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Lay abstractEarly Intervention systems provide therapeutic services to families of young children birth to 3 years with developmental delays and are considered a natural access point to services for young children and their families. Research studies in the autism field have been interested in training providers to deliver evidence-based practices in Early Intervention systems to increase access to services for young children with an increased likelihood of being autistic. However, research has often overlooked that Early Intervention systems prioritize family-centered care, an approach to working with families that honors and respects their values and choices and that provides supports to strengthen family functioning. This commentary points out that family-centered care deserves greater attention in research being done in Early Intervention systems. We describe how family-centered care may shape how interventions are delivered, and discuss directions for future research to evaluate the impact of family-centered care alongside intervention delivery.

Naturalistic developmental behavioral interventions (NDBIs) are evidence-based interventions for young children with autism spectrum disorder. There has been growing interest in implementing manualized NDBIs within the early intervention (EI) system without a clear understanding of how these programs and the broader strategies encompassed within them are already used by EI providers. This study examined the use of manualized NDBI programs and broader NDBI strategies within an EI system and factors that impacted their use. Eighty-eight EI providers completed a measure of NDBI program and strategy use. Thirty-three providers participated in a supplemental focus group or interview. Overall, providers described using broader NDBI strategies and the need to adapt manualized NDBI programs. Provider-, intervention-, and organization-level factors impacted their use of NDBI programs and strategies.

Moderate feeding problems affect many children with autism spectrum disorder and often co-occur with disruptive mealtime behaviors. Although parent-mediated interventions have shown promise to support feeding problems, research has primarily occurred within randomized controlled trials when delivered by highly trained clinicians in specialty clinics. Thus, the alignment of these approaches within community settings is unclear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to enhance its adoption, implementation, and sustainment within community settings, including factors that may support or hinder its translation. Participants were 14 multidisciplinary providers who attended one of the three workgroups that included semi-structured focus groups regarding the fit of MEAL Plan in their practice setting. Thematic analysis was used to determine emergent themes, which fell into the domains of content, contextual considerations, and training needs. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, adaptations to MEAL Plan delivery, billing considerations, agency-level support, and the format of ongoing training and consultation. By proactively responding to these factors, it may be possible to enhance the implementation and sustainability of parent-mediated interventions, including MEAL Plan, within community practices that support autistic children.

There is growing research aimed at translating parent-mediated interventions into Part C Early Intervention systems to examine the effectiveness and reach of these models. Although research to date suggests that Early Intervention providers deliver parent-mediated intervention near fidelity, current fidelity reporting practices make delivery difficult to discern. Understanding how parent-mediated interventions are delivered and adapted in a more nuanced manner, including fine-grained intervention delivery and adaptation processes, is important and may increase our understanding of how well these models are aligned within Early Intervention systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by Early Intervention providers and examined their intervention fidelity, the decisions they weighed when delivering Project ImPACT, and reported adaptations to Project ImPACT. Results from 24 providers demonstrated, on average, higher fidelity in response to consultative feedback but notable variability across providers. Preliminary qualitative data highlighted that many events arose within sessions that drove providers to augment their delivery of Project ImPACT. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems, and the impact of these decisions on fidelity metrics and service outcomes.

This mixed-methods study aimed to test the feasibility, acceptability, and fidelity of involving early childhood education (ECE) staff without special education training or prior parent coaching experience in the delivery of an adapted evidence-based parent coaching intervention for young children with autism (Focused Playtime Intervention-Preschool, FPI-P). Ten staff members of a university-affiliated, inclusive ECE program were trained to deliver parent coaching procedures during temporary classroom closures due to the coronavirus disease 2019 (COVID-19) pandemic. Child participants included nine preschool students with ASD aged between 34 and 52 months. While findings highlight several opportunities for improving FPI-P staff training and implementation procedures, results demonstrate (a) the feasibility of involving ECE staff in the delivery of ASD-specific parent coaching to promote social communication, (b) that both parents and preschool staff viewed the experience as beneficial for themselves and the child, and (c) that parents perceived the program to be aligned with family-centered intervention principles.

