The Use of Recommended Practices for Children with ASD in Urban Preschools

Background:  University-based treatment studies find substantial gains when intervention is provided to preschoolers with ASD, however children receiving intervention in the community on average make small gains. Evidence-based practices (EBPs) developed in university settings may not be available in community settings, or result in the same types of gains when delivered outside highly-controlled settings. Studying intervention as it is delivered as part of the public education system can provide important insights into which EBPs are in use in different types of preschool settings, and which recommended practices have the potential to be most effective, given the resources available.

Objectives:

To examine the use of recommended practices for children with ASD in different types of urban preschool settings and the association of EBP use with child outcomes.

Methods:

Participants are part of longitudinal observational study of community based interventions for preschoolers with ASD, data collection is ongoing. Implementation of EBPs for children with ASD were evaluated using the Educational Program Review (EPR) in three different school-based educational environments: ASD-only, Mixed disability, and Inclusion. For this measure, skill indicators of Teaming, Classroom Structure, Classroom Environment, Curriculum and Instruction, Social/Peer Relationships, Challenging Behaviors Management, and Building a Positive Instructional Climate are rated from “Minimal/No implementation” to “Full implementation” based on direct classroom observation and a teacher interview. Children’s cognitive and language development were assessed 9 months apart (Mullen Scales of Early Learning; MSEL), and parents and teachers completed a questionnaire assessing adaptive behaviors (Adaptive Behavior Assessment System-2^ndEd; ABAS). Multiple linear regression analyses controlling for child demographic characteristics were conducted to examine the association between EPR domain scores on developmental (MSEL) and adaptive behavior (ABAS) change scores.

Results:

Based on the preliminary results from 68 preschoolers (Mean age = 45.9 months, SD = 7.3, 77.9% Male, 45.6% Black/African American), the use of recommended practices significantly differed across ASD-only (n = 21), Mixed disability (n = 22), and Inclusion (n = 25) settings. ASD-only classrooms scored significantly better on teaming and classroom structure than the other types of classrooms, and on better classroom environment, curriculum, and challenging behaviors management than inclusion (ps <. 05). Inclusion classrooms provided better support of social/peer relationships (ps < .001). Mixed disability classrooms had better teaming and curriculum than inclusion (ps<. 01). The classroom types did not statistically significantly differ in their instructional climate.

In an adjusted analysis, better implementation of recommended practices for social/peer relationships was significantly associated with developmental gains (b = 3.9, t(63) = 2.28, p= .03). EBP use was not significantly associated with changes in adaptive behavior.

Conclusions:

These preliminary results suggest the programming available in ASD-only classroom settings is more closely aligned with recommended practices for preschoolers with ASD, than that available in less restrictive educational placements. However, implementation of EBPs related to supporting social/peer relationships (including opportunities to interact with typically developing peers), which was less available in ASD-only preschools, is an important predictor of developmental gains in urban preschools.