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Predictors of Parent Engagement in Part C Early Intervention for Autism: The Role of Single Parenthood and Initial Motivation

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Title: Predictors of Parent Engagement in Part C Early Intervention for Autism: The Role of Single Parenthood and Initial Motivation
Language: English
Authors: Hannah Tokish (ORCID 0009-0001-9302-3310), Brooke Ingersoll, RISE Research Network
Source: Autism: The International Journal of Research and Practice. --1291 2026 30(5):1278-1278.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 14
Publication Date: 2026
Sponsoring Agency: National Institute of Mental Health (NIMH) (DHHS/NIH)
Contract Number: R01MH12272501
R01MH12272601
Document Type: Journal Articles
Reports - Research
Descriptors: Predictor Variables, Parent Participation, Early Intervention, One Parent Family, Autism Spectrum Disorders, Educational Legislation, Federal Legislation, Equal Education, Students with Disabilities, Psychological Characteristics, Stress Variables, Self Efficacy, Motivation, Developmental Delays, Attendance, Child Rearing
Laws, Policies and Program Identifiers: Individuals with Disabilities Education Act Part C
Assessment and Survey Identifiers: Parenting Stress Index
DOI: 10.1177/13623613261430568
ISSN: 1362-3613
1461-7005
Abstract: Parent engagement in early intervention supports child progress but is variable in community settings and understudied in autism populations. Prior studies have examined attendance and homework completion rather than parent participation engagement--active, independent, and responsive contribution to treatment--and it is unclear how these distinct engagement measures are related. This study examined how observationally-coded parent participation engagement during early intervention sessions, between-session practice, and attendance were interrelated in addition to the influence of sociodemographic (marital status, minoritized racial/ethnic identity, and education) and psychological characteristics (stress, self-efficacy, and motivation) on engagement. The sample included 164 parents of toddlers (16-34 months) with an autism diagnosis or early autism indicators (i.e. social communication delays) receiving services through the publicly funded Part C Early Intervention system in the United States, which serves children under 36 months with developmental delays and disabilities. Observed parent participation engagement, parent-reported between-session practice, and attendance were not significantly correlated. Only marital status significantly predicted observed parent participation engagement, such that single parents exhibited lower parent participation engagement. Low motivation predicted lower parent-reported between-session practice. No parent characteristics predicted session attendance. Results suggest that early intervention providers should consider multiple aspects of parent engagement that are influenced by different parent characteristics when assessing and promoting engagement to support child progress.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1503144
Database: ERIC
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  Value: <anid>AN0193059427;f9d01may.26;2026Apr20.02:44;v2.2.500</anid> <title id="AN0193059427-1">Predictors of Parent Engagement in Part C Early Intervention for Autism: The Role of Single Parenthood and Initial Motivation </title> <p>Parent engagement in early intervention supports child progress but is variable in community settings and understudied in autism populations. Prior studies have examined attendance and homework completion rather than parent participation engagement—active, independent, and responsive contribution to treatment—and it is unclear how these distinct engagement measures are related. This study examined how observationally-coded parent participation engagement during early intervention sessions, between-session practice, and attendance were interrelated in addition to the influence of sociodemographic (marital status, minoritized racial/ethnic identity, and education) and psychological characteristics (stress, self-efficacy, and motivation) on engagement. The sample included 164 parents of toddlers (16–34 months) with an autism diagnosis or early autism indicators (i.e. social communication delays) receiving services through the publicly funded Part C Early Intervention system in the United States, which serves children under 36 months with developmental delays and disabilities. Observed parent participation engagement, parent-reported between-session practice, and attendance were not significantly correlated. Only marital status significantly predicted observed parent participation engagement, such that single parents exhibited lower parent participation engagement. Low motivation predicted lower parent-reported between-session practice. No parent characteristics predicted session attendance. Results suggest that early intervention providers should consider multiple aspects of parent engagement that are influenced by different parent characteristics when assessing and promoting engagement to support child progress. Parent engagement in early intervention for autism supports child progress but often varies in the community. Most research studies of parents' engagement in intervention have examined attendance and homework completion rather than active and independent contribution to treatment during intervention sessions (e.g. participating in practice activities, sharing perspectives about at-home practice). In addition, little research has examined parent engagement in early intervention for autism, which may be higher compared to broader child psychotherapy since parents typically report high satisfaction with early intervention. To address these gaps, we examined how active engagement observed and scored by trained researchers in video-recorded early intervention sessions, parent report of how often they practice intervention strategies at home, and session attendance were related to each other. We also examined how parents' personal (marital status, racial/ethnic identity, and education) and psychological characteristics (stress, self-efficacy, and motivation) influenced their active engagement, at-home practice, and attendance. Our sample included 164 parents of toddlers with an autism diagnosis or showing early signs of autism participating in the United States publicly funded early intervention system. We found that active engagement, at-home practice, and attendance were not related. While most parent characteristics did not influence active engagement, single parents showed lower engagement during intervention sessions. In addition, parents who reported lower motivation to change their parenting behavior reported less at-home practice. No parent characteristics influenced their session attendance. Our results suggest that active engagement, at-home practice, and attendance may represent different aspects of parent engagement. To assess and increase parent engagement in community early intervention for autism, clinicians should consider multiple signs of engagement and the influence of various parent characteristics.</p> <p>Keywords: ASD; autism; early intervention; parent engagement; social communication</p> <hd id="AN0193059427-2">Introduction</hd> <p>Early intervention (i.e. targeting fundamental developmental skills in the first 3 years of life) is key in supporting developmental skills and quality of life for young autistic children ([<reflink idref="bib2" id="ref1">2</reflink>]; [<reflink idref="bib23" id="ref2">23</reflink>]). Part C Early Intervention (EI) is the primary system for delivering EI services in the United States, serving children under 3 with or at increased likelihood of developmental delays or disabilities, and is often the first point of contact with formal services for young autistic children. It is publicly funded, available in all states, and delivers services in family homes to the extent possible. Part C serves a diverse population of children; approximately 50% come from a racially and/or ethnically minoritized background ([<reflink idref="bib60" id="ref3">60</reflink>]; for further information: [<reflink idref="bib19" id="ref4">19</reflink>]; [<reflink idref="bib22" id="ref5">22</reflink>]).</p> <p>Increasingly, best practice guidelines for autism EI focus on parent[<reflink idref="bib10" id="ref6">10</reflink>] engagement to support children and families ([<reflink idref="bib10" id="ref7">10</reflink>]; [<reflink idref="bib19" id="ref8">19</reflink>]). Broadly, parent engagement is particularly important in child therapy, as parents play a critical role in seeking services, facilitating attendance, and supporting efforts to adjust child behavior ([<reflink idref="bib32" id="ref9">32</reflink>]). Parent engagement in intervention is related to improvements in child skills, family well-being, and long-term retention of families in psychotherapy ([<reflink idref="bib20" id="ref10">20</reflink>]; [<reflink idref="bib28" id="ref11">28</reflink>]). Despite its importance, parent engagement in intervention varies in community-based settings, including those serving young autistic children ([<reflink idref="bib32" id="ref12">32</reflink>]). These findings highlight the need to identify factors that influence parent engagement in community-based EI for autism and to develop strategies to promote engagement to support child progress and quality of life.