Empirically-Derived Effect Size Distributions of Interventions for Young Children on the Autism Spectrum.

OBJECTIVE: The purpose of this study is to present a set of empirically derived effect size distributions to provide field-based benchmarks for interpreting the observed effects of interventions for young children on the autism spectrum, and for planning future studies. METHOD: We generated effect size distributions and reported quartile values for each by outcome domain, and by boundedness, proximity, and assessment approach using 1552 effect sizes from 144 early childhood autism intervention studies gathered for a previously published meta-analysis. RESULTS: Quartile values represent considerable heterogeneity in effect size distributions across outcome domains, as well as variability as a function of outcome boundedness, proximity, and assessment approach. CONCLUSIONS: Our results serve as field- and outcome-specific benchmarks (e.g., contextual guides for small, medium, and large effects) that will help autism intervention researchers easily incorporate information from relevant prior empirical literature when conducting power analyses to plan for future studies. Benchmarks will also assist researchers seeking to interpret the magnitude of observed effects in clinical trials relative to the broader distribution of intervention effects on similar outcomes. Nuanced discussions that contextualize study findings in light of relevant empirical benchmarks will better assist practitioners in understanding the magnitude and scope of demonstrated change relative to studies with similar outcomes and selecting interventions for clinical practice. We discuss the limitations of these data, our analyses, as well as directions for future work.

Research Review: Conflicts of Interest (COIs) in autism early intervention research - a meta-analysis of COI influences on intervention effects.

BACKGROUND: The presence, types, disclosure rates, and effects of conflicts of interest (COIs) on autism early intervention research have not previously been studied. The purpose of this study was to examine these issues. METHODS: This study is a secondary analysis of a comprehensive meta-analysis of all group-design, nonpharmacological early intervention autism research conducted between 1970 and 2018. We coded reports for the presence/absence of COI statements, the types of COIs that were disclosed, and for 8 types of COIs, including (a) the author developed the intervention, (b) the author is affiliated with a clinical provider, (c) the author is employed by a clinical provider, (d) the author is affiliated with an institution that trains others to use the intervention, (e) the author receives payment or royalties related to the intervention, (f) the study was funded by an intervention provider, (g) the study used a commercially available measure developed by the author, and (h) proceeds of the intervention fund the author's research. Frequencies and proportions were calculated to determine prevalence of COIs and COI disclosures. Meta-analysis was used to estimate summary effects by COI type and to determine if they were larger than for reports with no coded COIs. RESULTS: Seventy percent of reports were coded for ≥ 1 COI, but only ~ 6% of reports contained COI statements fully accounting for all coded COIs. Metaregressions did not detect significant influences of any COI type on summary effects; however, point estimates for each COI type were larger than for reports with no coded COIs. CONCLUSIONS: Conflicts of interest are prevalent but under-reported in autism early intervention research. Improved reporting practices are necessary for researcher transparency and would enable more robust examination of the effects of COIs on research outcomes.

Evidence-b(i)ased practice: Selective and inadequate reporting in early childhood autism intervention research.

LAY ABSTRACT: When researchers fail to report their findings or only report some of their findings, it can make it difficult for clinicians to provide effective intervention recommendations. However, no one has examined whether this is a problem in studies of early childhood autism interventions. We studied how researchers that study early childhood autism interventions report their findings. We found that most researchers did not register their studies when they were supposed to (before the start of the study), and that many researchers did not provide all of the needed information in the registration. We also found that researchers frequently did not publish their findings when their studies were complete. When we looked at published reports, we found that many of the studies did not report enough information, and that many studies were reported differently from their registrations, suggesting that researchers were selectively reporting positive outcomes and ignoring or misrepresenting less positive outcomes. Because we found so much evidence that researchers are failing to report their findings quickly and correctly, we suggested some practical changes to make it better.

Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children: A Meta-Analysis.

