Limited research has examined the active ingredients and mechanisms of change of naturalistic developmental behavioral interventions (NDBIs). The present study used an exploratory sequential mixed-methods design to develop a comprehensive Theory of Change of Project ImPACT, an empirically supported NDBI. We used qualitative data from interviews with intervention experts (n = 10), community providers (n = 22), and caregivers (n = 12) to develop a comprehensive causal model of the intervention process. We then tested select paths of the causal model using path analyses with an archival dataset (n = 92). The causal model described how developmental techniques aimed at supporting children’s attention and engagement lay the foundation for more adult-directed learning opportunities and subsequent child skill growth. However, hypothesized causal relationships were not supported by our quantitative analyses. In the future, this research can be used to develop and prioritize nuanced research questions related to the timing, optimization, and mechanistic process underlying NDBIs.
AldredC.GreenJ.EmsleyR.McConachieH. (2012). Brief report: Mediation of treatment effect in a communication intervention for pre-school children with autism. Journal of Autism and Developmental Disorders, 42(3), 447–454.
2.
BorglinG. (2015). The value of mixed methods for researching complex interventions. In RichardsD. A.HallbergI. R. (Eds.), Complex interventions in health: An overview of research methods (pp. 29–45). Routledge.
3.
Clark-WhitneyE.KleinC. B.HadleyP. A.LordC.KimS. H. (2022). Caregiver language input supports sentence diversity in young children with autism spectrum disorder. Journal of Speech, Language, and Hearing Research, 65(4), 1465–1477. https://doi.org/10.1044/2021_JSLHR-21-00458
4.
CollinsL. M.MurphyS. A.NairV. N.StrecherV. J. (2005). A strategy for optimizing and evaluating behavioral interventions. Annals of Behavioral Medicine, 30(1), 65–73. https://doi.org/10.1207/s15324796abm3001_8
5.
CraigP.DieppeP.MacintyreS.MichieS.NazarethI.PetticrewM. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ, 337, Article a1655. https://doi.org/10.1136/bmj.a1655
DimidjianS.HollonS. D. (2010). How would we know if psychotherapy were harmful?American Psychologist, 65(1), 21–33. https://doi.org/10.1037/a0017299
8.
EdmundsS. R.FrostK. M.SheldrickR. C.BravoA.StraitonD.PickardK.GrimV.DrahotaA.KuhnJ.AzadG.Pomales RamosA.IngersollB.WainerA.IbanezL. V.StoneW. L.CarterA.Broder-FingertS. (2022). A method for defining the CORE of a psychosocial intervention to guide adaptation in practice: Reciprocal imitation teaching as a case example. Autism, 26, 601–614. https://doi.org/10.1177/13623613211064431
9.
EdmundsS. R.KoverS. T.StoneW. L. (2019). The relation between parent verbal responsiveness and child communication in young children with or at risk for autism spectrum disorder: A systematic review and meta-analysis. Autism Research, 12, 715–731. https://doi.org/10.1002/aur.2100
10.
FarmerT.RobinsonK.ElliottS. J.EylesJ. (2006). Developing and implementing a triangulation protocol for qualitative health research. Qualitative Health Research, 16(3), 377–394. https://doi.org/10.1177/1049732305285708
11.
FrostK. M.BrianJ.GengouxG. W.HardanA.RiethS. R.StahmerA.IngersollB. (2020). Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi. Autism, 24(8), 2285–2297. https://doi.org/10.1177/1362361320944011
12.
FrostK. M.KoehnG. N.RussellK. M.IngersollB. (2019). Measuring child social communication across contexts: Similarities and differences across play and snack routines. Autism Research, 12, 636–644. https://doi.org/10.1002/aur.2077
13.
GaleN. K.HeathG.CameronE.RashidS.RedwoodS. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13(1), Article 117. https://doi.org/10.1186/1471-2288-13-117
14.
GriffithsP. E.TaberyJ. (2013). Developmental systems theory: What does it explain, and how does it explain it? In LernerR. M.BensonJ. B. (Eds.), Advances in child development and behavior (Vol. 44, pp. 65–94). Elsevier.
15.
GrzadzinskiR.CarrT.ColombiC.McGuireK.DufekS.PicklesA.LordC. (2016). Measuring changes in social communication behaviors: Preliminary development of the brief observation of social communication change (BOSCC). Journal of Autism and Developmental Disorders, 46(7), 2464–2479. https://doi.org/10.1007/s10803-016-2782-9
16.
GulsrudA. C.HellemannG.ShireS.KasariC. (2016). Isolating active ingredients in a parent-mediated social communication intervention for toddlers with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(5), 606–613. https://doi.org/10.1111/jcpp.12481
17.
HemmlerV. L.KenneyA. W.LangleyS. D.CallahanC. M.GubbinsE. J.HolderS. (2022). Beyond a coefficient: An interactive process for achieving inter-rater consistency in qualitative coding. Qualitative Research, 22, 194–219. https://doi.org/10.1177/1468794120976072
18.
IngersollB.DvortcsakA. (2019). Teaching social communication to children with autism and other developmental delays: The project ImPACT guide to coaching parents and the project ImPACT manual for parents (2nd ed.). Guilford Press.
