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

Background and Aims: Children with autism spectrum disorder (ASD) exhibit a heterogeneous clinical phenotype with wide variability in their language and intellectual profiles that complicates efforts at early detection. There is limited research examining observational measures to characterize differences between young children with and without ASD and co-occurring language delay (LD) and global developmental delay (GDD). The first aim of this study was to compare early social communication measured in the second year of life in children diagnosed at age 3 with ASD, developmental delays (DD), and typical development (TD). The second aim was to compare early social communication in six subgroups of children: ASD, ASDþLD, ASDþGDD, LD, GDD, and TD. Our third aim was to determine the collective and unique contributions of early social communication to predict verbal and nonverbal developmental outcomes at three years of age for children with and without ASD. Methods: Analyses of covariance controlling for maternal education were employed to examine group differences in social communication in 431 toddlers recruited through screening in primary care. Multiple linear regression analyses were conducted to evaluate associations between the Communication and Symbolic Behavior Scales (CSBS) Behavior Sample composite standard scores and Mullen Scales of Early Learning T scores for children with and without ASD. Results: Distinct patterns of early social communication were evident by 20 months. Children with TD differed significantly from children with ASD and DD on all three CSBS Behavior Sample composites. Children with ASD had significantly lower scores than those with DD and TD on the social and symbolic composites. Among the six subgroups, all three composites of the CSBS Behavior Sample differentiated children with TD from all other subgroups. Children with ASDþGDD scored significantly lower than all other subgroups on social and symbolic composites. Patterns of social communication emerged for children with and without ASD, which held among subgroups divided by developmental level. The CSBS Behavior Sample social and symbolic composites contributed unique variance in predicting developmental outcomes in both groups. The speech composite contributed unique variance to expressive language,

Purpose Most toddlers with autism spectrum disorder and other developmental delays receive early intervention at home and may not participate in a clinic-based communication evaluation. However, there is limited research that has prospectively examined communication in very young children with and without autism in a home-based setting. This study used granular observational coding to document the communicative acts performed by toddlers with autism, developmental delay, and typical development in the home environment. Method Children were selected from the archival database of the FIRST WORDS Project ( N = 211). At approximately 20 months of age, each child participated in everyday activities with a caregiver during an hour-long, video-recorded, naturalistic home observation. Inventories of unique gestures, rates per minute, and proportions of types of communicative acts and communicative functions were coded and compared using a one-way analysis of variance. Concurrent and prospective relationships between rate of communication and measures of social communication, language development, and autism symptoms were examined. Results A total of 40,738 communicative acts were coded. Children with autism, developmental delay, and typical development used eight, nine, and 12 unique gestures on average, respectively. Children with autism used deictic gestures, vocalizations, and communicative acts for behavior regulation at significantly lower rates than the other groups. Statistically significant correlations were observed between rate of communication and several outcome measures. Conclusion Observation of social communication in the natural environment may improve early identification of children with autism and communication delays, complement clinic-based assessments, and provide useful information about a child's social communication profile and the family's preferred activities and intervention priorities. Supplemental Material https://doi.org/10.23641/asha.14204522

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There is a critical need for validated screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. Few screeners exist for children between the recommended screening ages of 18–24 months. This study examined the utility of a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children 12–36 months. Field-testing was conducted from five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was evaluated in three age groups: 12–17, 18–23, and 24–36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Receiver operating characteristic curves were examined for all 46 items and the 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Area under the curve estimates for the total were greater than 0.90 across age groups. Cutoffs were established for each age group with sensitivity between 0.86 and 0.92 and specificity between 0.74 and 0.85. Results provide preliminary support for the validity of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12–36 months with elevated risk of communication delay or autism spectrum disorder. Lay abstract There is a critical need for accurate screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. However, there are few screeners designed for children 18–24 months. Developing screeners that pick up on the signs of autism spectrum disorder in very young children has proved even more challenging. In this study, we examined a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children between 12 and 36 months of age. Field-testing was done in five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was tested in three age groups: 12–17, 18–23, and 24–36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Analyses examined all 46 items and identified 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Cutoffs were established for each age group with good sensitivity and specificity. Results provide preliminary support for the accuracy of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12–36 months with elevated risk of communication delay or autism spectrum disorder.