Early Identification and Intervention of Autism

A special issue of Behavioral Sciences (ISSN 2076-328X). This special issue belongs to the section "Child and Adolescent Psychiatry".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 10512

Special Issue Editors


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Guest Editor
Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
Interests: early intervention for autism; caregiver-mediated interventions; naturalistic developmental behavioral intervention; implementation science; community-partnered research

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Guest Editor
Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30329, USA
Interests: early intervention for autism; caregiver-mediated interventions; naturalistic developmental behavioral intervention; implementation science; community-partnered research

Special Issue Information

Dear Colleagues,

Early intervention is critical for improving long-term outcomes for young children on the autism spectrum. Intervention for autism initiated at earlier ages improves children’s long-term cognition, communication, behavior, and development. Additionally, including caregivers in early intervention delivery bolsters child and family gains. Given the strong empirical support for early intervention in autism, a growing number of research studies have been focused on strategies to improve the implementation of early autism interventions in community settings, especially those serving children from marginalized backgrounds. Therefore, this current Special Issue of Behavioral Sciences welcomes original research, systematic reviews, conceptual and theoretical research, applied effectiveness research, and implementation research focused on early intervention for autism when delivered in community settings. Areas of interest include (but are not limited to) advancements in early intervention for autism, caregiver-mediated interventions for autism, naturalistic developmental behavioral interventions, the implementation of early autism intervention in community settings, community-partnered research for early autism intervention, research evaluating social validity, and research that focuses on autistic children under five years of age. Within these premises, this Special Issue aims to advance the literature concerning the extent to which autism early interventions can be effectively delivered within community settings and their effectiveness in supporting the outcomes of autistic children and their families. We welcome theoretical and/or empirical contributions that broaden knowledge on this topic.  

Dr. Melanie Pellecchia
Dr. Katherine E. Pickard
Guest Editors

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Keywords

  • autism
  • early intervention
  • toddlers and preschool-aged children
  • implementation
  • caregiver-mediated intervention
  • naturalistic developmental behavioral intervention
  • community-partnered research

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Published Papers (12 papers)

