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12 pages, 333 KB

Open AccessArticle

Confidence of Pediatric Primary Care Clinicians in Autism Screener Score and Their Own Diagnostic Impressions

by Georgina Perez Liz, Andrea Trubanova Wieckowski, Autumn Austin, Alexia Faith Dickerson, Erika Frick, Ashley Dubin, Ashley de Marchena and Diana L. Robins

Behav. Sci. 2026, 16(2), 289; https://doi.org/10.3390/bs16020289 - 17 Feb 2026

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Abstract

Autism-specific screening and developmental surveillance in primary care aid identification of autism. In this study, we assessed primary care clinicians’ (PCCs’) reported confidence in screening scores from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and in their own diagnostic impressions. Four [...] Read more.

Autism-specific screening and developmental surveillance in primary care aid identification of autism. In this study, we assessed primary care clinicians’ (PCCs’) reported confidence in screening scores from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and in their own diagnostic impressions. Four PCCs provided data for 50 children aged 16–36 months for whom they had any developmental concern. PCCs’ diagnostic impressions were “Definitely Autism” for 15 children (30%), “Unsure—Needs Further Evaluation” for 25 children (50%) and “Definitely Not Autism” for 10 children (20%). They reported High Confidence on the screener score in 33 cases (66%). Of the 17 cases for whom PCCs reported having Low Confidence on the M-CHAT-R, 14 children (82.3%) had a Low Likelihood score, with no significant association between M-CHAT-R likelihood and PCC’s confidence in the screening score. PCCs’ diagnostic impressions were concordant with the M-CHAT-R autism likelihood in 42% of cases, with a significantly higher mean in confidence rating when compared to the non-concordant cases. Language development and social engagement were the most frequently endorsed concerns by PCCs, with significant associations between these concerns and M-CHAT-R likelihood. Our results suggest that, when developmental concerns exist, PCCs may place greater confidence in the M-CHAT-R when scores indicate a higher likelihood of autism, and that confidence in their own diagnostic impressions may be associated with concordance with the screener score. Full article

(This article belongs to the Special Issue Early Identification and Intervention of Autism)

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21 pages, 702 KB

Open AccessArticle

Family Outcomes of a Community-Based Trial of Project ImPACT

by Sarah R. Rieth, Marissa Chemotti, Carmen Orendain Soto, Sarah F. Vejnoska, Scott Roesch, Amber Fitzgerald, Sarah Dufek and Aubyn C. Stahmer

Behav. Sci. 2026, 16(1), 64; https://doi.org/10.3390/bs16010064 - 31 Dec 2025

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Abstract

Caregiver-mediated approaches in early intervention can provide impactful support for families of young children with social communication needs. Project ImPACT (PI), a caregiver-mediated naturalistic developmental behavioral intervention, was tested for effectiveness in public early intervention (EI) programs in a randomized waitlist-control community trial [...] Read more.

Caregiver-mediated approaches in early intervention can provide impactful support for families of young children with social communication needs. Project ImPACT (PI), a caregiver-mediated naturalistic developmental behavioral intervention, was tested for effectiveness in public early intervention (EI) programs in a randomized waitlist-control community trial across California. Participants included EI service providers (n = 47) and caregiver–child dyads (n = 125; ages 14–32 months). Families received services-as-usual (SAU) or PI following provider training in PI. Multilevel models were used to examine provider coaching, caregiver–child interactions, caregiver PI strategy use, parenting stress, self-efficacy in parenting, and child social communication outcomes across approximately four months of services. Provider use of evidence-based coaching significantly improved after PI training. Caregivers who received PI showed greater gains in some domains of parent–child interaction; PI fidelity scores, stress, and self-efficacy did not differ by condition. Child communication outcomes improved over time in both groups, but differences between conditions were not detected during the study time period. Training community EI providers in PI improved coaching quality and enhanced caregiver–child interaction, demonstrating feasible, scalable use of PI in community settings. Differential child-level effects were not detected, underscoring the need for larger samples and longitudinal follow-up. Full article

(This article belongs to the Special Issue Early Identification and Intervention of Autism)

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16 pages, 481 KB

Open AccessArticle

Patterns of Caregiver Communicative Behaviors Among Low-Income Chinese Immigrant Mothers of Children with Autism—An Exploratory Study

by Yue Xu, Xian Kapetanakos, Madeleine Meehan, Jocelyn Tam and Sandra Beatriz Vanegas

Behav. Sci. 2025, 15(12), 1693; https://doi.org/10.3390/bs15121693 - 6 Dec 2025

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Abstract

Caregiver communicative behaviors are critical in supporting social and language development in children with autism, yet little is known about how these behaviors manifest among Chinese immigrant families who face unique cultural and socioeconomic challenges. This study examined the communicative strategies of 11 [...] Read more.

