Co-Principal Investigators: Lester, Jessica; Muller, Patricia

Purpose: This proposed research will examine the efficacy of Building Interactive Social Communication (BISC), an intervention framework that helps early intervention providers (EIPs) support families of toddlers with autism. Aimed at addressing emerging signs of autism during the developmentally malleable period of toddlerhood, BISC supports parent-mediated intervention with children that is delivered to families in person or virtually, and naturally integrates families' language and cultural preferences. In a prior IES-funded pilot study, BISC improved EIP, parent, and child learning more than typical practice. The current study will rigorously evaluate BISC's impact on key EIP, parent, and child outcomes while qualitatively examining parent-child interactions to better understand BISC's implementation, impact, and underlying influences. The results will be aimed at informing the practices and policies of early intervention systems.

Project Activities: The research team will use a randomized controlled trial to assess EIP, parent, and toddler outcomes; implementation fidelity; social validity; and sustainability of the BISC framework. A parallel qualitative study will provide additional context for understanding underlying influences on observed impacts.

Products: The products of this project will include an understanding of the impact of the BISC intervention on EIP, child, and parent outcomes and manualized guidance for parents and EIPs with the aim of commercial publication to provide broad accessibility. The project will also result in a final dataset to be shared, peer-reviewed publications and presentations, and additional dissemination products that reach education stakeholders such as practitioners and policymakers.

Structured Abstract

Setting: The research will take place in families' homes (in person or virtually) in rural, suburban, and urban locations throughout Indiana and Kansas.

Sample: Participants will include approximately 165 EIPs employed in state IDEA Part C early intervention systems that serve eligible families. Each EIP will serve one family, including a parent and their toddler under 31 months of age who meets criteria for autism. The research team will focus recruitment efforts in regions where provider agencies enroll families with a range of racial and ethnic identities.

Intervention: BISC provides intervention support to EIPs working to improve the development of toddlers with autism through parent-mediated learning. The intervention aims to address social communication challenges in toddlers by promoting active parental learning and empowerment. More specifically, EIPs guide families in weekly sessions, over the course of 20 weeks, to mediate toddler learning of social communication competencies. Providers introduce concepts related to targeted outcomes (content) and mediated learning practices (process). Videos of parent toddler interaction are used to demonstrate how parents can use their knowledge of child interests and family/cultural preferences to translate learned concepts into natural, everyday parent-child interaction. Parent learning is further supported by guided reflection on videos of them interacting with their toddlers. The intervention, which can be delivered in person or virtually depending on the system used by the provider, aims to be a cost-effective, non-intrusive model of service delivery.

Research Design and Methods: The research team will use a randomized controlled trial, with EIPs randomized to intervention and control groups, to rigorously test BISC's impact on toddler social communication, parent use of mediated learning principles, and EIP knowledge and application of targeted competencies. Observational data recorded during parent-child interactions and audio recordings of intervention sessions will be collected for primary outcome measures at pre- and post-intervention, as well as at a 6-month follow up. A parallel qualitative investigation of parent-child interactions, using the same recordings, will allow the research team to explore possible underlying influences on observed impacts, identify likely contributors to or detractors from discovered effects, and add needed context to any replication efforts.

Control Condition: EIPs in the control condition will deliver Part C early intervention serves as usual, planned and monitored by their local- and state-administered systems.

Key Measures: The research team will use the TELE-ASD-PEDS and the Childhood Autism Rating Scale toscreen for autism and determine eligibility. The Developmental Assessment of Young Children will be used to describe thesample of toddlers. Primary outcome measures will include the Mediation of Social and Transactional Engagement measure (MOSTE) to assess parent application of mediated learning principles andthe Preverbal Joint Attention Measure (PJAM) for child social-communication outcomes, both based on observations of videorecorded interactions. Measures that will be used to test for moderation and mediation will include surveys and checklists to assess demographic factors, implementationfidelity, social validity, and sustainability.

Data Analytic Strategy: Researchers will use an intent-to-treat model to test BISC's impacts. Key child, parent, and EIP outcomes will be examined using repeated measures analysis of variance (and covariance). Qualitative conversational analyses, based on recorded parent-child interactions, will be used to examine how BISC may impact parent-child interactions. Mixed methods will compare qualitative and quantitative findings to explore possible underlying factors that may contextualize the effects, identify likely contributors to or detractors from discovered effects, and add context for any replication efforts.

Cost Analysis: Costs will be determined using the ingredients method, with summary metrics calculated as average costs per child, broken down by cost category. In addition, a cost-effectiveness ratio will be calculated to reflect the differences in costs and effects on the primary child outcome variable (joint attention) between the treatment and control conditions. The ratio will provide the average cost per child above the control group to achieve the observed differences in outcomes.

Related IES Projects: Supporting Early Interventionists of Toddlers with Autism to Build Family Capacity (SEITA) (R324A180083)