Short-term outcomes and six-month follow-up of BEAR: a blended, pre-emptive intervention for infants and toddlers at elevated likelihood for autism.

To improve access to early interventions for infants and toddlers with a neurodevelopmental vulnerability, the BEAR (Blended E-health for children at eArly Risk) intervention was developed. BEAR is a parent-mediated, blended e-health intervention with the aim to promote parental sensitivity to their child's needs and to motivate the child to socially engage. The primary hypothesis was that the BEAR intervention would lead to improved joint engagement in parent-child interactions. Secondary hypothesis included improved social-communicative development of the child, enhanced parental skills (e.g., scaffolding, highlighting symbols, following the child's interest, caregiver affect), lower parental stress, improve parental well-being and overall improvement of parent-child interactions. A cluster randomized controlled trial (cRCT) was conducted to assess short-term and six-month effects. Fifty-five toddlers and their parents were randomized to either the BEAR group (n = 40) or the care-as-usual (CAU) group (n = 15). Results showed no significant treatment effects on the child, a positive treatment effect on the parental skills (scaffolding and affect), and a possible treatment effect on dyadic level (i.e. improved fluency and connectedness in parent-child interaction). The current study provides some support for BEAR as a promising pre-emptive intervention for young children with a neurodevelopmental vulnerability and their parents. Parents seem to benefit primarily from the intervention through the enhancement of their parental skills while direct effects on the child's behaviors were lacking. Longitudinal assessments are essential to evaluate the long-term impacts of the BEAR intervention and to assess its sustainability over time.