Autism and Developmental Disorders
2023. Vol. 21, no. 4, 3–14
doi:10.17759/autdd.2023210401
ISSN: 1994-1617 / 2413-4317 (online)
The Effectiveness of the “Kashenkin Lug” Counseling Technology in Supporting Families of Children with Autism Spectrum Disorder (ASD)
Abstract
Objectives. The increase in the number of children with autism spectrum disorder (ASD) has led to an increase in the need to develop effective support programs. This article presents the results of a pilot multicenter study of the effectiveness of the technology of consultative and diagnostic support for families raising children with ASD, "Kashenkin lug". Fifteen specialists from regional centers that help children with ASD participated in the testing of the technology. The "Kashenkin lug" technology consists of several meetings that includes the diagnosis of the child, counseling for the parents, and training in skills for working with the child to achieve the set goals.
Methods. Forty-one families raising a child with ASD participated in the study Each family attended a counseling appointment, which resulted in a list of individualized developmental goals and recommendations for their achievement. After 90 days, parents received a feedback questionnaire aimed at collecting data on the effectiveness of the corrective work, the reasons and degree of difficulties that parents face, their satisfaction, and the presence of a request for a second consultation. The program was evaluated on 8 criteria, grouped into 3 groups: criteria for the effectiveness of the diagnostic stage, criteria for the effectiveness of the consultative stage, and family satisfaction.
Results. The results of the testing allow us to conclude that diagnostic instruments included in “Kashenkin Lug” model have good psychometric properties. The planned individual goals are mostly achievable: by 63% of the tasks set, parents were able to organize corrective work in full. 95% of the families stated that they were able to receive the recommended education program. In 60% of cases, parents report that they are satisfied with their work with the child in accordance with the stated goals; 84-86% of families are interested in a repeat consultation.
Conclusions. The data obtained allow us to make preliminary conclusions about the effectiveness of the "Kashenkin Meadow" technology. The next stage of the study plans to introduce additional quantitative indicators that will allow us to more objectively and in detail assess the child's dynamics, the level of parental competence, and the quality of goals that are formulated within the framework of the consultative appointment.
General Information
Keywords: autism spectrum disorders (ASD); “Kashenkin lug” technology; diagnosis of ASD; diagnostic tools; family support; effectiveness of assessment; effectiveness of assessment; effectiveness of consultation; goal achievement scale
Journal rubric: Interventions for ASD: Evidence-Based Approach
Article type: scientific article
DOI: https://doi.org/10.17759/autdd.2023210401
Received: 14.11.2023
Accepted:
For citation: Pereverzeva D.S., Pantsyr S.N., Davydova E.Y., Vinevskaya A.V. The Effectiveness of the “Kashenkin Lug” Counseling Technology in Supporting Families of Children with Autism Spectrum Disorder (ASD). Autizm i narusheniya razvitiya = Autism and Developmental Disorders, 2023. Vol. 21, no. 4, pp. 3–14. DOI: 10.17759/autdd.2023210401. (In Russ., аbstr. in Engl.)
Full text
Introduction
In recent decades, there has been a significant increase in developmental disorders associated with autism spectrum disorders (ASD) [15]. This makes it important to develop family support protocols that can be scaled up and used by specialists from different organizations. When assessing the effectiveness of such a protocol, it is recommended to pay special attention to the structure of the diagnostic stage, psychoeducational opportunities, and assessment of the effectiveness of setting correctional goals [2; 5; 13; 17]. The diagnostic stage involves assessing the child's development in accordance with the goals and the parents' request. The counselling stage should be aimed at informing parents about the diagnostic results, the child's special needs, the possibilities of their satisfaction, the specifics of disorders and the possibilities of their correction. The presented work was conducted in order to analyze approaches to proving the effectiveness of counselling practices and to present the results of a pilot study of the effectiveness of the technology of counselling and diagnostic support for children with ASD "Kashenkin Lug", developed at the Federal Resource Centre for the organization of comprehensive support for children with autism spectrum disorders of the Moscow State University of Psychology and Education [4]. Pilot testing of the technology was conducted in 8 regions of the Russian Federation.
