Project Activities
This project used an iterative process to adapt the ePALS intervention for postnatal mothers with cognitive delays, conducted a single-case design study to ascertain the optimum mode of distal and in-person coach contacts, and ran a small, randomized pilot study to determine its impact on maternal responsiveness and infant social-emotional development.
Structured Abstract
Setting
The project was implemented online in home settings in Oregon, Washington, Michigan, Florida, and Ontario Canada.
Sample
The sample included 10 mother-infant dyads participating in focus groups, 3 dyads in the single-case study, and 21 dyads in the randomized pilot study. Participating mothers, recruited through community agencies, had an infant 1 to 12 months of age, identified by the agency as a mother with a cognitive delay who may potentially benefit from the ePALS program, and self-reported having a cognitive delay or learning difficulty.
ePALS is a computerized adaptation of the PALS parenting program. PALS is an in-home, empirically supported, cognitive-behavioral skills intervention for mothers of infants that targets improvement in sensitive and responsive parenting behaviors and minimizing insensitive, harsh, and intrusive behaviors to promote infants' social engagement and language. The web/app version of the intervention includes six sessions that take place over 2 to 3 months. Each session in ePALS includes (a) presentation of concepts, behaviors, and examples; (b) parent check-in questions for review by coach; (c) the creation and automatic upload of a 5-minute video of mother-infant interactions for later review; (d) a summary of topics; (e) daily activities (homework); (f) feedback about the program recorded to the database; and (g) weekly coach contact to review mother-infant interaction video as well as session topics and skills. For mothers with cognitive delays, the following adaptations to ePALS were made: (a) adding exemplar videos of parents with cognitive delays and their infants, (b) modifying existing online content and check-in questions to be instructionally sound for this population, (c) creating a behavioral performance criterion of parenting skills, and (d) creating interactive and gamification features to promote engagement. For this adaptation, the research team explored remote coach contact (phone or video) to support parenting skills learning.
Research design and methods
This project began with an iterative process of development using interviews, focus groups, and beta testers for the app. To evaluate the prototype ePALS program, three mother-infant dyads were randomized in a multiple-baseline single-case design. In the final year, the research team tested the promise of the intervention using a randomized controlled design with 21 mother-infant dyads assigned to experimental or wait-list control conditions. In order to determine the potential impact on maternal responsiveness and infant social-emotional development and communication, data were collected at two timepoints: (a) baseline and (b) post-test for the treatment group and second baseline for wait-list control.
Control condition
In the single-case design, participants serve as their own control. The waitlist control group in the pilot study received their usual-care services during the waiting period and then received ePALS.
Key measures
Feedback from the advisory committee, focus groups, and beta-testing guided development of the adapted ePALS program. For the single-case and randomized design studies, parent-child interaction videos were coded using the Landry Parent-Child Interaction Scales to assess naturalistic parent-child interactions. The positive interactions focused on maternal responsiveness (maternal positive affect, warmth, flexibility, and positive verbal content) and negative interactions examined ratings of maternal physical intrusiveness as well as verbal and affective negativity. Additional outcomes were assessed through questionnaires, including infant social-emotional and communication functioning (Ages and Stages Questionnaire-Social Emotional), parents' attitudes and knowledge (PALS Knowledge Questionnaire, Concepts of Development Questionnaire, and Parenting Sense of Competence), and consumer satisfaction. Post-intervention parent interviews were used to identify further adaptations to the implementation, additional module content, barriers to implementation and treatment fidelity, and strengths and facilitators of the program. Potentially moderating variables included demographics and adaptive behavior as an indication of disability severity (Vineland Adaptive Behavior Scales). Electronically captured user data measured coaching dosage, participant app-use, and intervention dosage.
Data analytic strategy
For the initial development phase, the research team used content analysis techniques to analyze the focus group transcript text. The common themes derived from content analysis were applied to the prototype. In the single-case design study, visual analysis was used to analyze graphed data along with a case-specific approach to estimation of effect size. In the pilot study, the research team used the Wilcoxon signed-rank test to find effects of ePALS on the parents. (Due to the sample size, the moderation analyses were not conducted.)
Key outcomes
The main findings of this project, as reported by the principal investigator, are as follows:
- The group participating in ePALS showed greater gains on maternal parenting compared to the wait-list control condition.
- More specifically, there were large effect sizes for parenting knowledge and small effect sizes for parent-reported risk scores.
People and institutions involved
IES program contact(s)
Products and publications
ERIC Citations: Find available citations in ERIC for this award here.
Additional online resources and information: https://epals-idd.web.app (intervention website)
Project website:
Publications:
Select Publications:
Journal articles
Guinness, K.E., Diercks, C., Vaughn, K., Davis, B., Landry, S., & Feil, E.G. (In press). Adapting an Internet-Based Parenting Intervention for Parents with Intellectual Disabilities: Preliminary Data and Lessons Learned. Infants and Young Children.
Proceedings
Feil, E.G. Vaughn, K., Davis, B., Landry, S., & Guinness, K.E. (May 2025). Mobile Parent- Training Program for Women with Cognitive Delays Who Are Mothers of Infants. Society for Prevention Research, Seattle, WA.
Questions about this project?
To answer additional questions about this project or provide feedback, please contact the program officer.