</p> <p>There is increasing recognition of parent engagement as a multidimensional construct, with several distinct but interrelated factors, most commonly identified in the literature as cognitive (e.g. treatment expectations), affective (e.g. motivation), behavioral (e.g. attendance, homework completion, in-session participation), and relational (e.g. therapeutic alliance; [<reflink idref="bib14" id="ref13">14</reflink>]; [<reflink idref="bib36" id="ref14">36</reflink>]; [<reflink idref="bib55" id="ref15">55</reflink>]). However, most research has focused narrowly on attendance and homework completion ([<reflink idref="bib38" id="ref16">38</reflink>]), with limited attention to more active forms of parent engagement, such as parent participation engagement (PPE). PPE is defined as active, independent, and responsive contribution to treatment and has been measured via in-session behaviors (e.g. asking questions, participating in practice activities) and perspective-sharing (e.g. about the intervention or about between-session practice/follow-through on recommendations; [<reflink idref="bib28" id="ref17">28</reflink>]; [<reflink idref="bib32" id="ref18">32</reflink>]). PPE is particularly relevant within the Part C system given its emphasis on family-centered services that prioritize parent-provider collaboration, building family skills, and providing home-based services ([<reflink idref="bib19" id="ref19">19</reflink>]). However, PPE remains understudied and not well-understood ([<reflink idref="bib4" id="ref20">4</reflink>]), particularly in autism populations. Furthermore, few studies have examined PPE using more objective methods, such as observational coding of in-session engagement behaviors ([<reflink idref="bib32" id="ref21">32</reflink>]; [<reflink idref="bib38" id="ref22">38</reflink>]). Although prior studies have examined influences on parent attendance ([<reflink idref="bib8" id="ref23">8</reflink>]; [<reflink idref="bib17" id="ref24">17</reflink>]) and practice/use of intervention strategies ([<reflink idref="bib9" id="ref25">9</reflink>]; [<reflink idref="bib35" id="ref26">35</reflink>]; [<reflink idref="bib50" id="ref27">50</reflink>]) in the context of autism services, to our knowledge, only one study has examined PPE in an autism-specific intervention ([<reflink idref="bib28" id="ref28">28</reflink>]). This study focused on older autistic children (5–14 years old) with externalizing behavior, and did not examine other aspects of engagement ([<reflink idref="bib28" id="ref29">28</reflink>]). Thus, it is unclear how PPE relates to other more commonly studied measures of parent engagement (e.g. attendance and homework) or whether similar parent-level factors predict this important form of engagement in autism-specific EI for children under 36 months.</p> <p>Research has identified numerous family demographic and psychological factors that are related to multiple components of parent engagement in community-based child mental health treatment ([<reflink idref="bib32" id="ref30">32</reflink>]; [<reflink idref="bib47" id="ref31">47</reflink>]). Although studies commonly suggest that child gender and diagnostic severity impact attendance ([<reflink idref="bib26" id="ref32">26</reflink>]), most research has focused on parent-level influences ([<reflink idref="bib32" id="ref33">32</reflink>]). For example, single parenthood, minoritized racial/ethnic identity, and low socioeconomic status (SES) have consistently been associated with reduced parent attendance, related to increased service barriers including limited access to healthcare, financial constraints, and cultural and language differences ([<reflink idref="bib32" id="ref34">32</reflink>]; [<reflink idref="bib47" id="ref35">47</reflink>]; [<reflink idref="bib58" id="ref36">58</reflink>]). Furthermore, parents with high stress, low self-efficacy, and low motivation to participate in treatment often demonstrate lower engagement ([<reflink idref="bib29" id="ref37">29</reflink>]; [<reflink idref="bib32" id="ref38">32</reflink>]). However, findings have not been entirely consistent across studies ([<reflink idref="bib47" id="ref39">47</reflink>]), which may stem, in part, from varying definitions of parent engagement and inconsistent measurement approaches. Furthermore, this work has primarily been conducted in the context of child psychotherapy for externalizing disorders ([<reflink idref="bib32" id="ref40">32</reflink>]; [<reflink idref="bib47" id="ref41">47</reflink>]); thus, it is unclear whether these same factors are related to parent engagement in autism-specific EI, which often incorporates a greater focus on parent training than broader child psychotherapy ([<reflink idref="bib20" id="ref42">20</reflink>]; [<reflink idref="bib52" id="ref43">52</reflink>]). In addition, parents typically report high satisfaction with Part C EI and perceive it to be family-centered, which may promote greater engagement given previously established associations between treatment satisfaction and engagement ([<reflink idref="bib24" id="ref44">24</reflink>]; [<reflink idref="bib45" id="ref45">45</reflink>]).</p> <p>This study addresses existing gaps in the literature by examining parent sociodemographic and psychological factors that influence PPE measured by observational coding, alongside more commonly studied measures of parent engagement (i.e. frequency of at-home practice and attendance) in families of young children with early autism indicators within the Part C EI system. We predicted that PPE, between-session practice, and attendance would be positively associated. Furthermore, we hypothesized that parents with single marital status, minoritized racial/ethnic identity, low SES background, high stress, low self-efficacy, and low motivation would demonstrate reduced engagement as measured by PPE, between-session practice, and attendance.</p> <hd id="AN0193059427-3">Methods</hd> <p></p> <hd id="AN0193059427-4">Study Design</hd> <p>This study used data collected from an ongoing, multi-site randomized controlled trial (RCT) examining the effectiveness of an established parent-mediated naturalistic developmental behavioral intervention, Caregiver-Implemented Reciprocal Imitation Teaching (CI-RIT) for young children with social communication delays in the Part C EI system ([<reflink idref="bib61" id="ref46">61</reflink>]; Trial Registration: ClinicalTrials.gov, ID: NCT05114538). The study was approved by the Michigan State University (MSU) Social Science/Behavioral/Education Institutional Review Board (IRB; 00001960, 00005932). All participants provided written informed consent and parents provided informed consent for their child.</p> <p>In the main trial, EI providers were recruited and randomly assigned to undergo comprehensive training in delivering CI-RIT or continue with treatment as usual and receive comprehensive training in CI-RIT at the end of their active study participation. Families were referred to the main trial by their EI providers based on concerns about their child's social communication development, which may or may not have included a formal autism diagnosis. To be eligible, children had to be between 16 and 34 months old at enrollment, the family had to speak English or Spanish, and the parents had to meet at least weekly with their provider (in-person or via telehealth) during their 4-month active study participation. Families whose providers were randomized to CI-RIT training were provided CI-RIT while families whose providers were randomized to receive CI-RIT training after their study participation were provided with EI treatment-as-usual based on their provider's discretion, which may or may not have incorporated aspects of parent-mediated intervention. An EI session was recorded approximately every 4 weeks beginning at study enrollment, with up to three EI session recordings collected per family. The recording length and modality of EI session delivery were documented. See [<reflink idref="bib61" id="ref47">61</reflink>] for a full description of the main trial protocol and CI-RIT. Although the main trial is a randomized controlled trial, this study reflects an observational analysis of influences on multiple measures of parent engagement.</p> <hd id="AN0193059427-5">Participatory Methods</hd> <p>The main trial was developed by a team of clinical researchers with expertise in autism and early intervention. Stakeholder input from EI providers, families, and EI administrators was obtained during a formative phase to optimize recruitment, provider training, and data collection procedures for the main trial. This study did not incorporate additional participatory methods.</p> <hd id="AN0193059427-6">Participants</hd> <p>Participants included 93 EI providers and 164 parent-child dyads. Parent-provider dyads who completed at least one intervention session recording in English were included; 13 parents whose recordings were conducted in Spanish were excluded. Providers represented a range of disciplines including speech-language pathology (32.3%), developmental therapy (21.5%), occupational therapy (15.1%), special education (15.1%), social work (6.5%), early childhood education (4.3%), and physical therapy (1.1%).</p> <p>Parents were predominantly mothers (88.4%) living with a spouse/partner (76.2%) and were between 21 and 55 years old (<emph>M</emph> = 34.22, <emph>SD</emph> = 6.14). Their children were predominantly males (66.5%) between 16 and 34 months (<emph>M</emph> = 26.61, <emph>SD</emph> = 3.75). Most parents separately identified their race as White (53.0%) and ethnicity as non-Hispanic/Latine (67.7%); when race and ethnicity were combined into minoritized status, approximately 60% of parents were of a minoritized racial/ethnic background. There was considerable variability in education level; slightly over half of parents reported having received below a 4-year college degree. Demographics are presented in Table 1.