Participants

The study sample was formed by convenience. Eight mothers participated in the study, ranging from 34 to 44 years of age. Their children, all diagnosed with ASD, had a mean age of 3.75. The children had been undergoing behavioral intervention at a specialized center in the South of Brazil for approximately eight months. More information about the sample is shown in Table 1 (sample characterization) and Table 2 (data on the children of the sample).

Instruments

Socio-demographic questionnaire: an instrument constructed by the researchers, with the aim of eliciting information about the children and mothers participating in the research. The questionnaire sought to characterize the children according to: sex, age, year of diagnosis, school situation, total length of time the child had been in intervention, and length of time at the center. The mothers were characterized by place of birth, marital status, level of education, profession, family income, number of children, members of the household, and caregivers of the child, and whether they were receiving psychological follow-up.

Videoconference Checklist: A document created by researchers to be used as a script during the videoconferences held with mothers of the treatment group, in order to standardize the online meetings. This included reminders, such as keeping the videoconference to a maximum of ten minutes, guidelines on how to conduct the meeting, and the information that should be collected.

In-person practical training script: this was created entirely by the researchers so that during the in-person meetings, the researchers could observe the participants’ skills in implementing the practices taught in the videos. The document presented a series of requests for the researcher to ask the participant. If the request was carried out by the participant, the researcher moved on to the next. Or if the participant had difficulty performing the request, the researcher gave assistance. The requests provided opportunities to consolidate the contents shown in the videos, with the participants putting them into actual practice with their children. Skills were reinforced such as engaging the child, motivation, reinforcement, instruction, token economy, types and help, incidental and subtle forms of teaching, behavior function, managing inappropriate behavior, and imitation. The script also gave information on what the researcher should do if the child presented inappropriate behavior.

Protocol for observing in-person training: This protocol was created entirely by the authors, with closed questions on a Likert scale through which the observers were able to analyze the mothers’ performance during the videos of the in-person training. This document was related to the Roadmap of practical in-person training, as it enabled the researchers to evaluate whether participants were able to perform the tasks they were asked to carry out, and whether they did so independently, or needed some kind of help from the researcher (modeling or verbal).

Social Responsiveness Scale (SRS-2): This is a Likert scale composed of different forms for different age groups. It seeks to quantitatively and reliably quantify a wide range of possible losses of socialization, communication, repetitive behaviors and restricted interests that may be associated with ASD, and present the level of symptoms: mild, moderate or severe, through the responses filled out by the parents or teachers. The SRS-2 is composed of sixty-five measurements (^{Constantino & Gruber, 2020}). The validation studies for the Brazilian context of this scale demonstrate psychometric properties with values of consistency α = .95 and α = .97, sensitivity of 96.8 %, specificity of 100 % and a negative predictive value of 99.99 % for the identification of ASD (Borges & Hauck-Filho,).

Parental Stress Index - Short Form: To evaluate parental stress, the Portuguese adaptation of the Parental Stress Index - Short Form (PSI-SF) was used. It consists of thirty-six items, and is divided into three subcategories: difficult child; parental suffering; and dysfunctional interactions (^{Santos, 2008}). The validation study of PSI-SF in Portugal (Santos, 2008) presents psychometric properties, with Cronbach's alpha coefficient of .92. The instrument has not yet been validated for Brazil context, but since Brazil and Portugal share the same language, it was decided to use this scale, due to a lack of evaluation instruments in this area validated for Brazil.

Procedures

Hybrid Parental Training

The proposal for training parents of children with ASD was constructed according to the following steps: A) discussion among researchers on parental training in hybrid format for parents/caregivers of preschool children diagnosed with ASD, b) a review of the literature on the subject over the last five years, c) deciding on the contents of each video, d) preparing the visual material (slides) to be presented in the videos, recording and editing the videos, e) checking and correcting the videos, f) making the videos available, g) applying the parental training, and h) evaluating their effectiveness.

The topics covered in the training were: 1) What is Autism Spectrum Disorder and the ABA used with this demand, 2) basic principles such as reinforcement, punishment, and extinction, among others, 3) What is behavior, how to define it, and its possible functions, 4) How to establish motivating operation and carry out a preference assessment with the child, 5) systems to assist in the teaching of skills (system of tips) and how to present instructions clearly and if necessary, redirect behavior, 6) differential reinforcement strategies applied in daily life, 7) the importance of play and the possibilities of playing and teaching with the child, 8) how to set up and perform a schedule of activities with the child, and the importance of and how to establish instructional control, 9) the difference between naturalistic and structured teaching, and how to apply each.

