Ying Qi Kang

Background/Objectives: With rising autism prevalence, parent coaching has emerged as a useful model for teaching parents responsive strategies to support their child’s social communication and interaction skills within daily routines and play contexts. Telehealth parent coaching provides benefits of real-time guided generalisation in naturalistic environments as well as cost savings for families and providers. Methods: This randomised controlled trial examined whether parent coaching delivered via synchronous video conferencing was non-inferior to in-person sessions for improving the primary outcome of developmental skills in children with autism. 200 parent-child dyads were randomly assigned to receive 16 to 18 weekly parent coaching sessions based on naturalistic, relationship-focused intervention principles, delivered either through video conferencing (telerehabilitation arm) or in-person (standard arm). Results: Participants in both groups demonstrated comparable improvement in developmental skills, together with comparable changes in adaptive functioning, parent-child interaction, parental stress reduction and family quality of life. Conclusions: The findings of this study support video conferencing as a feasible and acceptable alternative platform for parent coaching while providing cost savings. However, given this study’s high attrition rate and the limited evidence base for telehealth parent coaching, additional research is needed to further validate the findings and parameters of use for optimal outcomes.

Background/Objectives: Feeding difficulties are more common in children with autism spectrum disorder (ASD) or other developmental conditions and are associated with nutritional risk and caregiver stress. However, they may be overlooked as growth tends to be preserved. We aimed to identify clinical and behavioral features associated with feeding difficulties among children with developmental conditions. Methods: This cross-sectional study included caregiver–child dyads, with children aged 1–7 years with ASD and other developmental conditions. Caregivers completed the Repetitive Behavior Questionnaire, Second Edition (RBQ-2) to assess child restricted and repetitive behaviors (RRBs) and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) to assess feeding difficulties. Demographics, anthropometric measures and cognitive and adaptive scores were retrieved from medical records. Results: Of the 132 participants (mean age 41.8 months, range 15–67; 74.2% male) included, majority had normal weight (87.7%) and height (89.2%) z scores. Among participants, 54.5% had autism, 26.5% language delay and 18.9% other developmental diagnoses. Over half (53.0%) had elevated BPFAS scores. Children not enrolled in school showed significantly more feeding difficulties compared to those who were enrolled (32.6% vs. 16.7%, p < 0.05). The RBQ-2 total score positively correlated with the BPFAS total frequency score (r = 0.33, p = 0.01) after adjusting for gender, age and developmental diagnosis. Conclusions: Feeding difficulties were common in this sample. Higher RRBs and absence of formal schooling were associated with higher rates of feeding difficulties. Longitudinal studies are needed to ascertain the role of RRBs and school enrollment as clinical indicators associated with feeding difficulties.

Introduction: This study aimed to determine patterns of screen viewing time (SVT) in preschool children with developmental, behavioural or emotional (DBE) issues, and to identify its relationship with social-emotional development. Method: This cross-sectional study involved children aged 0–5 years who were referred to a developmental paediatric clinic for DBE issues. Parents completed a screen time questionnaire, and the Devereux Early Childhood Assessment-Clinical (DECA-C) questionnaire which assessed the social-emotional competence of the children. Data were analysed using logistic regression, correlational analyses and tests of comparison. Results: Among 225 children (mean age: 32.4 months), mean daily SVT was 138 minutes. More than half (51.1%) of the children had clinical features of language delay, while 26.6% had features suggestive of autism spectrum disorder. Screen time was first introduced at a mean age of 13.8 months, with 32.4% of children previously experiencing higher SVT. Compared to SVT introduction after 1 year of age, SVT in the first 12 months was primarily to facilitate feeding (P<0.05). Children with higher past SVT had poorer attention, more aggression, and increased behavioural concerns. Children with DBE issues have significantly more screen time than same-aged peers. Conclusion: Children with DBE issues are exposed to SVT at a very young age and have significantly more screen time than their peers. It is crucial to guide parents to reduce SVT in early childhood, particularly around mealtimes.

Prevalence of hearing loss in children with autism spectrum disorder (ASD) is uncertain, as it is more challenging to assess hearing function in children with developmental difficulties (DD). We aimed to determine the prevalence and profiles of hearing loss in preschool children with ASD in a Southeast-Asian population who passed newborn hearing screening. A retrospective study of preschool children with DD (ASD, Global Developmental Delay (GDD), and Speech and Language Delay (SLD)) attending the Child Development Unit (CDU) at our hospital was performed. Three hundred and thirty-three children (ASD: n = 129; GDD: n = 110; and SLD: n = 94) underwent hearing assessments. Of these, 10.8% of children (n = 36, comprising 15 with ASD, 12 with GDD and 9 with SLD) had confirmed hearing loss. Hearing loss was predominantly bilateral in children with ASD and GDD; in those with SLD, unilateral and bilateral hearing loss were equally common. Conductive hearing loss occurred as frequently as sensorineural hearing loss in children with ASD and SLD, but was the dominant subtype in those with GDD. Moderate to severe hearing loss (n = 2) was noted only in children with ASD. Children with ASD and GDD required significantly more audiology visits and procedures to obtain conclusive hearing test results, compared to those with SLD. The need to identify hearing loss and monitor for resolution is particularly important in vulnerable populations with communication deficits, such as in those with ASD.

Background: Early parent-implemented intervention enhances parent-child interaction and improves language skills in children with autism spectrum disorders (ASD). Parent coaching is often delivered as standard care for children with ASD, where parents are taught to apply strategies in their child’s play activities and daily routines to achieve the prior stated goals. However, the ability to conduct parent coaching in physical in-clinic sessions is limited by resource constraints such as clinic space and therapist manpower. Furthermore, parents may experience difficulties with the generalisation of intervention strategies taught in the clinic to their natural home environments. In this study, telerehabilitation is evaluated as an alternative platform to deliver parent coaching for parent-implemented interventions to children with ASD in their homes. Methods: This parallel-group, randomised, controlled, non-inferiority trial aims to evaluate the effectiveness of parent coaching delivered through video conferencing (telerehabilitation) versus in-clinic (standard care) delivery. Children aged 15 to 48 months (n = 200) who meet the cut-off score for ASD on the Autism Diagnostic Observation Schedule-2 are eligible. Parent-child dyads are randomly assigned to receive parent coaching either through weekly telerehabilitation or standard care. The primary outcome is the child’s development as measured by the subscale and composite scores of a standardised developmental assessment. Primary analysis will determine if the lower boundary of the 95% confidence interval for the mean difference in pre-post change between groups exceeds −5 (the non-inferiority margin). Secondary outcomes are the child’s adaptive behaviour, parent-child interaction, parental stress, and family quality of life. Outcomes will be measured pre-intervention, midterm, and post-intervention. Secondary analysis will determine if there is any between-group difference for the pre-post change in scores at the 5% significance level using two-sample t-test or Mann-Whitney U test. Discussion: As a randomised controlled trial of a moderately large scale, this study will contribute to the limited existing literature on the effectiveness of parent coaching via telerehabilitation for early parent-implemented intervention for children with ASD. The results of this study will provide insights on whether telerehabilitation is comparable to conventional in-clinic parent coaching in enhancing parent-child interaction and improving language skills. Trial registration: ClinicalTrials.gov NCT05792449. Registered (retrospectively) on 31 March 2023.