Characterizing mechanisms of caregiver-mediated naturalistic developmental behavioral interventions for autistic toddlers: A randomized clinical trial

Abstract

To address the variability of naturalistic developmental behavioral intervention outcomes, the current study sought to isolate the effects of the instructional strategies of caregiver-mediated naturalistic developmental behavioral interventions. In this comparative efficacy trial, mothers of 111 autistic children (18–48 months) were randomized to learn one of two sets of naturalistic developmental behavioral intervention language facilitation strategies (responsive or directive). We aimed to characterize the effect of strategy type on language outcomes and explore the extent to which joint engagement outcomes mediated language outcomes. Children in the directive condition had significantly greater scores across multiple language assessments. At follow-up, the effect of strategy type on the frequency of spontaneous directed communication acts was fully mediated by coordinated joint engagement (indirect effect = −2.070, 95% CI = [−4.394, −0.06], p < 0.05). Thus, children may benefit from caregiver prompts to facilitate long-term language outcomes. The current study is an initial step in the identification of the mechanisms of caregiver-mediated NDBIs. Lay abstract Caregiver-mediated early interventions support caregivers’ use of strategies to improve their young autistic child’s communication. In the current clinical trial, we sought to isolate the most effective strategies to improve short-term and long-term child communication outcomes. Results demonstrated how children may benefit from caregiver prompts to facilitate long-term language outcomes. In conclusion, the current study improves our understanding of how early intervention facilitates child communication outcomes.

Barriers, Facilitators, and Adaptations to Autism Support Services for Lower Income Aotearoa New Zealand Families

“…Marama's desire for the programme to take '…another step up' may have been met had the support lasted longer and more directive teaching strategies were used. Recent research conducted by M. K. Jones et al (2023) found that directive strategies alone (e.g., providing child communication opportunities followed by prompts) led to significantly greater communication outcomes than responsive strategies only (e.g., following the child's lead and modelling language). Responsive strategies were, however, associated with a greater number and longer length of child supported engagement (i.e., engagement with a mutual focus where the child does not exhibit directed gaze or communication to the adult).…”

“…Responsive strategies were, however, associated with a greater number and longer length of child supported engagement (i.e., engagement with a mutual focus where the child does not exhibit directed gaze or communication to the adult). Although there are some methodological challenges within the study conducted by M. K. Jones et al (2023), for example in the ways in which directive and responsive strategies were divided and defined, it may be that the use of responsive, relationship-based strategies from the ESDM in Study 3 aligned with Marama's goal for increased engagement with Rawiri. However, given it appears as though directive strategies may be useful for increasing communication (M. K. Jones et al, 2023), it is imperative that future research examine ways in which directive strategies may be defined, and the extent to which such strategies align with neurodiversity affirming approaches.…”