Discovering Practitioners’ Knowledge and Use of Evidence-Based Practices for Autism Early Childhood Interventions

Abstract

Young children with autism spectrum disorder (ASD) require supports and services designed to meet their unique needs. Research has identified 27 evidence-based practices (EBPs) for children ages birth to 5 years. However, there is a paucity of research that examines whether early childhood providers are implementing EBPs with children with ASD. In this study we determined the levels of training, confidence, and frequency of EBP implementation by U.S.-based early childhood providers, including early childhood educators and early intervention providers. These findings indicate gaps in both knowledge and implementation of EBPs. Implications for research and practice are discussed.

Keywords

early childhood providers autism spectrum disorder evidence-based practices early childhood education early intervention

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts social communication with the display of restricted and repetitive patterns of behavior (American Psychiatric Association, 2013; Lord et al., 2020). According to the Surveillance Summaries from the Center for Disease Control and Prevention (Shaw et al., 2023), prevalence of ASD continues to rise in the younger population. For example, the prevalence of ASD in eleven states has increased from 21.5% in 2018 to 26% in 2020. ASD accounts for approximately 12% of the population of students receiving special education services in the United States (National Center for Education Statistics [NCES], 2022b). Of the 828,338 children ages 3 to 21 identified with ASD, there were 194,472 children ages 3 to 5 years who were not yet in kindergarten but receiving special education services through the category of ASD in the United States in the 2020 to 2021 school year (National Center for Education Statistics [NCES], 2022a). It is more difficult to determine the prevalence of ASD in younger children and toddlers since, on average, diagnosis does not occur until age 4 (Maenner et al., 2020). However, research suggests prevalence is as high as 30.14% in toddlers receiving early intervention (EI) in Louisiana (Worley et al., 2011).

Rationale for Early Intervention

There are legal requirements that states provide appropriate EI and early childhood special education (ECSE) services for infants, toddlers, and preschool-age children with disabilities and their families under the Part C and Part B Individuals with Disabilities Education Improvement Act (2004). EI services are available for children birth through 2 years old and ECSE services typically become available for children at age 3 for those who qualify (Centers for Disease Control and Prevention, 2020). When young children with ASD are provided intervention early in life, clear evidence supports positive developmental outcomes (Debodinance et al., 2017; Hume et al., 2021; Reichow, 2012). Follow-up studies further reveal that when young children receive EI, they can maintain gains across years (Estes et al., 2015).

Families of newly diagnosed, young children are often reliant upon early childhood educators’ knowledge and expertise when making educational and intervention decisions for their children (Grant et al., 2016). The growing rates of children with ASD have also increased the demand for effective, high-quality early interventions (Suhrheinrich, 2015). Thus, it is imperative that all ECSE teachers and EI providers (e.g., developmental specialists, speech, occupational, and physical therapists) are qualified to serve milies and children with ASD (Chopra et al., 2013; McLaren & Rutland, 2013). While there has been steady growth in ASD EI research and identifying evidence-based practices (EBPs), additional efforts are needed to ensure practitioners can access, understand, and implement effective interventions. However, few studies have focused specifically on early childhood professionals and the training, usage, and confidence in implementation of EBPs for children with ASD.

Early Childhood Settings and Professionals

When compared to school-age (K-12) children, young children with ASD attend a wider variety of settings which can include both publicly and privately funded state preschool, preschool classes, Head Start, child care, and kindergarten (Cate & Peters, 2018). The most recent State of Preschool 2021 yearbook (Friedman-Krauss et al., 2022) shows that the majority of preschool-age children (89% for 3-year-olds, and 61% of 4-year-olds) are enrolled private early childhood programs. In these differing settings, there are limited (or no) mandates related to instruction for young children with ASD. Further, there are often no educational requirements for early childhood teachers working in private childcare programs which enroll the majority of young children. For example, many early childhood professionals do not complete special education teacher preparation programs where EBPs for children with ASD are taught. Specific examples are seen when looking at the qualifications to become an early intervention provider in North Carolina (North Carolina Department of Health and Human Services, 2023) and Virginia (Infant and Toddler Connection of Virginia, 2023). These states allow individuals to become an early intervention provider if they have a degree in early childhood, special education, education, counseling, or in a related field. Thus, many professionals enter the workforce without specialized knowledge in special education instruction or EBPs, let alone specific training in ASD. Another example is seen in a recent study completed by Coleman et al. (2021) which provided an analysis of 1,053 infant and toddler classrooms and found most teachers did not have a 4-year degree and the average educational level was between “some college or less” and a “2-year community college degree” (p. 138). Considering varying educational requirements and the wide range of settings, it is not surprising many early childhood professionals continuously report they do not feel equipped to support children with disabilities, including those with ASD (Bruns & Mogharreban, 2007; Yu, 2019).

