Juliann Woods

Early Social Interaction Project for Children With Autism Spectrum Disorders Beginning in the Second Year of Life: A Preliminary Study

The Early Social Interaction (ESI) Project (Woods & Wetherby, 2003) was designed to apply the recommendations of the National Research Council (2001) to toddlers with autism spectrum disorders (ASD) by using a parent-implemented intervention that (a) embeds naturalistic teaching strategies in everyday routines and (b) is compatible with the mandate of the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, Part C. This quasi-experimental study is a preliminary effort by the authors to evaluate the effects of ESI on the social communication outcomes for a group of 17 children with ASD who entered ESI at age 2 years. The results indicated significant improvement on 11 of 13 social communication measures. The researchers compared the ESI group with a contrast group of 18 children with ASD who entered early intervention at age 3 years. The contrast groups results were comparable to those of the ESI postintervention group on communicative means and play, but the contrast group as a whole demonstrated significantly poorer performance on all other social communication measures. These findings offer promise for the use of parent-implemented interventions in promoting social communication for toddlers with ASD.

Effects of Embedding Caregiver-Implemented Teaching Strategies in Daily Routines on Children's Communication Outcomes

Effects of instructing caregivers to implement teaching strategies within daily routines were investigated using a multiple baseline design across caregiver strategies and participants. Four toddlers with developmental delays participated in intervention conducted by their primary caregiver within the familys preferred play routines. To assess generalization, caregiver teaching strategy use was observed during other caregiving and outdoor play routines. Caregiver strategy use increased subsequent to instruction within indoor play routines. Generalization to other routines, however, was limited in three of the four dyads. All four children demonstrated gains in communication objectives and test scores across multiple developmental domains improved. This study demonstrates the viability of teaching caregivers to embed effective teaching strategies within daily routines to improve the communication skills of toddlers.

Parent-implemented social intervention for toddlers with autism: an RCT.

OBJECTIVES: To compare the effects of two 9-month parent-implemented interventions within the Early Social Interaction (ESI) Project. Both individual-ESI, offered 2 or 3 times per week at home or in the community, and group-ESI, offered once per week in a clinic, taught parents how to embed strategies to support social communication throughout everyday activities. METHODS: Participants in the randomized controlled trial included 82 children diagnosed with autism spectrum disorder at 16 to 20 months. Children were matched on pretreatment nonverbal developmental level and pairs were randomly assigned to treatment condition. Child outcomes included measures of social communication, autism symptoms, adaptive behavior, and developmental level. Child outcomes are reported from baseline to the end of the 9-month interventions. RESULTS: Children in individual-ESI showed differential change on a standardized examiner-administered observational measure of social communication, as they improved at a faster rate than children in group-ESI. Individual-ESI also showed differential efficacy on a parent report measure of communication, daily living, and social skills, as they showed improvement or stability, whereas group-ESI led to worsening or no significant change on these skills. Finally, individual-ESI showed differential change on examiner-administered measures of receptive language skills, as children in individual-ESI improved significantly, whereas group-ESI showed no change. CONCLUSIONS: These findings support the efficacy of individual-ESI compared with group-ESI on child outcomes, suggesting the importance of individualized parent coaching in natural environments. The efficacy of a parent-implemented intervention using little professional time has potential for community viability, which is particularly important in light of the lack of main effects on child outcomes of most other parent-implemented interventions.

Caregiver Coaching Strategies for Early Intervention Providers: Moving toward Operational Definitions.

Early intervention (EI) providers increasingly coach and collaborate with caregivers to strengthen and support caregiver–child interactions. The EI providers learning to coach other adults benefit from knowing what, exactly, they should do to support caregivers. This article serves two purposes. First, it proposes an operationally defined, theoretically based, and reliably used set of definitions (behaviors) that describe coaching strategies that providers can use to support caregiver learning. Second, it suggests possible applications of these definitions for EI providers, administrators, and researchers. We discuss underlying theories of adult learning and the process by which the definitions were developed. Preliminary evidence regarding the utility of these definitions is presented by using videotape data of provider coaching practices in home visits from three different studies. Descriptive data from these programs and home visits illustrate how the coaching definitions can be used to distinguish implementation differences and how they could be used to support professional development efforts for EI coaching and consultation.