Cognitive behavioral therapy for youth with autism spectrum disorder and anxiety is effective, but disparities exist in accessing these programs. Training school providers to deliver cognitive behavioral therapy may help to address these disparities. However, little is known about how cognitive behavioral therapy programs are implemented by interdisciplinary school providers and the broader impact of these programs. This study aimed to address this gap and was part of a larger trial that examined the effectiveness of Facing Your Fears--School-Based across 25 public schools. Study aims were to understand the impact of Facing Your Fears--School-Based and factors that impacted implementation. Thirty providers participated in exit interviews guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Primary themes included (1) the fit of Facing Your Fears--School-Based for diverse students; (2) the effects of Facing Your Fears--School-Based on students' school participation; and (3) planned Facing Your Fears--School-Based maintenance. Participants also highlighted the program's accessibility for non-mental health providers and reported adapting Facing Your Fears--School-Based in response to student needs. Results suggest that Facing Your Fears--School-Based may have a broader impact on students and highlight the importance of task sharing to overcome mental health staff shortages within public schools. Programs that can be implemented flexibly are also critical given variability in school structures and student needs.

Defining the central components of an intervention is critical for balancing fidelity with flexible implementation in both research settings and community practice. Implementation scientists distinguish an intervention's essential components (thought to cause clinical change) and adaptable periphery (recommended, but not necessary). While implementing core components with fidelity may be essential for effectiveness, requiring fidelity to the adaptable periphery may stifle innovation critical for personalizing care and achieving successful community implementation. No systematic method exists for defining essential components a priori. We present the CORE (COmponents & Rationales for Effectiveness) Fidelity Method--a novel method for defining key components of evidence-based interventions--and apply it to a case example of reciprocal imitation teaching, a parent-implemented social communication intervention. The CORE Fidelity Method involves three steps: (1) gathering information from published and unpublished materials; (2) synthesizing information, including empirical and hypothesized causal explanations of component effectiveness; and (3) drafting a CORE model and ensuring its ongoing use in implementation efforts. Benefits of this method include: (1) ensuring alignment between intervention and fidelity materials; (2) clarifying the scope of the adaptable periphery to optimize implementation; and (3) hypothesizing--and later, empirically validating--the intervention's active ingredients and their associated mechanisms of change.

Anxiety disorders are among the most common co-occurring psychiatric conditions for youth with ASD (van Steensel et al. in Clin Child Fam Psychol Rev 14:302-317, 2011). Although modified cognitive behavioral therapies (CBT) have yielded significant reductions in anxiety, substantial disparities in access to mental health services exist for youth from diverse and low-income families. Schools represent a consistent resource for underserved communities; thus, there is a critical need to adapt and implement CBT programs in school settings. Engaging stakeholders in the initial phase of adaptation is essential to support adoption and sustainability of best practice interventions in schools. The primary purpose of the study was to adapt group CBT (Facing Your Fears (FYF); Reaven et al. in Facing your fears: group therapy for managing anxiety in children with high-functioning autism spectrum disorders, Paul Brookes Publishing, Baltimore, 2011) via iterative processes with key stakeholders to create a feasible, effective, and sustainable school-based program to manage anxiety in underserved students with ASD. Two rounds of parent and professional focus groups were conducted across three school districts (total 14 groups), using qualitative content analysis methodology. Details regarding the delivery of FYF, selection of students, training considerations for staff, and identifying meaningful outcomes were obtained in anticipation of an implementation trial of FYF.