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Research

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16 pages, 1480 KB  
Article
Cognitive Development in Children with Autism Spectrum Disorder and the Moderating Role of Intervention and ASD Persistence
by Maya J. Golden, Lianna R. Lipton, Georgios Sideridis, Stephanie J. Brewster, William Barbaresi and Elizabeth Harstad
Behav. Sci. 2025, 15(11), 1445; https://doi.org/10.3390/bs15111445 - 23 Oct 2025
Abstract
This study examined whether Bayley Scales of Infant and Toddler Development-III (Bayley-III) standardized cognitive scores from toddlers diagnosed with autism spectrum disorder (ASD) predict intellectual quotient (IQ) at early school age and whether ASD persistence or interventions received moderate this relationship. Children diagnosed [...] Read more.
This study examined whether Bayley Scales of Infant and Toddler Development-III (Bayley-III) standardized cognitive scores from toddlers diagnosed with autism spectrum disorder (ASD) predict intellectual quotient (IQ) at early school age and whether ASD persistence or interventions received moderate this relationship. Children diagnosed clinically with ASD at 12–36 months underwent research assessments at 5–7 years. Of 212 children diagnosed as toddlers, 133 continued to meet DSM-5 ASD criteria based on current functioning at school age (“persistent ASD”), and 79 did not (“non-persistent ASD”). A moderate positive correlation was found between baseline cognitive scores in toddlerhood and school age IQ (r (210) = 0.45, p < 0.001). Children with baseline cognitive scores < 70 showed greater variation in school age IQ compared to those with baseline scores > 85. Non-persistent ASD status was associated with a higher rate of cognitive change from toddler to school age (Sdiff = 15.044; z = 4.432, p < 0.001). Overall, 94.3% of the sample received ASD-specific interventions. There was no relation between hours of ASD-specific interventions and change in cognitive trajectories for children with non-persistent ASD and an inverse relationship for children with persistent ASD. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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29 pages, 3413 KB  
Article
Multimodal Communication Outcomes for Hispanic Autistic Preschoolers Following Coached Student Clinician and Caregiver-Led NDBIs
by Cindy Gevarter, Jaime Branaman, Jessica Nico, Erin Gallegos and Richelle McGuire
Behav. Sci. 2025, 15(10), 1425; https://doi.org/10.3390/bs15101425 - 20 Oct 2025
Viewed by 144
Abstract
This study examined child outcomes for five minimally verbal (or non-speaking) autistic preschoolers who participated in cascading coaching programs in which naturalistic developmental behavioral intervention (NDBI) techniques were taught to graduate student clinicians and Hispanic caregivers (three who primarily spoke English, and two [...] Read more.
This study examined child outcomes for five minimally verbal (or non-speaking) autistic preschoolers who participated in cascading coaching programs in which naturalistic developmental behavioral intervention (NDBI) techniques were taught to graduate student clinicians and Hispanic caregivers (three who primarily spoke English, and two who spoke Spanish). While prior studies reported on adult participant outcomes, this study analyzed child multimodal communication outcomes, using multiple baselines/probes single case experimental designs across contexts. Neurodiversity-affirming and culturally responsive principles were embedded within the intervention procedures. Following the introduction of a coached NDBI, all five children (three who received the intervention in English and two who received the intervention in Spanish) demonstrated increased use of (a) the total targeted communicative responses and (b) the targeted unprompted communicative responses, across both student clinician-led and caregiver-led play sessions. The Tau-U effect size measures revealed large-to-very large effects across all of the variables. Overall, higher rates of communication responses were observed during student clinician-led sessions than in caregiver-led sessions. Additionally, behavioral coding of the multimodal response forms (e.g., gestures, aided augmentative and alternative communication, signs, vocal words) using the Communication Matrix revealed that the children used a variety of response topographies during the intervention sessions beyond their preferred communication mode (e.g., signs for three participants). Four of the five children used symbolic communication forms consistently across both caregiver and student clinician-led sessions. Importantly, adults’ reinforcement of pre-symbolic or less advanced communication forms during the intervention did not inhibit the use of more advanced forms. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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16 pages, 312 KB  
Article
Characterizing the Relationship Between Intervention Delivery and Outcomes Within Part C Community Settings
by Katherine Pickard, Scott Gillespie, Aubyn Stahmer, Jennifer Singh and Lawrence Scahill
Behav. Sci. 2025, 15(10), 1394; https://doi.org/10.3390/bs15101394 - 15 Oct 2025
Viewed by 238
Abstract
Routine Early Intervention services are an ideal context to evaluate parent-mediated intervention (PMI) delivery. While effectiveness research suggests that receiving manualized PMIs positively affects caregivers’ learning and use of intervention strategies, the impact of other aspects of delivery, such as PMI adaptation, on [...] Read more.
