Emergent life events in the delivery of a caregiver-mediated evidence-based intervention for children with autism spectrum disorder in publicly funded mental health services.
Teresa Lind, Anna S Lau, Christopher Gomez and 6 others
PMID 32003224WHAT IT FOUND
Unexpected life crises appeared in 36% of early therapy sessions for children with autism.
More child diagnoses predicted more crises, while more experienced clinicians reported fewer. Contrary to some prior studies, these crises did not reduce clinician adherence to the treatment plan in that session.
Key findings
01At least one emergent life event was identified in 36.0% of sessions, affecting 57.9% of children.
02The expected number of emergent life events increased by 1.68 times for each additional comorbid diagnosis, and decreased for each year of clinician experience.
03The number of emergent life events in a session was not significantly associated with clinician adherence to caregiver-directed strategies in the same session.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size was relatively small (100 sessions from 38 dyads), which may have reduced the power to detect subtle associations between life events and clinician adherence. The study only analyzed the first two months of treatment, so it does not show whether life events disrupt adherence later in therapy. Sessions were coded using a consensus method rather than independent coding, which may have influenced the reliability of event identification. The findings come from a controlled effectiveness trial with ongoing clinician feedback, which may not reflect routine community practice where such support is absent.
Declared interests
The study was supported by the National Institute of Mental Health (NIMH). The authors did not report other conflicts of interest.
The easy way to misread this
Do not assume that unexpected life crises will always leave treatment adherence unaffected. This study found no immediate link to adherence, but the sample was small, limited to early sessions, and clinicians received ongoing training and feedback, which may have buffered the impact of these events.