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This study examined how teachers and paraprofessionals in 126 kindergarten-second grade general and special education classrooms talked with their 194 students with autism, and further, how individual student characteristics in language, autism symptoms, and social abilities influenced this talk. Using systematic observational methods and factor analysis, we identified a unidimensional model of teacher language for general and special education classrooms yet observed differences between the settings, with more language observed in special education classrooms—much of which included directives and close-ended questions. Students’ receptive vocabulary explained a significant amount of variance in teacher language beyond its shared covariance with social impairment and problem behavior in general education classrooms but was non-significant within special education classrooms. Research implications are discussed.

Purpose This study examined predictors of preschool enrollment and attendance in an inclusive, university-based lab preschool (Preschool Education Lab [PEL]) serving children with and without autism spectrum disorder (ASD). Method PEL operates as a full-day, state-licensed preschool and consists of three classrooms serving 2-, 3-, and 4-year-olds (class sizes of 12, 16, and 18 children, respectively). Between July 2018 and October 2019, parents of 84 children with a prior diagnosis of ASD or parental concerns about ASD contacted PEL to seek enrollment. Parents completed several eligibility surveys, including a demographic survey and the MacArthur-Bates Communicative Development Inventories (MB-CDI). The process for determining eligibility and enrollment consisted of four steps: Step 1, review of eligibility surveys to select children for an in-person eligibility observation (EO); Step 2, completion of an in-person EO to determine program eligibility; Step 3, enrollment of eligible and interested families; and Step 4, sustained PEL attendance. Results We used logistic regression analyses to identify child or demographic characteristics that predict decisions at each step. Results show that parent-reported early gestures (MB-CDI) were the strongest predictor of PEL's decision to invite children for an EO (Step 1). Furthermore, higher parent-reported language skills (MB-CDI, Words Produced) and a younger chronological age were the strongest predictors of PEL's decision to invite families to enroll (Step 2). Whether eligible families chose to enroll (Step 3) and whether enrolled families chose to remain enrolled (Step 4) were best explained by practical family considerations such as tuition expenses, daily commute, and alternative programming options. Conclusion This research paints a complex picture of forces that influence placement decisions for children with ASD who seek enrollment in an inclusive early childhood education program. A better understanding of these forces is necessary to evaluate outcomes and increase access to inclusive preschool options for children with ASD.

Robust evidence supports the efficacy of early autism intervention. Despite broad consensus that earlier intervention leads to better outcomes, evidence for this has been limited to correlational studies. This study examined timing effects of the Early Social Interaction (ESI) model, a parent-implemented intervention, using a complete crossover randomized controlled trial (RCT). Effects of Individual-ESI were compared when initiated at 18 or 27 months of age, and also contrasted with effects of the less intensive Group-ESI as an active control condition. Participants included 82 autistic toddlers who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order randomized. Blinded clinicians completed assessments at baseline (18 months of age), end of Condition 1 (27 months), and end of Condition 2 (36 months). Toddlers randomized to Individual-ESI at 18 months showed greater gains during treatment than those starting Individual-ESI at 27 months in receptive/expressive language, social communication, and daily living skills. This pattern was not observed for Group-ESI, demonstrating that timing effects were specific to Individual-ESI and ruling out maturation effects. This RCT demonstrated that earlier intensive, individualized intervention led to greater improvements, and suggests that even a narrow window of 18 versus 27 months may impact child outcomes. Lay abstract Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.