Caregiver communicative behaviors are critical in supporting social and language development in children with autism, yet little is known about how these behaviors manifest among Chinese immigrant families who face unique cultural and socioeconomic challenges. This study examined the communicative strategies of 11 Chinese immigrant caregivers of preschool-aged children with autism in the US during structured caregiver–child interactions. Caregiver behaviors were coded across directive and non-directive categories, including supportive directives, directives, labeling, praise, imitation, and expansion, and joint engagement quality was rated using the Joint Engagement Rating Inventory (JERI). Results showed that supportive directives and directives were the most frequent behaviors, reflecting cultural values of parental guidance and educational scaffolding, whereas non-directive strategies such as imitation and expansion were less common and more often observed among higher-income and more acculturated families. Caregiver self-efficacy in using evidence-based strategies was positively associated with greater use of non-directive communicative strategies and higher joint engagement scores. Results suggest that providers should recognize and build on culturally grounded strengths, such as the educator role and calm authority, while introducing complementary strategies that enhance joint engagement. Culturally and linguistically responsive support is especially needed to ensure equitable access for families with limited English proficiency or lower income. Although limited by a small sample size, this exploratory study provides preliminary insight into culturally influenced caregiver–child communication patterns and offers directions for larger, more rigorous research. Full article

(This article belongs to the Special Issue Early Identification and Intervention of Autism)

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18 pages, 421 KB

Open AccessArticle

One Size Doesn’t Fit All: Variability in Autistic Children’s Response to Pivotal Response Treatment

by Rachel K. Schuck, Ella Jevtić, Emily F. Ferguson, Maria Estefania Millan, Devon M. Slap, Mirko Uljarević, Jennifer M. Phillips, Antonio Y. Hardan and Grace W. Gengoux

Behav. Sci. 2025, 15(12), 1629; https://doi.org/10.3390/bs15121629 - 27 Nov 2025

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Abstract

Pivotal Response Treatment (PRT) is a naturalistic developmental behavioral intervention designed to strengthen autistic children’s social communication skills. Few studies have examined which children benefit the most from PRT and which characteristics are associated with meaningful progress. We analyzed data from 23 children [...] Read more.

Pivotal Response Treatment (PRT) is a naturalistic developmental behavioral intervention designed to strengthen autistic children’s social communication skills. Few studies have examined which children benefit the most from PRT and which characteristics are associated with meaningful progress. We analyzed data from 23 children with autism and significant language delay who had been randomized to receive PRT in a previously completed 24-week randomized controlled trial of parent training and clinician-delivered intervention. Participants were categorized as intervention responders and non-responders based on the demonstration of meaningful improvement (or lack thereof) in social communication using the MacArthur-Bates Communicative Development Inventories (MCDI) Reliable Change index scores and clinician determination based on review of language samples and the Clinical Global Impressions—Improvement Scale (CGI). Baseline child characteristics associated with being a responder were assessed. Sixteen participants were responders on the language sample, ten on the MCDI, and sixteen on the CGI. Nine were consistent responders across all three measures; six were consistent non-responders. Verbal ability at baseline was associated with being a responder across all measures. In our small sample, baseline verbal ability was associated with being a responder to PRT, though categorization as a responder differed somewhat based on outcome measure. Future research should explore responder profiles specifically in children who are nonspeaking to inform the development of more effective supports for this group. Full article

(This article belongs to the Special Issue Early Identification and Intervention of Autism)

16 pages, 1480 KB

Open AccessArticle

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

Viewed by 3136

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 (S_diff = 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

Open AccessArticle

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

Cited by 1 | Viewed by 1066

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

Open AccessArticle

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

Cited by 2 | Viewed by 907

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

Open AccessArticle

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 2 | Viewed by 1504

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

Open AccessArticle

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

Cited by 2 | Viewed by 3812

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

Open AccessArticle

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 1561

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

Open AccessArticle

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 4623

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

Open AccessArticle

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 1969

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

Open AccessArticle

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 2 | Viewed by 2075

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

Open AccessArticle

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 2147

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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12 pages, 397 KB

Open AccessCommentary

Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers

by Andrea Trubanova Wieckowski, Georgina Perez Liz, Elizabeth McGhee Hassrick, Emmanuel Koku, Erika Frick, Autumn Austin and Diana L. Robins

Behav. Sci. 2026, 16(1), 79; https://doi.org/10.3390/bs16010079 - 6 Jan 2026

Viewed by 765

Abstract

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and [...] Read more.

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and supports. Prior findings indicate that new solutions must be developed to bridge the gap in access to autism screening for families, particularly among those who are under-resourced. One approach is expanding screening to other community settings, such as childcare centers, but there are barriers to this approach, which this commentary aims to address. We discuss challenges and barriers in childcare screening identified through our recently completed pilot study screening for autism in childcare centers, with suggested strategies to address them. These challenges include hesitation among childcare staff to guide conversations or concerns about autism, and stigma around autism diagnosis and presentation. Other challenges relate to emerging concerns regarding legal, ethical, and professional roles and responsibilities surrounding informed consent and data privacy, as well as the identification of children without timely follow-up evaluation and services. There is a need for increasing public awareness as an essential component of autism screening across settings. Our commentary discusses different considerations and practice strategies to meet these needs. Full article

(This article belongs to the Special Issue Early Identification and Intervention of Autism)

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10 pages, 214 KB

Open AccessOpinion

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 1357

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

Open AccessOpinion

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

Cited by 1 | Viewed by 1161

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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