Importance: Health professionals routinely recommend intensive interventions (ie, 20-40 hours per week) for autistic children. However, primary research backing this recommendation is sparse and plagued by methodological flaws. Objective: To examine whether different metrics of intervention amount are associated with intervention effects on any developmental domain for young autistic children. Data Sources: A large corpus of studies taken from a recent meta-analysis (with a search date of November 2021) of early interventions for autistic children. Study Selection: Studies were eligible if they reported a quasi-experimental or randomized clinical trial testing the effects of a nonpharmacological intervention on any outcome in participant samples comprising more than 50% autistic children 8 years or younger. Data Extraction and Synthesis: Data were independently extracted by multiple coders. Meta-regression models were constructed to determine whether each index of intervention amount was associated with effect sizes for each intervention type, while controlling for outcome domain, outcome proximity, age of participants, study design, and risk of detection bias. Data were analyzed from June 2023 to February 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Main Outcomes and Measures: The primary predictor of interest was intervention amount, quantified using 3 different metrics (daily intensity, duration, and cumulative intensity). The primary outcomes of interest were gains in any developmental domain, quantified by Hedges g effect sizes. Results: A total of 144 studies including 9038 children (mean [SD] age, 49.3 [17.2] months; mean [SD] percent males, 82.6% [12.7%]) were included in this analysis. None of the meta-regression models evidenced a significant, positive association between any index of intervention amount and intervention effect size when considered within intervention type. Conclusions and Relevance: Findings of this meta-analysis do not support the assertion that intervention effects increase with increasing amounts of intervention. Health professionals recommending interventions should be advised that there is little robust evidence supporting the provision of intensive intervention.

Guidance for Increasing Primary Study Inclusion and the Usability of Data in Meta-Analysis: A Reporting Tutorial.

Meta-analyses can be used to comprehensively summarize the state of a given literature base, understand development and relations between constructs, and synthesize intervention effects to identify "what works for whom," all of which can directly inform research, practice, and policy. In this tutorial, we first argue that data reporting in primary studies can meaningfully affect the results of meta-analyses and, most importantly, the subsequent interpretations and use of the findings in research, practice, and policy in speech, language, and hearing sciences. Though reporting guidelines have been well established for the results of meta-analyses, there is limited focus on the essentials for primary study reporting that allow for inclusion in meta-analyses. To this end, we provide guidance for primary study authors to ensure their studies can maximize their contributions to research syntheses and, specifically, to meta-analyses. We discuss current and ongoing issues related to reporting, provide data-based examples of instances where lack of reporting or transparency has rendered a study ineligible from inclusion in a meta-analysis, encourage editorial teams and peer reviewers to be flexible in the inclusion of supplemental data reporting based on journal requirements and limits, and suggest being explicit and earnest about why these requests are important to advancing the field. Supplemental Material: https://doi.org/10.23641/asha.23117996.

Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis.

