Co-Principal Investigator: Baggett, Kathleen

Purpose: The purpose of this project is to develop and test a framework, Supporting Early Interventionists of Toddlers with Autism to Build Family Capacity (SEITA), to help early interventionists (EIs) promote parent mediation of social communication in toddlers with emerging signs of autism spectrum disorder (ASD). ASD is the fastest growing developmental disability, and earlier detection means that more children showing early signs of ASD will be receiving services through the Individuals with Disabilities Education Act Part C programs. SEITA will be developed to work within Part C systems and will address the need for interventions that enhance family capacity and integrate interventions into natural environments for toddlers with ASD. Ultimately, the aim of SEITA is to improve the social communication skills of toddlers with ASD.

Project Activities: The research team will conduct three studies to develop and test the SEITA framework. In Study 1, they will use focus groups to inform intervention development. Specifically, they will explore the perspectives of EIs and parents about intervention-related topics. In Study 2, they will iteratively implement a preliminary framework while assessing EI, parent, and toddler outcomes, as well as the feasibility and acceptability of the framework. In the final pilot study, the team will use a multiple-baseline single-case design to test the promise of SEITA for improving EI, parent, and child outcomes.

Products: The products of this project will include a fully developed framework to support EIs in building family capacity to work on social-communication skills with their toddlers with ASD. Products will also include peer-reviewed publications and presentations.

Structured Abstract

Setting: Research will take place in homes  in urban and rural areas of Indiana and Kansas where Part C early intervention services are received,

Sample: Approximately 24 EIs and families within the Part C system will participate in Study 1. Six EIs who serve families that include a toddler with ASD (one family per EI) will participate in Study 2. For the pilot study, 12 EIs, parents/caregivers, and toddlers with ASD will participate. Toddlers will be under 30 months of age and have at least one social communication outcome on their Individual Family Service Plan.

Intervention: In the SEITA framework, an Intervention Consultant will guide EIs to help parents learn to mediate their toddlers' learning in social communication, a core challenge for children with ASD. There are three major components to the framework. First, the content to be learned is social communication. EIs, and in turn, the parents, will learn to distinguish between social communication and instrumental communication (e.g., requesting, following directions), as the former but not the latter is generally the challenge in ASD. The distinction will be illustrated through four different focus areas: reciprocal interaction, joint attention, play, and functional behavior (repetitive and challenging behaviors). The content will be learned through manuals, online modules, and other resource materials. The focus of the intervention will depend upon the identified area of need for each child. The second component is mediated learning, the intervention process through which the EI guides the parents and the parents, in turn, guide their children. The mediated learning processes used to enhance toddlers' social communication skills include focusing, organizing and planning, giving meaning, encouraging self-reliance, and expanding. The third key component is the parent-child relationship,which is the learning context in which interactive learning takes place. Rather than working directly with the child, the EI will provide systematic and focused support for the parent in implementing learning strategies with their children.

Research Design and Methods: This project will involve three studies. In Study 1, the research team will gather information from focus groups of parents and EIs about their perception of intervention-related topics (e.g., intervention priorities, their own competencies, feasibility issues, initial SEITA features) to inform the development of the initial framework. The team will perform this initial development work in conjunction with the Intervention Consultant, who will be working with the EIs in implementing the framework in subsequent studies. The team will also develop project-specific measures of fidelity during this phase. In Study 2, the team will conduct a series of single-case design studies to gather data on various iterations of the framework. The team will iteratively develop and test the framework with two groups of EIs, and gather data on fidelity of implementation, feasibility, and social validity, as well as child outcomes. In Study 3, the pilot study, the team will use a multiple-baseline single-case design to determine the potential efficacy of the revised SEITA framework in improving EIs' implementation fidelity when working with caregivers, caregivers' implementation fidelity when working with their toddlers, and toddlers' social communication skills. For each child, the focus will be on one of four competencies: reciprocal interaction, joint attention, play, and repetitive/challenging behavior, with multiple children in each focus area.

Control Condition: For the pilot study, each EI, parent, and child serves as their own control during the baseline phase of the single-case design study.

Key Measures: To determine child eligibility for the study researchers will use the Modified Checklist for Autism in Toddlers — Revised (M-CHAT) screening tool followed by the Autism Diagnostic Observation Schedule for Toddlers (ADOS-T). For Study 1, data will be gathered through focus groups with EIs and parents. For Studies 2 and 3, the research team will measure feasibility, usability, and acceptability/social validity through researcher-developed checklists and rating scales. For child outcomes, one social communication domain will be measured for each child, depending on their needs and primary area of intervention focus. Precursors of Joint Attention Measures, an observation coding system, will be used to measure reciprocal interactions (turn taking between caregiver and child) and joint attention (responding to joint attention and initiating joint attention). An observation-based coding system, based in part on The Developmental Play Assessment, will be used to measure play during parent-child interaction. Repetitive and challenging behavior will be assessed through observations of the frequency of these behaviors.

Data Analytic Strategy: The researchers will analyze qualitative focus group data in Study 1 to identify themes that inform the development of the initial version of SEITA. Single-case design data from Study 2 will be analyzed using visual analysis. To analyze data from Study 3, researchers will use both visual analysis and a between-case standardized effect size analysis.