Vol.:(0123456789) 1 3 J Autism Dev Disord DOI 10.1007/s10803-017-3268-0 ORIGINAL PAPER Parent-Mediated Intervention for One-Year-Olds Screened as At- Risk for Autism Spectrum Disorder: A Randomized Controlled Trial Linda R. Watson 1  · Elizabeth R. Crais 1  · Grace T. Baranek 1,2  · Lauren Turner-Brown 1  · John Sideris 1,2  · Linn Wakeford 1  · Jessica Kinard 1  · J. Steven Reznick 1  · Katrina L. Martin 1,3  · Sallie W. Nowell 1   © Springer Science+Business Media, LLC 2017 Introduction Early identifcation and early intervention (EI) for children with autism spectrum disorder (ASD) have become pub- lic health goals due to evidence that long-term outcomes in this population can be improved with EI. Given rapid neurodevelopmental changes occurring prior to 2 years of age, and complex transactions among infant, caregiver, and environmental characteristics that infuence development over time, researchers have proposed that intervening prior to the time a defnitive ASD diagnosis can be made (i.e., pro- dromal interventions) may be especially efective in improv- ing outcomes (Dawson 2008; Thomas et al. 2015). Pursuing this idea, we examined the efcacy of a parent-mediated intervention called Adaptive Responsive Teaching (ART; Baranek et al. 2015) in improving outcomes for infants iden- tifed via community screening at 12 months of age as at-risk for later ASD diagnoses. As an adaptation of the Responsive Teaching Curriculum (Mahoney and MacDonald 2007), the ART model is built on two primary conceptual foundations. The frst is that piv- otal behaviors play key roles in positive outcomes in infants both with and at-risk for ASD. That is, targeting pivotal behaviors (e.g., intentional communication, joint engage- ment, self-regulation, exploration) theoretically will lead to improvements in broader areas of functioning not directly addressed by the intervention (Koegel et al. 1999). Indeed, prior studies with children diagnosed with ASD provide evi- dence that targeting pivotal behaviors results in better, more general developmental outcomes in areas such as cognition, language and communication, socialization, and adaptive behavior, as well as reductions in ASD symptoms (Gengoux et al. 2015; Hardan et al. 2015; Kasari et al. 2008; Mahoney and Perales 2005; Ventola et al. 2014, 2016). Abstract Theoretically, interventions initiated with at-risk infants prior to the point in time a defnitive autism spec- trum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efcacy of a parent-mediated early intervention called Adapted Respon- sive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identifed by community screening with the First Year Inventory as at-risk of later ASD diagno- ses. We found minimal evidence for main efects of ART on child outcomes. However, ART group parents showed signifcantly greater increases in responsiveness to their infants than control group parents. Further, signifcant indi- rect (mediation) efects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change. Keywords Infants · Autism spectrum disorder · Screening · Prodromal · Intervention · Responsiveness J. Steven Reznick is now deceased. Electronic supplementary material The online version of this article (doi:10.1007/s10803-017-3268-0) contains supplementary material, which is available to authorized users. * Linda R. Watson lwatson@med.unc.edu 1 The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 2 University of Southern California, Los Angeles, CA, USA 3 Present Address: SRI International, Menlo Park, CA, USA