Routine Early Intervention services are an ideal context to evaluate parent-mediated intervention (PMI) delivery. While effectiveness research suggests that receiving manualized PMIs positively affects caregivers’ learning and use of intervention strategies, the impact of other aspects of delivery, such as PMI adaptation, on caregiver engagement and learning is less clear. The current study aimed to address this gap by closely characterizing the delivery and associated outcomes of an autism PMI, Project ImPACT, within an Early Intervention (EI) Part C system. In total, 21 EI providers and 23 caregivers of children with social communication delays participated. Following training in Project ImPACT, the providers submitted videos of their Project ImPACT sessions as part of routine service delivery. The sessions were behaviorally coded for Project ImPACT coaching fidelity and instances in which Project ImPACT was adapted. After each session, the caregivers rated their participatory engagement and therapeutic alliance. Before and immediately following the intervention, the caregivers also completed measures of their self-efficacy and their child’s social communication skills, and their use of Project ImPACT strategies (i.e., fidelity) was behaviorally coded. The results demonstrated that EI providers’ Project ImPACT coaching fidelity was not related to caregiver ratings of therapeutic alliance or participatory engagement at the session level. Augmenting Project ImPACT sessions was associated with higher caregiver ratings of therapeutic alliance but not with participatory engagement. Although provider coaching fidelity was not associated with changes in caregiver ratings of self-efficacy, it was associated with caregiver use of Project ImPACT strategies focused on teaching their children new skills. There was no association between provider fidelity and caregiver report of child social communication outcomes. The current study highlights the complicated relationship between the delivery of autism PMIs and caregiver-reported outcomes. The findings highlight the value of holistic delivery models that support adaptations in response to child- and family-level factors. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
27 pages, 2429 KB  
Article
Coaching Bilingual Speech-Language Student Clinicians and Spanish-Speaking Caregivers to Use Culturally Adapted NDBI Techniques with Autistic Preschoolers
by Richelle McGuire, Jessica Nico, Naomi Nattress, Carlos Irizarry-Pérez and Cindy Gevarter
Behav. Sci. 2025, 15(9), 1292; https://doi.org/10.3390/bs15091292 - 22 Sep 2025
Cited by 1 | Viewed by 394
Abstract
A cascading coaching model was used to teach bilingual speech-language pathology (SLP) graduate student clinicians and Spanish-speaking caregivers to implement naturalistic developmental behavioral intervention (NDBI) techniques with autistic preschoolers. Two triads (each consisting of a graduate student clinician, a minimally vocal child diagnosed [...] Read more.
A cascading coaching model was used to teach bilingual speech-language pathology (SLP) graduate student clinicians and Spanish-speaking caregivers to implement naturalistic developmental behavioral intervention (NDBI) techniques with autistic preschoolers. Two triads (each consisting of a graduate student clinician, a minimally vocal child diagnosed with autism, and a caregiver) participated in the study. Following the cascading approach, a lead instructor (with limited Spanish conversational skills) coached bilingual student clinicians (in English) to apply culturally adapted NDBI with child participants. Following additional instruction in coaching, student clinicians coached caregivers in Spanish. Effects were evaluated using a multiple methods approach consisting of multiple probes across participants single case experimental design and a qualitative analysis of semi-structured interviews with adult participants. All adult participants increased their use of targeted NDBI skills including elicitation techniques (creating communication temptations, using wait time, and prompting) and response techniques (reinforcing children’s communication with natural consequences and providing a contextually relevant vocal model), demonstrating large to very large effect sizes. Although qualitative findings indicated areas for improvement (e.g., additional Spanish supports for clinicians), thematic analysis revealed additional benefits in terms of positive changes across adult learning, behavior, and perspectives; child communication; and child-caregiver relationships. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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18 pages, 695 KB  
Article
Telehealth Pilot Study of the Effects of a Naturalistic Developmental Behavioral Intervention on Child Social Communication Outcomes in a Community Mental Health System
by Jessie Greatorex, Diondra Straiton-Webster and Brooke Ingersoll
Behav. Sci. 2025, 15(9), 1171; https://doi.org/10.3390/bs15091171 - 28 Aug 2025
Viewed by 1190
Abstract
Little is known about the effectiveness of caregiver-mediated naturalistic developmental behavioral interventions (NDBIs) implemented via telehealth for autistic children served in under-resourced settings. This mixed methods pilot study examined social communication outcomes for autistic children whose families received a caregiver-mediated NDBI in a [...] Read more.