Results of randomized controlled trials have demonstrated significant reductions in anxiety symptoms following cognitive behavior therapy participation. Although promising, the extent to which previous research has included families from low socioeconomic status or racially/ethnically diverse backgrounds is unknown. Aims of this study are as follows: (1) What is the race, ethnicity, and educational attainment of youth with autism spectrum disorder and their families who have participated in research examining the efficacy of cognitive behavior therapy for anxiety? and (2) How do the demographics of these participants compare to that of the United States census? A total of 14 studies were reviewed that included 473 participants. Chi-square analyses indicated that there are significant differences between the race/ethnicity of youth with autism spectrum disorder participating in cognitive behavior therapy research for anxiety and that of youth in the United States. Standard residuals indicated significant overrepresentation of White youth and significant underrepresentation of Black and Latino youth in cognitive behavior therapy research (all p-values <0.001). Similarly, there were significant differences in the educational attainment of caregivers participating in cognitive behavior therapy research, with a significant underrepresentation of caregivers from low socioeconomic status backgrounds (p < 0.001). These findings have implications for the development of cognitive behavior therapy interventions for youth with autism spectrum disorder and anxiety that are both rigorous and inclusive.

Within the autism spectrum disorder field, rates of attrition in parent-mediated interventions have highlighted the need to engage families around improving the delivery of these services. The primary goal of this study was to approximate the impact of adaptations to an evidence-based, parent-mediated intervention, Project ImPACT (Improving Parents as Communication Teachers), that had been made in collaboration with families in a Medicaid system. A total of 103 parents of a child with autism spectrum disorder were randomized to watch a presentation of either the original or adapted Project ImPACT program. After watching the presentation, participants rated (1) demographic information, (2) perceived structural barriers, (3) Project ImPACT attributes, and (4) intent to use the program. Results from hierarchical linear regression models demonstrated that program type alone predicted parents' ratings of perceived structural barriers. Additionally, both program type and the interaction of program type and annual household income were unique predictors of parents' ratings of program attributes and intent to use. Qualitatively, although many parents reflected positively on both Project ImPACT programs, parents who viewed the adapted program appeared more likely to report positive program attributes. Results suggest the importance of engaging families in improving the fit of parent-mediated interventions for use within a variety of community settings.

This brief article examines the community services delivered to youth with autism spectrum disorder (ASD) in a Southern Californian city as a way to better understand ASD service provision and service attitudes. Specific goals of the study were to identify the services being delivered within the area, and how the use, perceived evidence, and value attached to these services mapped onto recent systematic ASD service reviews. Forty-six providers completed the ASD Strategies and Interventions Survey (ASD-SIS), which consisted of 21 treatment strategies and 22 interventions packages commonly used with children with ASD. Participants: (1) indicated each treatment strategy and intervention package they use, and (2) rated the perceived evidence and value of each treatment strategy and intervention package they endorsed using. Results demonstrated that a variety of treatment strategies and intervention packages, both with and without an established evidence base, were reportedly being delivered to youth with ASD through community-based agencies. Additionally, a large number of providers reported not knowing the evidence of many treatment strategies and intervention packages. Finally, although no relationship was found between evidence base and use, perceived evidence, and value for treatment strategies, providers reported significantly higher use, perceived evidence, and value for established intervention packages. Results demonstrate the need to more effectively disseminate strategies that can support providers in selecting services to deliver to youth with ASD, and underscore the need to better understand the community service landscape on a larger scale.

Dissemination efforts play an important role in bridging the gap between research and practice. Many evidence-based early intervention programs for young autistic children have yet to be widely disseminated to the early childhood workforce. The purpose of this letter is to discuss how packaging and branding early intervention approaches may facilitate or hinder widespread dissemination to community-based early childhood settings. To disseminate early interventions more effectively, we argue that it will be important to account for factors that are known to impact the widespread uptake within community settings. Dissemination, or the widespread sharing of information, is important for moving research evidence into community practice. Early intervention programs for young autistic children have not yet been widely disseminated to the early childhood workforce. This letter describes factors that may support or prevent dissemination to community-based settings, such as packaging and branding early intervention approaches. We argue that an increased focus on dissemination research is needed. [ABSTRACT FROM AUTHOR]