Evidence-Based Practices for Early Childhood

While early childhood experiences can have positive impact on children with ASD (Debodinance et al., 2017; Hume et al., 2021; Reichow, 2012), if professionals are not adequately prepared to support them, children with ASD may not receive needed quality intervention. EBPs are important for teaching as these are the practices that are effective based on “multiple, high-quality studies that use experimental research designs and demonstrate robust effects on student outcomes” (Cook et al., 2015, p. 220). Although a set of 28 EBPs has been identified for working with individuals with ASD (Steinbrenner et al., 2020), there is evidence to suggest many educators are not receiving effective training and that a lack of implementation exists for children with ASD (Hendricks, 2011; Layden et al., 2022). Further, a number of EI models designed for young children with ASD are effective in improving outcomes (e.g., Dawson et al., 2010; Stadnick et al., 2015; Turner-Brown et al., 2019; Wetherby et al., 2014). However, these intervention models are typically not common practice by Part B and C EI/ECSE providers and there remains a large gap between research and practice (e.g., Nahmias et al., 2019). This gap between research and educators has been challenging for teachers and EI providers working with children with ASD (Steinbrenner et al., 2015).

In 2014, Wong et al. conducted a large-scale systematic review that focused on identifying EBPs for children between birth and 22 years of age with ASD or similar conditions. Included studies occurred between 1990 and 2011. This review included 456 articles and identified 27 EBPs (Wong et al., 2014). Building on the work of Wong et al. (2014), Steinbrenner et al. (2020) conducted a second large-scale systematic review of the existing literature focused on practices implemented with individuals with ASD. Articles considered in this review had to be published between 1990 and 2017, include individuals with ASD or similar conditions, and the participants were between 0 and 22 years of age. The review included 972 articles and found 28 practices that met their criteria to be considered evidence-based. Results of the review revealed an array of variables, including age of individuals with ASD for whom evidence supports the practice. The ages of individuals with ASD were grouped into age groups: 0 to 2 years, 3 to 5 years, 6 to 11 years, 12 to 14 years, 15 to 18 years, and 19 to 22 years. Of the 28 practices found to be evidence-based for children with ASD, 17 had sufficient evidence for children 0 to 2 years and 27 had evidence for children 3 to 5 years (Steinbrenner et al., 2020).

Practitioners’ Knowledge and Use of Evidence-Based Practices

Despite the identification of EBPs for young children with ASD, a gap exists between the research and the use of these practices in school and community settings. Nahmias et al. (2019) found EI providers with better outcomes for children reported higher usage of EBPs. EBP training has also been difficult to implement in school settings (Suhrheinrich, 2015). In addition, there may be bias in choosing which EBPs to use. Hugh et al. (2022) suggested preschool special educators often select instructional approaches based on their positive perceptions and implementation ability. Additionally, many public school teachers have reported modifying EBPs for children with ASD (Suhrheinrich et al., 2013) which may impact outcomes.

Training needs and use of EBPs is an important consideration. McNeill (2019) conducted a survey of 130 North Carolina educators working in pre-k through 12th grade. This survey focused on the 27 EBPs identified by Wong et al. (2014) and looked at self-reported training and use of EBPs as well as social validity of the EBPs for participants (McNeill, 2019). McNeill (2019) found that while participants had knowledge of approximately 23 practices, they only used about 13 daily. However, when broken down by EBP, only seven of the EBPs were used daily by at least half of the participants (i.e., reinforcement, prompting, modeling, visual supports, social skills training, redirection, and self-management). Hamrick et al. (2021) conducted a survey of special educators in public schools in Texas. This survey focused on training, feelings of preparedness, use of, and factors that influence decision-making of EBPs. Results indicated few participants reported high feelings of preparedness and while many indicated the need for more training, only 5% of participants indicated having accessed freely available state education agency provided training (Hamrick et al., 2021). These findings were supported by Layden et al. (2022) who found educators generally reported receiving little to no training (i.e., less than 3 hr per EBP) on EBPs for students with ASD, low confidence in their ability to implement EBPs independently, and a low frequency of implementation. Furthermore, approximately three quarters of responses indicated EBPs were implemented less than once per week or not at all.

