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IES Grant

Title: Adapting an Evidence-Based Program for Infants and Toddlers at High Risk for Autism
Center: NCSER Year: 2013
Principal Investigator: Stahmer, Aubyn Awardee: University of California, Davis
Program: Early Intervention and Early Learning      [Program Details]
Award Period: 7/1/13–6/30/16 Award Amount: $1,155,999
Type: Development and Innovation Award Number: R324A140004

Previous Award Number: R324A130350
Previous Awardee: University of California

Previous Award Number: R324A130145
Previous Awardee: Rady Children’s Hospital, San Diego

Purpose: Infants and toddlers who have difficulties in communication, behavior regulation, and developing early relationships are at risk for Autism Spectrum Disorders (ASD) and represent a significant public health challenge. Service providers hesitate to serve very young children with social and communicative difficulties in the hopes that the infants will "grow out" of these delays. Yet these issues persist over time in 75 percent of young children presenting with multiple problems and, if untreated, these children are likely to need intervention when they reach school age. Early intervention agencies are also struggling to implement appropriate, effective programs for this population, and families have limited access to services. Evidence-based practices for young children with ASD were not designed for community contexts and very few communities are providing them.

The purpose of this project is to adapt an evidence-based practice for infants and toddlers (aged 12–24 months) at risk for ASD and their families. The proposed study builds directly on the promising results of a pilot study in which a parent-implemented program originally targeted for preschoolers called Teaching Social Communication to Children with Autism (TSC) was selected in collaboration with community stakeholders to address the needs of infants and toddlers at risk for ASD. This study will focus on specific adaptations identified during the pilot that will be needed to meet the needs of early intervention agencies, as well as infants and toddlers and their families (e.g., enhancing provider coaching and support, revising the manual to be more developmentally appropriate).

Project Activities: The researchers will use an existing community collaborative structure to adapt TSC for use in early intervention agencies serving young children at risk for ASD. There will be three phases of the proposed research. In Phase 1, a qualitative focus group approach will be used to obtain a comprehensive understanding of how different providers and parents use, modify, and apply TSC with infants and toddlers and their families and to examine additional support that might be needed for ongoing implementation. During Phase 2, information from Phase 1 will be used to adapt TSC supports to enhance sustainability. A toddler TSC manual and accompanying supports will be developed using an iterative process of community testing and feedback. Finally, in Phase 3 of the project, the research team will conduct a community-based pilot study of the training plan and the adapted TSC program in terms of fidelity, feasibility, and promise for change in child outcomes.

Products: The expected products of this project include a fully developed TSC program that can be implemented in early intervention settings with infants and toddlers, data on the feasibility and promise of the program, and peer-reviewed publications and presentations.

Structured Abstract

Setting: This research will take place in early intervention settings in California.

Sample: Phase 1 will include 20 early intervention providers and 20 parents of children 12–24 months of age at risk for ASD; Phase 2 will include 5 providers and 5 infants and toddlers in the field testing; and Phase 3 will include 12 providers and 24 infants and toddlers in the pilot testing of TSC implementation.

Intervention: TSC is a manualized parent-implemented program with a 12-week curriculum in which providers teach parents to facilitate their child's development during daily activities. TSC uses developmental strategies (e.g., joint attention) as the basis of parent-child interactions to increase children's engagement and initiation skills, and intersperses behavioral techniques to teach specific communication, play, and cognitive skills. Materials include a manual for providers describing the strategies and methods for teaching parents in group or individual settings, a parent manual that describes each strategy, weekly homework, and handouts that highlight important points. The provider actively collaborates with the parent(s) to identify goals and develop a treatment plan. In addition, web-based training materials will be available to supplement parent education and provide distance learning opportunities.

Research Design and Methods: The research team will use an iterative process that includes focus groups with early intervention providers and parents, and input from expert consultants on ways that TSC can be adapted for use with this age group. This will be followed by the development, field testing, and revision of the TSC and supporting materials with the help of practitioner feedback throughout this process. For the pilot study, a multiple baseline design across providers will be used to examine the adapted training program and provider fidelity of implementation over time. A quasi-experimental design, with matched pairs of families assigned to either the intervention or comparison condition, will be used to examine changes in parent and child behavior related to the intervention. Families will be matched based on marital status, race-ethnicity, the language of intervention delivery, child age at intake, and funding source (IDEA Part C, insurer, fee for service).

Control Condition: Participants in the comparison condition will receive the regularly scheduled therapy they are provided in their community. Data will be gathered on the services received by the comparison children and families.

Key Measures: Provider questionnaires and surveys will be used to assess acceptability, feasibility, and satisfaction with the TSC intervention, and video observations will be used to code fidelity of implementation. Child measures will include the use of standardized assessments of ASD symptoms (Autism Diagnostic Observations Scale–Toddler), developmental functioning (Mullen Scales of Early Learning: AGS Edition), parent-child interaction and social behaviors (Mahoney Maternal and Child Behavior Rating Scales), communicative development (MacArthur-Bates Child Development Inventory), and adaptive behavior (The Adaptive Behavior Assessment System). Parent satisfaction will be measured using a questionnaire.

Data Analytic Strategy: Qualitative methods will be used to analyze data from focus groups. Descriptive analyses will be conducted on the survey and questionnaire ratings from providers and parents. Visual and time series analyses will be conducted on the data from the multiple baseline study of providers. Repeated-measures analysis of variance will be used to analyze changes in child outcomes.

Project website:


Book chapter

Rieth, S.R., Stahmer, A.C., and Brookman-Frazee, L.I. (in press). A Community Collaborative Approach to Scaling-Up Evidence-Based Practices: Moving Parent- Implemented Interventions From Research to Practice. In M. Siller, and L. Morgan (Eds.), Handbook of Family-Centered Practice for Very Young Children With Autism. New York: Springer.

Journal article, monograph, or newsletter

Stahmer, A.C., Brookman-Frazee, L., Rieth, S.R., Stoner, J.T., Feder, J.D., Searcy, K., and Wang, T. (in press). Parent Perceptions of an Adapted Evidence-Based Practice for Toddlers With Autism in a Community Setting. Autism: International Journal of Research and Practice. doi:10.1177/1362361316637580 Full text