Caregiver behavioral changes mediate the effects of naturalistic developmental behavioral interventions: Combining evidence from three randomized controlled trials.
Deanna Swain, Ji Eun Han, Hallie Brown and 6 others
PMID 40211599WHAT IT FOUND
Caregivers trained in naturalistic developmental behavioral interventions significantly improved their strategy use, but the intervention did not produce a significant overall reduction in child social communication symptoms.
Changes in caregiver behavior mediated child outcomes, though this finding weakened when accounting for measurement error.
Key findings
01Caregivers in the intervention group showed a significant increase in NDBI strategy implementation compared to controls.
02The intervention did not significantly reduce child social communication symptoms directly or as a total effect.
03Caregiver strategy use mediated the effect of intervention on child outcomes, but this mediation was not robust to sensitivity analyses accounting for correlated measurement errors.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The analysis was restricted to the first three months of intervention, so long-term effects are unknown. A large number of original participants were excluded due to missing video data or not meeting inclusion criteria, potentially biasing the sample toward families with higher engagement. The study relied on a single outcome measure (BOSCC-SC) for child social communication, limiting the ability to detect changes in other domains. The robustness of the mediation finding was compromised when accounting for correlated measurement errors, suggesting the link between caregiver change and child outcome may be less certain than initially estimated.
Declared interests
The authors declare no conflicts of interest. The study was supported by grants from the National Institute of Health (NIH) and other US government sources.
The easy way to misread this
Do not conclude that caregiver training fails to improve child social communication. The lack of a significant total effect on child symptoms may reflect the short three-month window analyzed, the sensitivity of the statistical model to measurement error, or the fact that caregiver change is a mechanism that may precede or drive slower child changes. The null total effect does not negate the significant improvement in caregiver skills.