OBJECTIVE: To summarize the breadth and quality of evidence supporting commonly recommended early childhood autism interventions and their estimated effects on developmental outcomes. DESIGN: Updated systematic review and meta-analysis (autism intervention meta-analysis; Project AIM). DATA SOURCES: A search was conducted in November 2021 (updating a search done in November 2017) of the following databases and registers: Academic Search Complete, CINAHL Plus with full text, Education Source, Educational Administration Abstracts, ERIC, Medline, ProQuest Dissertations and Theses, PsycINFO, Psychology and Behavioral Sciences Collection, and SocINDEX with full text, Trials, and ClinicalTrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any controlled group study testing the effects of any non-pharmacological intervention on any outcome in young autistic children younger than 8 years. REVIEW METHODS: Newly identified studies were integrated into the previous dataset and were coded for participant, intervention, and outcome characteristics. Interventions were categorized by type of approach (such as behavioral, developmental, naturalistic developmental behavioral intervention, and technology based), and outcomes were categorized by domain (such as social communication, adaptive behavior, play, and language). Risks of bias were evaluated following guidance from Cochrane. Effects were estimated for all intervention and outcome types with sufficient contributing data, stratified by risk of bias, using robust variance estimation to account for intercorrelation of effects within studies and subgroups. RESULTS: The search yielded 289 reports of 252 studies, representing 13 304 participants and effects for 3291 outcomes. When contributing effects were restricted to those from randomized controlled trials, significant summary effects were estimated for behavioral interventions on social emotional or challenging behavior outcomes (Hedges' g=0.58, 95% confidence interval 0.11 to 1.06; P=0.02), developmental interventions on social communication (0.28, 0.12 to 0.44; P=0.003); naturalistic developmental behavioral interventions on adaptive behavior (0.23, 0.02 to 0.43; P=0.03), language (0.16, 0.01 to 0.31; P=0.04), play (0.19, 0.02 to 0.36; P=0.03), social communication (0.35, 0.23 to 0.47; P<0.001), and measures of diagnostic characteristics of autism (0.38, 0.17 to 0.59; P=0.002); and technology based interventions on social communication (0.33, 0.02 to 0.64; P=0.04) and social emotional or challenging behavior outcomes (0.57, 0.04 to 1.09; P=0.04). When effects were further restricted to exclude caregiver or teacher report outcomes, significant effects were estimated only for developmental interventions on social communication (0.31, 0.13 to 0.49; P=0.003) and naturalistic developmental behavioral interventions on social communication (0.36, 0.23 to 0.49; P<0.001) and measures of diagnostic characteristics of autism (0.44, 0.20 to 0.68; P=0.002). When effects were then restricted to exclude those at high risk of detection bias, only one significant summary effect was estimated-naturalistic developmental behavioral interventions on measures of diagnostic characteristics of autism (0.30, 0.03 to 0.57; P=0.03). Adverse events were poorly monitored, but possibly common. CONCLUSION: The available evidence on interventions to support young autistic children has approximately doubled in four years. Some evidence from randomized controlled trials shows that behavioral interventions improve caregiver perception of challenging behavior and child social emotional functioning, and that technology based interventions support proximal improvements in specific social communication and social emotional skills. Evidence also shows that developmental interventions improve social communication in interactions with caregivers, and naturalistic developmental behavioral interventions improve core challenges associated with autism, particularly difficulties with social communication. However, potential benefits of these interventions cannot be weighed against the potential for adverse effects owing to inadequate monitoring and reporting.

Keeping up with the evidence base: Survey of behavior professionals about Naturalistic Developmental Behavioral Interventions.

LAY ABSTRACT: Primary service providers for young children on the autism spectrum and developmentally delayed children use many strategies under the umbrella of applied behavior analysis therapy. The evidence supporting interventions for children on the autism spectrum has changed last decade, and powerful research supports the relative effectiveness of Naturalistic Developmental Behavior Interventions, yet a few professionals serving young children on the autism spectrum receive training in this category of interventions. Board Certified Behavior Analysts and related professionals are the primary service providers for this population. The purpose of this survey study is to describe and understand the knowledge and beliefs that Behavior Analyst Certification Board certificants have around Naturalistic Developmental Behavior Interventions. The survey was completed by 901 respondents. Respondents indicated, on average, little to no knowledge of Naturalistic Developmental Behavior Intervention practices and few believe that these practices are effective or appropriate for the field. Recommendations include increasing training opportunities for related professionals, and changing certification requirements to match the current evidence.

The influence of language knowledge and test components on reading comprehension scores.