</p> <p>Table 1. Parent and child demographics (n = 164).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Parent: <italic>n</italic> (%)</th><th align="left">Child: <italic>n</italic> (%)</th></tr></thead><tbody><tr><td colspan="3">Study Condition</td></tr><tr><td><italic> CI-RIT Intervention</italic></td><td>83 (50.6%)</td><td>83 (50.6%)</td></tr><tr><td><italic> Treatment-as-Usual</italic></td><td>81 (49.4%)</td><td>81 (49.4%)</td></tr><tr><td>Age: <italic>Mean (SD)</italic></td><td>34.22 (6.14) years</td><td>26.61 (3.75) months</td></tr><tr><td colspan="3">Sex</td></tr><tr><td><italic>Male</italic></td><td>18 (11.0%)</td><td>109 (66.5%)</td></tr><tr><td><italic> Female</italic></td><td>146 (89.0%)</td><td>55 (33.5%)</td></tr><tr><td colspan="3">Parent Relationship to Child</td></tr><tr><td><italic> Mother</italic></td><td>145 (88.4%)</td><td>-</td></tr><tr><td><italic> Father</italic></td><td>17 (10.4%)</td><td>-</td></tr><tr><td><italic> Foster Mother</italic></td><td>1 (0.6%)</td><td>-</td></tr><tr><td><italic> Grandmother</italic></td><td>1 (0.6%)</td><td>-</td></tr><tr><td colspan="3">Parent Marital Status</td></tr><tr><td><italic> Lives with spouse/partner</italic></td><td>125 (76.2%)</td><td>-</td></tr><tr><td><italic> Does not live with spouse/partner</italic></td><td>39 (23.8%)</td><td>-</td></tr><tr><td colspan="3">Race</td></tr><tr><td><italic>Asian</italic></td><td>13 (7.9%)</td><td>9 (5.5%)</td></tr><tr><td><italic> Black/African American</italic></td><td>33 (20.1%)</td><td>30 (18.3%)</td></tr><tr><td><italic> Indigenous/Native Alaskan</italic></td><td>1 (0.6%)</td><td>1 (0.6%)</td></tr><tr><td><italic> Native Hawaiian/Other Pacific Islander</italic></td><td>2 (1.2%)</td><td>0 (0.0%)</td></tr><tr><td><italic> White</italic></td><td>87 (53.0%)</td><td>85 (51.8%)</td></tr><tr><td><italic> More than one race</italic></td><td>11 (6.7%)</td><td>23 (14.0%)</td></tr><tr><td><italic> Other/Not listed</italic></td><td>6 (3.7%)</td><td>5 (3.0%)</td></tr><tr><td><italic> Prefer not to answer</italic></td><td>11 (6.7%)</td><td>11 (6.7%)</td></tr><tr><td colspan="3">Ethnicity</td></tr><tr><td><italic> Hispanic/Latine</italic></td><td>48 (29.3%)</td><td>53 (32.3%)</td></tr><tr><td><italic> Not Hispanic/Latine</italic></td><td>111 (67.7%)</td><td>106 (64.6%)</td></tr><tr><td><italic> Prefer not to answer</italic></td><td>5 (3.0%)</td><td>5 (3.0%)</td></tr><tr><td colspan="3">Parent Minoritized Status</td></tr><tr><td><italic>Minoritized</italic></td><td>96 (58.5%)</td><td>-</td></tr><tr><td><italic> Non-Hispanic/Latine White</italic></td><td>63 (38.4%)</td><td>-</td></tr><tr><td><italic> Unknown</italic></td><td>5 (3.0%)</td><td>-</td></tr><tr><td colspan="3">Parent College Degree</td></tr><tr><td><italic>4</italic>-<italic>year college degree or above</italic></td><td>74 (45.1%)</td><td>-</td></tr><tr><td><italic> Below 4</italic>-<italic>year college degree</italic></td><td>88 (53.7%)</td><td>-</td></tr><tr><td><italic> Prefer not to answer</italic></td><td>2 (1.2%)</td><td>-</td></tr></tbody></table> </ephtml> </p> <hd id="AN0193059427-7">Measures</hd> <p></p> <hd id="AN0193059427-8">Parent Self-Report Measures</hd> <p>At intake, parents completed family sociodemographics and psychological measures of parenting perceptions. To account for missing items, prorated scores were calculated as the sum score multiplied by the total number of items on that measure, divided by the number of items completed. Missingness was low; the average percentage of items missing was less than 1% (<emph>SD</emph> range = 1.6%–3.0%) across all measures. Scores were grand mean centered prior to analysis to facilitate comparison of predictor effects relative to the full sample.</p> <p>Family demographics included child and parent age, sex, race, ethnicity, marital status,[<reflink idref="bib11" id="ref48">11</reflink>] education level, and number of children and adults in the home. Race and ethnicity were combined to create a minoritized status variable, which was dichotomously coded 0 for White, Non-Hispanic/Latine parents and 1 for parents of a racial and/or ethnic minoritized background. Marital status was coded 0 for single parents and 1 for parents living with a spouse/partner. Education level was coded 0 for parents who completed education below a 4-year college degree and 1 for parents who completed a 4-year college degree or above.</p> <p> <emph>The Parenting Stress Index-4 Short Form</emph> (<emph>PSI-4 SF;</emph>[<reflink idref="bib1" id="ref49">1</reflink>]) measured stress specifically related to parenting. Parents rated 36 items (e.g. "My child's behavior is more of a problem than I expected") on a 5-point Likert-type scale, with a higher sum score indicating higher parenting stress. Internal consistency was excellent (α = 0.93).</p> <p> <emph>The Parent Motivation Inventory</emph> (<emph>PMI;</emph>[<reflink idref="bib44" id="ref50">44</reflink>]) "<emph>Readiness to Change" Subscale</emph> measured parents' motivation to adjust their parenting behavior through intervention. Parents rated 14 items (e.g. "I am willing to change my current parenting techniques and try new ones") on a 5-point Likert-type scale, with a higher sum score indicating greater motivation to participate. Internal consistency was excellent (α = 0.93).</p> <p> <emph>The Parenting Efficacy Survey</emph> (<emph>PES;</emph>[<reflink idref="bib56" id="ref51">56</reflink>]) measured parent perceptions of their parenting abilities and quality as a parent. Parents rated 10 items (e.g. "When your child is upset, fussy, or crying, how good are you at soothing him or her?") on a 4-point Likert-type scale, with a higher sum score indicating a greater sense of parenting efficacy. Internal consistency was fair (α = 0.79).</p> <hd id="AN0193059427-9">Observed PPE</hd> <p>Observed PPE was coded from video recordings of EI sessions using the <emph>Parent Participation Engagement in Child Psychotherapy: Observational Coding Manual</emph> ([<reflink idref="bib30" id="ref52">30</reflink>]). While developed for psychotherapy, this manual was adapted in part from "An Individualized Mental Health Intervention for ASD" (AIM HI) observational coding manual ([<reflink idref="bib7" id="ref53">7</reflink>]). It was previously used in a study of a parent-mediated autism intervention ([<reflink idref="bib28" id="ref54">28</reflink>]) and no adaptations were deemed necessary for this study. Trained coders rated parents on the frequency and thoroughness of six behaviors indicating active engagement using a 5-point Likert-type scale. Items included (<reflink idref="bib1" id="ref55">1</reflink>) <emph>General perspective sharing</emph> (e.g. child skills/progress, the intervention overall), (<reflink idref="bib2" id="ref56">2</reflink>) <emph>Perspective sharing about home actions</emph> (i.e. between-session practice at home), (<reflink idref="bib3" id="ref57">3</reflink>) <emph>Expressing agreement with or enthusiasm about home actions</emph>, (<reflink idref="bib4" id="ref58">4</reflink>) <emph>Asking questions</emph>, (<reflink idref="bib5" id="ref59">5</reflink>) <emph>Participating in intervention activities</emph> (i.e. in-session practice of strategies), and (<reflink idref="bib6" id="ref60">6</reflink>) <emph>Demonstrating commitment to therapy</emph> (e.g. commenting on helpfulness, thinking about therapy between sessions). If the session did not include discussion of home actions or intervention activities, those items were rated as not applicable. All scored items were averaged to produce an observed overall PPE score, with higher scores indicating higher engagement. Internal consistency for the overall scale was good (α = 0.82).</p> <p>Coders were trained to reliability (>80%), participated in monthly meetings to prevent drift, and remained masked to condition. Approximately 20% of videos (<emph>n</emph> = 103) were coded by two independent observers. Inter-rater reliability was excellent (ICC = 0.82, 95% CI [0.73, 0.88]), assessed via intraclass correlations and their 95% confidence intervals based on an average measures one-way random effects model.</p> <hd id="AN0193059427-10">Between-Session Practice</hd> <p>Parent-reported frequency of practice was measured via a survey developed for the main trial that was administered to parents approximately every 4 weeks, corresponding with the time of each EI session recording. This study utilized the following single item from the survey: "In the past week, how often did you practice (or use) strategies that your child's EI provider taught you?" Parents answered this question on a 5-point Likert-type scale with ratings of 4 (Every day), 3 (Almost every day), 2 (Some days), 1 (At least 1 day), and 0 (I did not practice or use strategies).</p> <hd id="AN0193059427-11">Parent Session Attendance</hd> <p>During monthly study meetings, providers reported to research assistants whether or not each family had canceled any EI sessions since the last study meeting. Provider yes/no responses were entered into REDCap. Since exact attendance and cancelation counts were not collected, a ratio score was calculated as a proxy for parent session attendance. The ratio score was calculated as the number of study meetings in which a provider reported a parent cancelation over the total number of study meetings the provider attended while the parent was enrolled. Ratio scores closer to 0 indicated lower estimated frequency of parent cancelations (i.e. higher attendance) and ratio scores closer to 1 indicated higher estimated frequency of parent session cancelations (i.e. lower attendance).