Little is known about the effectiveness of caregiver-mediated naturalistic developmental behavioral interventions (NDBIs) implemented via telehealth for autistic children served in under-resourced settings. This mixed methods pilot study examined social communication outcomes for autistic children whose families received a caregiver-mediated NDBI in a community mental health setting. Twenty-one families of Medicaid-enrolled autistic children aged 2–6 received Project ImPACT (a caregiver-mediated NDBI) via telehealth. Caregivers completed the Autism Impact Measure at 5 timepoints. We fit three, 2-level multilevel models to estimate the effect of time (weeks of Project ImPACT), child age (mean-centered), and the interaction of time x age on the Autism Impact Measure domains of Communication, Social Reciprocity, and Peer Interaction. Six caregivers completed follow-up interviews, which were analyzed using the framework method. There were statistically significant decreases in caregiver-reported peer interaction challenges. Decreases in communication challenges approached statistical significance. Scores for social reciprocity challenges did not significantly change over time. Six qualitative themes centered around how the child- and family-centered aspects of the NDBI strategies led to improvements in the children’s social communication outcomes and suggestions for improving Project ImPACT. Preliminary findings suggest that NDBIs may be feasible and potentially effective in under-resourced settings. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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19 pages, 340 KB  
Article
A Pilot Evaluation of the PEACE Implementation Toolkit to Improve the Use of Caregiver Coaching in Early Intervention
by Melanie Pellecchia, Rinad S. Beidas, Liza Tomczuk, David S. Mandell and Aubyn C. Stahmer
Behav. Sci. 2025, 15(9), 1164; https://doi.org/10.3390/bs15091164 - 26 Aug 2025
Viewed by 855
Abstract
Caregiver coaching is an essential component of caregiver-mediated interventions for young autistic children. Previous research evaluating usual practice in early intervention (EI) has found that EI providers often do not use caregiver coaching. Increasing the use of caregiver coaching strategies is critical to [...] Read more.
Caregiver coaching is an essential component of caregiver-mediated interventions for young autistic children. Previous research evaluating usual practice in early intervention (EI) has found that EI providers often do not use caregiver coaching. Increasing the use of caregiver coaching strategies is critical to improving the outcomes of EI. We used a community-partnered process to develop a toolkit of implementation strategies to improve the use of caregiver coaching in EI. This study presents findings from a preliminary evaluation of the toolkit using a non-concurrent multiple-baseline design across groups of providers and caregiver–child dyads. The results indicate that providers’ caregiver coaching fidelity improved following the introduction of the toolkit. Caregivers demonstrated moderate growth in their use of supportive parenting techniques. All providers rated the toolkit as acceptable, appropriate, and feasible. The findings suggest that a toolkit of implementation strategies tailored to support the needs of community-based providers shows promise for improving caregiver coaching in EI. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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17 pages, 1237 KB  
Article
Addressing Emotional Dysregulation Within NDBI for Young Autistic Children: Outcomes and Factors Related to Change
by Elizabeth H. Kushner, Chloe B. Holbrook, Nicole M. Hendrix, Josie Dylan Douglas-Brown and Katherine E. Pickard
Behav. Sci. 2025, 15(7), 975; https://doi.org/10.3390/bs15070975 - 17 Jul 2025
Cited by 1 | Viewed by 1745
Abstract
Despite high rates of emotional dysregulation among autistic children, few studies have explored interventions addressing dysregulation. Naturalistic developmental behavioral interventions (NDBIs) are a class of interventions focused on supporting social communication. As social communication and emotion regulation skills emerge from similar developmental processes, [...] Read more.
Despite high rates of emotional dysregulation among autistic children, few studies have explored interventions addressing dysregulation. Naturalistic developmental behavioral interventions (NDBIs) are a class of interventions focused on supporting social communication. As social communication and emotion regulation skills emerge from similar developmental processes, NDBIs may be one approach for addressing dysregulation among autistic children. The present study sought to characterize change in dysregulation among one-hundred and eleven caregiver–child dyads completing Project ImPACT, a caregiver-mediated NDBI. Caregivers reported on child communication and social engagement using the Social Communication Checklist and emotion regulation using the Emotional Dysregulation Inventory-Young Child at the beginning and end of services. Clinicians reported on caregiver fidelity at each intervention session. Children showed reductions in emotional dysregulation throughout Project ImPACT, though reductions were specific to children who began the program with elevated dysregulation. Child social engagement at baseline and caregivers’ fidelity to specific strategies within Project ImPACT were associated with reductions in emotional dysregulation. Very few studies have tested interventions aimed at supporting emotion regulation among young autistic children. These findings demonstrate that NDBIs may support emotion regulation as well as social communication skills. Further incorporating support for emotion regulation in NDBI may address this critical gap without increasing service coordination for families. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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20 pages, 297 KB  
Article
Item Analysis of an Early Social Responsiveness Scale for Assessing Autism Risk
by Chloe Boynton, Opal Ousley and Reina S. Factor
Behav. Sci. 2025, 15(5), 615; https://doi.org/10.3390/bs15050615 - 1 May 2025
Viewed by 1171
Abstract
Early diagnosis of autism spectrum disorder (ASD) is vital for effective intervention and improves social and behavioral development. The previous literature has shown that the Early Social Responsiveness (ESR) assessment is effective at detecting ASD risk in individuals as early as 13 months [...] Read more.
