An Efficacy Trial of the Early Achievements Comprehensive Intervention for Preschoolers with Autism
Purpose: The purpose of the study is to evaluate the effects of the Early Achievements Intervention for Preschoolers with ASD (EA), an intervention aimed at addressing the learning challenges of young children (ages 3 to 5 years) with autism spectrum disorders (ASD), implemented by teachers (specifically, early childhood educators and special educators) 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 intervention has been 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 will investigate whether teachers implementing the EA intervention do so with high fidelity and preschoolers receiving the intervention demonstrate more rapid and greater growth in language, communication, social, and concept development.
Project Activities: The research team will examine effects of EA using a randomized controlled trial. Baseline testing will occur prior to the conduct of professional development workshops and follow-up tests will assess the effect of EA on language, communication, cognitive, and social outcomes for children in preschool.
Products: The products of this project will include evidence of the efficacy of the EA intervention for preschoolers with ASD when implemented by teachers, as well as peer-reviewed publications and presentations.
Setting: The research will take place in public preschool classrooms in Maryland, Delaware, and Pennsylvania, representing rural and urban settings, diverse racial/ethnic groups, and diverse socio-economic income levels.
Sample: Participants will include 60 teachers and 150 children ages 3 to 5 years with ASD.
Intervention: The EA instruction targets the learning challenges of ASD and cognitive development. The goals, addressing developmental levels 12 months to 6 years, 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. They are intended to be implemented in natural settings (in this case, group-based classroom contexts). The professional development program for EA consists of workshops and explicit coaching as teachers are instructing students in their classrooms, with the aim of helping teachers implement the EA intervention as intended.
Research Design and Methods: A cluster randomized controlled trial design will be used to evaluate the efficacy of EA, with randomization at the classroom/teacher level. Teachers in the EA intervention condition will receive the EA professional development program (including coaching). A new cohort of teachers and their students will be included in each of the 3 implementation years to assess the impact of newly trained teachers on child outcomes. Child outcome data will be collected at baseline and at the end of the year, as well as on a monthly basis during teachers' instruction to assess intermediate effects. Teacher and coach fidelity of implementation data will be collected throughout the year.
Control Condition: Teachers in the comparison condition will receive non-EA professional development workshops but no training or coaching related to the EA intervention.
Key Measures: Primary outcome measures include the Mullen Scales of Early Learning to assess cognitive skills; the Peabody Picture Vocabulary Test, Expressive One-Word Picture Vocabulary Test, and Brigance Early Childhood Screens to assess emergent literacy; and the Early Social-Communication Scales and Pervasive Developmental Disorder Behavior Inventory for social skills. A secondary outcome measure will be completed to assess children's autism-related behaviors and problem behaviors using a questionnaire completed by parents and/or teachers. Observational measures will assess teachers' EA intervention implementation fidelity. Teachers will also complete forms to indicate their frequency of intervention use and their satisfaction with and feasibility of the intervention. Coaches' fidelity will be assessed by observations of the training sessions using a checklist.
Data Analytic Strategy: The research team will conduct the primary analysis of the effect of EA using hierarchical linear models (HLM) to compare outcomes of children in the EA and comparison conditions. This analysis will be a 3-level model with students clustered within classrooms and classrooms within schools. Models will control for any baseline student, classroom, or school characteristics that were found to differ significantly between groups. An analysis of moderating and mediating variables will also be conducted using HLM and path analyses with structural equation models. Fidelity data will be analyzed descriptively and used to investigate associations with outcomes and determine which practices were similar or different across conditions.