While there has been some research conducted on the training, confidence, and frequency of EBP implementation by educators, few studies focus specifically in these areas for those who work with young children with ASD. For example, McNeill (2019) included pre-k teachers in their sample, which consisted of only eight pre-k teachers. One notable study included Gevarter et al. (2022) who focused on early childhood professionals and surveyed developmental specialists and speech language pathologists (SLPs) as to their self-assessment ratings and knowledge about 24 EBPs. Gevarter et al. (2022) found, while SLPs performed better than developmental specialists, a gap in provider knowledge and EBPs for children with ASD, particularly in a rural area of the United States. Dynia et al. (2020) conducted a survey of 45 early childhood special education teachers that included measures of their use of EBPs. Though nearly all teachers reported using EBPs (97.6%), when asked about specific EBPs such as reinforcement, visual supports, modeling, and prompting, the percentages decreased to a range of 9.5% to 71.4% (Dynia et al., 2020). It should be noted, Dynia et al. (2020) asked about domain areas and did not include all EBPs identified by Wong et al. (2014) or Steinbrenner et al. (2020).

Purpose

The current study expands on previous findings in three distinct ways. First, the number of EBPs have increased and have been modified through the most recent findings by Steinbrenner et al. (2020). Second, there have been relatively few studies that have focused solely on early childhood professionals and this study only included professionals working with young children with ASD. Third, this study focused not only on training and use of EBPs, but also included measures of self-reported confidence to implement and frequency of usage. Thus, based on the survey published by Layden et al. (2022), we conducted a survey to determine how much training EI providers and pre-school educators receive in each of the 27 EBPs identified by Steinbrenner et al. (2020) for children ages 0 to 5 years. We also assessed professionals’ confidence in implementing EBPs, and the frequency with which they are doing so.

The current study seeks to examine the following research questions:

How much, if any, training do professionals working in early intervention/early childhood report they have received on the 28 identified EBPs for individuals with ASD?

How confident do professionals working in early intervention/early childhood report they feel in implementing any of the 28 identified EBPs?

How often do professionals report they implement any of the 28 identified EBPs?

Method

Survey Construction

The survey used in this study was an adapted version of the survey disseminated in the Layden et al. (2022) article. Layden et al. (2022) sent a survey to educators and administrators in the public school system and sought information about their practices working with children ages 5 to 21 years who received special education services under an educational label autism. Layden et al. (2022) examined: self-reported level of training, confidence in implementation, and self-reported frequency of implementation of each of the EBPs. The researchers investigated the 27 EBPs that were established in 2014 (Wong et al., 2014). Thus, we updated the survey used in the Layden et al. (2022) article to investigate the same dependent variables but focused on children 0 to 6 years of age and included the updated list of 28 EBPs (Steinbrenner et al., 2020).

The survey was constructed and disseminated using an electronic platform, Qualtrics, that allowed for anonymous data collection. It included three sections that focused on self-reported training in EBPs, implementation of EBPs, and demographic information. Before these sections, a brief description about the EBPs was provided:

The National Professional Development Center for Autism Spectrum Disorders (NPDC) published a comprehensive review of research for evidence-based practices for working with individuals with Autism Spectrum Disorder (ASD) in 2020 (Steinbrenner et al., 2020). The NPDC report cited 28 evidence-based practices (EBPs) which have been shown to be effective with individuals with ASD when implemented with fidelity.

Each section listed each of the 28 EBPs with the corresponding Likert scale. For each EBP, a brief description could be seen by hovering over the EBP in case participants had training in or were using an EBP, but may not have been familiar with the name. For a summary of the Likert scale responses, please see Table 1.

Table 1.

Questions on Survey for Knowledge and Use of Evidence-based Practices.

