Through Parents' Eyes: Perspectives on Child Development and Family Experience During ESDM Intervention

Early intensive intervention for autistic children aims to support developmental progress in social and communication domains. Although outcomes are typically assessed using standardized measures of child development, parental perspectives during early intervention remain largely understudied. Here, we examined parental perceptions after 6 months of intensive Early Start Denver Model (ESDM) intervention. Participants were parents of 104 autistic children aged 1.3-3.5 years enrolled in an individualized therapist-delivered ESDM intervention following diagnosis confirmation. Child development was assessed at entry (baseline) and 6 months later (follow-up). At follow-up, parents completed an 18-item questionnaire capturing their perceptions of child progress across twelve domains as well as changes in parenting skills, personal well-being, and family life. Descriptive analyses, item-level correlations, and principal component analysis (PCA) were conducted to identify underlying components. Parents generally indicated improvements across all domains, with aggravation rarely reported. PCA revealed three intercorrelated components (Social Communication, Nonverbal Social Engagement, and Positive Parental Experience), each showing distinct associations with child or parent measures. Parental perceptions of child development were strongly correlated with standardized developmental assessments, particularly in social communication. While parents also reported enhanced parenting skills and positive personal and familial impacts, these experiences were not associated with child developmental gains but with parental education and the number of siblings in the household. These findings underscore the importance of integrating parental perspectives alongside clinical assessments when evaluating early intervention outcomes. Future research should investigate how parental perceptions evolve over longer periods and how they may inform family-centered care and post-intervention support.