Megan Y Roberts

Objective Early measurement of atypical disruptive behavior within autistic children is critical for later referrals to behavioral screenings, diagnoses, and services. Disruptive behavior in autistic toddlers is often measured using a categorical approach and identifies the presence or absence of behavior. In contrast, dimensional approaches evaluate behavior on a spectrum of typical to atypical by measuring the clinical salience of disruptive behavior. We sought to assess the validity of the Infant/Toddler version of the multidimensional assessment profile of disruptive behavior (MAP‐DB‐IT), a dimensional approach measurement tool, in a sample of autistic toddlers. Methods Autistic toddlers ( n = 82, M age = 33.2 months, SD = 6.28 months) and their mothers received 8 weeks of caregiver‐mediated social communication intervention. Mothers completed the MAP‐DB‐IT and the Infant Toddler Social Emotional Assessment (ITSEA) across three timepoints: before intervention, immediately after intervention, and at 3 months post‐intervention follow‐up. The MAP‐DB‐IT provided scores for three subdomains: temper loss, noncompliance, and aggression (generically or specifically with siblings). Ratings on the MAP‐DB‐IT were compared to the ITSEA using several analytic strategies such as evaluating (a) the internal consistency of the MAP‐DB‐IT domain scores; (b) the convergent validity between the two measures; and (c) its convergent change due to intervention and if this varied by child characteristics. Results The MAP‐DB‐IT demonstrated excellent internal consistency across all four subdomains. We evaluated convergent validity and found positive correlations between the (a) ITSEA externalizing and MAP‐DB‐IT aggression domain, (b) ITSEA externalizing and MAP‐DB‐IT aggression with siblings domain, and (c) ITSEA dysregulation and MAP‐DB‐IT temper loss domain. Conclusion The MAP‐DB‐IT is a valid measurement tool for disruptive behavior in autistic toddlers. Clinicians should consider the use of the MAP‐DB‐IT for young autistic clients presenting with disruptive behavior to (a) discriminate between early developmentally appropriate tantrums from clinically salient dysregulation, and (b) refer to additional behavioral evaluations and services.

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.