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IES Grant

Title: An Efficacy Trial of the Early Achievements Comprehensive Intervention for Preschoolers with Autism
Center: NCSER Year: 2016
Principal Investigator: Landa, Rebecca Awardee: Hugo W Moser Research Institute at Kennedy Krieger, Inc.
Program: Autism Spectrum Disorders      [Program Details]
Award Period: 4 years (7/1/2016-6/30/2020) Award Amount: $3,499,999
Type: Efficacy and Replication Award Number: R324A160228

Purpose: The purpose of the study was to evaluate the effects of the Early Achievements Intervention for Preschoolers with ASD (EA-ASD), an intervention aimed at addressing the learning challenges of young children with autism spectrum disorders (ASD) implemented by teachers in authentic public preschool educational settings. The multifaceted learning challenges of children with ASD lead to entering school without the fundamental skills necessary for academic and social success. The EA-ASD intervention was designed to improve school readiness skills related to meaning construction, including development of communication, symbolic, linguistic, concept, and event representation; reciprocal social engagement with peers; and perspective taking. This study investigated whether teachers fully trained to implement the EA-ASD intervention would do so with high fidelity and whether preschoolers receiving the intervention demonstrate more rapid and greater growth in language, communication, and social development than those in comparison classrooms.

Project Activities: The research team examined effects of EA-ASD using a cluster randomized controlled trial to determine teacher fidelity and child language, communication, cognitive, and social outcomes over time. Follow-up assessments into the following school year examined sustainability of impacts.

Pre-registration site:

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

  • Teachers randomized to the EA-ASD intervention group quickly learned to implement the intervention with high fidelity and sustained high levels of fidelity of implementation into the following school year.
  • Children receiving the EA-ASD intervention showed significantly greater improvements in motor imitation than children whose teachers were in the control group. This was true on proximal measures of motor imitation obtained during classroom observation as well as distal measures of motor imitation conducted by an unfamiliar examiner at the beginning and end of the school year.
  • Children receiving the EA-ASD intervention showed significantly greater improvement in joint attention (social attention sharing) during classroom activities than children whose teachers were in the control group.
  • Children receiving the EA-ASD intervention showed significantly greater improvement in initiating interactions with peers during classroom activities than children whose teachers were in the control group.

Structured Abstract

Setting: The research took place in public preschool classrooms in Maryland, Delaware, Pennsylvania, and Minnesota, representing rural, suburban, and urban settings, diverse racial/ethnic groups, and diverse socio-economic income levels.

Sample: Participants included 62 teachers (early childhood educators and special education teachers) and 159 children with ASD ages 33 months to 5 years.

Intervention: The EA-ASD instruction targets the learning challenges of ASD and cognitive development. The goals are taught using Meaning-Enhancement and Naturalistic Developmental Behavioral Intervention strategies, which blend evidence-based principles and approaches from applied behavior analysis and the developmental sciences. EA-ASD is intended to be implemented in natural settings (in this case, group-based classroom contexts). The professional development program for EA-ASD consists of workshops and explicit job-embedded coaching, with the aim of helping teachers implement the EA-ASD intervention as intended.

Research Design and Methods: A cluster randomized controlled trial design was used to evaluate the efficacy of EA-ASD with randomization at the school level. Teachers in the EA-ASD intervention condition received the EA professional development (PD) program, with interactive workshops as well as job-embedded coaching. Teachers in the control condition attended a 5-day PD workshop unrelated to EA-ASD. A new cohort of teachers and their students enrolled each of the implementation years. Child behaviors were coded from classroom observations at pre-training, training months 2 and 6, and post-training to assess intervention effects. Testing at pre- and post-intervention assessed the effect of EA-ASD on distal measures of children's language, communication, cognitive, and social development. Teacher fidelity of implementation data were obtained at pre-training; training months 2, 4, and 6; post-training; and, to assess sustainability, month 2 of the following school year.

Control Condition: Teachers in the comparison condition received non-EA-ASD PD workshops but no training or coaching related to the EA-ASD intervention.

Key Measures: Primary child outcome measures included the Mullen Scales of Early Learning Visual Reception subscale to assess cognitive skills; the Peabody Picture Vocabulary Test and Expressive One-Word Picture Vocabulary Test to assess language (vocabulary); and the Early Social-Communication Scales (Joint Attention tasks only)and Motor Imitation assessment for social skills. A secondary outcome measure, the Pervasive Developmental Disorder Behavior Inventory, was completed by parents and teachers to assess children's autism-related behaviors and problem behaviors. Other proximal measures included production of the following child behaviors during classroom instruction: peer-to-peer engagement, directed communicative verbalizations, imitation, joint attention, and gestures. Teacher fidelity of EA-ASD intervention implementation was coded from videotapes collected monthly. Teachers also completed forms to indicate their frequency of intervention use and their satisfaction with and feasibility of the intervention. Coach fidelity was coded from audio recording of the training sessions using a checklist.

Data Analytic Strategy: The research team examined the effect of EA-ASD using hierarchical linear models (HLM) to compare outcomes of children in the EA-ASD and comparison conditions. This 3-level model, with students clustered within classrooms and classrooms within schools, controlled for baseline student characteristics that were found to differ significantly between groups. An analysis of moderating variables was conducted using HLM and path analyses with structural equation models. Fidelity data were analyzed descriptively and used to investigate associations with outcomes and determine which practices were similar or different across conditions.

Related IES Projects: Development of a Social and Communication Intervention for Preschoolers with Autism (R324A120330); Development of an Intervention for Center-Based Early Childhood Care and Education Providers to Support Evidence-Based Instruction of Children with Developmental Disabilities (R324A180085); Developing Early Achievements for Pre-K Children with Developmental Language Disorders: A Comprehensive Contextualized Embodied Approach (R324A210031)

Publicly available data: Researchers interested in obtaining access to the database should contact the PI, Rebecca Landa.

Project website:

Products and Publications

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