Differential Learning of a Blended Intervention Approach Among Therapists of Varied Backgrounds

Background: Recently there has been an increase in the variety of intervention approaches used with young children with autism spectrum disorders (ASD). Providers from different theoretical backgrounds are implementing approaches that may or may not align with their previous experience. Two prominent approaches are naturalistic, behavioral interventions based on applied behavior analysis (ABA) and developmental, social pragmatic interventions based on the social, relational learning of typical development. Approaches based on ABA have been empirically validated and are widely used in research and applied settings. Developmental, interventions are acquiring a growing body of support and are the subject of much current investigation. Recent research has called for cross-fertilization between these two approaches to advance the understanding of active ingredients in autism intervention and improve treatment. Blended models of early intervention are gaining support for young children with ASD.

Objectives: Examine the differences in therapist fidelity for specific intervention strategies by therapist background, discipline and experience.

Methods:   As part of a pilot project examining a treatment for young children at-risk for ASD, providers from varied theoretical backgrounds were trained in a blended behavioral and developmental intervention.  Participants included seven therapists from four community agencies serving children with ASD.  Each therapist had a self-reported background in behavioral interventions (n=3), developmental/social pragmatic interventions (n=2), or family systems (n=2). All therapists worked with children ages 12-24 months, and received training in the blended behavioral and developmental intervention approach described in Teaching Social Communication to Children with Autism (Ingersoll & Dvortscak, 2008). Ten minute video probes were collected of each therapist implementing the intervention and were scored for fidelity of implementation of intervention techniques. Fidelity scores on individual strategies were compared among therapists of differing backgrounds.

Results:  No differences based on theoretical background were found in therapist skill level for three strategies including: following the child’s lead, using varied levels of animation to keep the child engaged, providing consequences immediately following child behavior and following through with prompting specific behavior.  However, therapists differed in their use of other strategies.  For example, therapists from behavioral backgrounds were more likely than therapists from other backgrounds to meet fidelity for using prompts to elicit more complex skills, and adjusting prompts to support spontaneity.  Therapists with developmental backgrounds were more likely than other groups to meet fidelity for modeling play and expanding on child responses.

Conclusions: Therapists from all backgrounds had some common areas of strengths and weakness in a blended intervention model. Therapists were most likely to meet fidelity on strategies consistent with their theoretical training. Therapists with behavioral backgrounds were better able to implement directive teaching techniques; those with developmental backgrounds were more skilled at interactive strategies. Family systems therapists excelled in the interactive techniques but struggled with direct teaching techniques. Directed suggestions for areas of optimal cross-fertilization will be discussed.