19.
IngersollB.WainerA. L.BergerN. I.PickardK.BonterN. (2016). Comparison of a self-directed and therapist-assisted telehealth parent-mediated intervention for children with ASD: A pilot RCT. Journal of Autism and Developmental Disorders, 46(7), 2275–2284. https://doi.org/10.1007/s10803-016-2755-z
20.
IngersollB.WainerA. L.BergerN. I.WaltonK. M. (2017). Efficacy of low intensity, therapist-implemented Project ImPACT for increasing social communication skills in young children with ASD. Developmental Neurorehabilitation, 20(8), 502–510. https://doi.org/10.1080/17518423.2016.1278054
21.
KallioH.PietiläA.-M.JohnsonM.KangasniemiM. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. https://doi.org/10.1111/jan.13031
22.
KappS. K. (2018). Social support, well-being, and quality of life among individuals on the autism spectrum. Pediatrics, 141(Suppl. 4), S362–S368.
23.
KirkM. A.HainesE. R.RokoskeF. S.PowellB. J.WeinbergerM.HansonL. C.BirkenS. A. (2021). A case study of a theory-based method for identifying and reporting core functions and forms of evidence-based interventions. Translational Behavioral Medicine, 11, 21–33. https://doi.org/10.1093/tbm/ibz178
24.
KoegelR. L.KoegelL. K.McNerneyE. K. (2001). Pivotal areas in intervention for autism. Journal of Clinical Child & Adolescent Psychology, 30(1), 19–32. https://doi.org/10.1207/S15374424JCCP3001_4
25.
LittleT. D. (2013). Longitudinal structural equation modeling. Guilford Press.
26.
LordC.RisiS.LambrechtL.CookE. H.LeventhalB. L.DiLavoreP. C.PicklesA.RutterM. (2000). The autism diagnostic observation schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.
MalterudK.SiersmaV. D.GuassoraA. D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753–1760. https://doi.org/10.1177/1049732315617444
MaysN.PopeC. (2000). Qualitative research in health care: Assessing quality in qualitative research. BMJ, 320(7226), 50–52. https://doi.org/10.1136/bmj.320.7226.50
31.
MorseJ. M. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25(9), 1212–1222. https://doi.org/10.1177/1049732315588501
32.
MuthénL. K.MuthénB. O. (2021). Mplus (Version 8).
33.
PicklesA.HarrisV.GreenJ.AldredC.McConachieH.SlonimsV.Le CouteurA.HudryK.CharmanT., & PACT Consortium. (2015). Treatment mechanism in the MRC preschool autism communication trial: Implications for study design and parent-focussed therapy for children. Journal of Child Psychology and Psychiatry, 56(2), 162–170. https://doi.org/10.1111/jcpp.12291
SaldañaJ. (2013). The coding manual for qualitative researchers (2nd ed.). Sage.
36.
SandbankM.Bottema-BeutelK.CrowleyS.CassidyM.DunhamK.FeldmanJ. I.CrankJ.AlbarranS. A.RajS.MahbubP.WoynaroskiT. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1–29. https://doi.org/10.1037/bul0000215
37.
SchreibmanL.DawsonG.StahmerA. C.LandaR.RogersS. J.McGeeG. G.KasariC.IngersollB.KaiserA. P.BruinsmaY.McNerneyE.WetherbyA.HalladayA. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8
38.
ScrivenM. (1994). The fine line between evaluation and explanation. Research on Social Work Practice, 15(1), 75–77.
39.
ShenoudaJ.BarrettE.DavidowA. L.SidwellK.HalperinW.SilenzioV. M. B.ZahorodnyW. (2022). Disparities in early intervention program participation by children with autism spectrum disorder in a US metropolitan area, 2006 to 2016. JAMA Pediatrics, 176(9), 906–914. https://doi.org/10.1001/jamapediatrics.2022.2366
TiedeG.WaltonK. M. (2019). Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder. Autism, 23, 2080–2095. https://doi.org/10.1177/1362361319836371
43.
WeissC. H. (1995). Nothing as practical as good theory: Exploring theory-based evaluation for comprehensive community initiatives for children and families. In ConnellJ.KubischA.SchorrL.WeissC. (Eds.), New approaches to evaluating community initiatives: Concepts, methods, and contexts (pp. 65–92). Aspen Institute. https://pdfs.semanticscholar.org/ff5a/3eea8d1d4e07a768ded6b426b425efde8f7c.pdf
44.
WeissC. H. (1997). Theory-based evaluation: Past, present, and future. New Directions for Evaluation, 1997(76), 41–55. https://doi.org/10.1002/ev.1086
45.
YoderP. J.StoneW. L.EdmundsS. R. (2021a). For which younger siblings of children with autism spectrum disorder does parent-mediated intervention work?Autism, 25(1), 58–69. https://doi.org/10.1177/1362361320943373
46.
YoderP. J.StoneW. L.EdmundsS. R. (2021b). Parent utilization of ImPACT intervention strategies is a mediator of proximal then distal social communication outcomes in younger siblings of children with ASD. Autism, 25(1), 44–57. https://doi.org/10.1177/1362361320946883
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
