Previous Award Number: R324A160033
Previous Awardee: University of North Carolina, Chapel Hill

Co-Principal Investigators: Reszka, Stephanie; Childress, Deb

Purpose: The purpose of this project was to develop and pilot test a web-based enhancement of the classroom-based Advancing Social-Communication and Play (ASAP) intervention to support collaborations between home and school. ASAP was designed to develop joint attention (shared attention toward an object or event with another person) and symbolic play (pretending), both pivotal skills for young children with autism spectrum disorders (ASD). Although there is evidence that ASAP has an impact, there is little evidence of generalization across school and home contexts. Further, providing a greater connection between the two settings may help establish a more comprehensive assessment of the child's needs as part of ASAP. This new website, Promoting ASAP Collaboration through Technology (PACT), was designed to generate individualized implementation recommendations based on child needs and allow for electronic communication between school providers and parents who are implementing ASAP across school and home settings.

Project Activities: The project was conducted in three phases. In phase 1, the PACT website was developed using feedback from parents and school providers. In phase 2, the research team assessed the feasibility of parents using the website in their homes to implement the ASAP intervention and examine fidelity of implementation using single-case design studies. In phase 3, the team collected pilot data on the co-implementation of ASAP by school providers and parents across both contexts using a quasi-experimental design.

Key Outcomes: The main findings of this project, as reported by the principal investigator, are as follows:

• In the iterative development and feasibility/usability testing, the research team found that engaging parents of children with ASD as stakeholders early in website development enhanced their future acceptability and utility of the website to support their child's development.
• During the pilot study, the research team learned of strategies that classroom practitioners can use to successfully increase parent participation and engagement in a technology supported intervention, including the importance of (a) frequently updating child goal progress, (b) providing specific suggestions and ideas in their timely responses to parent requests for help, and (c) helping parents get started with selecting intervention goals to work on at home with their child.
• Practitioners and researchers should carefully consider context when deciding on how to measure changes in the social-communication and related skills of children with ASD. During the pilot study, the research team found that some skills showed improvement across both home and school contexts while others did not.

Structured Abstract

Setting: The research took place in the classrooms and homes of preschool-aged children with ASD in North Carolina.

Sample: Preschool children (ages 3-5 years) with ASD, as well as their parents and school providers, participated in this project. For phase 1, six parents participated in both initial and follow-up focus groups and six school providers, who had previously used ASAP, participated in semi-structured interviews. For phase 2, seven parent-child dyads participated in the single-case design studies. In phase 3, 12 classrooms participated in the pilot study. All classrooms were trained to implement ASAP throughout the school year. Within each classroom, there were two target children participating, resulting in a total of 22 children and families.

Intervention: ASAP, previously developed and evaluated through IES funding, is a classroom-based intervention aimed at increasing social-communication and play skills. The classroom team implements the intervention through group activities and one-to-one sessions. For the current study, after the school team is trained in ASAP, teachers invited parents of children with ASD to participate in the new PACT website, and the parents, in turn, were able to invite additional caregivers to participate. The website consists of a tutorial on using the website, an overview of ASAP for parents, a language assessment, supports for parents to implement ASAP at home (including a video library, implementation guide, activity examples), questions for self-monitoring, and ASAP tips of the week. An additional feature is the home/school communication component. The parent website automatically transfers information about the child's progress to the lead teacher, and teachers can send emails or texts to the parents to share progress information or ideas for implementation. Finally, the website generates child progress reports. A mobile interface of the website was also developed.

Research Design and Methods: The PACT website was developed and tested iteratively through three phases. In phase 1, the website was developed with input from focus groups of parents and semi-structured interviews with school providers of children with ASD. Participants then had access to the website to evaluate usability, with data gathered through the software and rating scales. In phase 2, multiple-baseline, single-case design studies were conducted to assess feasibility and fidelity of implementation of parents' use of the website at home. In the final stage, a quasi-experimental design was used for the pilot study. Classrooms included those in which the lead teacher was already trained in ASAP. The treatment group, receiving ASAP with PACT, was larger than the control group (16 versus 8 classrooms) to examine variability in implementation. This study aimed to examine the promise of the website for improving parent outcomes, improving the generalization of child skills to the home, and exploring associations between parental characteristics (such as self-efficacy, quality of relationship with teacher) and fidelity of implementation.

Control Condition: For the pilot study, the control group participated in ASAP as usual, without access to the PACT website.

Key Measures: In the first phase, parent and school provider usability outcomes were measured through software usage data (such as time for task completion, frequency of errors) and feedback provided through focus groups and semi-structured interviews. For the single-case design studies, parent usage data were measured again, fidelity of implementation was measured through a modified version of the previously developed ASAP fidelity rating scale measure, and feasibility and social validity were measured through parental interviews. In addition, observations of parent-child dyads were used to assess child outcome data (such as engagement). For the final pilot study, fidelity of implementation by classroom teachers was measured through interviews and behavioral observations. Feasibility data were gathered from teachers through software usage data and questionnaires. Parent characteristic measures included the Parental Efficacy subscale of the Parent Locus of Control Scale and the Parent Teacher Relationship Scale. Child outcome measures included the behavioral observations and coding of engagement and social-communication and play skills. Treatment acceptability and usability scales also measured parents' and school teams' satisfaction with the website. The Autism Diagnostic Observation Schedule-2 was used to determine child participant eligibility.

Data Analytic Strategy: Focus group and interview data were transcribed and analyzed qualitatively by identifying themes and perspectives. The team used visual analysis for the single-case design studies. For the pilot study, analysis of covariance was used to examine associations between exposure to the website and changes in parent outcomes and group differences across time in the generalization of children's social and play skills to the home setting. Additional associations between fidelity of implementation and parent characteristics were explored through correlational analyses.

Related IES Projects: Social Communication and Symbolic Play Intervention for Preschoolers with Autism (R324B070056); Advancing Social-Communication and Play (ASAP): An Intervention Program for Preschoolers with Autism (R324A110256); Making Professional Development Work for Preschool Classroom Teams Serving Students with ASD: Adapting a PD Model Using Normalization Process Theory (R324A200188).

Products and Publications

ERIC Citations: Find available citations in ERIC for this award here and here.

Project Website: https://www.med.unc.edu/ahs/asap/

Select Publications

Journal articles

Amsbary, J., Alzamel, A., Lin, M-L., Savage, M., Reszka, S., Crais, E., Watson, L., & Boyd, B. (2021). Identifying and targeting social-communication and play skills for preschoolers with autism. Young Exceptional Children. Advance online publication.

Amsbary, J., Lin, M.-L., Savage, M. N., Fanning, L., Reszka, S., Watson, L. R., & Boyd, B. (2022). Engaging Parents in the Development and Testing of a Website to Support Social-Communication and Play Development for Preschoolers with Autism Spectrum Disorder. Journal of Special Education Technology, 37(4), 523&ndashl;535.