</p> <hd id="AN0193059427-12">Statistical Analysis</hd> <p>Pearson product-moment correlations were used to examine associations between parent engagement measures. For measures with multiple timepoints (i.e. observed overall PPE and frequency of practice), timepoint scores were averaged to create a single score for each variable to include in correlational analysis. Multilevel modeling (MLM) and regression analysis were used to examine predictors of parent engagement. Exploratory moderation analyses were conducted to examine sociodemographic differences in the impact of statistically significant psychological characteristics on parent engagement measures. Due to the repeated and/or nested nature of the outcome variables, intraclass correlations (ICCs) were calculated through fitting null models to inform the analysis approach for each outcome. Descriptive statistics (Tables 2 and 3) were run in SPSS (IBM Corp., [<reflink idref="bib34" id="ref61">34</reflink>]) and multilevel analyses were run using the nlme package in R ([<reflink idref="bib49" id="ref62">49</reflink>]).</p> <p>Table 2. Parent measure characterization.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Mean (<italic>SD</italic>) or <italic>n</italic> (%)</th></tr></thead><tbody><tr><td>Parenting Stress Index (PSI) Total Sum Score (<italic>n</italic> = 162)</td><td>81.40 (21.50)</td></tr><tr><td>Parenting Efficacy Scale (PES) Total Sum Score (<italic>n</italic> = 164)</td><td>30.72 (4.25)</td></tr><tr><td>Parent Motivation Inventory Readiness to Change Score (<italic>n</italic> = 164)</td><td>63.75 (7.17)</td></tr><tr><td>Observed Overall Parent Participation Engagement (PPE) Score (<italic>n</italic> = 377)</td><td>3.16 (0.93)</td></tr><tr><td>Parent-Reported Frequency of Practice (<italic>n</italic> = 435)</td><td>2.97 (0.87)</td></tr><tr><td><italic> 0 (I did not practice or use strategies)</italic></td><td>23 (5.3%)</td></tr><tr><td><italic> 1 (At least 1 day)</italic></td><td>13 (3.0%)</td></tr><tr><td><italic> 2 (Some days)</italic></td><td>76 (17.5%)</td></tr><tr><td><italic> 3 (Almost every day)</italic></td><td>160 (36.8%)</td></tr><tr><td><italic> 4 (Every day)</italic></td><td>163 (37.5%)</td></tr><tr><td>Session Attendance Ratio (<italic>n</italic> = 152)</td><td>0.52 (0.36)</td></tr></tbody></table> </ephtml> </p> <p>Table 3. Early intervention session recording characterization (n = 377).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left"><italic>n</italic> (%) or mean (<italic>SD</italic>)</th></tr></thead><tbody><tr><td colspan="2">Study Condition</td></tr><tr><td><italic> CI-RIT Intervention</italic></td><td>190 (50.4%)</td></tr><tr><td><italic> Waitlist Control</italic></td><td>187 (49.6%)</td></tr><tr><td colspan="2">EI Session Recording Timepoint</td></tr><tr><td><italic>Timepoint 1</italic></td><td>146 (38.7%)</td></tr><tr><td><italic> Timepoint 2</italic></td><td>119 (31.6%)</td></tr><tr><td><italic> Timepoint 3</italic></td><td>112 (29.7%)</td></tr><tr><td>Video Length (mm: ss)</td><td>46:40 (11:49)</td></tr><tr><td colspan="2">Session Modality</td></tr><tr><td><italic>In-Person</italic></td><td>313 (83.0%)</td></tr><tr><td><italic> Telehealth</italic></td><td>64 (17.0%)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0193059427-13">Data Availability</hd> <p>The data sets analyzed in this study are not publicly available due to the ongoing nature of the main RCT but are available from the authors upon reasonable request.</p> <hd id="AN0193059427-14">Results</hd> <p>The current sample included 377 EI session recordings, 435 frequency of practice surveys, and 152 attendance observations at Level 1, 164 parents at Level 2, and 93 providers at Level 3. Observations at each level were approximately evenly split between study intervention conditions and distributed across data collection timepoints. EI session recordings were approximately 46 min on average (<emph>SD</emph> = 11:49), ranging in length from 17 min to 1 h 33 min.</p> <hd id="AN0193059427-15">Preliminary Analyses</hd> <p>ICCs for the observed overall PPE score indicated that the variance was split across providers (34.3%), parents (31.9%), and EI session recordings (33.9%). For self-reported frequency of practice, the variance was predominantly split across parent (36.9%) and measurement timepoint (58.5%) levels with little variance explained across providers (4.6%). For session attendance, estimated by a single score per parent, ICCs indicated little variance explained at the provider level (7.1%). Thus, three-level MLMs were used for observed overall PPE, two-level MLMs for parent-reported between-session practice, and linear regressions for session attendance.</p> <p>While the residuals were approximately normally distributed for observed overall PPE, the self-reported frequency of practice and attendance residuals were not. Examination of variance inflation factors indicated no multicollinearity concerns. Pearson product-moment correlations between predictors and engagement measures are presented in Table 4.</p> <p>Table 4. Correlation matrix of predictors and parent engagement measures.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Parent Marital Status</th><th align="left">Parent Minoritized Status</th><th align="left">Parent Education</th><th align="left">Parenting Stress</th><th align="left">Parenting Efficacy</th><th align="left">Parent Motivation</th><th align="left">Overall PPE</th><th align="left">Frequency of Practice</th></tr></thead><tbody><tr><td>Parent Marital Status</td><td>1</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Parent Minoritized Status</td><td>−0.37<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>1</td><td /><td /><td /><td /><td /><td /></tr><tr><td>Parent Education</td><td>0.33<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>−0.21<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>1</td><td /><td /><td /><td /><td /></tr><tr><td>Parenting Stress</td><td>0.13</td><td>−0.10</td><td>−0.06</td><td>1</td><td /><td /><td /><td /></tr><tr><td>Parenting Efficacy</td><td>−0.10</td><td>0.09</td><td>0.02</td><td>−0.54<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>1</td><td /><td /><td /></tr><tr><td>Parent Motivation</td><td>0.02</td><td>−0.13</td><td>0.07</td><td>0.01</td><td>−0.01</td><td>1</td><td /><td /></tr><tr><td>Observed Overall PPE</td><td>0.23<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>−0.20<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>0.01</td><td>0.10</td><td>−0.10</td><td>0.06</td><td>1</td><td /></tr><tr><td>Frequency of Practice</td><td>0.04</td><td>−0.15</td><td>0.10</td><td>−0.04</td><td>0.06</td><td>0.26<xref ref-type="table-fn" rid="tfn1">*</xref></td><td>0.11</td><td>1</td></tr><tr><td>Attendance</td><td>−0.04</td><td>0.11</td><td>−0.09</td><td>−0.09</td><td>0.15</td><td>−0.02</td><td>−0.06</td><td>−0.08</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>p</emph> < 0.05.</p> <p>An initial examination of potentially relevant predictors of each engagement measure was conducted to inform covariates. Data collection timepoint did not significantly predict any outcome and was not included as a fixed effect. While session duration did not significantly predict observed overall PPE, session modality (in-person versus telehealth) did, <emph>t</emph>(<reflink idref="bib211" id="ref63">211</reflink>) = 2.93, <emph>p</emph> = 0.004, and was included in PPE analyses. We examined several additional demographic variables (parent and child age, parent and child sex, number of adults and children in the household) that were not the focus of our investigation for possible inclusion as covariates. None were significantly associated with the outcome measures. Since data were drawn from an ongoing RCT, intervention condition was included as a covariate in all analyses, as in previous studies examining PPE in the context of ongoing RCTs ([<reflink idref="bib18" id="ref64">18</reflink>]; [<reflink idref="bib53" id="ref65">53</reflink>]).</p> <p>To determine whether modeling random slopes and/or accounting for autocorrelation significantly improved model fit, log likelihood ratio tests were conducted for each outcome. Based on these tests, all MLMs were specified with random intercepts for parsimony and observed overall PPE models accounted for autocorrelation.</p> <p>Given previous research suggesting differences in PPE across ethnicity ([<reflink idref="bib18" id="ref66">18</reflink>]; [<reflink idref="bib28" id="ref67">28</reflink>]; [<reflink idref="bib53" id="ref68">53</reflink>]) and income ([<reflink idref="bib32" id="ref69">32</reflink>]), minoritized status was replaced with ethnicity and education was substituted with household income in all analyses. Findings were similar, so minoritized status and education level are reported below.</p> <hd id="AN0193059427-16">Interrelations of Engagement Measures</hd> <p>Observed overall PPE was not significantly associated with either frequency of practice, <emph>r</emph>(<reflink idref="bib158" id="ref70">158</reflink>) = 0.11, <emph>p</emph> = 0.16, or attendance, <emph>r</emph>(<reflink idref="bib151" id="ref71">151</reflink>) = −0.06, <emph>p</emph> = 0.46. Parent frequency of practice and session attendance were not significantly correlated, <emph>r</emph>(<reflink idref="bib146" id="ref72">146</reflink>) = −0.08, <emph>p</emph> = 0.37.