Early diagnosis of autism spectrum disorder (ASD) is vital for effective intervention and improves social and behavioral development. The previous literature has shown that the Early Social Responsiveness (ESR) assessment is effective at detecting ASD risk in individuals as early as 13 months of age (“parent study”). However, an item analysis that examines individual item scores has not been conducted to further elucidate the strength of this assessment. In this study, we analyzed an existing dataset (collected in the parent study) containing individual item responses from the ESR assessment of 120 children (n = 61 males and n = 59 females; age range = 15–24 months). Through item analysis, we determined which ESR items or item sets are best at differentiating ASD risk from non-ASD risk. Ease of social engagement (i.e., questions assessing the administrator’s perceived level of effort in engaging the child) was the most effective risk indicator, with the hat and tickle activities being least effective at indicating ASD risk. These results could contribute to optimizing the scale and facilitating its clinical adoption. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
21 pages, 746 KB  
Article
Exploring the Social Validity and Diffusion Potential of Common Naturalistic Developmental Behavioral Intervention Strategies Implemented in Community Preschools
by Sophia R. D’Agostino, Trenton J. Landon, Alyssa Roylance, Avery Briggs and Naima Bhana-Lopez
Behav. Sci. 2025, 15(3), 357; https://doi.org/10.3390/bs15030357 - 13 Mar 2025
Cited by 1 | Viewed by 1051
Abstract
It is imperative that researchers include the perspectives from key voices regarding early support practices, yet very few studies have included direct assessment of autistic individuals and parents of young autistic children. Despite emerging evidence of effectiveness of naturalistic developmental behavioral intervention (NDBI) [...] Read more.
It is imperative that researchers include the perspectives from key voices regarding early support practices, yet very few studies have included direct assessment of autistic individuals and parents of young autistic children. Despite emerging evidence of effectiveness of naturalistic developmental behavioral intervention (NDBI) strategies, it is currently unknown whether autistic adults and parents of autistic individuals know about NDBI and if they view NDBI strategies as socially valid practice. We aimed to explore the perceptions of autistic adults and parents of young autistic children regarding the social validity of NDBI strategies implemented in community preschool classrooms and their dissemination potential. We conducted a convergent mixed methods research design to collect quantitative survey data and qualitative semi-structured interview data. We received survey responses from 33 autistic adults and 37 parents of young autistic children and interviewed 12 autistic adults and 12 parents of young autistic children. We conducted a series of paired samples and independent samples t-tests to compare perceptions between groups and thematic analysis to analyze qualitative data. Results indicated high levels of social validity for NDBI across both groups of participants and the need for dissemination of NDBI. Agreement between autistic adults and parents of young autistic children on the social validity of NDBI and recommendations for dissemination are promising preliminary findings that NDBI researchers and practitioners may draw upon when engaging in collaborative support planning and participatory research efforts. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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16 pages, 258 KB  
Article
Characterizing Federally Mandated Early Intervention for Children with Social Communication Delays: A Mixed-Methods Analysis
by Yael G. Dai, Kyle M. Frost, Ellie M. Harrington, Yael Stern, Emily R. Britsch, Brooke R. Ingersoll, Allison Wainer, Wendy L. Stone, Sarabeth Broder-Fingert and Alice S. Carter
Behav. Sci. 2025, 15(3), 293; https://doi.org/10.3390/bs15030293 - 2 Mar 2025
Cited by 1 | Viewed by 1456
Abstract
The most common way for children with social communication delays to receive intervention before age three in the United States is through Part C early intervention (EI). Part C was designed to take a multidisciplinary approach to address a range of developmental domains. [...] Read more.
The most common way for children with social communication delays to receive intervention before age three in the United States is through Part C early intervention (EI). Part C was designed to take a multidisciplinary approach to address a range of developmental domains. The type of intervention delivered in Part C EI has rarely been examined through direct observation. Our team conducted a mixed-methods analysis to characterize EI sessions by 33 providers across four states. Specifically, we describe the quantity and quality of caregiver coaching based on provider report and researcher coding of EI session content. Eligible providers conducted weekly EI sessions with at least one child with social communication delays. Providers self-reported greater use of caregiver coaching relative to the video coding conducted by researchers. While there were similarities in session topics, presumed goals, and intervention strategies used across providers, differences were observed in session duration, session location, and caregiver engagement in session. This study begins to fill a substantial gap by illuminating the types of interventions children with social communication delays receive in federally mandated Part C. It also highlights the need for more specialized training and standardization in EI practices to ensure that children with social communication delays and their caregivers benefit from the most efficacious interventions during a critical time of increased brain plasticity. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)