Background Late talkers are a heterogeneous group of toddlers and reliable predictors of persistent language delay have been elusive. The purpose of this study was to determine the extent to which early social communication and vocabulary production predicted variance in language outcomes at 2 and 3 years of age. Methods Participants were 408 typically developing and late-talking toddlers who completed the Communication and Symbolic Behavior Scales Caregiver Questionnaire and Behavior Sample (CSBS CQ and CSBS BS) at a mean of 20 months, the Language Development Survey (LDS) at a mean of 24 months, and the Mullen Scales of Early Learning (MSEL) at a mean of 25 months. A subgroup of 198 children completed a second MSEL at 3 years of age. Associations among the LDS, CSBS CQ, CSBS BS, and MSEL were examined using correlational and hierarchical linear regression analyses. Logistic regression was used to examine each measure’s contribution to predicting language delay at 2 and 3 years. Results Moderate to large correlations were observed among all variables. The LDS, CSBS CQ, and CSBS BS added unique contributions to the prediction of 2- and 3-year expressive and receptive language outcomes. Measures of speech and vocabulary production were the strongest predictors of language outcomes at age 2. At age 3, social and symbolic communication played a more significant role in accounting for variance in expressive and receptive language outcome. A similar pattern emerged for the categorical prediction of language delay. Conclusions Measures of social communication between 18–21 months added important information to predicting language outcomes at 2 and 3 years, above and beyond parent-reported expressive vocabulary production measured at 24 months, with small effect sizes overall. Implications for identifying younger children who are at risk for continued language delay and recommendations for referral to early intervention programs are discussed.

Research examining restricted and repetitive patterns of behavior or interests (RRB) in autism spectrum disorder (ASD) has increased our understanding of its contribution to diagnosis and its role in development. Advances in our knowledge of RRB are hindered by the inconsistencies in how RRB is measured. The present study examined the factor structure of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 350 children with ASD ages 2-9. Confirmatory factor analysis designed for items with categorical response types was implemented to examine six proposed structural models. The five-factor model demonstrated the most parsimonious fit based on common overall fit indices that was further supported by examination of local model fit indicators, though, the four- and six-factor models evidenced adequate-to-good fit as well. Examination of RRB factor score approaches indicated only minor differences between summed item subscale scores and extracted factor scores with regard to associations with diagnostic measures. All RRB subtypes demonstrated significant associations with cognitive functioning and adaptive behavior. Implications for future research validating the RBS-R as a more extensive clinical measure of RRB in ASD are discussed. Autism Res 2019, 12: 1399-1410. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Repetitive behaviors are one of the two main symptoms of autism spectrum disorder (ASD). To better understand the role of repetitive behaviors, we must establish effective ways of measuring them. This study assessed the measurement qualities of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 350 children with ASD ages 2-9. We found that the RBS-R measures multiple types of repetitive behaviors and that these behaviors are related to thinking ability and independence.

Objective This cluster randomized trial (CRT) evaluated the efficacy of the Classroom Social, Communication, Emotional Regulation, and Transactional Support (SCERTS) Intervention (CSI) compared with usual school-based education with autism training modules (ATM). Method Sixty schools with 197 students with autism spectrum disorder (ASD) in 129 classrooms were randomly assigned to CSI or ATM. Mean student age was 6.79 years (SD 1.05) and 81.2% were male. CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation. A CRT, with students nested within general and special education classrooms nested within schools, was used to evaluate student outcomes. Results The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction. The CSI group also had significantly better outcomes on measures of adaptive communication, social skills, and executive functioning with Cohen's d effect sizes ranging from 0.31 to 0.45. Conclusion These findings support the preliminary efficacy of CSI, a classroom-based, teacher-implemented intervention for improving active engagement, adaptive communication, social skills, executive functioning, and problem behavior within a heterogeneous sample of students with ASD. This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures. (PsycINFO Database Record

Purpose The need for community-viable, evidence-based intervention strategies for toddlers with autism spectrum disorder (ASD) is a national priority. The purpose of this research forum article is to identify gaps in intervention research and needs in community practice for toddlers with ASD, incorporate published findings from a randomized controlled trial (RCT) of the Early Social Interaction (ESI) model (Wetherby et al., 2014) to illustrate community-based intervention, report new findings on child active engagement from the ESI RCT, and offer solutions to bridge the research-to-community practice gap. Method Research findings were reviewed to identify gaps in the evidence base for toddlers with ASD. Published and new findings from the multisite ESI RCT compared the effects of two different ESI conditions for 82 toddlers with ASD to teach parents how to support active engagement in natural environments. Results The RCT of the ESI model was the only parent-implemented intervention that reported differential treatment effects on standardized measures of child outcomes, including social communication, developmental level, and adaptive behavior. A new measure of active engagement in the natural environment was found to be sensitive to change in 3 months for young toddlers with ASD and to predict outcomes on the standardized measures of child outcomes. Strategies for utilizing the Autism Navigator collection of web-based courses and tools using extensive video footage for families and professional development are offered for scaling up in community settings to change developmental trajectories of toddlers with ASD. Conclusions Current health care and education systems are challenged to provide intervention of adequate intensity for toddlers with ASD. The use of innovative technology can increase acceleration of access to evidence-based early intervention for toddlers with ASD that addresses health disparities, enables immediate response as soon as ASD is suspected, and rapidly bridges the research-to-practice gap. Presentation Video https://doi.org/10.23641/asha.7297817