Naturalistic, Developmental, and Behavioral Interventions (NDBIs) are an empirically supported intervention approach for young autistic children and their families. Spanish-speaking (SS) Latinx families have been underrepresented in autism intervention research, limiting our understanding of whether NDBIs are aligned with Latinx family values and belief systems. This study piloted a parent-mediated NDBI, Project ImPACT, within outpatient services for SS Latinx families. We aimed to examine the preliminary impact of Project ImPACT on family and child outcomes while using the Ecological Validity Model to evaluate program adaptations made by bilingual clinicians. Results from 15 families indicated good treatment completion and high satisfaction, alongside significant increases in child social communication skills and parent self-efficacy in supporting their child's development. Mixed-methods data examining program adaptations indicated the need to provide additional information related to autism, bilingual language development, and service navigation, as well as adaptations to language and metaphors used in the program. [ABSTRACT FROM AUTHOR]

Naturalistic developmental behavioral interventions are an empirically supported intervention approach for young autistic children. Despite the prevalence of disruptive behaviors among autistic children, most manualized caregiver-mediated naturalistic developmental behavioral interventions include limited formal guidance on when and how to manage disruptive behavior. The present study sought to characterize how clinicians address disruptive behaviors within the caregiver-mediated naturalistic developmental behavioral intervention, Project ImPACT, the effect of disruptive behavior on Project ImPACT delivery, and the extent to which disruptive behavior impacts social communication outcomes. Data collection was embedded within outpatient early intervention services and included clinicians' report of adaptations to address behavior within the electronic medical record, child social communication outcomes from 124 children and their caregivers, and interviews with certified Project ImPACT coaches and trainers. Results indicate that close to one-third of Project ImPACT sessions included adaptations made to address behavior and regulation. Furthermore, adaptations made to address disruptive behavior were associated with more adaptations to Project ImPACT overall, although behavior adaptations were not associated with child social communication outcomes. Qualitatively, clinicians described using a flexible approach to integrate content and coaching related to behavior and regulation. The present study indicates several future directions for supporting clinicians in addressing behavior and regulation within the naturalistic developmental behavioral intervention framework. Naturalistic developmental behavioral interventions are a common and well-researched type of intervention for young autistic children that focus on supporting social communication. These interventions often do not include formal guidelines on how to address disruptive behaviors, even though they are common among autistic children. This study measured how often clinicians delivering a specific naturalistic developmental behavioral intervention, Project ImPACT, adapted how they delivered the program to address disruptive behavior, and how these adaptations related to children's social communication outcomes at the end of their participation in the intervention. We also spoke with clinicians about how they address disruptive behavior and emotion regulation during their sessions. In this study, clinicians adapted Project ImPACT to address disruptive behaviors in about one-third of all sessions. These adaptations did not affect children's social communication outcomes. Clinicians discussed how they felt social communication, disruptive behavior, and emotion regulation are linked to one another and that they often try to integrate intervention strategies to address each of these areas. However, they note that a clinicians' approach to addressing disruptive behavior might vary depending on their level of training and experience. These results indicate several future directions for supporting clinicians in addressing behavior and regulation effectively within these types of interventions. [ABSTRACT FROM AUTHOR]

Research within the autism spectrum disorder field has called for the use of service delivery models that are able to more efficiently disseminate evidence-based practices into community settings. This study employed telehealth methods in order to deliver an Internet-based, parent training intervention for autism spectrum disorder, ImPACT Online. This study used mixed-methods analysis to create a more thorough understanding of parent experiences likely to influence the adoption and implementation of the program in community settings. Specific research questions included (1) What are parents' perceptions of the online program? (2) How does ImPACT Online compare to other services that parents are accessing for their children? And (3) Do parents' experience in, and perceptions of, the program differ based on whether they received a therapist-assisted version of the program? Results from 28 parents of a child with autism spectrum disorder indicate that parents saw improvements in their child's social communication skills and their own competence during the course of the program, regardless of whether they received therapist assistance. However, qualitative interviews indicate that parents who received therapist assistance were more likely endorse the acceptability and observability of the program. These findings support the potential for Internet-based service delivery to more efficiently disseminate evidence-based parent training interventions for autism spectrum disorder.