</p> <hd id="AN0193059427-17">Predictors of Observed Overall PPE</hd> <p>Initially, separate three-level random intercepts models accounting for autocorrelation were run to examine the independent effect of each parent-level sociodemographic and psychological predictor on observed overall PPE. Not controlling for other parent factors, marital status significantly predicted PPE, <emph>t</emph>(<reflink idref="bib71" id="ref73">71</reflink>) = 2.97, <emph>β</emph> = 0.18, <emph>SE</emph> = 0.13, <emph>p</emph> = 0.004. Parent minoritized status was marginally significant, <emph>t</emph>(<reflink idref="bib68" id="ref74">68</reflink>) = −1.93, <emph>β</emph> = −0.12, <emph>SE</emph> = 0.12, <emph>p</emph> = 0.057, trending toward lower PPE for families of a minoritized racial/ethnic background. Neither education nor psychological factors (i.e. parenting stress, parenting efficacy, parent motivation) significantly predicted PPE.</p> <p>A final three-level random intercepts model accounting for autocorrelation was run with all parent-level sociodemographic and psychological predictors and observed overall PPE as the outcome (Table 5). Parent marital status significantly predicted PPE when controlling for other parent characteristics, <emph>t</emph>(<reflink idref="bib59" id="ref75">59</reflink>) = 3.24, <emph>β</emph> = 0.21, <emph>SE</emph> = 0.14, <emph>p</emph> = 0.002, indicating that parents living with a spouse/partner demonstrated higher PPE than single parents. The model did not indicate statistically significant effects of any other parent characteristics.</p> <p>Table 5. Three-level MLM results for predictors of observationally-coded overall parent participation engagement (PPE) in EI.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left" colspan="4">Observed overall PPE<xref ref-type="table-fn" rid="tfn2">a</xref></th></tr><tr><th align="left"><italic>Fixed effects</italic></th><th align="left"><italic>b [95% CI]</italic></th><th align="left"><italic>β [95% CI]</italic></th><th align="left"><italic>SE</italic></th><th align="left"><italic>p</italic></th></tr></thead><tbody><tr><td>Intercept</td><td>2.41 [2.07, 2.76]</td><td>−0.03 [−0.17, 0.11]</td><td>0.18</td><td>0.00</td></tr><tr><td>Parent Lives with Spouse/Partner</td><td><bold>0.45 [0.17, 0.72]</bold></td><td><bold>0.21 [0.08, 0.33]</bold></td><td><bold>0.14</bold></td><td><bold>0.002</bold></td></tr><tr><td>Parent Minoritized Status</td><td>−0.06 [−0.30, 0.17]</td><td>−0.03 [−0.16, 0.09]</td><td>0.12</td><td>0.59</td></tr><tr><td>Parent College or Higher</td><td>−0.07 [−0.30, 0.16]</td><td>−0.04 [−0.16, 0.09]</td><td>0.12</td><td>0.55</td></tr><tr><td>Parenting Stress</td><td>0.001 [−0.004, 0.01]</td><td>0.03 [−0.11, 0.16]</td><td>0.003</td><td>0.67</td></tr><tr><td>Parenting Efficacy</td><td>−0.01 [−0.03, 0.02]</td><td>−0.02 [−0.15, 0.10]</td><td>0.01</td><td>0.71</td></tr><tr><td>Parent Motivation</td><td>0.01 [−0.00, 0.03]</td><td>0.10 [−0.01, 0.21]</td><td>0.01</td><td>0.07</td></tr><tr><th align="left"><italic>Random effects</italic></th><th align="left"><italic>Variance</italic></th><th align="left"><italic>95% CI of variance</italic></th><th align="left"><italic>SD</italic></th><th /></tr><tr><td>Level 3 (Provider) Intercept</td><td>0.18<xref ref-type="table-fn" rid="tfn3">b</xref></td><td>0.08–0.41</td><td>0.43</td><td /></tr><tr><td>Level 2 (Parent) Intercept</td><td>0.04</td><td>0.00–6.00</td><td>0.21</td><td /></tr><tr><td>Residual</td><td>0.42<xref ref-type="table-fn" rid="tfn3">b</xref></td><td>0.26–0.68</td><td>0.65</td><td /></tr><tr><th align="left"><italic>Correlation structure</italic></th><th align="left"><italic>Estimate</italic></th><th align="left"><italic>95% CI</italic></th><th /><th /></tr><tr><td>Phi</td><td>0.33</td><td>[−0.02, 0.60]</td><td /><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>2 358 EI sessions, 91 providers, 155 parents</item> <item>3 Significance demonstrated with 95% confidence intervals.</item> <item>4 Bold values represent the significant results.</item> </ulist> <hd id="AN0193059427-18">Predictors of Between-Session Practice</hd> <p>A two-level random intercepts model with all parent-level sociodemographic and psychological predictors and frequency of practice as the outcome was run (Table 6[<reflink idref="bib12" id="ref76">12</reflink>]). Controlling for other parent factors, only parent motivation significantly predicted frequency of practice, <emph>t</emph>(<reflink idref="bib260" id="ref77">260</reflink>) = 3.03, <emph>β</emph> = 0.19, <emph>SE</emph> = 0.01, <emph>p</emph> = 0.003, indicating that higher baseline parent motivation predicted greater practice between EI sessions. Exploratory analyses indicated that this relationship was not significantly moderated by parent sociodemographics. No other parent characteristics significantly predicted parent-reported frequency of practice.</p> <p>Table 6. Two-level MLM results for predictors of parent-reported frequency of practice in EI.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left" colspan="4">Frequency of practice<xref ref-type="table-fn" rid="tfn5">a</xref></th></tr><tr><th align="left"><italic>Fixed effects</italic></th><th align="left"><italic>b [95% CI]</italic></th><th align="left"><italic>β [95% CI]</italic></th><th align="left"><italic>SE</italic></th><th align="left"><italic>p</italic></th></tr></thead><tbody><tr><td>Intercept</td><td>2.98 [2.58, 3.37]</td><td>−0.01 [−0.13, 0.12]</td><td>0.20</td><td>0.00</td></tr><tr><td>Parent Lives with Spouse/Partner</td><td>−0.03 [−0.37, 0.31]</td><td>−0.01 [−0.15, 0.13]</td><td>0.18</td><td>0.86</td></tr><tr><td>Parent Minoritized Status</td><td>−0.15 [−0.43, 0.14]</td><td>−0.07 [−0.20, 0.06]</td><td>0.15</td><td>0.31</td></tr><tr><td>Parent College or Higher</td><td>0.17 [−0.11, 0.45]</td><td>0.08 [−0.05, 0.21]</td><td>0.14</td><td>0.24</td></tr><tr><td>Parenting Stress</td><td>−0.001 [−0.008, 0.006]</td><td>−0.03 [−0.17, 0.12]</td><td>0.004</td><td>0.72</td></tr><tr><td>Parenting Efficacy</td><td>0.01 [−0.02, 0.05]</td><td>0.05 [−0.09, 0.20]</td><td>0.02</td><td>0.47</td></tr><tr><td>Parent Motivation</td><td><bold>0.03</bold> [<bold>0.01, 0.05</bold>]</td><td><bold>0.19 [0.07, 0.31]</bold></td><td><bold>0.01</bold></td><td><bold>0.003</bold></td></tr><tr><th align="left"><italic>Random effects</italic></th><th align="left"><italic>Variance</italic></th><th align="left"><italic>95% CI of variance</italic></th><th align="left"><italic>SD</italic></th><th /></tr><tr><td>Level 2 (Parent) Intercept</td><td>.39<xref ref-type="table-fn" rid="tfn6">b</xref></td><td>.26–.57</td><td>.62</td><td /></tr><tr><td>Residual</td><td>.65<xref ref-type="table-fn" rid="tfn6">b</xref></td><td>.55–.77</td><td>.81</td><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>5 411 observations, 150 parents.</item> <item>6 Significance demonstrated with 95% confidence intervals.</item> <item>7 Bold values represent the significant results.</item> </ulist> <hd id="AN0193059427-19">Predictors of Session Attendance</hd> <p>A multiple linear regression was run with all parent-level sociodemographic and psychological predictors and session attendance as the outcome (Table 7).[<reflink idref="bib13" id="ref78">13</reflink>] The model was not significant, <emph>F</emph>(<reflink idref="bib7" id="ref79">7</reflink>, 136) = 0.95, <emph>R</emph><sups>2</sups> = 0.05, <emph>p</emph> = 0.47. No parent sociodemographic or psychological characteristics significantly predicted attendance.</p> <p>Table 7. Linear regression results for predictors of session attendance in EI.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left" colspan="4">Session attendance<xref ref-type="table-fn" rid="tfn8">a</xref></th></tr><tr><th align="left"><italic>Fixed effects</italic></th><th align="left"><italic>b [95% CI]</italic></th><th align="left"><italic>β [95% CI]</italic></th><th align="left"><italic>SE</italic></th><th align="left"><italic>p</italic></th></tr></thead><tbody><tr><td>Intercept</td><td>0.49 [0.31, 0.67]</td><td>1.26e−16 [−0.17, 0.17]</td><td>0.09</td><td>0.00</td></tr><tr><td>Parent Lives with Spouse/Partner</td><td>0.02 [−0.13, 0.18]</td><td>0.03 [−0.16, 0.22]</td><td>0.08</td><td>0.75</td></tr><tr><td>Parent Minoritized Status</td><td>0.06 [−0.07, 0.19]</td><td>0.08 [−0.10, 0.26]</td><td>0.07</td><td>0.39</td></tr><tr><td>Parent College or Higher</td><td>−0.08 [−0.21, 0.05]</td><td>−0.11 [−0.29, 0.06]</td><td>0.06</td><td>0.21</td></tr><tr><td>Parenting Stress</td><td>−0.0001 [−0.0033, 0.0031]</td><td>−0.008 [−0.20, 0.19]</td><td>0.002</td><td>0.94</td></tr><tr><td>Parenting Efficacy</td><td>0.01 [−0.004, 0.03]</td><td>0.15 [−0.04, 0.35]</td><td>0.01</td><td>0.13</td></tr><tr><td>Parent Motivation</td><td>0.001 [−0.007, 0.009]</td><td>0.01 [−0.16, 0.18]</td><td>0.004</td><td>0.88</td></tr><tr><th align="left"><italic>Random effects</italic></th><th align="left"><italic>Median</italic></th><th align="left"><italic>SE</italic></th><th /><th /></tr><tr><td>Residual</td><td>0.008</td><td>0.36</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>8 152 observations.</p> <hd id="AN0193059427-20">Discussion</hd> <p>This study examined how parent sociodemographic and psychological factors influence multiple measures of engagement in families of young children with early autism indicators within the United States Part C EI system. While we replicated previous findings that motivation and single parenthood influence certain dimensions of parent engagement ([<reflink idref="bib29" id="ref80">29</reflink>]; [<reflink idref="bib32" id="ref81">32</reflink>]; [<reflink idref="bib47" id="ref82">47</reflink>]), the patterns of predictors differed across engagement measures (i.e. observed PPE, parent-reported frequency of at-home practice, and attendance).