Area	Possible response
Training	1—I have received no training on this EBP 2—I have received 1 hr or less on this EBP 3—I have received more than 1 hr but less than 3 hr of training on this EBP 4—I have received more than 3 hr but less than 6 hr of training on this EBP 5—I have received more than 6 hr of training on this EBP.
Confidence	1—I cannot implement this practice. 2—I can implement the practice with someone providing verbal and physical modeling for each step. 3—I can implement the practice with someone providing verbal guidance. 4—I can implement the practice with minimal guidance provided only when requested. 5—I can implement this practice independently.
Frequency of implementation	1—I have never implemented the practice. 2—I have implemented the practice once within the past 6 months. 3—I have implemented the practice more than once but not monthly within the past 6 months 4—I have implemented he practice at least monthly within the past 6 months 5—I have implemented the practice at least weekly within the past 6 months

Section 1: Training

Section 1 focused on participants’ self-reported level of training based on each of the 28 EBPs. Consistent with Layden et al. (2022), participants were provided a 5-point Likert scale to rate their level of training for each of the 28 EBPs with 1 representing I have received no training on this EBP to 5, I have received more than 6 hr of training on this EBP. In the survey, we explained training included any of the following: face to face workshops, online webcasts, reading journal articles or formal reports, observing an expert implement the training, college coursework, attending conferences, or other opportunities if they directly taught the EBP and its application with children. We further explained training does not include word of mouth or informal education such as reading blogs, websites, magazine articles, and similar materials.

Section 2: Implementation

Section 2 focused on self-reported implementation of each of the 28 EBPs that included ratings for confidence and frequency. Consistent with Layden et al. (2022), participants were asked to rate their level of confidence and frequency of implementation on the same 5-point Likert scales. For example, in the confidence rating they were asked to report their confidence in their ability to implement each EBP with 1 representing I cannot implement this practice to 5, I can implement this practice independently. In the frequency rating, 1 represented I have never implemented the practice. and 5 represented I have implemented the practice at least weekly within the past 6 months.

Section 3: Demographics

Section 3 of the survey asked about participants’ demographic information. This included what age group of children they worked with, their role, general level of education, level of education related to ASD, number of children with ASD with whom they have worked, years of experience with children with ASD and in the field, and in which state they work.

Survey Dissemination

Prior to disseminating the survey to prospective participants, the study was approved by the university’s Institutional Review Board (IRB) and consent was gathered via the first page of the survey before participants were permitted to continue. Participants were told they could skip any questions they did not want to answer and/or stop taking the survey at any point. Participants were not paid for participating. All survey responses were anonymous.

We utilized several different methods to disseminate the survey. We used the snowball sampling procedure (Rea & Parker, 2014) to identify participants and ask them to share the survey with their colleagues. For example, we obtained publicly available emails for the North Carolina (NC) Preschool Coordinators and Early Childhood Regional Representatives and used the local Children’s Developmental Services Agencies directory (CDSAs are responsible for the NC Infant-Toddler Program [EI]) to obtain emails from the CDSA regional representatives. We asked these NC Early Childhood leaders to send the survey and email invitation to their early childhood educators and early interventionists. Similar methods were used to recruit participants from Virginia. Further, we asked several state-wide early childhood/EI professional organizations to advertise the survey via email invitation and social media. Last, we posted the survey on our personal social media accounts to request the invitation to be shared widely. Since we utilized the snowball sampling procedure, it is impossible to know how many potential participants received the prompt to begin the survey on Qualtrics. Potential participants viewed the social media announcements and/or received an initial e-mail inviting them to complete the survey. If we did not hear back from the individuals we contacted via email, we sent two follow-up emails at approximately 2 and 4 weeks after the initial invitation. We also posted the social media announcements twice (at 2 and 4 weeks after the initial post).

Design and Analyses

Descriptive statistics were planned to illustrate the levels of respondents’ confidence in performing EBPs, reported training in the EBPs, and their reported frequency of implementing those EBPs. To determine the extent to which a link between the amount of training respondents reported having in the identified EBPs and the confidence they had in implementing those practices, chi-square tests were performed. These tests allow for determination of whether the proportion of individuals’ different levels of confidence to implement specific EBPs is dependent upon the training in that EBP they report having received.