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10 pages, 214 KB  
Opinion
Value-Based Care and Accountable Care Organizations: Implications for Early Autism Diagnosis and Access to Quality Care
by Kyle M. Frost, Heather E. Hsu, Marisa Petruccelli, Rebecca McNally Keehn, Hanna Rue, Angela Beeler and Sarabeth Broder-Fingert
Behav. Sci. 2025, 15(10), 1354; https://doi.org/10.3390/bs15101354 - 4 Oct 2025
Viewed by 257
Abstract
The incentives in fee-for-service healthcare payment systems to increase clinical volume often work in opposition to efforts to coordinate care or improve care delivery in partnership with community-based services. There has been increasing interest in and adoption of value-based care as an alternative [...] Read more.
The incentives in fee-for-service healthcare payment systems to increase clinical volume often work in opposition to efforts to coordinate care or improve care delivery in partnership with community-based services. There has been increasing interest in and adoption of value-based care as an alternative healthcare delivery model in which clinician reimbursement is based on measures of healthcare quality and patient outcomes, meant to shift the focus from generating volume toward providing more efficient, coordinated care. In this commentary, we discuss potential benefits, challenges, and unintended consequences of this fundamental shift in payment systems and the specific implications for autism services, highlighting critical areas of focus for future research and policy development. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
8 pages, 433 KB  
Opinion
Caregiver Self-Regulation as a Key Factor in the Implementation Potential of Caregiver-Mediated Interventions
by Sarah R. Edmunds, Maya Renaud, Nada M. Goodrum, Jessica Bradshaw, Daniel K. Cooper and Brooke Ingersoll
Behav. Sci. 2025, 15(10), 1336; https://doi.org/10.3390/bs15101336 - 29 Sep 2025
Viewed by 377
Abstract
Caregiver self-regulation may be a critical component of caregivers’ effective delivery of caregiver-mediated interventions (CMIs). CMIs are a highly evidence-based group of interventions that target a broad range of challenges, including social communication, emotion regulation, and externalizing behaviors, for autistic and neurotypical children. [...] Read more.
Caregiver self-regulation may be a critical component of caregivers’ effective delivery of caregiver-mediated interventions (CMIs). CMIs are a highly evidence-based group of interventions that target a broad range of challenges, including social communication, emotion regulation, and externalizing behaviors, for autistic and neurotypical children. CMIs teach caregivers to be “coaches” to help their children learn and practice skills in daily life. However, being a good “coach” likely requires caregivers to optimally self-regulate their emotions, thoughts, and behaviors when working with their children in moments that are often emotionally heightened. Caregiver self-regulation is a set of skills that promote parenting autonomy and confidence: self-sufficiency, self-efficacy, self-management, personal agency, and problem solving. This conceptual paper will briefly discuss the literature on the role of caregiver self-regulation in CMIs and argue that future implementation research on CMIs should measure caregiver self-regulation because, in line with recent expansion of the theory of planned behavior, caregiver self-regulation may predict more effective implementation of CMIs. We also argue, in line with CFIR 2.0, that supporting caregiver self-regulation could ultimately improve the implementation of CMIs with regard to each implementation outcome in the Implementation Outcomes Framework. For example, enhancing caregiver self-regulation may improve CMI appropriateness (by increasing alignment with each caregiver’s values and culture), adoption (by increasing engagement to finish the full CMI protocol), and even CMI sustainability (by increasing caregivers’ ability to problem-solve and generalize to new child challenges independently, freeing up provider time to work with new caregivers and allowing the agency to provide the CMI for a reduced relative cost). Should future research demonstrate that caregiver self-regulation is an implementation determinant, future implementation strategies may need to include support for caregiver self-regulation, because it may explain or enhance the implementation of CMIs across early intervention and community mental health systems. Full article
(This article belongs to the Special Issue Early Identification and Intervention of Autism)
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