Parents’ experiences of remote parent-mediated communication therapy for toddlers with autism: a qualitative study using Proctor’s implementation outcomes framework

Background Parent-mediated interventions, in which therapists guide caregivers to support their child’s communication, are widely used in early autism care, and telehealth may improve access to them. Delivering therapy by videoconference, however, also moves part of the therapeutic work into the home, and families’ experience of this format soon after diagnosis remains poorly understood. This study explored parents’ experiences of remotely delivered Paediatric Autism Communication Therapy, focusing on acceptability, feasibility, appropriateness and fit with family life. Methods This qualitative study was nested in a multicentre randomised controlled trial in France. Fourteen parents of toddlers with autism who had completed the 12-month videoconference programme took part in semi-structured videoconference interviews, conducted within three months of completion by a researcher independent of the intervention. Data were analysed using thematic analysis informed by phenomenological principles, and themes were then mapped onto Proctor’s implementation outcomes framework. Results Four themes were identified: limited alignment with the wider needs of the early post-diagnostic period; positive effects on parental skills, confidence and interactions; influence on family dynamics and routines; and the experience of remote delivery. Parents valued the accessibility of the format, the therapeutic alliance and video feedback, and reported continuing to use strategies after the programme ended. Acceptability was high, whereas appropriateness and feasibility were more variable, shaped by emotional readiness after diagnosis, unaddressed behavioural difficulties, the mental load of recording home videos, and technical problems. Conclusions Remote delivery of this parent-mediated intervention was perceived as acceptable and implementable, mainly through parental empowerment, but it partly shifted the burden of therapy onto households. Preparatory psychoeducation, explicit discussion of the programme’s scope, technical support and hybrid formats may improve its fit with families’ needs early after diagnosis. Trial registration: ClinicalTrials.gov, NCT04244721. Date of registration: January 28, 2020