This study investigated the dependability of reading comprehension scores across different text genres and response formats for readers with varied language knowledge. Participants included 78 fourth-graders in an urban elementary school. A randomized and counterbalanced 3 × 2 study design investigated three response formats (open-ended, multiple-choice, retell) and two text genres (narrative, expository) from the Qualitative Reading Inventory (QRI-5) reading comprehension test. Standardized language knowledge measures from the Woodcock Johnson III Tests of Achievement (Academic Knowledge, Oral Comprehension, Picture Vocabulary) defined three reader profiles: (a) < 90 as emerging, (b) 90-100 as basic, and (c) > 100 as proficient. Generalizability studies partitioned variance in scores for reader, text genre, and response format for all three groups. Response format accounted for 42.8 to 62.4% of variance in reading comprehension scores across groups, whereas text genre accounted for very little variance (1.2-4.1%). Single scores were well below a 0.80 dependability threshold (absolute phi coefficients = 0.06-0.14). Decision studies projecting dependability achieved with additional scores varied by response format for each language knowledge group, with very low projected dependability on open-ended and multiple-choice scores for readers with basic language knowledge. Multiple-choice scores had similarly low projected dependability levels for readers with emerging language knowledge. Findings evidence interactions between reader language knowledge and response format in reading comprehension assessment practices. Implications underscore the limitations of using a single score to classify readers with and without proficiency in foundational skills.

Evaluating evidence-based practice in light of the boundedness and proximity of outcomes: Capturing the scope of change.

Evidence-based practice (EBP) reviews abound in early childhood autism intervention research. These reviews seek to describe and evaluate the evidence supporting the use of specific educational and clinical practices, but give little attention to evaluating intervention outcomes in terms of the extent to which they reflect change that extends beyond the exact targets and contexts of intervention. We urge consideration of these outcome characteristics, which we refer to as "proximity" and "boundedness," as key criteria in evaluating and describing the scope of change effected by EBPs, and provide an overview and illustration of these concepts as they relate to early childhood autism intervention research. We hope this guidance will assist future researchers in selecting and evaluating intervention outcomes, as well as in making important summative determinations of the evidence base for this population. LAY SUMMARY: Recent reviews have come to somewhat different conclusions regarding the evidence base for interventions geared toward autistic children, perhaps because such reviews vary in the degree to which they consider the types of outcome measures used in past studies testing the effects of treatments. Here, we provide guidance regarding characteristics of outcome measures that research suggests are particularly important to consider when evaluating the extent to which an intervention constitutes "evidence-based practice."

Adverse event reporting in intervention research for young autistic children.

LAY ABSTRACT: In this study, we looked at published research on interventions for young autistic children that did not involve administering medication. We were interested in determining how often studies reported on whether adverse events (i.e. physical or psychological distress to the participants) or adverse effects (i.e. adverse events that are thought to be caused by the intervention) had occurred. We found that of the 150 reports we examined, only 11 mentioned adverse events. One of these studies reported adverse events occurred, and three reported that adverse effects occurred. We also reviewed the studies to examine the reasons that were given to explain why any participants dropped out of the intervention (termed "withdrawal"), to determine if any of these reasons could be considered adverse events or adverse effects. Fifty-four studies described reasons for withdrawal, and 10 of these studies had reasons that could be categorized as an adverse event, 8 studies had reasons that could be categorized as an adverse effect, and an additional 12 studies had reasons that were too vaguely described to determine whether they were adverse events or not. We recommend that autism intervention researchers develop more systematic methods of looking for and reporting adverse events and effects, so that professionals and families can be better informed when choosing to enroll their autistic children in interventions.

Understanding the Effects of Naturalistic Developmental Behavioral Interventions: A Project AIM Meta-analysis.

