The Use of Recommended Practices for Children with ASD in Public Preschool and Elementary Schools

Background: Outcomes for children with ASD in community service systems do not match those demonstrated in controlled trials (Nahmias et al., under review). It is important to understand what factors support best outcomes in usual care. As the educational system is the primary service children for children with ASD (Brookman-Frazee et al., 2009), studying intervention as it is delivered in the public education system can provide important insights which recommended practices have the potential to be most effective, given the resources available (Stahmer & Aarons, 2009). Evaluation of classroom quality measures that are specific to the instructional needs of students with ASD may specifically inform this goal.

Objectives:

• To examine predictors of use of recommended practices for children with ASD based on teacher and classrooms characteristics, and
• To examine the association of recommended practice use with student cognitive gains.

Methods:

Participants (45 teachers, 95.7% female; 68 students, 86.8% male) were part of the control arm of a randomized trial of an educational intervention for students with ASD in public preschool and elementary schools (mean student age = 68.0 months, SD = 22.1). Observers rated implementation of recommended practices for children with ASD using the Educational Program Review (EPR) in four classroom types: Mild/Moderate, Moderate/Severe, Autism, and Inclusion. Based on observation and teacher interview, raters coded skill indicators of Teaming, Classroom Structure, Classroom Environment, Curriculum and Instruction, Social/Peer Relationships, Challenging Behaviors Management, and Positive Instructional Climate. Teachers completed a demographic questionnaire. Children were assessed at the beginning and end of the school year with the same standardized cognitive assessment (either the Mullen Scale of Early Learning or the Differential Abilities Scales). Analyses included: (1) ANOVAs comparing EPR scores among classroom types, (2) Pearson correlations and ANOVAs examining associations between teacher characteristics and EPR scores, (3) a paired t-test assessing student cognitive gains over the school year, and (4) Generalized Estimating Equations examining the association between EPR domain scores on cognitive change scores.

Results:

EPR scores did not differ by classroom type, teacher years of experience in special education or with ASD, or teacher reported job-related stress (all ps > .08). Teachers with Bachelor’s degrees had higher positive Instructional Climate scores than those with Master’s degrees. Teachers with higher job satisfaction had higher Classroom Structure, Classroom Environment, Curriculum, and Social/Peer relationships scores (all ps < .03). Student cognitive scores increased by 4.7 points on average over the school year (t(67) = 5.3, p < .0001). Better implementation of recommended practices for Classroom Environment (e.g., low student-teacher ratio, use of natural/direct reinforcement, use of clear and meaningful instructions) was the unique significant predictor associated with cognitive gains (B = 4.28, p = .03) in adjusted analyses.

Conclusions:

Unlike in our previous research (Nahmias, 2017), the use of recommended practices for children with ASD did not differ by classroom type. The implementation of recommended practices for the classroom environment were particularly important for cognitive gains in students receiving publicly funded special education and offer strategies that may be beneficial for teachers in community settings to emulate.