134 Chapter 6 PSQ: The RM ANOVA revealed no significant effects of time, group, or interaction on parental stress as measured by the PSQ (see Table 4). Sensitivity analyses confirmed these findings (see Supplementary Materials). Dyad Outcome Measure RM ANOVAs were conducted to assess changes in fluency and connectedness in the parentchild interaction across baseline, endpoint, and follow-up. The analysis based on imputed data revealed no significant time × group interaction effect (see Tables 4 and 5). However, sensitivity analyses (see Supplementary Materials) revealed a significant time x group interaction effect across baseline, endpoint and follow-up (F(2,33) = 4.84, p = .014, η2 = .227). Post-hoc analyses indicated that this significant interaction effect occurred between baseline (T1) and endpoint (T2) for the BEAR group (F(1,39) = 9.53, p = .004) as well as between baseline (T1) and follow-up (T3) (F(1,39) = 8.39, p = .006). These findings suggest that parent-child dyads in the BEAR group significantly improved in fluency and connectedness after completing the intervention (T2), and that this improvement was maintained six months later (T3). In contrast, post-hoc analyses revealed no significant changes in the CAU group when comparing baseline, endpoint, and follow-up. Figure 2.3A presents the fluency & connectedness scores for the BEAR and CAU groups across all time points for the main analyses, while Figure 2.3B shows the results from the sensitivity analyses. Discussion The aim of this study was to evaluate the short-term and six-months effects of a new pre-emptive intervention called BEAR for infants and toddlers aged 12-30 months with a neurodevelopmental vulnerability and/or concerns regarding their social-communicative development, and their parents. Effects of BEAR were studied on multiple levels; that of the child, the parent and the parent-child interaction. Our findings indicate the absence of significant treatment effects on the child, a positive treatment effect on the parent in terms of improved parental scaffolding and affect, and a possible treatment effect on dyadic level (i.e. improved fluency and connectedness in the parent-child interaction). The effect sizes of the BEAR intervention were large for caregiver affect and scaffolding skills (Richardson (2011). Regarding child level, effects of BEAR compared to CAU were explored on joint engagement (JERI), severity of ASD symptoms (BOSCC, ADOS), language development (N-CDI) and adaptive functioning (Vineland Screener). The absence of significant treatment effects on child developmental outcomes does not confirm our hypotheses but is in line with recent systematic reviews on pre-emptive interventions (Hamptom & Rodriquez, 2022; Law et al., 2022). Note that changes observed in joint engagement (JERI) and in ASD symptoms (BOSCC) are in the
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