Research within the autism spectrum disorder field has emphasized the role of socioeconomic status in shaping parents' ability to access services for their child with autism spectrum disorder. However, research has yet to explore the possible mechanisms underlying this relationship. This study sought to address this research gap by examining the following questions: (1) Does parents' service knowledge mediate the relationship between parent socioeconomic status and parents' autism spectrum disorder service use? (2) What are parents' reported service needs and service barriers, and do these needs vary across higher and lower socioeconomic status groups? Quantitative results from 244 parents of a child with autism spectrum disorder indicate that parents' autism spectrum disorder service knowledge partially mediates the relationship between parent socioeconomic status and parents' autism spectrum disorder service use. Qualitative findings helped to clarify this relationship by suggesting that both high and low socioeconomic status parents are aware of their child's basic autism spectrum disorder needs. However, low socioeconomic status parents more often report needing more information about services and more in-home services and emphasize that a number of structural barriers impede their ability to meet their child's autism spectrum disorder needs. On the other hand, high socioeconomic status parents more often report a need for "higher quality services," possibly reflecting their better recognition of best practice guidelines. These results highlight the need for a multi-pronged approach to tackling unmet service needs within the autism spectrum disorder field.

Autistic youth frequently experience interfering anxiety, and schools may be an ideal setting to deliver mental health care. A type 1 hybrid-effectiveness, cluster randomized trial was used to examine the effectiveness of school-based Facing Your Fears compared to usual care. Change in provider cognitive behavior therapy knowledge and treatment fidelity (adherence and provider competence) were also examined. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained via a train-the-trainer approach. Eighty-one students, ages 8–14 years, with autism or suspected autism and anxiety participated. Students who received school-based Facing Your Fears displayed significantly greater reductions in anxiety compared to students in usual care according to caregiver and child report (Screen for Anxiety and Related Emotional Disorders). Significant reductions in total anxiety (p = 0.012), separation (p = 0.002), and social anxiety (p = 0.003) subscales occurred, according to parent report. Student self-report indicated significant reductions on the social anxiety subscales (p = 0.001). Interdisciplinary school providers demonstrated significantly increased cognitive behavior therapy knowledge following training (p < 0.001). Mean adherence and competence ratings were strong. The positive effectiveness and implementation outcomes are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears has the potential to increase access to care for anxious autistic students. Future directions and limitations are discussed. Autistic youth frequently experience anxiety that can negatively affect them at home, with friends, and at school. Autistic youth have difficulty accessing mental health care, and this is particularly true for youth from traditionally underserved backgrounds. Providing mental health programs in schools may increase access to care for autistic youth with anxiety. The purpose of the study was to train interdisciplinary school providers to deliver school-based Facing Your Fears, a cognitive behavior therapy program for anxiety in autistic youth. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained by their colleagues and members of the research (train-the-trainer approach). Eighty-one students with autism or suspected autism, ages 8–14 years, were randomly assigned to either school-based Facing Your Fears or usual care. Students in school-based Facing Your Fears showed significant reductions in anxiety compared to students in usual care according to caregiver and student report. Other measures involved examining change in provider cognitive behavior therapy knowledge after training and determining how well interdisciplinary school providers were able to deliver school-based Facing Your Fears. Results indicated that interdisciplinary school providers showed significant improvements in cognitive behavior therapy knowledge after training. Interdisciplinary school providers were able to deliver most of school-based Facing Your Fears activities and with good quality. The positive outcomes in this study are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears may increase access to care for anxious autistic students. Future directions and limitations are discussed. [ABSTRACT FROM AUTHOR]

Frequency of high-level (showing/pointing) and low-level (coordinated gaze shifts) behaviors on the Early Social Communication Scales are often used as a measure of joint attention initiations (IJA). This study examined the degree to which these skills and response to joint attention (RJA; e.g. gaze following) were differentially related to measures of language and imitation in 53 children with autism spectrum disorder between the ages of 22 and 93 months. High-level and low-level IJA were not associated with each other, and only high-level IJA was associated with RJA, and language and imitation measures. High-level IJA and RJA were unique predictors of imitation, while RJA was a unique predictor of language. Findings indicate that IJA involves distinct skills, with high-level behaviors more closely related to social-communication skills.