Within the 28 EBPs, 27 were identified as being evidence-based for children 0 to 2 years and/or children 3 to 5 years of age. Cognitive behavioral/instructional strategies (CBIS) does not have enough reported evidence to be considered an EBP for children 0 to 2 or those 3 to 5 years (Steinbrenner et al., 2020). Thus, we omitted this from our analyses, leaving 27 remaining EBPs.

Participants

Participants were advised that the purpose of the survey was to gain information about early childhood professionals’ use and knowledge of evidence-based practices for children with ASD. One hundred ninety-five surveys were returned with usable data. Specific numbers are provided for all questions described below. Most respondents were from the mid-Atlantic area of the United States: 126 of 139 (90.6%) specifically indicated they were from North Carolina or Virginia; the remaining 13 (9.4%) indicated their provenance as eight other states.

Education

Of the 125 individuals who reported the level of education they had completed, the majority had either a bachelor’s degree or equivalent (45, 36.0%) or a master’s degree or equivalent (45, 36.0%). Twenty (16.0%) reported completing a community college or equivalent program. Five (4.0%) reported having earned a doctoral degree; 5 (4.0%) reported having earned a specialist degree beyond a master’s degree. Three (2.4%) reported a high school diploma or equivalent; 2 (1.6%) reported having earned a post-baccalaureate certificate.

Professional Experience in Education

Years in the profession was reported by 126 respondents. Sixty (47.6%) reported 15 or more years in education, 50 (39.7%) reported more than 4 and less than 15 years, 16 (12.7%) reported less than 1 to 4 years in education. When asked how many years they had spent working specifically with children with ASD, 4 (3.2%) indicated never, 36 (28.6%) specified less than 1 to 4 years, 57 (45.2%) endorsed more than 4 to 15 years, and 29 (23.0%) indicated 15 or more years.

Training Relevant to ASD

Of 126 respondents reporting coursework, 65 (49.2%) indicated they had completed no coursework relevant to ASD; 9 (7.1%) reported taking 1 to 2 credits in ASD. Nineteen (15.1%) reported 3 to 5 credits, 15 (11.9%) reported 6 to 11 credits, and 15 (11.9%) reported completing at least 12 credits in ASD. Three of the respondents (2.4%) had a teaching endorsement in ASD.

Role

Respondents (n = 125) shared their employment roles on the survey. Most of those who responded (45, 36.0%) were special education teachers and 25 (20.0%) were general education teachers. Twenty-two (17.6%) reported that they provided special instruction or that they were early intervention developmental specialists. Twenty-one (16.8%) served in administrative capacities and included positions such as principals, coordinators, and directors. The remainder were related service personnel (e.g., Physical Therapy, Orientation and Mobility Specialist; n = 8, 6.4%) or other (n = 4, 3.2%). Participants were not asked about their specific setting, however.

Age of Students Taught

Respondents reported the age categories of the children with whom they worked: 3 to 6 years, birth to 3 years, birth to 6 years, and other. For the 125 individuals who responded to this question, 66 (52.8%) reported they worked with children 3 to 6 years old, 31 (24.8%) with children from birth to 3 years, 23 (18.4%) with children from birth to 6 years, and 5 (4.0%) reported other.

Count of Children with ASD Taught

One hundred twenty-seven respondents provided data on the number of children with ASD they had taught. Forty-eight (37.8%) indicated they taught more than 21 students with ASD; 43 (33.9%) reported that they had taught between 6 and 20 students with ASD. Thirty-six (28.3%) reported teaching five or fewer students with ASD.

Results

We sought to examine the extent to which preschool special educators and related personnel reported they were trained in the 27 EBPs identified by Steinbrenner et al. (2020) appropriate for children ages birth to 5 years. CBIS was removed from the analysis as it was not identified as an EBP for children 0 to 2 or 3 to 5 years. We also focused on whether participants were confident in their abilities to perform those EBPs, as well as the frequency with which they reported implementing the identified EBPs.