Approaches to Assessing the Effectiveness of the Diagnostic Phase
There are various diagnostic protocols and standards recommended for use in working with children with ASD. At a generalized level, diagnostic models may differ in several ways, the most important of which seem to be the following [14]:
- Diagnostic protocol structure. The main factor that determines the objectivity and validity of conclusions about the child's features and level of development is the quality of the diagnostic tools used. There are recommendations in which diagnostic tools are classified in terms of their reliability and validity [6; 11; 12]. At the same time, the issue of the mandatory inclusion of certain tools remains debatable. For example, the CMAP protocol (Comprehensive Multi-Disciplinary Assessment Protocol for Autism Spectrum Disorder) [12] proposes to perform an overly detailed assessment in various areas: cognitive functioning, executive functions, visual-spatial functions, memory, speech development, academic skills, adaptive functioning, sensory processes, and motor skills. The choice of a particular instrument may vary depending on the child's level of development, but should be made from a defined list of techniques. Another type of recommendation allows for a more flexible approach to the indicators to be assessed. In particular, for example, the AAP (American Academy of Pediatrics) protocol recommends assessing cognitive functioning and adaptive skills, but does not define a formal assessment conducted by a psychologist [14]. The recommendations of specialists from the Institute of Special Education offer criteria for assessing a child's behavior as part of a diagnostic session [3].
- Multidisciplinarity. On the one hand, it seems obvious that the more specialists are involved in the examination of a child, the more differentiated the recommendations will be. On the other hand, the choice of specialists should be consistent with the diagnostic objectives and be economically justified. It should be noted that, despite recommendations for multidisciplinary assessment [12], there is little accompanying empirical evidence to suggest that the conclusions reached by a team of specialists will be more accurate than those of an individual clinician [16].
Taking all this into account, it is assumed that the diagnostic model should have a staged character, when at the first stage the necessity of involving specialists of a certain profile and a set of diagnostic techniques is determined, and at subsequent stages the implementation of the planned strategy takes place [10].
Approaches to Assessing the Effectiveness of the Counselling Phase
The purpose of the counselling stage is to present the results obtained in the framework of diagnostics, as well as information about the child's special needs, recommended educational routes and remedial assistance. There are several approaches to analyzing the effectiveness of the consultation phase. Firstly, conclusions can be drawn from an assessment of the child's symptom dynamics. For example, a recent meta-analytic review showed that parental exposure to group psychological education programmes had an effect on the child with ASD. The effect was rated as low (for social skills), medium for psychological development and high for measures of well-being [9]. Another important indicator of counselling quality is parental satisfaction. Importantly, family satisfaction can be considered as an independent criterion. In addition, parents' satisfaction with the outcome of counselling will determine their willingness to implement the recommendations and move along the developed route of help. In other words, this indicator may also mediate the effect of other factors that influence the success of help for the child.
Another approach proposes to capture the extent to which the practice under investigation allows us to set goals and work towards achieving them [18; 19]. For example, the study by Ruble et al. [17] evaluated the effectiveness of COMPASS (collaborative model for promoting competence and success), which was designed to improve goal setting when building an individual educational programme for children with ASD. For this purpose, it was assessed to what extent the child's progress in the experimental and control groups on each of the stated goals met expectations (GAS, goal attainment scaling).
Thus, the criteria for the effectiveness of the counselling and diagnostic protocol depend on the objectives set at each stage. To assess the diagnostic part of the protocol, it is necessary, first of all, to analyze the tools used (whether they are standardized or not, whether there are data from psychometric studies, whether they are included in clinical recommendations). In addition, an important indicator is the approach to interaction between specialists of different profiles. The quality of the counselling stage can be assessed by studying the dynamics of the family and the child, their satisfaction with the work carried out, and the achievement of the goals set.
