Early Achievements for Education Settings: An Embedded Teacher-Implemented Social Communication Intervention for Preschoolers With Autism Spectrum Disorder

Abstract

Purpose Early Achievements for Education Settings (EA-ES) is a teacher-implemented naturalistic developmental behavioral intervention for preschoolers with autism spectrum disorder (ASD) targeting core social communication impairments. The purpose of this pilot randomized controlled clinical trial (RCT) was to examine promise of efficacy of this iteratively developed intervention when implemented in authentic education settings. We examined (1a) whether a high level of implementation fidelity was attained by EA-ES trained teachers and (1b) whether their fidelity attainment differed from that of untrained teachers; and (2) whether the EA-ES intervention showed promise of improving child social, communication, and cognitive outcomes as determined by within- and between-group comparisons of children in EA-ES classrooms and children in classrooms randomized to the business as usual condition. Method Participants included six preschool teachers and 43 eligible preschoolers with ASD. Classrooms were randomized to EA-ES or business as usual. Analyses of intervention effects using baseline and postintervention data were conducted on teachers' fidelity of EA-ES implementation and children's performance on a proximal measure of social and communication behavior and on a distal standardized measure of verbal and nonverbal functioning. Results Teachers trained to implement EA-ES attained a high level of implementation fidelity, with significantly greater gains compared to untrained teachers. Children receiving EA-ES showed significantly greater gain from baseline to postintervention in frequency of produced initiation of joint attention and nonverbal cognitive functioning compared to children in business-as-usual classrooms. A trend toward significance for Group × Time effects was detected for frequency of spontaneous verbalizations produced, favoring the EA-ES group. Conclusions EA-ES shows promise of feasibility for teacher implementation in group contexts and for improving social communication and cognitive skills in preschoolers with ASD. Implications of results for future research and speech-language pathologist–teacher collaboration to increase language intervention dosage are discussed.