Exportable Communication Intervention for Classroom Staff Serving Children with Autism Spectrum Disorder: Towards Improving the Feasibility of Evidence-Based Practices in Community Settings

Background:

Naturalistic Developmental Behavioral Intervention (NDBI) is an intervention model for young children with autism based on behavioral and developmental principles, naturally occurring contexts and contingencies, and shared control between the interventionist and student. Recent studies have found empirical support for NDBI in controlled research trials. Further, a number of studies have replicated findings in community preschool settings with some degree of success. However, reported roadblocks to community implementation include teacher’s lack of time to add new components to their preschool day, insufficient staffing numbers to work in one-on-one settings with children, and difficulty understanding and applying the less structured techniques that characterize NDBI, (as opposed to more manualized behavioral practices). A further complication for community-based intervention studies is that implementation data for intervention in preschool classes is often under-reported and challenging to collect.

Objectives:

1. Develop an NDBI program that maximizes feasibility, acceptability and implementation fidelity for stakeholders.

To meet this objective, NDBI principles were mapped onto four existing classroom routines (e.g. snack, outdoor/gross motor time, story time and free play) resulting in the development of four curricula. This was done to improve the fit of NDBI principles to preschool contexts and promote implementation fidelity. Additionally, intervention activities and coaching sessions took place within an integrated classroom environment, and did not rely on “pull out time” for students in order to maximize feasibility and sustainability.

2. Promote positive changes in target children’s social communication as measured by both quantity and quality of communication bids.

 To meet this objective, consent for video-taped data was obtained from the majority of students in classrooms, allowing for outcome data to be analyzed in natural preschool contexts from video-recorded samples of whole class activities.

Methods:

This multiple-baseline design study piloted a social communication intervention using NDBI principles with four teacher/target child dyads in the Early Childhood Education Center at the Nisonger Center. After two to six weeks of baseline data collection, participating classroom staff members received eight weeks of intervention. Active intervention consisted of four didactic training sessions and seven live-coaching sessions. Implementation fidelity data and communication outcomes were video-recorded and coded by blinded research assistants.

Results:

Regarding outcomes, the present study examined 1) teacher fidelity to intervention practices in pre-identified classroom contexts 2) child outcomes in terms of communication targets and classroom engagement 3) stakeholder ratings of feasibility/acceptability and effectiveness.

Preliminary findings indicate that classroom staff are able to implement NDBI techniques at high levels of fidelity within classroom contexts (no “pull out” time required), report that the intervention is feasible, and that target children have increased communication bids as a result of intervention.

Conclusions:

Integration within whole class activities, as well as presenting strategies in a clearly delineated, exportable fashion while keeping intervention intensity minimal may have been key to high teacher fidelity, high ratings of feasibility, and in turn, increased communication on the part of target children. Future research and clinical intervention efforts should focus on considering the match between intervention strategies, their presentation, and integration into natural contexts.