Research Materials and Methods
Technology of Counselling and Diagnostic Support for Children with ASD "Kashenkin Lug"
The "Kashenkin Lug" technology [4] is a cycle of individual meetings with a family raising a child with ASD [4] for the purpose of psychological and pedagogical support on issues of education and upbringing. The technology consists of 3 stages:
- Diagnostic stage. This stage involves a child’s comprehensive psychological and pedagogical examination. For this purpose, it is suggested to use methods from the following list: Modified Checklist for Autism in Toddlers (M-CHAT-R/F) - for children from 16 to 30 months; Social and Communication Questionnaire (SCQ); Kent Infant Development Scale (Russian version of KID-R) - for children up to 16 months of age; Child Development Inventory for children aged 14 months to 3.5 years (adapted version to Russian conditions - RCDI); Psychological-Educational Profile (PEP-3); Vineland Adaptive Behavior Scale (VABS); Verbal Behavior Milestones Assessment and Placement Programme (VB-MAPP); Assessment of Basic Language and Learning Skills - Revised (ABLLS-R); Wechsler Intelligence Scale for Children (WISC-3); Semago Diagnostic Kit [7]; Sensory Profile by O.B. Bogdashina [8]. If necessary, it is advisable to use additional methods, for example, in case of suspicion of a hereditary cause of disorders [1].
- Counselling stage. This stage is conducted in the form of a training session for parents, which includes consultation on the results of psychological and pedagogical examination, familiarization of parents with the recommendations of specialists, setting goals, clarification of emerging issues, training in methods that contribute to achieving the goals of work with the child. The training process is based on the demonstration of examples of the correct application of methods and technologies of work with the child (including the demonstration of video recordings of examples). In addition, parents can be trained in their own skills of interaction with the child.
- Obtaining feedback from parents. Information about the results of work with the child in accordance with the recommendations of specialists is collected on the basis of an individualized questionnaire. The questionnaire data allow to assess the extent to which the family succeeds in working in accordance with the set goals, and to determine the need for a repeated meeting to adjust them.
Specialists' Training to Participate in the Study
15 specialists of various institutions providing assistance to children with ASD from 8 regions of the Russian Federation: Ulyanovsk Oblast, Chuvash Republic, Khabarovsk Krai, Volgograd Oblast, Khanty-Mansi Autonomous Okrug, Moscow Oblast, Rostov Oblast, Perm Krai took part in the approbation and evaluation of the effectiveness of the implementation of the "Kashenkin Lug" model of counselling and diagnostic support for children with ASD. From May to September 2022, the specialists were trained in the implementation of all stages of the technology and received the necessary materials and forms, as well as supervision on specific cases. Among the specialists trained were educational psychologists, teachers of defectologists, teachers of speech therapists, social rehabilitation specialists, and deputy directors of institutions.
During the training, a series of online consultations and training seminars were held on organizing consultation and diagnostic activities with families raising children with ASD within the framework of the "Kashenkin Lug" technology. The programme of the seminars included the following topics:
- developmental peculiarities of children with ASD;
- psychological and pedagogical diagnosis of children with ASD;
- organization of special educational conditions for children with ASD;
- modern approaches, methods and programmes of corrective and developmental work with children with ASD;
- the "Kashenkin Lug" technology of counselling and diagnostic support for families raising children with ASD.
The outcome of the training programme was the organization of consultation and diagnostic courses for families raising children with ASD and other developmental disorders on the basis of selected regional educational organizations.
Sample Characteristics
During the implementation of the research stages, 858 families were consulted by regional project participants, including 191 children with ASD and 667 children with other developmental disorders. The consultations were organized in accordance with the recommendations and techniques of the "Kashenkin Lug" support technology.
For further research, families who had undergone a full cycle of individual meetings in accordance with the technology were selected, a total of 41 families with a child with ASD. To assess the effectiveness of the technology, the results of the survey, the proposed recommendations and parents' feedback were analyzed. The age of the children ranged from 2.6 to 13 years. The distribution of children by age and gender can be seen in Table 1.