</p> <p>Contrary to our hypothesis, observationally coded overall PPE, parent-reported between-session practice, and session attendance were not significantly correlated. This contrasts with prior research suggesting positive associations between in-session engagement, homework completion, and attendance ([<reflink idref="bib14" id="ref83">14</reflink>]). However, [<reflink idref="bib14" id="ref84">14</reflink>] examined associations between engagement factors emerging from youth and parent self-report measures on their engagement. It is possible that we did not observe the same associations in this study due to our distinct and separately collected measures of PPE, between-session practice, and attendance. It may also be the case that measurement limitations may have restricted our findings. For example, parent ratings of at-home practice could have been inflated by social desirability response bias due to the self-reported nature of the data ([<reflink idref="bib5" id="ref85">5</reflink>]). Our proxy score of attendance may also have been skewed, as it only reflected whether or not any parent cancelations were reported rather than exact attendance and cancelation counts. Thus, a parent with one cancelation would have received the same attendance score as a parent with multiple cancelations. Importantly, future research should continue to prioritize developing and refining measurement approaches to accurately capture multiple dimensions of parent engagement. Nonetheless, these results contribute to emerging literature emphasizing the multidimensional nature of parent engagement and indicate that parents exhibit distinct patterns of active engagement, between-session practice, and attendance.</p> <p>Single parents demonstrated significantly lower overall PPE during sessions. This is consistent with prior research indicating lower attendance and participation more broadly for single parents ([<reflink idref="bib32" id="ref86">32</reflink>]). Given the central role of parent-provider collaboration in the Part C system ([<reflink idref="bib19" id="ref87">19</reflink>]), low PPE during sessions may be expected to negatively impact child outcomes. Single parents, who often face greater demands and less flexibility in balancing work, home, and parenting responsibilities, may need specific supports to actively engage in session activities ([<reflink idref="bib11" id="ref88">11</reflink>]; [<reflink idref="bib48" id="ref89">48</reflink>]). Although we controlled for sociodemographic factors often correlated with single parenthood (e.g. race/ethnicity and income; [<reflink idref="bib15" id="ref90">15</reflink>]), it is possible that the complex interplay between these sociodemographic factors influenced current findings. Further research should examine how quality of partner support, in addition to other forms of familial, social, and/or community support, may influence engagement and how single parents may be better supported to actively engage in their child's services within the Part C EI system.</p> <p>Higher motivation to change parenting behavior at the start of intervention was associated with greater between-session practice at home throughout intervention. This finding is consistent with previous research showing that parent motivation promotes intervention participation ([<reflink idref="bib32" id="ref91">32</reflink>]; [<reflink idref="bib53" id="ref92">53</reflink>]) and suggests that motivation may more specifically impact the engagement dimension of at-home practice. However, it is possible that parent motivation was confounded with other factors not measured in our study that also impact engagement, such as parental mental health and/or child behavioral challenges ([<reflink idref="bib32" id="ref93">32</reflink>]; [<reflink idref="bib40" id="ref94">40</reflink>]). Future research should examine whether incorporating motivation-building strategies prior to intervention may promote greater at-home practice, particularly for parents reporting lower motivation to participate and/or hesitance to adjust their parenting behavior.</p> <p>Contrary to previous research ([<reflink idref="bib29" id="ref95">29</reflink>]; [<reflink idref="bib32" id="ref96">32</reflink>]), neither parenting stress nor parent self-efficacy predicted PPE, between-session practice, or attendance in this study, which could be related to measurement characteristics. While we used the Parenting Stress Index (PSI) as a proxy for stress, it may be that parenting stress does not impact parent engagement as much as broader life stressors examined in the literature (e.g. competing demands; reduced financial resources, parent psychopathology, work commitments; [<reflink idref="bib26" id="ref97">26</reflink>]; [<reflink idref="bib32" id="ref98">32</reflink>]; [<reflink idref="bib57" id="ref99">57</reflink>]; [<reflink idref="bib58" id="ref100">58</reflink>]). Interestingly, another study examining parent involvement in Intensive Behavioral Intervention for autism did not find a relationship between PSI scores and parent- or therapist-reported involvement in their child's intervention ([<reflink idref="bib52" id="ref101">52</reflink>]). Additional research is needed to better understand the relationship between parent engagement and both self-efficacy and stress in the Part C system.</p> <p>It is notable that neither minoritized status nor ethnicity predicted lower engagement. This contrasts with previous studies which found lower PPE among Hispanic/Latine parents in child psychotherapy using the same observational coding scheme ([<reflink idref="bib18" id="ref102">18</reflink>]; [<reflink idref="bib28" id="ref103">28</reflink>]; [<reflink idref="bib53" id="ref104">53</reflink>]). In our study, minoritized status predicted observed overall PPE without controlling for other parent-level predictors and findings remained consistent when ethnicity (Hispanic/Latine) was substituted for minoritized status. However, when controlling for parent education and marital status in the full model, parent minoritized status was no longer significant, suggesting that lower engagement observed for minoritized families may be better explained by barriers related to single parenthood and corresponding level of support at home. Another possibility is differences in the current sample of Hispanic/Latine families compared to previous research (i.e., [<reflink idref="bib18" id="ref105">18</reflink>]; [<reflink idref="bib28" id="ref106">28</reflink>]; [<reflink idref="bib53" id="ref107">53</reflink>]). Our Hispanic/Latine families were recruited from multiple regions of the United States (Michigan, Illinois, Washington, and Massachusetts) and were English-speaking or bilingual Spanish- and English-speaking. [<reflink idref="bib28" id="ref108">28</reflink>] found reduced PPE only for Spanish-speaking Hispanic/Latine parents compared to non-Hispanic/Latine White and English-speaking Hispanic/Latine parents. Thus, it is important for researchers and clinicians to consider the intersecting characteristics of each individual parent to understand their unique facilitators of and barriers to active engagement.</p> <p>Surprisingly, we did not identify any parent predictors of session attendance, especially since attendance is the most common measure of parent engagement across studies ([<reflink idref="bib38" id="ref109">38</reflink>]). One possibility for this finding is the fact that services were primarily delivered within family homes, which may facilitate retention and attendance for parents who would otherwise face increased barriers to attending clinic-based sessions, as suggested by prior research ([<reflink idref="bib57" id="ref110">57</reflink>]). It may also be the case that the availability of telehealth sessions facilitated more consistent attendance and mitigated circumstances leading to cancelation (e.g. family illness and childcare availability; [<reflink idref="bib21" id="ref111">21</reflink>]), though findings remain mixed in the literature regarding the impact of telehealth on therapy attendance ([<reflink idref="bib12" id="ref112">12</reflink>]; [<reflink idref="bib13" id="ref113">13</reflink>]; [<reflink idref="bib27" id="ref114">27</reflink>]; [<reflink idref="bib37" id="ref115">37</reflink>]). Another possibility is our use of a ratio proxy score of attendance may have prevented a more nuanced understanding of how parent characteristics impact the exact number of sessions attended. Future studies should more intentionally collect exact numbers of sessions attended versus canceled to facilitate greater understanding of how parent characteristics influence attendance in Part C EI.</p> <p>Importantly, though this study and much of the existing literature has focused on family influences on engagement, parent engagement occurs in the context of a bidirectional parent-provider relationship. This makes it difficult to parse out which individual is driving the level of engagement observed. Research suggests that provider behaviors (e.g. use of evidence-based practices, collaboration with parents, shared decision-making; [<reflink idref="bib3" id="ref116">3</reflink>]; [<reflink idref="bib18" id="ref117">18</reflink>]; [<reflink idref="bib25" id="ref118">25</reflink>]; [<reflink idref="bib43" id="ref119">43</reflink>]) and prior training in parent-mediated intervention ([<reflink idref="bib53" id="ref120">53</reflink>]) also impact engagement. Additional studies suggest that training community mental health providers in engagement strategies ([<reflink idref="bib31" id="ref121">31</reflink>]) and early intervention providers in parent-mediated intervention ([<reflink idref="bib54" id="ref122">54</reflink>]) promotes greater PPE compared to treatment-as-usual. Although this study controlled for intervention condition to understand the impact of parent sociodemographic and psychological characteristics on parent engagement across different intervention approaches, differences in provider training may have impacted parent engagement. Further research is needed to understand how provider characteristics and behaviors impact parent engagement, and whether training providers in specific engagement or parent-mediated intervention strategies can improve engagement for families at risk for lower engagement (i.e. single parents, low motivation).