We examined the quality of evidence supporting the effects of Naturalistic Developmental Behavioral Interventions (NBDIs) for facilitating change in young children with autism. We also investigated whether effects varied as a function of specific features of the intervention, samples, and outcomes measured. Twenty-seven studies testing the effects of NDBIs were extracted from data collected for the Autism Intervention Meta-analysis (Project AIM), a comprehensive meta-analysis of group design, nonpharmacological intervention studies for children with autism aged 0-8 years. We extracted effect sizes for 454 outcomes from these studies for use in meta-regression analyses testing associations between intervention effects and mean participant chronological age, language age, autism symptomatology, percentage of sample reported as male, cumulative intervention intensity, interventionist, outcome boundedness, outcome proximity, and risk of parent/teacher training correlated measurement error. The extant literature on NDBIs documents effects on social communication, language, play, and cognitive outcomes. However, our confidence in the positive and significant summary effects for these domains is somewhat limited by methodological concerns. Intervention effects were larger for context-bound outcomes (relative to generalized), and for proximal outcomes (relative to distal). Our results indicate that NDBIs have promise as an approach for supporting development for some, but not all of the core and related features of autism in early childhood. Confidence in summary effect estimates is limited by study quality concerns, particularly an overreliance on measures subject to high detection bias. The results of this review support the use of proximity and boundedness as indicators of the limits of intervention effects. LAY SUMMARY: Naturalistic Developmental Behavioral Interventions may increase language, social communication, play skills, and cognition in young children with autism, but these increases are largest for skills directly targeted by the intervention, and in contexts that are similar to that of the intervention. These conclusions are tempered by some concerns regarding research design across the studies that have been conducted to date. Autism Res 2021, 14: 817-834. © 2021 International Society for Autism Research and Wiley Periodicals LLC.

Psychophysiological and Eye-Tracking Markers of Speech and Language Processing in Neurodevelopmental Disorders: New Options for Difficult-to-Test Populations.

It can be challenging to accurately assess speech and language processing in preverbal or minimally verbal individuals with neurodevelopmental disabilities (NDD) using standardized behavioral tools. Event-related potential and eye tracking methods offer novel means to objectively document receptive language processing without requiring purposeful behavioral responses. Working around many of the cognitive, motor, or social difficulties in NDDs, these tools allow for minimally invasive, passive assessment of language processing and generate continuous scores that may have utility as biomarkers of individual differences and indicators of treatment effectiveness. Researchers should consider including physiological measures in assessment batteries to allow for more precise capture of language processing in individuals for whom it may not behaviorally apparent.

Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis.

Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.

Project AIM: Autism intervention meta-analysis for studies of young children.

In this comprehensive systematic review and meta-analysis of group design studies of nonpharmacological early interventions designed for young children with autism spectrum disorder (ASD), we report summary effects across 7 early intervention types (behavioral, developmental, naturalistic developmental behavioral intervention [NDBI], TEACCH, sensory-based, animal-assisted, and technology-based), and 15 outcome categories indexing core and related ASD symptoms. A total of 1,615 effect sizes were gathered from 130 independent participant samples. A total of 6,240 participants, who ranged in age from 0-8 years, are represented across the studies. We synthesized effects within intervention and outcome type using a robust variance estimation approach to account for the nesting of effect sizes within studies. We also tracked study quality indicators, and report an additional set of summary effect sizes that restrict included studies to those meeting prespecified quality indicators. Finally, we conducted moderator analyses to evaluate whether summary effects across intervention types were larger for proximal as compared with distal effects, and for context-bound as compared to generalized effects. We found that when study quality indicators were not taken into account, significant positive effects were found for behavioral, developmental, and NDBI intervention types. When effect size estimation was limited to studies with randomized controlled trial (RCT) designs, evidence of positive summary effects existed only for developmental and NDBI intervention types. This was also the case when outcomes measured by parent report were excluded. Finally, when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Using a motion-tracking device to facilitate motion control in children with ASD for neuroimaging.

Purpose: Conducting neurological scans of children with disabilities is difficult because participants exhibit excessive motion. We examined whether a motion-tracking system that combined real-time visual feedback with positive reinforcement and shaping could facilitate motion control in two children with autism spectrum disorder. Methods: Using a modified changing criterion design, we evaluated whether the intervention could facilitate decreases in the participants' range of motion and increases in duration of motion control in a mock scanner. Results: Participants restricted head motion to increasingly smaller distance windows for 2 min. Once participants limited head displacement to 3 mm for 2 min, duration of motion control increased to a range of 7-20 min. Summary-level data from the actual scan suggests increases in motion control generalized outside of the intervention context. Conclusion: This study adds to the limited research on the use of behavioral interventions to increase motion control for neuroimaging in children with disabilities.

Word Processing in Children With Autism Spectrum Disorders: Evidence From Event-Related Potentials.

