Feasibility and acceptability of a parent-toddler programme to support the development of executive functions in children at elevated likelihood of autism or ADHD: Pilot findings

This study reports feasibility, fidelity and acceptability of a pilot of START; a 12-week parent-toddler, group-based, neurodiversity-affirming programme aiming to support executive function development in toddlers at elevated likelihood of autism or ADHD. After 4 days' training, community early years practitioner pairs delivered START to 13 UK families with a toddler showing elevated autistic traits, or with a parent or sibling with autism or ADHD, in groups of 6 and 7. Sessions were audio-recorded and rated by practitioners and researchers regarding the extent to which programme and session aims were met. Practitioners' reflections on strengths and challenges in session delivery, adaptations to the session plan and researchers' observations from the audio recordings were probed in weekly debrief calls, and one-to-one interviews at programme end-point. Recruitment and retention were monitored. Parent participants were asked to complete a feedback questionnaire after each session. Results show recruitment to the programme is feasible, but a large minority of parents experience barriers to regular attendance, which is a challenge for achieving exposure targets. Practitioners delivered the programme to a high quality and at least partially met programme and session-specific aims in every session. The most significant barrier to fully meeting session aims was families' late arrival. Parents reported regularly engaging with the suggested activities at home and found the sessions useful, although not all parents responded each week. Overall, the results of this small-scale pilot indicate START is feasible and acceptable as a parent-mediated programme to support toddlers at elevated likelihood of autism or ADHD to thrive.