Comparative Analysis of Effectiveness of Online Versus Offline Parent-Mediated Therapeutic Intervention in Preschool Children With Autism Spectrum Disorder

Luna Bajracharya, Praveen Suman, Imran Mushtaq


Background: Proper management of an autistic child requires a multidisciplinary team of professionals such as a developmental pediatrician, psychologist, special educator, speech-language pathologist, occupational therapist, etc. With the increase in the prevalence of autism spectrum disorder (ASD), there is a lack of trained specialists in providing adequate services to autistic children in underserved countries. During the COVID-19 pandemic, the implementation of online therapy for autistic children was found to be effective in several types of research. Naturalistic developmental behavioral interventions (NDBIs) delivered by parents at an early age are effective in improving long-term outcomes for these children. Therapists-guided online parent-mediated intervention in preschool autistic children may reduce substantial service system demands due to the scarcity of professionals. This research was conducted to compare the effectiveness of online versus in-person parent-mediated interventions in preschool autistic children in resource-limited settings.

Methods: Preschool children (55 online, 65 offline) with ASD from March 8, 2022 to 30 September 30, 2022 were recruited in the Child Development Clinic of a tertiary hospital for the study. The mean changes in cognitive, language, and motor composite scores of the Bayley Scale of Infant Development, third edition (BSID III) and Childhood Autism Rating Scale, second edition (CARS 2) after 3 months of either intervention based on NDBI were compared.

Results: Most children were boys (89 (74.2%)). The mean age of children was 30.58 (3.88) months and 31.36 (5.06) months for offline and online groups, respectively. There was statistically significant improvement in all three BSID III scores (P < 0.005) and a decrease in CARS 2 score (P < 0.001) from baseline mean scores after either intervention indicating both interventions to be effective. When compared between interventions, statistically significant mean score changes were not found for cognitive and motor but for language (P = 0.012) and CARS 2 scores (P = 0.034) favoring in-person therapy in improving communication and autistic symptoms in preschool children with ASD.

Conclusion: The preferred mode of intervention for preschool autistic children was in-person parent-mediated intervention.Therapist-assisted online intervention can be an alternative mode of intervention in countries with fewer specialists capable of managing autistic children.

Int J Clin Pediatr. 2024;13(1):14-25


Autism; BSID III; CARS 2; Children; Offline; Online; Parent-mediated

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