Purpose: This investigation was conducted to determine whether young children with autism spectrum disorders exhibited a canonical neural response to word stimuli and whether putative event-related potential (ERP) measures of word processing were correlated with a concurrent measure of receptive language. Additional exploratory analyses were used to examine whether the magnitude of the association between ERP measures of word processing and receptive language varied as a function of the number of word stimuli the participants reportedly understood. Method: Auditory ERPs were recorded in response to spoken words and nonwords presented with equal probability in 34 children aged 2-5 years with a diagnosis of autism spectrum disorder who were in the early stages of language acquisition. Average amplitudes and amplitude differences between word and nonword stimuli within 200-500 ms were examined at left temporal (T3) and parietal (P3) electrode clusters. Receptive vocabulary size and the number of experimental stimuli understood were concurrently measured using the MacArthur-Bates Communicative Development Inventories. Results: Across the entire participant group, word-nonword amplitude differences were diminished. The average word-nonword amplitude difference at T3 was related to receptive vocabulary only if 5 or more word stimuli were understood. Conclusions: If ERPs are to ever have clinical utility, their construct validity must be established by investigations that confirm their associations with predictably related constructs. These results contribute to accruing evidence, suggesting that a valid measure of auditory word processing can be derived from the left temporal response to words and nonwords. In addition, this measure can be useful even for participants who do not reportedly understand all of the words presented as experimental stimuli, though it will be important for researchers to track familiarity with word stimuli in future investigations. Supplemental Material: https://doi.org/10.23641/asha.5614840.

Predicting Intentional Communication in Preverbal Preschoolers with Autism Spectrum Disorder.

Intentional communication has previously been identified as a value-added predictor of expressive language in preverbal preschoolers with autism spectrum disorder. In the present study, we sought to identify value-added predictors of intentional communication. Of five theoretically-motivated putative predictors of intentional communication measured early in the study (at study entry and 4 months after), three had significant zero-order correlations with later intentional communication (12 months after study entry) and were thus added to a linear model that predicted later intentional communication scores controlling for initial intentional communication scores at study entry. After controlling for initial intentional communication, early motor imitation was the only predictor that accounted for a significant amount of variance in children's later intentional communication.

The Association Between Parental Mean Length of Utterance and Language Outcomes in Children With Disabilities: A Correlational Meta-Analysis.

PURPOSE: The purpose of this correlational meta-analysis was to examine the association between parental utterance length and language outcomes in children with disabilities and whether this association varies according to other child characteristics, such as age and disability type. This association can serve as a starting point for language intervention practices for children with disabilities. METHOD: We conducted a systematic search of 42 electronic databases to identify relevant studies. Twelve studies reporting on a total of 13 populations (including 257 participants) were identified. A random-effects model was used to estimate a combined effect size across all studies as well as separate effect sizes across studies in each disability category. RESULTS: The combined effect size across all studies suggests a weak positive association between parental input length and child language outcomes. However, subgroup analyses within disability categories suggest that this association may differ for children with autism. Results of 4 studies including 47 children with autism show that parental input length is strongly associated with positive language outcomes in this population. CONCLUSIONS: Present evidence suggests that clinicians should reconsider intervention practices that prescribe shorter, grammatically incomplete utterances, particularly when working with children with autism.

Measuring Representative Communication in Young Children with Developmental Delay.

Generalizability and decision studies provide a mathematical framework for quantifying the stability of a given number of measurements. This approach is especially relevant to the task of obtaining a representative measure of communicative behavior in young children and supports an alternative to the debate regarding which type of assessment yields the most representative scores. The current paper provides a report of a generalizability and decision study on 63 toddlers with developmental delay who were treated for 6 months using an intervention that targeted communication and vocabulary goals. Two variables - rate of intentional communication acts and rate of different words - were measured across three assessment contexts at four communication sampling periods. Results verified that measurement stability increased with time and development for both variables, regardless of the type of assessment procedure used.