Provider Perspectives on Adopting and Using Collaborative Consultation in Natural Environments

An exploratory case study was undertaken to investigate the perspectives and experiences of six early intervention providers as they adopted and implemented a collaborative consultation approach to home visiting in urban neighborhoods. Survey, semistructured interview, and focus group methods were used over a 2-year period to obtain data about provider perspectives about the home visiting approach and their experiences in implementing it with parents of infants and toddlers receiving Part C services. The intensity of provider concerns about the use of collaborative consultation and routines-based, family-centered home visiting practices improved at posttest. Providers attributed these changes in large part to the culture of the organization as a learning community and its ongoing administrative support for reflective practice and problem solving about implementation issues. Providers also identified specific factors, such as time and opportunity to practice and problem solving with feedback, as having an impact on their ability to move forward in adopting and using family-centered home visiting practices. Challenges were identified related to home visiting generally, and a consultative approach specifically, in complex urban family settings. Implications for research and practice are discussed.

Effects of a Triadic Parent-Implemented Home-Based Communication Intervention for Toddlers

A series of three multiple-baseline single-case studies with replication across nine parent–child dyads was used to evaluate the effects of a parent-implemented communication intervention on parent and child communication for toddlers with Down syndrome, autism spectrum disorder, and developmental delays. Interventionists coached parents to implement communication strategies and supports in family-identified routines over 24 intervention sessions. Parents demonstrated increased responsive and modeling strategy use, and children exhibited higher rates of targeted communication forms from baseline to intervention phases. For eight of the nine dyads, the gains increased across the intervention phase, and effects were carried over into the maintenance phase. The results support the use of triadic parent-implemented communication interventions that can be implemented in the early intervention system. Clinical and research implications of teaching parents of toddlers with various etiologies to use responsive and modeling strategies through a collaborative family-guided coaching process are discussed.

Technology-Supported Performance-Based Feedback for Early Intervention Home Visiting

This study was conducted to evaluate the effects of a Distance Mentoring Model (DMM), including performance-based feedback and technology support, on expanding the use of recommended home visiting practices by early interventionists. Data from 18 early interventionists indicated that participation in the DMM approach was associated with increased use of various caregiver coaching strategies and routine contexts. Specifically, participants spent significantly less time in child-focused intervention and more time using specific coaching interactions with the caregiver and child as a dyad after participating in technology-supported, performance-based feedback. All participants reported that they would participate in technology-supported, professional development opportunities again in the future.

Integrating Family Capacity-Building and Child Outcomes to Support Social Communication Development in Young Children with Autism Spectrum Disorder.

The focus of this article is on the transactional relationship of research and practice for speech–language pathologists serving infants and toddlers with and at risk for autism spectrum disorder in Individuals with Disabilities Education Act supported early intervention. Specifically, information is provided on (a) the relationship between parent-implemented social communication interventions for young children with autism spectrum disorder and family-centered practice; (b) the importance of family-centered practice to capacity building with families within their natural environments; and (c) adult learning principles that build the familys capacity to meet their childs social communication needs. Examples from previous and current research, as well as implications for future research, are provided.

When the Toddler Takes Over Changing Challenging Routines Into Conduits for Communication

The applicability of teaching communication replacement behavior for challenging behavior has not been fully recognized by early interventionists Working With young children in their natural environments. This article describes hoW challenging routines for families can be converted into opportunities to teach communication skills and increase participation in family activities. A case description is presented to illustrate hoW routines-based intervention can extend the process and procedures of functional assessment and positive behavior support interventions to ongoing early intervention that facilitates increasingly more sophisticated communication skills. We demonstrate hoW communication skills can be targeted in an individualized fashion first as a replacement behavior serving the same function as the challenging behavior for the child and second to correspond to the interests and concerns of the family and child. This approach offers flexibility in applying a variety of effective intervention strategies Within a family-guided process.

Providers' Reported and Actual Use of Coaching Strategies in Natural Environments.

This case study examined the agreement between reported and actual use of coaching strategies based on home visit data collected on a diverse sample of providers and families. Paired videotape and contact note data of and from providers during home visits were collected over a six month period and analyzed using structured protocols. Results of both descriptive and correlation analyses indicated providers used a range of coaching strategies, tended to underreport (under-represent) their efforts on contact notes, and demonstrated practices that were primarily collaborative and family-centered. Agreement between actual and reported use of coaching strategies was variable and did not support our anticipated finding. Implications for future research and practice are discussed.