ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy): an innovative intervention for infants at risk of Autism Spectrum Disorder

INTERVENTION: ENACT is an early parenting intervention that is designed for mothers of infants that are at risk of developing Autism Spectrum Disorder. It supports parent‐infant interactions, targets parent‐infant social reciprocity and supports parental mental health. The intervention is delivered online using the edX platform and is available to mothers when they are 6‐8 months pregnant. The course uses acceptance and commitment therapy (ACT) to support parenting and parental mental health and contains a teaching component that is designed to support parental responsiveness and non‐intrusivness, to provide psychoeducation on parent‐infant sleep and promote social reciprocity in infants. The course contains educational videos, homework assignments, discussion boards, educational activities, journal and reflection activities and mindfulness exercises. ENACT is designed to be a 6 week course consisting of 3 modules. To complete each module participants are expected to spend a total of 1‐2 hours over 14 days. Participants are allowed 2 weeks for the completion of each module; however, they may complete each module faster if they wish. Participants will also be offered 20‐30 minute video conferencing or phone consultations with a researcher to support them as they move through the course. Website analytics on the edX platform will be used to monitor the completion of activities within the ENACT course. CONDITION: Autism Spectrum Disorder; ; Autism Spectrum Disorder Mental Health ‐ Autistic spectrum disorders PRIMARY OUTCOME: Infant development and autism symptomatology will be measured using the Autism Observation Schedule in Infants (AOSI). [6 months of age and 12 months of age (primary endpoint) ] Parent infant interaction and emotional availability will be coded using the Emotional Availability Scales (EAS) Observation [6 months of age (primary endpoint) and 12 months of age] Parent‐infant interaction and emotional availability will be measured using the Emotional Availability Scales (EAS) Self‐Report[3 months, 6 months (primary endpoint) and 12 months of age] INCLUSION CRITERIA: To be included in the study potential participants must (1) be women who are pregnant with a child who will have a first‐degree relative with a diagnosis of Autism Spectrum Disorder; (2) have reliable internet access ; (3) be able to travel to Brisbane to attend assessments when their infant is 12 months of age SECONDARY OUTCOME: Changes in infant regulation will be measured through the Infant Toddler Social & Emotional Assessment (ITSEA) scale,[12 months of age] Child cognitive development will be measured using the Early Learning Composite (ELC) of the Mullen Scale for Early Learning (MSEL), which contains the sub‐domains of Visual Reception, Fine Motor, Receptive Language and Expressive Language.[6 months and 12 months of age] Infant adaptive skills will be measured using the Vineland Adaptive Behaviour Scale (2nd edition; VABS‐II)[6 months and 12 months of age] Infant regulation and crying patterns will be measured using the Crying Patterns Questionnaire (CPQ) [3 months and 6 months of age] Infant sleep patterns will be measured using the Brief Infant Sleep Questionnaire (BISQ) Extended. [3 months, 6 months and 12 months of age] Infant visual attention will be measured using The Gap‐Overlap task [6 months and 12 months of age] Infant visual perception skills will be measured on the Communication and Symbolic Behavior Scales Developmental Profile Infant‐Toddler Checklist (CSBS DP ITC)[6 months and 12 months of age] Infant's spontaneous motor activity as a marker of adverse neurological outcomes will be measured using the General Movements Assessment [3 months of age] Parental mental health will be assessed using the Depression, Anxiety and Stress Scale (DASS) [Baseline, 3 months and 6 months of age ] The Neurosensory Motor Developmental Assessment (NSMDA) will be used to measure infant sensorimotor skills[12 months of age]