</p> <hd id="AN0193059427-21">Limitations</hd> <p>There are several additional limitations to acknowledge. First, measurement and statistical limitations may have impacted current findings. As previously noted, our proxy measure of session attendance had clear limitations and response bias may have impacted parent-reported frequency of at-home practice. Furthermore, although simulation studies suggest that the current sample is sufficiently powered with stable fixed effect estimates, the current analyses may have been underpowered to find small effects of parent characteristics on engagement outcomes ([<reflink idref="bib16" id="ref123">16</reflink>]; [<reflink idref="bib39" id="ref124">39</reflink>]; [<reflink idref="bib41" id="ref125">41</reflink>], [<reflink idref="bib42" id="ref126">42</reflink>]).</p> <p>In addition, although our sample demographics were representative of families receiving Part C services, current findings should be interpreted with caution when generalizing to all families in EI. While the recruitment team of the main trial strongly encouraged providers to refer all eligible families on their caseload to the study, it is possible that providers only referred families they perceived as more motivated or willing to participate. Prior studies also indicate that parents who choose to participate in research often demonstrate higher motivation than families in standard care settings ([<reflink idref="bib32" id="ref127">32</reflink>]); thus, our sample likely included parents with higher baseline motivation and engagement compared to community samples.</p> <p>Furthermore, this study excluded EI sessions conducted exclusively in Spanish and used minoritized status as a proxy due to low sample sizes of individual racial/ethnic groups. Future research should focus on recruiting and examining parent engagement dimensions across multiple racial, ethnic, and linguistic groups to contribute to more nuanced understanding. Importantly, further research is needed to expand our limited knowledge of parent engagement across global contexts ([<reflink idref="bib6" id="ref128">6</reflink>]; [<reflink idref="bib46" id="ref129">46</reflink>]) to understand potential differences in definitions and predictors of engagement across various cultures and service systems. For example, engagement may differ based on family roles, social expectations, community support structures, and treatment expectations (e.g. hierarchy of authority) across collectivist versus individualist societies ([<reflink idref="bib33" id="ref130">33</reflink>]; [<reflink idref="bib59" id="ref131">59</reflink>]; [<reflink idref="bib62" id="ref132">62</reflink>]) and/or cultural identities ([<reflink idref="bib28" id="ref133">28</reflink>]; [<reflink idref="bib51" id="ref134">51</reflink>]; [<reflink idref="bib53" id="ref135">53</reflink>]).</p> <hd id="AN0193059427-22">Conclusion</hd> <p>In sum, parent characteristics influence different dimensions of parent engagement in distinct ways for families receiving autism-specific EI in the Part C system. Providers should incorporate multiple measures to understand distinct facets of engagement rather than focusing solely on one behavioral indicator (e.g. attendance). When providers perceive low engagement, it is important to consider family characteristics that may make certain engagement dimensions more difficult. Providers should incorporate discussions with families about how to support parents' ability to engage actively in their child's services to ultimately promote child progress and quality of life.</p> <hd id="AN0193059427-23">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-aut-10.1177_13623613261430568 for Predictors of Parent Engagement in Part C Early Intervention for Autism: The Role of Single Parenthood and Initial Motivation by Hannah Tokish and Brooke Ingersoll in Autism</p> <p>We are grateful to the Part C EI providers and parents for participating and we thank the following individuals for their contributions to PPE data collection: Claire Bongiorno, Alyssa Bonikowski, Emily Assemany, Olivia Bowman, Grace Kim, Naomi Alvarado, Jessie Greatorex. The RISE Research Network collaborators include Sarabeth Broder-Fingert, Alice Carter, Sarah Edmunds, Brooke Ingersoll, Chris Sheldrick, Wendy Stone, and Allison Wainer. Study data were collected and managed using REDCap electronic data capture tools hosted at Boston University, CTSI 1UL1TR001430.</p> <ref id="AN0193059427-24"> <title> References </title> <blist> <bibl id="bib1" idref="ref49" type="bt">1</bibl> <bibtext> Abidin R. R. (1990). Parenting Stress Index–short form. Pediatric Psychology Press.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref1" type="bt">2</bibl> <bibtext> Althoff C. E., Dammann C. P., Hope S. J., Ausderau K. K. (2019). Parent-mediated interventions for children with autism spectrum disorder: A systematic review. The American Journal of Occupational Therapy, 73(3), 7303205010p1–7303205010p13. https://doi.org/10.5014/ajot.2019.030015</bibtext> </blist> <blist> <bibl id="bib3" idref="ref57" type="bt">3</bibl> <bibtext> Baker-Ericzén M. J., Jenkins M. 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A hybrid type I randomized effectiveness-implementation trial of a naturalistic developmental behavioral intervention in the Part C early intervention system: Study protocol. BMC Pediatrics, 25(1), Article 263. https://doi.org/10.1186/s12887-025-05587-8</bibtext> </blist> <blist> <bibtext> Wang Y., Wai Li L. M. (2024). Relationships between parental involvement in homework and learning outcomes among elementary school students: The moderating role of societal collectivisim-individualism. British Journal of Educational Psychology, 94(3), 881–896. https://doi.org/10.1111/bjep.12692</bibtext> </blist> </ref> <ref id="AN0193059427-25"> <title> Footnotes </title> <blist> <bibtext> Hannah Tokish</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0009-0001-9302-3310</bibtext> </blist> <blist> <bibtext> The RISE Study was approved by the Michigan State University (MSU) Social Science/Behavioral/Education Institutional Review Board (IRB; 00001960, 00005923).</bibtext> </blist> <blist> <bibtext> All participants provided verbal and written informed consent and parents provided informed written consent on behalf of their child.</bibtext> </blist> <blist> <bibtext> Not applicable.</bibtext> </blist> <blist> <bibtext> Hannah Tokish: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Project administration; Writing—original draft; Writing—review & editing.Brooke Ingersoll: Conceptualization; Funding acquisition; Methodology; Project administration; Supervision; Writing—review & editing.The RISE Research Network: Conceptualization; Data curation; Funding acquisition; Methodology; Project administration; Supervision; Writing—review & editing.</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Blue Cross Blue Shield of Michigan Foundation Student Award Program (2023020029.SAP). The RISE Study is supported by NIMH R01 MH122725-01, R01 MH122726-01, R01 MH122727-01, and R01 MH122728-01.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The data sets analyzed in this study are not publicly available due to the ongoing nature of the RCT but are available from the corresponding author upon reasonable request.</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> <blist> <bibtext> In this article, parent refers to the wide variety of caregiver roles such as biological parent, stepparent, adoptive parent, grandparent, foster parent, and other guardians.</bibtext> </blist> <blist> <bibtext> The phrase marital status is used to reflect whether or not parents reported living with a spouse or partner. As such, some parents may have been living with a partner without being married.</bibtext> </blist> <blist> <bibtext> Given non-normality of residuals, a two-level cumulative link logit model was also run to account for the ordinal nature of the outcome variable (see https://journals.sagepub.com/doi/suppl/10.1177/13623613261430568; https://journals.sagepub.com/doi/suppl/10.1177/13623613261430568). Findings were similar, so the simpler two-level MLM is reported.</bibtext> </blist> <blist> <bibtext> Given non-normality of the residuals, a beta regression was also run to account for the proportional nature of the outcome variable. For the beta regression, 0s and 1s were recoded into 0.001 and 0.99, respectively, to adhere to model assumptions. The findings were unchanged, so the simpler multiple linear regression is reported (see https://journals.sagepub.com/doi/suppl/10.1177/13623613261430568; https://journals.sagepub.com/doi/suppl/10.1177/13623613261430568).