Table 1 Distribution by sex and age of children who participated in the study
|
|
Total |
2-4 years |
4-7 years |
7-11 years |
11-14 years |
Boys with ASD |
Girls with ASD |
|
N (% of the group) |
41 |
9 (21%) |
5 (12%) |
25 (62%) |
2 (5%) |
32 (78%) |
9 (22%) |
90 days after the consultation, parents were sent a feedback questionnaire in which they had to answer a number of questions regarding information on the creation of special conditions for their child's education in accordance with the specialists' recommendations prepared earlier. Parents were asked to indicate the version of the child's educational programme approved at the time of the questionnaire, the model of education, and the availability of support specialists. In addition, parents were asked about the dynamics of achieving the goals specified by the specialists in the individual plan of correctional work with the child. Parents' answers were evaluated according to three criteria: the level of skill formation, the degree of compliance with the recommendations of specialists of the applied technology of skills training, the degree of parental satisfaction with the child's results at the time of the survey. Additionally, information was collected about any difficulties in the implementation of the child support programme and the need for a second consultation. Then, for the purpose of additional analysis, the collected data on the questionnaire were compared with the initial information in the psychological and pedagogical report on the child prepared based on the results of the course.
In accordance with the existing approaches to analyzing the effectiveness of counselling and diagnostic models of child support, we selected criteria for evaluating the "Kashenkin Lug" technology, dividing them into three subgroups: 1. Criteria for the effectiveness of the diagnostic stage; 2. Criteria for the effectiveness of the counselling stage; 3. Family satisfaction (see Table 2).
Table 2
Criteria for assessing the effectiveness of the "Kashenkin Lug" technology
|
Criteria |
Assessment approach |
|
|
|
1.1. Implementing a staggered approach to the selection of professionals involved in the survey |
Analyzing the strategy for attracting specialists, in accordance with the methodological recommendations |
|
1.2. Use of standardized diagnostic techniques |
Analyzing the recommended diagnostic tools |
|
|
|
2.1. The family's success in realizing its goals |
Percentage of goals that the family is able to work on fully |
|
2.2. Having goals that are not in line with the child's capabilities |
Percentage of goals that the family is unable to work on due to inaccessibility for the child (lack of necessary skills of the child, incompetence of parents, difficulties in other areas that do not allow to work in the chosen direction) |
|
2.3. Opportunities for revising objectives |
Analyzing the strategy implemented in the accompaniment protocol, according to the methodological recommendations |
|
2.4. Possibility of receiving recommended assistance (educational programme, form of study) |
Proportion of families who, following diagnosis, were able to receive the recommended assistance |
|
|
|
3.1. Family satisfaction with the child's progress on the stated correctional goals |
Average satisfaction score (arithmetic mean of the family's satisfaction score for the child's development of each skill), according to the feedback questionnaire is calculated |
|
3.2. Parental involvement in the accompaniment programme |
Percentage of families who find it difficult to achieve their goals and report dissatisfaction with their child's progress, but state that a second counselling session is needed. |
Results and Discussion
- Criteria for the effectiveness of the diagnostic stage
1.1. Implementation of a staged approach to the selection of specialists involved in the examination. According to the methodological recommendations, during the counselling and diagnostic reception the involvement of specialists is carried out according to a step-by-step procedure. The first step is to identify the family's request, which makes it possible to determine the areas of psychological and pedagogical diagnosis and select diagnostic tools. The second step includes the procedure of examining the child, collecting information from parents, which creates opportunities for determining the level of the child's basic areas of development, as well as determining the need for additional examination by specialists of another profile (for example, a psychiatrist). Thus, the number of specialists involved in the examination can be increased depending on the need to clarify data on the child's development. The content of the third step is related to the first two: depending on the family's request and the findings of the examination, an appropriate algorithm of actions will be determined and recommendations of specialists will be given during the counselling process.
