This thesis explores implementation and intervention fidelity within parent-mediated interventions for children suspected or diagnosed with autism spectrum disorder. The first chapter is a systematic literature review exploring the measurement and the methodological quality of reporting implementation and intervention fidelity within parent-mediated randomised controlled trials (RCTs) for children. A literature search returned 2253 papers, 23 met inclusion criteria for systematic review for fidelity components dose, adherence, responsiveness and quality of delivery. The review highlights the inconsistent approach to reporting intervention and implementation fidelity for both the clinician and the parent. Methodological quality of reporting was most often moderate and very few studies linked fidelity to outcomes. This highlights the need for future research to focus on a consistent theoretical framework for the measurement of fidelity within parent-mediated RCT’s.
The second chapter presents the parent’s perspectives of participating in a parent-mediated intervention, Paediatric Autism Communication Therapy (PACT) delivered in a clinical community setting. The semi-structured interview was conducted with eight participants and designed to illicit parents’ views of the acceptability of the intervention and analysis was guided by principles of thematic analysis. Two superordinate themes and six subordinate themes emerged from the data representing parents therapeutic learning journey and is discussed within the theoretical framework of acceptability.
The third chapter reflects on the theoretical and clinical implications that emerged from the first two papers, highlighting the need for a consistent implementation fidelity framework within the field of ASD to ensure the translation of EBP into routine clinical care. The thesis concludes with my personal reflections on the process of researching and writing during a global pandemic.