An Intersubjectivity Parental-Based Intervention (I-PBI) for Preschoolers with ASD

*Paola Venuti, Silvia Perzolli and Arianna Bentenuto*

## **Abstract**

Given the influence of parents' qualities and dyadic characteristics on child developmental outcomes, recent findings strengthened the importance of involving caregivers during the intervention to increase dyadic syntonization levels and to extend the acquisition of competencies in naturalistic contexts. The Intersubjectivity Parental-Based Intervention (I-PBI) presented throughout this chapter is delivered involving caregivers in two different modalities: first, in the therapeutic setting, together with the child to support interactions within the dyad. Second, the focus is on the parental representation of the child and the caregivers in their role. Trained psychologists deliver the intervention after receiving specific licenses on developmental intervention models for children with autism spectrum disorder (ASD). Finally, the team is constantly supervised at least once every month by an expert psychotherapist. Unlike parent-mediated intervention and parent training, the I-PBI does not require home assignments or fidelity schedules, and the therapist entirely delivers the intervention. Throughout this chapter, the structure and therapeutic techniques of the intervention will be presented. Further, results considering the child's developmental trajectories and changes in caregiver-child interaction will be discussed.

**Keywords:** autism spectrum disorder, intervention, parental involvement, caregiver-child interaction, Italian context

## **1. Introduction**

Parents are genetically predisposed to intuitively capture and understand children's signals with typical development. However, parents may struggle to understand the signs and needs of children with autism spectrum disorder (ASD), and their approaches might not always be successful.

Given the influence of parents' qualities on child developmental outcomes, recent findings strengthen the importance of involving caregivers during the intervention to increase dyadic syntonization levels and extend the acquisition of competencies in naturalistic contexts (e.g., home) [1–4]. Currently, many guidelines [5, 6] recommend parental inclusion during intervention with children with ASD. A significant amount of research showed that involving the parent during the intervention enhances outcomes in children with ASD [3, 7–11]. Specifically, parental involvement during intervention seems to be extremely important in order to guarantee the adaptation to the child's difficulties and impairments, allowing the child to respond with enhanced communicative and social development [9], long-term symptom reduction [12], and to generalize these outcomes across settings [13]. Further, marked difficulties in social communication and responsiveness in parents of children with ASD might create a potential barrier to care for their children. In line with this, recent findings suggest that parental involvement was able to guarantee more noticeable results considering caregivers.

Interestingly, some research found a significant relationship between the degree of change in parental interaction and the rate of the child's improvement [14], underlying the importance of the dyadic relational aspects in child developmental outcomes. Because parents are central in ensuring success and a good prognosis, it is critical to include them throughout the intervention process. These findings shed new light on the idea that if parents are adequately informed during the intervention and if they constantly deliver intervention strategies in naturalistic contexts, the intensity of the intervention dwindles on intervention outcomes. In line with this, caregivers can continue to teach competencies to their children in the home context, improving parent-child interactions and increasing the amount of treatment they receive. Findings considering the evaluation of Naturalistic Developmental Behavioral Interventions (NDBI) are mainly focused on child outcomes demonstrating the improvements in both child's social engagement and cognitive development [4]. Child gains are predominantly assessed through outcome measures using standardized instruments such as Autism Diagnostic Observation Schedule [15] and Griffiths Scales [16–22]. Although empirical efforts have been made in this field, most of the research on interventions for ASD is focused on child outcomes more than parental outcomes [23]. However, a recent systematic review underlined the importance of a greater focus on both parents to provide tailored intervention [24]. Some evidence in this field showed that parents increased well-being and quality of life after being involved in the therapeutic setting with their children [25, 26].
