ECHO Autism Washington: Autism Diagnostic Evaluations in Primary Care.

ECHO (Extensions for Community Healthcare Outcomes) Autism is a telementoring learning model to increase community capacity for autism-related health care. Seventy-seven pediatric providers (mostly primary care, seeing exclusively Medicaid patient populations) enrolled in 1 year of ECHO Autism Washington. Analysis of self-report surveys showed a significant increase in autism diagnoses made by ECHO providers after 1 year, F(1, 65) = 7.52, P = .008. Providers who attended more sessions reported making more diagnoses, F(2, 613.26), P = .045. Of note, autism diagnoses were not externally validated. The total number of reported barriers reduced, F(2, 61) = 13.5), P < .001, and confidence ratings increased F(2, 60) = 24.21, P < .001. The average number of diagnostic referrals from ECHO providers to the state's largest autism specialty clinic significantly reduced, t(43) = 4.23, P < .001, with significantly fewer diagnostic referrals made during and after ECHO training compared with a comparison group of 28 non-ECHO providers, t(58.77) = -3.36, P < .001. Overall, 1 year of ECHO Autism Washington participation led to significant changes in autism diagnostic practices.

Beyond the Task List: A Proposed Integration of Naturalistic Developmental Behavioral Interventions to BCBA Training.

Naturalistic developmental behavioral intervention (NDBI) is firmly rooted in both the science of ABA as well as developmental science. Research indicates that many practicing board certified behavior analysts (BCBAs) are unfamiliar with NDBI models and do not implement these approaches when working with young autistic children (Hampton and Sandbank Autism, 26(4), 875-888, 2022). In this article we align NDBI to the seven dimensions of ABA, describe their compatibility with the ABA service system, and urge community agencies and insurance funders to support NDBI use. Finally, we provide a roadmap for BCBAs who provide behavior analytic intervention to young autistic children and for Verified Course Sequence faculty to effectively align the 6th edition BCBA Test Content Outline with the principles and application of NDBI.

Concordance of multiple informant assessment of school-based social skills intervention and association with child outcomes: Results from a randomized trial.

Background: Fidelity, or the degree to which an intervention is implemented as designed, is essential for effective implementation. There has been a growing emphasis on assessing fidelity of evidence-based practices for autistic children in schools. Fidelity measurement should be multidimensional and focus on core intervention components and assess their link with program outcomes. This study evaluated the relation between intervention fidelity ratings from multiple sources, tested the relation between fidelity ratings and child outcomes, and determined the relations between core intervention components and child outcomes in a study of an evidence-based psychosocial intervention designed to promote inclusion of autistic children at school, Remaking Recess. Method: This study extends from a larger randomized controlled trial examining the effect of implementation support on Remaking Recess fidelity and child outcomes. Schools were randomized to receive the intervention or the intervention plus implementation support. Observers, intervention coaches, and school personnel completed fidelity measures to rate completion and quality of intervention delivery. A measure of peer engagement served as the child outcome. Pearson correlation coefficients were calculated to determine concordance between raters. Two sets of hierarchical linear models were conducted using fidelity indices as predictors of peer engagement. Results: Coach- and self-rated completion and quality scores, observer- and self-rated quality scores, and observer- and coach-rated quality fidelity scores were significantly correlated. Higher observer-rated completion and quality fidelity scores were predictors of higher peer engagement scores. No single intervention component emerged as a significant predictor of peer engagement. Conclusions: This study demonstrates the importance of using a multidimensional approach for measuring fidelity, testing the link between fidelity and child outcomes, and examining how core intervention components may be associated with child outcomes. Future research should clarify how to improve multi-informant reports to provide "good enough" ratings of fidelity that provide meaningful information about outcomes in community settings. Plain Language Summary: Fidelity is defined as how closely an intervention is administered in the way the creators intended. Fidelity is important because it allows researchers to determine what exactly is leading to changes. In recent years, there has been an interest in examining fidelity of interventions for autistic children who receive services in school. This study looked at the relationship between fidelity ratings from multiple individuals, the relationship between fidelity and child outcomes, and the relationship between individual intervention component and child changes in a study of Remaking Recess, an intervention for autistic children at school. Schools were randomly selected to receive the intervention only or the intervention plus implementation support from the research team. Observers, intervention coaches, and individuals delivering the intervention themselves completed fidelity measures. Child engagement with peers was measured before and after the intervention. Several measures of self-, coach-, and observer-report fidelity were associated with each other. Higher observer-reported fidelity was associated with higher child peer engagement scores. No single intervention step was linked to child peer engagement and both treatment groups had similar outcomes in terms of fidelity. This study shows the importance of having multiple raters assess different parts of intervention fidelity, looking at the link between fidelity and child outcomes, and seeing how individual intervention steps may be related to outcomes. Future research should aim to find out which types of fidelity ratings are "good enough" to lead to positive changes following treatment so that those aspects can be used and targeted in the future.

Social Validity in Behavioral Research: A Selective Review.

Through the application of behavioral principles, behavior analysts seek to produce socially meaningful behavior change, defined as alterations in behavior that yield important outcomes immediately beneficial for the direct consumers of interventions and key stakeholders. Behavioral practitioners and researchers often engage in assessment and reporting of the meaningfulness of behavior change using social validity assessments. These assessments ensure that target behaviors are appropriately selected, intervention procedures are acceptable, and satisfactory outcomes are produced. The purpose of this review is to identify the current state of social validity within behavioral literature. We reviewed eight peer-reviewed journals between 2010 and 2020. We found that 47% of the intervention studies reviewed included a social validity assessment. Social validity assessment across journals has increased over time, with a significant rise from 2019 to 2020. Implications of these findings and suggestions for future work are discussed.

