Content and Process of Communication Intervention for Toddlers with Autism: Trends and Current Status
Intervention models for toddlers on the autism spectrum have emerged and evolved since 2000. While subsequent research has focused largely on outcomes, the communication-focused content and intervention processes that influenced those outcomes are relatively unexplored.
The study’s aim was to explore intervention content and process variables described in recent studies of communication-focused intervention for toddlers with autism and to assess their alignment with recommendations from extant reviews of early intervention for this population.
A search of intervention studies of toddlers with autism yielded 23 intervention descriptions as reported in 31 original studies (some duplicated). Studies were limited to peer-reviewed publications since 2010 that reported on communication-focused interventions with all participants under age 36 months. The intervention descriptions were coded for intervention content (primary outcomes and communication focus/level) and process (strategies, setting, agent, and learning framework). A parallel search of published reviews of interventions for toddlers with autism yielded seven reviews, which were ordered chronologically with findings classified by their component studies’ approaches, foci, agents, and settings as well as by overall identified needs. Original studies and reviews were independently coded with consensus on coding reached by the full team (all presenters).
Viewed chronologically, the seven reviews revealed a decreasing use of exclusively behavioral and a commensurate increasing use of developmental and combined approaches, an increasing focus on preverbal social communication with a decreasing focus on verbal language, an increasing use of natural environments, and minimal change over time in the use of parent- versus professional-implemented interventions. Needs cited by multiple reviews included more developmentally grounded intervention focusing on prelinguistic social communication, more implementation in natural environments, and greater use of family-centered/capacity-building practices with parent implementation. The parallel review of the 23 recent communication intervention descriptions showed interventions focused on social communication (8), general communication (6), or a mixture (9) that targeted pre-symbolic (8), symbolic (4), or mixed (11) levels. Interventions were relatively evenly distributed between home-only (12) and preschool/clinic/lab/mixed (11) settings and between implementation exclusively by parents (12) and fully/partially by professionals (11) with the majority of home-only interventions implemented by parents and non-home-only at least in part by professionals. A review of intervention strategies revealed theoretical mechanisms assumed to guide child learning: These included response to reinforcement, modeling, and/or prompting (7), reciprocal contributions to learning (4), response to environmental arrangement (1) or a mixture (11).
Paralleling recommendations from the seven reviews, analysis of 23 recent intervention descriptions revealed that, while progress toward developmentally grounded content and recommended practices is evident, continued advancement toward a primary emphasis on social communication at the preverbal level, active facilitation of the parent role in implementation, and delivery in natural environments is needed. A number of recent interventions relied primarily on external reinforcement strategies or prompting/modeling while fewer relied primarily on reciprocal learning processes that might promote child active engagement and initiations. Future investigations should explore the role that interventions driven by differing underlying learning assumptions might play in promoting meaningful interactive social engagement on the toddlers’ own volition.