1.2. Use of standardized diagnostic techniques.
Table 3 lists the techniques recommended for use in the "Kashenkin Lug" counselling and diagnostic session. For each tool, it is indicated whether it is standardized and included in the recommendations of the Ministry of Health of the Russian Federation "Autism Spectrum Disorders: Clinical Recommendations" [6].
Table 3
Diagnostic tools recommended for use within the framework of the "Kashenkin Lug" technology
|
Diagnostic tool |
Standardization and availability of norms |
Recommended or not, according to the clinical guidelines of the Ministry of Health of the Russian Federation [6] |
|
Modified Checklist for Autism in Toddlers, revised (M-CHAT-R/F) |
Threshold value for the risk group. Standardized |
+ |
|
Social and Communication Questionnaire (SCQ). A tool for rapid screening of autism spectrum disorders |
Threshold value for the risk group. Standardized |
+ |
|
Kent Infant Development Scale (KID-R) |
Percentiles, age equivalent |
- |
|
Child Development Inventory for children aged 14 months to 3.5 years (adapted version to Russian conditions - RCDI) |
Percentiles, age equivalent |
- |
|
Psychological-Educational Profile (PEP-3) |
Percentiles, age equivalent |
- |
|
Vineland Adaptive Behavior Scale (VABS) |
Standardized scores on individual subtests and composite scales |
+ |
|
Verbal Behavior Milestones Assessment and Placement Programme (VB-MAPP)
Assessment of Basic Language and Learning Skills - Revised (ABLLS-R) |
Not standardized |
They are the main diagnostic tools for skills assessment and programme design in behavioural analysis approaches (approaches with proven effectiveness, recommended for ASD). |
|
Wechsler Intelligence Scale for Children (WISC-3) |
Standardized scores on individual subtests and composite scales |
+ |
|
Semago Diagnostic Kit |
Not standardized |
- |
|
Sensory Profile by O.B. Bogdashina |
Not standardized |
- |
Thus, four instruments (M-CHAT/R, SCQ, Wechsler test, Vineland Adaptive Behavior Scale) are specified in the clinical recommendations of the Ministry of Health of the Russian Federation, developed by the Association of Psychiatrists and Psychologists for Evidence-Based Practice [6]. Two techniques (VB-MAPP and ABLLS-R) are generally accepted for building a correction programme within the framework of applied behaviour analysis and combine practices with high proven effectiveness.
- Criteria for the effectiveness of the counselling stage
2.1. Success in realizing goals
Fig. 1. Analyzing the effectiveness of the goals set.
Figure 1 shows the results of the analysis of the goals set during counselling. The share of goals on which the family managed to work in full is 62.6%. Due to peculiarities of the child's behavior or development, 32.6% of the goals were unattainable. For the remaining 4.9 per cent of the goals, work could not be organized for external reasons. The percentage of families who were able to organize work on at least one goal after the consultation was 86.
2.2. Having goals that are not in line with the child's capabilities
According to the data obtained, 32.6% of the set goals could not be realised because they did not correspond to the actual capabilities of the child. Among the most frequent reasons were mentioned:
- Lack of child’s motivation.
- Undesirable behaviour (autostimulation, aggression, overexcitement).
- Lack of skills prior to working towards a goal (underdeveloped productive contact skills, attention retention, co-operation skills, listening skills).
2.3. Opportunities for revising objectives
The "Kashenkin Lug" support technology provides for repeated consultations at the request of parents, where the goals set can be reviewed and adjusted. The protocol of the feedback stage (in the form of individualized questionnaires) allows specialists to initiate a meeting with the family if difficulties become evident.
2.4. Possibility of receiving recommended assistance (educational programme, form of study).
95% of the families surveyed stated that they were able to receive the recommended training programme following the consultation. The form of education was in line with the recommendations in 90% of cases.