</bibtext> </blist> </ref> <aug> <p>By Hannah Tokish and Brooke Ingersoll</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib23" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib60" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib19" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib22" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib10" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib32" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib20" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib28" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib36" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib55" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib38" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib17" firstref="ref24"></nolink> <nolink nlid="nl14" bibid="bib35" firstref="ref26"></nolink> <nolink nlid="nl15" bibid="bib50" firstref="ref27"></nolink> <nolink nlid="nl16" bibid="bib47" firstref="ref31"></nolink> <nolink nlid="nl17" bibid="bib26" firstref="ref32"></nolink> <nolink nlid="nl18" bibid="bib58" firstref="ref36"></nolink> <nolink nlid="nl19" bibid="bib29" firstref="ref37"></nolink> <nolink nlid="nl20" bibid="bib52" firstref="ref43"></nolink> <nolink nlid="nl21" bibid="bib24" firstref="ref44"></nolink> <nolink nlid="nl22" bibid="bib45" firstref="ref45"></nolink> <nolink nlid="nl23" bibid="bib61" firstref="ref46"></nolink> <nolink nlid="nl24" bibid="bib11" firstref="ref48"></nolink> <nolink nlid="nl25" bibid="bib44" firstref="ref50"></nolink> <nolink nlid="nl26" bibid="bib56" firstref="ref51"></nolink> <nolink nlid="nl27" bibid="bib30" firstref="ref52"></nolink> <nolink nlid="nl28" bibid="bib34" firstref="ref61"></nolink> <nolink nlid="nl29" bibid="bib49" firstref="ref62"></nolink> <nolink nlid="nl30" bibid="bib211" firstref="ref63"></nolink> <nolink nlid="nl31" bibid="bib18" firstref="ref64"></nolink> <nolink nlid="nl32" bibid="bib53" firstref="ref65"></nolink> <nolink nlid="nl33" bibid="bib158" firstref="ref70"></nolink> <nolink nlid="nl34" bibid="bib151" firstref="ref71"></nolink> <nolink nlid="nl35" bibid="bib146" firstref="ref72"></nolink> <nolink nlid="nl36" bibid="bib71" firstref="ref73"></nolink> <nolink nlid="nl37" bibid="bib68" firstref="ref74"></nolink> <nolink nlid="nl38" bibid="bib59" firstref="ref75"></nolink> <nolink nlid="nl39" bibid="bib12" firstref="ref76"></nolink> <nolink nlid="nl40" bibid="bib260" firstref="ref77"></nolink> <nolink nlid="nl41" bibid="bib13" firstref="ref78"></nolink> <nolink nlid="nl42" bibid="bib48" firstref="ref89"></nolink> <nolink nlid="nl43" bibid="bib15" firstref="ref90"></nolink> <nolink nlid="nl44" bibid="bib40" firstref="ref94"></nolink> <nolink nlid="nl45" bibid="bib57" firstref="ref99"></nolink> <nolink nlid="nl46" bibid="bib21" firstref="ref111"></nolink> <nolink nlid="nl47" bibid="bib27" firstref="ref114"></nolink> <nolink nlid="nl48" bibid="bib37" firstref="ref115"></nolink> <nolink nlid="nl49" bibid="bib25" firstref="ref118"></nolink> <nolink nlid="nl50" bibid="bib43" firstref="ref119"></nolink> <nolink nlid="nl51" bibid="bib31" firstref="ref121"></nolink> <nolink nlid="nl52" bibid="bib54" firstref="ref122"></nolink> <nolink nlid="nl53" bibid="bib16" firstref="ref123"></nolink> <nolink nlid="nl54" bibid="bib39" firstref="ref124"></nolink> <nolink nlid="nl55" bibid="bib41" firstref="ref125"></nolink> <nolink nlid="nl56" bibid="bib42" firstref="ref126"></nolink> <nolink nlid="nl57" bibid="bib46" firstref="ref129"></nolink> <nolink nlid="nl58" bibid="bib33" firstref="ref130"></nolink> <nolink nlid="nl59" bibid="bib62" firstref="ref132"></nolink> <nolink nlid="nl60" bibid="bib51" firstref="ref134"></nolink>
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  Label: Title
  Group: Ti
  Data: Predictors of Parent Engagement in Part C Early Intervention for Autism: The Role of Single Parenthood and Initial Motivation
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Hannah+Tokish%22">Hannah Tokish</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0001-9302-3310">0009-0001-9302-3310</externalLink>)<br /><searchLink fieldCode="AR" term="%22Brooke+Ingersoll%22">Brooke Ingersoll</searchLink><br /><searchLink fieldCode="AR" term="%22RISE+Research+Network%22">RISE Research Network</searchLink>
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  Label: Source
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  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. --1291 2026 30(5):1278-1278.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 14
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
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  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institute of Mental Health (NIMH) (DHHS/NIH)
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  Label: Contract Number
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  Data: R01MH12272501<br />R01MH12272601
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  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Participation%22">Parent Participation</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Intervention%22">Early Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22One+Parent+Family%22">One Parent Family</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Legislation%22">Educational Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Federal+Legislation%22">Federal Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Equal+Education%22">Equal Education</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Characteristics%22">Psychological Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Motivation%22">Motivation</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Delays%22">Developmental Delays</searchLink><br /><searchLink fieldCode="DE" term="%22Attendance%22">Attendance</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Rearing%22">Child Rearing</searchLink>
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  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Individuals+with+Disabilities+Education+Act+Part+C%22">Individuals with Disabilities Education Act Part C</searchLink>
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  Label: Assessment and Survey Identifiers
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  Data: <searchLink fieldCode="SU" term="%22Parenting+Stress+Index%22">Parenting Stress Index</searchLink>
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  Data: 10.1177/13623613261430568
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  Data: 1362-3613<br />1461-7005
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Parent engagement in early intervention supports child progress but is variable in community settings and understudied in autism populations. Prior studies have examined attendance and homework completion rather than parent participation engagement--active, independent, and responsive contribution to treatment--and it is unclear how these distinct engagement measures are related. This study examined how observationally-coded parent participation engagement during early intervention sessions, between-session practice, and attendance were interrelated in addition to the influence of sociodemographic (marital status, minoritized racial/ethnic identity, and education) and psychological characteristics (stress, self-efficacy, and motivation) on engagement. The sample included 164 parents of toddlers (16-34 months) with an autism diagnosis or early autism indicators (i.e. social communication delays) receiving services through the publicly funded Part C Early Intervention system in the United States, which serves children under 36 months with developmental delays and disabilities. Observed parent participation engagement, parent-reported between-session practice, and attendance were not significantly correlated. Only marital status significantly predicted observed parent participation engagement, such that single parents exhibited lower parent participation engagement. Low motivation predicted lower parent-reported between-session practice. No parent characteristics predicted session attendance. Results suggest that early intervention providers should consider multiple aspects of parent engagement that are influenced by different parent characteristics when assessing and promoting engagement to support child progress.
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  Data: 2026
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  Data: EJ1503144
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        Value: 10.1177/13623613261430568
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 1278
    Subjects:
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Parent Participation
        Type: general
      – SubjectFull: Early Intervention
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      – SubjectFull: One Parent Family
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      – SubjectFull: Autism Spectrum Disorders
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      – SubjectFull: Motivation
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      – SubjectFull: Developmental Delays
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      – SubjectFull: Attendance
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      – SubjectFull: Child Rearing
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      – SubjectFull: Individuals with Disabilities Education Act Part C
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      – SubjectFull: Parenting Stress Index
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      – TitleFull: Predictors of Parent Engagement in Part C Early Intervention for Autism: The Role of Single Parenthood and Initial Motivation
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              Type: published
              Y: 2026
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