Pilot Randomized Controlled Trial of the WHO Caregiver Skills Training in Public Health Services in Italy.
Erica Salomone, Michele Settanni, Helen McConachie and 6 others
PMID 34677755WHAT IT FOUND
The WHO Caregiver Skills Training improved parent interaction skills and reduced stress, but did not significantly change child joint engagement or autism severity scores at 3 months.
Parents gained confidence and children gestured more, but primary child outcomes were null.
Key findings
01Parents in the training group showed a large, significant improvement in supporting the interaction (scaffolding, following the child's focus, affective communication) compared to controls.
02There was no significant difference between groups in the primary child outcomes of autism symptom severity (BOSCC) or joint engagement (JERI) at 3 months post-intervention.
03Secondary outcomes showed significant improvements in autism-specific parental self-efficacy, reduced parental stress, and increased child spontaneous gestures.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This was a pilot study with a relatively small sample (86 children), so it may be underpowered to detect smaller effects on child outcomes. The trial was conducted in a specific cultural and healthcare context (public services in Northern Italy), which may limit generalizability to other settings. The intervention was delivered by clinicians with varying levels of prior experience in behavioral interventions, and fidelity varied slightly between sites. There was no significant effect on the primary child outcomes, which may reflect a need for a longer follow-up period or increased intervention intensity (e.g., booster sessions) to see child-level changes. The control group received 'enhanced' treatment as usual (one psychoeducation session), which is not a pure no-treatment control.
Declared interests
Funding was provided by H2020 Marie Skłodowska-Curie Actions, Compagnia di San Paolo, Autism Speaks, and Università degli Studi di Milano - Bicocca. No specific conflicts of interest declarations for the authors are provided in the text beyond the funding sources.
The easy way to misread this
Do not interpret the lack of significant change in primary child outcomes (joint engagement and autism severity) as evidence that the intervention fails to help children. The study showed significant improvements in parent interaction skills and child gestures, and the authors suggest that changes in child joint engagement may take longer to emerge or require additional support, as parent-mediated change is a multi-stage process.