Thus, the format of the consultation stage allows to successfully organize work on the majority of the set goals (62.6% of the goals). The remaining 37.4% of goals fall into two groups. A small percentage of cases concern situations in which the family, due to external reasons, does not work in the recommended direction. The remaining goals cannot be achieved due to the inaccessibility of certain activities for the child. This situation implies the need to revise the goals, which is included in the follow-up protocol: the family can come for a second appointment if requested. It is characteristic that in 84% of cases, parents who have difficulties in implementing the recommendations indicate the need for a second consultation. The need for repeated counselling is also explained by the need to define new prospective goals of correctional work with the child. These data indicate the formation of a stable motivation among parents to participate in the implementation of the support route and the presence of a request for counselling assistance.
- Criteria of effectiveness: family satisfaction
3.1. Family satisfaction with the dynamics of the child's development in relation to the stated correctional goals.
A three-point rating system (0 - not satisfied, 1 - partially satisfied, 2 - fully satisfied) was used to assess family satisfaction with the work on skills development. Figure 2 shows the percentage of parents' answers to the question about their satisfaction with the child's progress in accordance with the set goals. It can be seen that almost 60% of answers are "Fully satisfied"; 34.2% - "Partially satisfied"; 6.2% - "Not satisfied".
Fig. 2. Satisfaction with the progress of work with the child to achieve the set goals.
Analysis of parental satisfaction with the dynamics of achieving the goals was conducted both by total indicators (Fig. 2) and separately by groups of goals: cooperation skills, communication and speech, social interaction skills, motor skills, learning behavior and academic skills. According to individual plans of correctional work, drawn up according to the algorithm of the "Kashenkin Lug" technology, the development of specific aspects of social interaction was recommended for 92% of the study participants; the development of the child's communication and speech skills - 95% of families, the development of social and everyday skills - 97%. Development of motor skills was required by 58% of participants, academic skills and learning behavior by 34% and 39% respectively. The number of specific remedial tasks in each goal group ranged from 3 to 21. Further detailed analyses of satisfaction with the dynamics of achieving the goals will be conducted.
3.2. Parental involvement in the accompaniment programme
The share of families who declared interest in repeated counselling was 86%. Among families who reported difficulties in achieving goals, such answers were 84%.
Thus, according to the data obtained, more than half of the families after the first consultation express satisfaction with the dynamics of the child's performance in achieving the set goals. The absolute majority of the study participants still request a second consultation, regardless of whether they consider the work with the child to be successful or not.
Conclusions
We conducted a pilot study of the effectiveness of the "Kashenkin Lug" technology for supporting families raising children with ASD. As part of the research project, the results of the participation of 41 families raising a child with ASD were analyzed. Evaluation criteria were selected that allowed, firstly, to conclude whether the counselling appointment procedure complied with the recommendations developed for the evidence-based approach. Secondly, to quantify the protocol results. The parameters selected for evaluation were divided into three groups: criteria for the effectiveness of the diagnostic stage, criteria for the effectiveness of the counselling stage, and family satisfaction with the correctional work. The analysis of the obtained data allowed us to draw the following conclusions.
- The "Kashenkin Lug" support technology implements a step-by-step approach to the involvement of specialists, which makes it both maximally flexible and adaptable to the family's needs, as well as economical in terms of time and money.
- Most of the methods used at the diagnostic stage are standardized, which allows the assessment procedure to be considered objective.
- The format of the consultation stage, which is implemented within the framework of the technology under study, allows successfully organizing the work to achieve most of the set goals.
- There is consistency between the recommendations received and the possibilities of their realization, which is an important indicator of the goals achievability.
- Most families express satisfaction with the dynamics of the child's development in accordance with the goals set during the consultation and remain interested in repeated consultations.
The article presents a pilot stage of evaluation of the effectiveness of the counselling technology "Kashenkin Lug". We have obtained quantitative data indicating that the structure and content of this support technology allow us to develop a correctional programme, within the framework of which the family manages to achieve the set individual goals. Further research into the effectiveness of the technology can be based on various quantitative indicators, which would allow for a more objective and detailed assessment of the child's dynamics (e.g., the introduction of expert evaluation), as well as the level of parental competence. In order to assess the quality of the goals that are formulated as part of the counselling session, a detailed analysis of the goals by their content is planned.
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