Telehealth Delivery in Part C Early Intervention: Provider and Caregiver Perspectives.

Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.

Toward deeper understanding and wide-scale implementation of naturalistic developmental behavioral interventions.

LAY ABSTRACT: Naturalistic Developmental Behavioral Interventions (NDBIs) are a group of early interventions that use a variety of strategies from applied behavioral and developmental sciences. Although Naturalistic Developmental Behavioral Interventions have been demonstrated effective, Naturalistic Developmental Behavioral Interventions are not implemented on a wide scale within early intervention programs for children on the autism spectrum. Potential reasons likely stem from differing theoretical orientations of developmental and behavioral sciences and practitioners' lack training, knowledge, and support for implementing Naturalistic Developmental Behavioral Interventions. In support of efforts to promote wide-scale implementation of Naturalistic Developmental Behavioral Interventions, we (1) clarify their common features, (2) discuss possible misconceptions, and (3) offer reasons why Naturalistic Developmental Behavioral Interventions should be widely implemented. We also provide recommendations to the autism service community, intervention developers, and researchers.

Supporting the inclusion and retention of autistic students: Exploring teachers' and paraeducators' use of evidence-based practices in public elementary schools.

Introduction: Educators in public schools are required to serve students in their least restrictive environment. While many evidence-based practices (EBPs), defined as practices and strategies shown by research to have meaningful effectson outcomes for autistic students are documented in the literature, less is known about EBP use among educators in public schools. Methods: Eighty-six general and special education teachers and para educators completed a survey about familiarity, training, and EBP use for included autistic children. Results: Across roles, educators reported familiarity (98.8%), use (97.7%), and training (83.7%) in reinforcement. They reported the least familiarity with behavioral momentum (29.1%), training in both video modeling and peer-mediated instruction and intervention (18.6%), and use of video modeling (14.0%). Follow-up interviews (n = 80) highlighted mixed understanding of EBP definitions and use. Discussion: Implications for inclusive education are discussed including autism-specific EBP training within pre-service teacher preparation programs.

A method for defining the CORE of a psychosocial intervention to guide adaptation in practice: Reciprocal imitation teaching as a case example.

LAY ABSTRACT: Interventions that support social communication include several "components," or parts (e.g. strategies for working with children and families, targeting specific skills). Some of these components may be essential for the intervention to work, while others may be recommended or viewed as helpful but not necessary for the intervention to work. "Recommended" components are often described as "adaptable" because they can be changed to improve fit in different settings where interventions are offered or with different individuals. We need to understand which parts of an intervention are essential (and which are adaptable) when translating interventions from research to community settings, but it is challenging to do this before studying an intervention in the community. This article presents the CORE (COmponents & Rationales for Effectiveness) Fidelity Method-a new method for defining the essential components of evidence-based interventions-and applies it to a case example of Reciprocal Imitation Teaching, an intervention that parents are taught to deliver with their young children with social communication delays. The CORE Fidelity Method involves three steps: (1) gathering information from multiple sources; (2) integrating information from previous research and theory; and (3) drafting a CORE model for ongoing use. The benefits of using the CORE Fidelity Method may include: (1) improving consistency in intervention and research materials to help all providers emphasize the most important skills or strategies; (2) clarifying which parts of the intervention can be adapted; and (3) supporting future research that evaluates which intervention components work and how they work.

Teaching Imitation to Young Children with Autism Spectrum Disorder Using Discrete Trial Training and Contingent Imitation.

Imitation is a pivotal skill for children with and without disabilities, serving both learning and social interaction functions for young children. Children with autism spectrum disorder (ASD) frequently experience delays in acquiring this skillset, demonstrating challenges in the ability and/or propensity to imitate the actions of others. Current intervention programs frequently use discrete trial teaching (DTT) or contingent imitation to support imitation development in young children with ASD. This study combined contingent imitation with DTT to teach imitation to individuals who had previously struggled with acquiring this skill. A multiple probe design across three preschool children with ASD was conducted within participants' early learning classrooms. Response to intervention varied across participants, with participants with more advanced imitation skills at study onset demonstrating greater outcomes. Combining contingent imitation with DTT may facilitate the propensity to imitate for individuals who exhibit some appropriate object engagement and are inconsistently imitating others' actions with objects. However, further research using stronger research design is needed to improve the teaching of imitation to young children with ASD who exhibit challenges with this skillset.

Early Intervention Providers' Perspectives About Working with Families of Toddlers with Suspected ASD: A Qualitative Study.

Part C early intervention (EI) providers are at the front line of service provision for children under 3 years old with developmental delays or disabilities. As such, they can play a key role in both the early detection of autism spectrum disorder (ASD) and the provision of ASD-specialized treatment. Focus groups were conducted with 25 EI providers from three agencies in a Northwestern U.S. county to understand their role in the identification of ASD and communication about ASD concerns to families. Results revealed the tension that providers experience between maintaining a positive and supportive relationship with families and raising the issue of possible ASD. Cultural influences affecting ASD care and suggestions for desired resources were also discussed.