Examples and practical relationship with daily life were presented in the videos, in clear language, explaining any technical terms with terms that could be more easily understood by the mothers. Each video lasted approximately forty minutes. Themes 1-6 were contained in two videos, and the others, in one video. All the videos were made available on YouTube, via a private link. Throughout the training, the mothers of the treatment group continued to have access to the videos they had already watched.

Data collection

First step

Initially the researcher sent an invitation via WhatsApp to the parents or guardians of children who attended the center, inviting them to take part in the research. The mothers who accepted the invitation (by replying to the message) and who met the study inclusion criteria, took part. The inclusion criteria were: a child diagnosed with ASD, from mild to severe, according to the Social Responsiveness Scale (SRS-2); a child who had been in early intervention at the center for the past 6 to 12 months; child aged between 2 years 6 months and 6 years; participants who had not previously received training or courses in applied behavior analysis; access to the Internet; literate; had time to attend the center. The exclusion criteria were: a neurodevelopmental deficiency or disorder that could prevent the individual from attending and participating in the training classes or responding to the instruments.

The groups were divided randomly. The first four mothers who agreed to participate in the research were assigned to the Treatment Group, and the remainder to the Control Group. A visit was scheduled with each participant, to come to the center, where they were asked to sign an Informed Consent Form - ICF. The sociodemographic questionnaire, SRS-2, and the Parental Stress Index (PSI) were also applied. In this visit, only the mothers of the Treatment Group received instructions from the researcher on the process of the program, and how to access the videos (approximately 30/40 minutes each), on different themes related to ASD and ABA.

The mothers were asked to watch two videos of two modules per week in the next seven days. After they had watched the videos, a video conference with the researcher was scheduled and conducted. After that, two more modules were made available. However, some mothers were unable to watch all the videos within the established deadline, so a period of fifteen days was given, for the mothers to watch the videos and attend the videoconference. This procedure continued, until a final face-to-face meeting was carried out. This meeting included the practical part, which was recorded for analysis by the researcher. The entire process took 13 weeks.

For the four participants of the Control Group, the researcher listened to any requests the participants had, and they were informed that they would receive messages via WhatsApp, to monitor the case, and that any requests would be forwarded to the technical team responsible for the child's care at the center. The mothers were also informed that they would receive the same training once the research was completed.

Second step

After the first stage, the mothers watched the first two videos and took part in the videoconference. During the videoconference with the participants of the Treatment Group, a videoconference checklist was administered and the subsequent videos were made available for them to watch. This procedure was repeated fortnightly, until the participants had finished watching all the videos. Next, an in-person meeting was scheduled, to carry out the practical part of the training.

Third step

In the third stage of data collection, the researcher and the participants of the Treatment Group attended the center individually, with their children, where the practical part of the training was carried out. This session was recorded for observation by the judges.

The meeting took place in a room equipped with two cameras to capture audio and video. The sessions lasted no more than twenty minutes, and followed the itinerary for the hands-on training. At the end of the session, the participant was referred to another room in which the Parental Stress Index-Short Form (PSI-SF) was applied again.

Fourth step

Two judges with training and experience in ABA, employees of the intervention center where the research took place, performed an independent analysis of the four recorded videos of the practical face-to-face sessions with the participants of the Treatment Group. For the analysis they followed the protocol of observation of the practical training in face-to-face.

Data analysis

First, the information collected through the sociodemographic questionnaire was organized, tabulated and analyzed descriptively, in order to characterize the participants’ profile in relation to the research objectives.

The data obtained from the Parental Stress Index-Short Form (PSI-SF) were analyzed using descriptive statistics, seeking to describe a set of data, and through inferential statistics, aiming to understand, compare and draw conclusions on the responses to the questionnaires applied to the research participants (^{Dancey & Reidy, 2019}). The Wilcoxon non-parametric tests were used to evaluate intragroup differences and the Mann Whitney test was used to analyze the differences between the Treatment and Control Groups (^{Dancey & Reidy, 2019}).

The video recordings of the in-person training with the participants were analyzed individually, through the observation protocol of the hands-on training, counting the occurrence of each item of this instrument during the training. The first three minutes of the videos were disregarded from the analysis, as this period was allowed for the mothers and children to settle themselves in the care room. The rest of the video time was coded.

To verify the reliability of the instrument for observing the participants’ behavior during the training, the analyses of two expert judges were used, each with more than 2 years of experience in ABA. They were instructed on the use of the protocol for observation of the practical in-person training. They watched the videos independently, and through the protocol, identified whether or not the participants presented behaviors requested by the researcher. In the items where they did not correctly present these behaviors, the researcher acted as a third judge, and analyzed the items to make the final decision.

In general, inter-observer agreement should be at least 80 %. To obtain the level of agreement, the following formula was applied: ∑A/ ∑(A+D) x 100 after each judge had analyzed each video. An overall average of 95.45 % was obtained for inter-observer agreement.