult learning and coaching models, and the Maori practice of tuakana-teina (i.e., coaching of novice peers by experienced peers).

Let’s Play will be delivered by Autism New Zealand staff who designed and developed the programme, using a coaching handbook they also created. Facilitator 1 is a registered teacher in New Zealand and the United Kingdom (Bachelor of Education with Honours) and co-authored the programme. They specialise in autism and are a National Educator at Autism New Zealand. Facilitator 2 has a Bachelor of Teaching and postgraduate diplomas in Early Childhood Education and Specialist Teaching. They are part of the early intervention team at Autism New Zealand. Facilitator 3 is the parent of an autistic child. They have a Bachelor of Media Arts and experience in the publishing industry. All three have current and clean New Zealand Police vetting checks.

Each programme will include a cohort of up to 10 families. One family member will consistently attend each workshop, though additional extended family members (e.g., grandparent, family friend, etc.) are also able to attend. The programme will be delivered over a period of 9 weeks and will include three 3-hour group workshop sessions (Weeks 1, 3, and 5), five 1-hour in-home coaching visits (Weeks 2, 4, 6, 7, and 8), and an end-of-programme group celebration (Week 9).

The group workshop sessions will be conducted at the Autism New Zealand Auckland offices face-to-face; however, its structure makes it possible to deliver online if necessary (e.g., nation-wide lockdown). During in-home coaching programme facilitators will meet with caregivers in the family home to provide coaching face-to-face in the child’s natural environment. This is a single-site study. The programme is delivered at Autism New Zealand (Auckland), and the research will be conducted at the University of Canterbury (Christchurch).

Group coaching
Each group coaching session focuses on a different component of play (i.e., Group Session 1: The Basics of Play; Group Session 2: Following Your Child’s Lead; Group Session 3: Using Everyday Routines). In each session, the facilitator works through a presentation that describes: the theory behind that week’s play and/or communication techniques, examples of how the techniques can be used, exemplar videos of parents using the techniques with their autistic children, and group discussions. Each family will also be given a printed handbook that includes notes on the content covered in the group workshop sessions and reflective tasks for them to complete (e.g., a brainstorming of when and how they could utilise the techniques from the workshops with their child).

In-home visits
Before families’ participation in the programme begins, the facilitator will visit the families’ homes and introduce themselves to the family, talk to them about the programme, and film a baseline parent-child play video. During the programme home visits, facilitators will provide one-on-one guidance to the families and help them implement the techniques described during group coaching sessions. This can include facilitators discussing the achievements and challenges the family had faced that week, helping them to reflect on these experiences and providing guidance on what to try next. The family can also demonstrate how they have been using the techniques from the Let’s Play programme in-person or in a recorded video to get feedback on what they are doing well and further strategies that they could try.

Programme adherence and fidelity
Four measures will be used to ascertain parents’ levels of adherence and implementation of the Let’s Play programme’s outside of the workshops and in-home visits. First, during the programme, parents will be asked to keep a weekly log of which Let’s Play techniques they use with their child and how long (mins) they use them for each day. In this same log, they will be asked to include all of the other professional support services they have accessed to support their child’s development (e.g., speech or occupational therapy services) including the length of appointments (mins). Second, a record of the number of workshop sessions parents attend will be used a measure of support dosage. Third, the 10-minute parent-child interaction videos will be used to assess parents’ implementation of the workshop modules when with their child. One 10-minute parent-child interaction video will be provided at baseline, immediately post-participation, and at 6-month follow-up. And fourth, an independent observer will use a checklist to assess whether the Let’s Play Programme was implemented with fidelity, for at least 15% of the workshop sessions and home visits. This will ensure that the programme is being administered as laid out in the coaching handbook and, hence, participants are receiving the same service.

Intervention code [1]

Treatment: Other

Intervention code [2]

Behaviour

Comparator / control treatment

The control participants will not have access to the Let’s Play programme materials while they are on the waitlist. The duration of their wait will be 9 weeks (the length of the programme). Once the waitlist controls finish their wait period, they will be invited to take part in the Let’s Play programme. If they choose to take part, they will be scheduled into the next available cohort. Waitlist controls will be asked to keep a log of the standard care support services (e.g., speech therapist appointment) they and their child access each month that they are on the waitlist.

Control group

Active

Outcomes

Primary outcome [1]

Changes in children's engagement with their parent - coded from filmed 10-minute parent-child play interactions using Bakeman and Adamson's (1984) method

Timepoint [1]

Measured at baseline (Time 1; Week 0), immediately post-participation (Time 2; Week 10, primary timepoint), and at 6-month follow-up (Time 3; Week 35)

Primary outcome [2]

Changes in parent's mean stress scores using the self-report Parenting Stress Index (Fourth Edition, Short Form; PSI-4-SF; Abidin, 2012)

Timepoint [2]

Measured at baseline (Time 1; Week 0), immediately post-participation (Time 2; Week 10, primary timepoint), and at 6-month follow-up (Time 3; Week 35)

Secondary outcome [1]

Changes in parent's mean mental health scores using the self-report Depression, Anxiety, and Stress Scale (DASS-21; Henry & Crawford, 2005)

Timepoint [1]