Early Intervention Provider Ratings of Strategies to Promote Social Communication: Differentiating “All” Children from Children with ASD

Background: Several evidence-based naturalistic, developmental, and behavioral interventions (NBDIs) exist for toddlers with autism spectrum disorder (ASD; Schreibman et al., 2015; Wong et al., 2015). However, these types of interventions have been rarely tested within community settings (Nahmias, Kase, & Mandell, 2014; Vivanti, Zierhut, Dawson, & Rogers, 2017). Yet, toddlers with ASD receive early intervention services from Early Intervention (EI) providers who translate research findings into practice (Campbell & Halbert, 2002; Fleming, Sawyer, & Campbell, 2011). Translation will require identification of interventions’ common active ingredients as well as strategies that are more easily disseminated in community settings (Kasari 2012, Pellecchia et al., 2015). Given that EI’s are implementing these strategies in the community, their perceptions about the clinical effectiveness of evidence-based NBDI strategies are needed to inform dissemination efforts and to identify specific behavioral strategies to evaluate as potential active ingredients in future research.

Objectives: To explore early intervention providers’ perceived beliefs of the clinical effectiveness of various intervention strategies on specific behaviors in “children with an ASD” and “all children.”

Methods: Early interventionists who reported providing early intervention services for a toddler with ASD between 12-to-36 months of age within the last 12 months were recruited via email to complete an Internet based survey evaluating the perceived effectiveness of 31 strategies on specific target behaviors. Of 48 early intervention directors invited to distribute surveys to all of their EI providers, 28 responded and 22 agreed to distribute our survey. Ninety-three EI providers completed our survey. EI providers were predominantly female (n=91) and were highly educated (75 MA, 17 BA, 1 PhD). EI providers rated 31 behavioral strategies from 1-to-5 from least to most effective for each group (i.e., ASD, all children). Providers ranged in years of experience between 0 to 33 years (M= 9.25, 8.34).

Box-cox transformations were completed on 38 (of 62) variables to address non-normality. Then, paired samples t-tests were completed for 31 intervention strategies comparing EIs ratings of efficacy for each strategy across “children with an ASD” and “all children.” Effect sizes were calculated for all significant pairs.

Results: Twenty-two of the intervention strategies were rated as significantly more effective for “all children” than for children with ASD. Effect sizes were robust with 6 strategies having large effect sizes (>0.8), 10 strategies having medium effect sizes (≥0.5, and ≤0.8), and 6 strategies having small effect sizes (≥0.2, and ≤0.5). No intervention strategies were rated as being statistically more effective for children with ASD on any of the behavioral targets. EI provider ratings did not result in significant mean differences for children with ASD or “all children” for the remaining strategies.

Conclusions: EI provider ratings indicated different effectiveness expectations for intervention strategies when applied to children with autism versus all children. Strategies related to make-believe play resulted in the largest effect sizes (d=.99-1.05) whereas strategies related to establishing routines and some aspects of joint attention were rated comparably. These findings could be useful in developing interventions that are sensitive to community settings (i.e., inclusive versus special education).