This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, n = 50), developmental delays without ASD (DD; n = 25) and typical development (TD, n = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.

OBJECTIVES: To compare the effects of two 9-month parent-implemented interventions within the Early Social Interaction (ESI) Project. Both individual-ESI, offered 2 or 3 times per week at home or in the community, and group-ESI, offered once per week in a clinic, taught parents how to embed strategies to support social communication throughout everyday activities. METHODS: Participants in the randomized controlled trial included 82 children diagnosed with autism spectrum disorder at 16 to 20 months. Children were matched on pretreatment nonverbal developmental level and pairs were randomly assigned to treatment condition. Child outcomes included measures of social communication, autism symptoms, adaptive behavior, and developmental level. Child outcomes are reported from baseline to the end of the 9-month interventions. RESULTS: Children in individual-ESI showed differential change on a standardized examiner-administered observational measure of social communication, as they improved at a faster rate than children in group-ESI. Individual-ESI also showed differential efficacy on a parent report measure of communication, daily living, and social skills, as they showed improvement or stability, whereas group-ESI led to worsening or no significant change on these skills. Finally, individual-ESI showed differential change on examiner-administered measures of receptive language skills, as children in individual-ESI improved significantly, whereas group-ESI showed no change. CONCLUSIONS: These findings support the efficacy of individual-ESI compared with group-ESI on child outcomes, suggesting the importance of individualized parent coaching in natural environments. The efficacy of a parent-implemented intervention using little professional time has potential for community viability, which is particularly important in light of the lack of main effects on child outcomes of most other parent-implemented interventions.

During the last decade, research on Autism Spectrum Disorder (ASD) has made tremendous progress with regard to early identification and diagnosis. These advances were made possible by a growing number of rigorous research studies with large sample sizes that utilized a combination of: (1) retrospective parent report and home video studies [1], (2) prospective studies of infant siblings of children with ASD [2], (3) population-wide studies of ASD screening tools [3], and (4) studies on the early stability of diagnostic classifications [4]. Advances in best practices related to early identification are reflected in a 2006 policy statement published by the American Academy of Pediatrics [5], and a corresponding set of clinical practice guidelines [6]. According to these guidelines, it is recommended that Primary Care Providers (PCPs; e.g., family physicians, pediatricians) administer formal screening tests during every well-child visit scheduled at 18 and 24 months, independent of known risk factors or reported concerns. Moreover, PCPs are urged to promptly refer children for Early Inter‐ vention1 services as soon as ASD is seriously considered.

Objectives: The purpose of this study was to examine group differences and relationships with later developmental level and autism symptoms using a new clinical tool developed to measure repetitive and stereotyped movements (RSM) in young children. Method: Videotaped behavior samples using the Communication and Symbolic Behavior Scales Developmental Profile (CSBS; Wetherby & Prizant, 2002) were coded for children with autism spectrum disorders (ASD; n = 50), developmental delays without ASD (DD; n = 25), and typical development (TD; n = 50) between 18 and 24 months of age. Results: Children with ASD demonstrated significantly higher rate and larger inventory of RSM with objects and body during a systematic behavior sample than both the DD and TD groups. Measures of RSM were related to concurrent measures of social communication and predicted developmental outcomes and autism symptoms in the fourth year for the ASD group. None of the correlations between RSM and autism symptoms remained significant when controlling for CSBS Symbolic level. RSM with objects predicted unique variance in the severity of autism symptoms in the fourth year beyond that predicted by social communication measures alone. Conclusions: This study provides support for the diagnostic significance of RSM in children under 24 months of age and documents the utility of this RSM measurement tool as a companion to the CSBS.