Training

Table 2 includes the amount of training survey respondents reported having received on each of the 27 EBPs. We were interested in the frequency with which respondents reported that they had not received training in the EBPs; consequently, they were sorted in descending order according to the percentage of respondents who reported that they had had no training in specific EBPs. More than 70% of respondents reported having had no training in Sensory Integration (77.8%) and Music-Mediated Intervention (75.8%). Between 60% and 70% of respondents reported no training in nine practices from Time Delay (69.8%) to Extinction (62.0%), to Discrete Trial Training (61.3%). Please see Table 2 for specific data for all EBPs. More than 25% of the respondents rated only four practices as those on which they had received 6 hr or more of training. In descending order of frequency, these included Visual Supports (32.8%), Reinforcement (29.7%), Direct Instruction (28.5%), and Prompting (25.3%). Please see Table 2.

Table 2.

Training in Evidence-Based Practice Categories.

Evidence-based practice	Amount of training in EBP reported						Total
	No training		Hours		>6 hr
	n	%	n	%	n	%
Sensory integration^® (SI)	151	77.8	29	14.9	14	7.2	194
Music-mediated intervention (MMI)	147	75.8	35	18.0	12	6.2	194
Time delay (TD)	134	69.8	46	24.0	12	6.3	192
Behavioral momentum intervention (BMI)	133	68.9	44	22.8	16	8.3	193
Parent-implemented intervention (PII)	124	63.9	48	24.7	22	11.3	194
Technology-aided instruction and intervention (TAII)	123	63.7	53	27.5	17	8.8	193
Naturalistic intervention (NI)	122	62.6	44	22.6	29	14.9	195
Extinction (EXT)	119	62.0	56	29.2	17	8.9	192
Discrete trial training (DTT)	119	61.3	47	24.2	28	14.4	194
Video modeling (VM)	117	60.6	55	28.5	21	10.9	193
Self-management (SM)	117	60.3	55	28.4	22	11.3	194
Peer-based instruction and intervention (PBII)	114	59.4	60	31.3	18	9.4	192
Differential reinforcement of alternative, incompatible, or other behavior (DR)	111	56.9	54	27.7	30	15.4	195
Exercise and movement (EXM)	111	56.9	65	33.3	19	9.7	195
Functional communication training (FCT)	104	53.6	62	32.0	28	14.4	194
Response interruption/ redirection (RIR)	100	52.4	61	31.9	30	15.7	191
Antecedent based interventions (ABI)	91	47.2	63	32.6	39	20.2	193
Task analysis (TA)	87	45.3	65	33.9	40	20.8	192
Prompting (PP)	83	42.8	62	32.0	49	25.3	194
Social narratives (SN)	78	41.3	78	41.3	33	17.5	189
Social skills training (SST)	77	39.9	75	38.9	41	21.2	193
Augmentative and alternative communication (AAC)	76	39.0	75	38.5	44	22.6	195
Direct instruction (DI)	71	36.8	67	34.7	55	28.5	193
Reinforcement (R)	66	34.4	69	35.9	57	29.7	192
Functional behavioral assessment (FBA)	66	34.2	82	42.5	45	23.3	193
Modeling (MD)	62	32.0	87	44.8	45	23.2	194
Visual supports (VS)	51	26.6	78	40.6	63	32.8	192

Confidence

With respect to the reported level of confidence to perform EBPs, the data on Confidence to Implement were somewhat higher. These data appear in Table 3, and we have sorted these in descending order according to the percentage of respondents who reported that they cannot perform an EBP. Only one EBP, Sensory Integration, was rated by more than 60% of respondents as cannot perform (62.6%), and one EBP appeared in the 50% to 59% range: Music Mediated Intervention (52.3%). Seven practices appeared between 40% and 50% for cannot perform, and included practices such as Extinction (45.8%), Time Delay (42.9%), Discrete Trial Training (40.6%), and Response Interruption/Redirection (40.0%). On the other hand, five practices appeared in the can perform independently group for greater than 30% of respondents. These included, in descending order or frequency, Visual Supports (39.4%), Reinforcement (36.6%), Modeling (35.1%), Prompting (34.4%), and Direct Instruction (33.8%).

Table 3.

Confidence to Implement Evidence-Based Practice Categories.

Evidence-based practice	Confidence to perform EBP						Total
	Cannot perform		Can perform with support		Can perform independently
	n	%	n	%	n	%
Sensory integration® (SI)	97	62.6	47	30.3	11	7.1	155
Music-mediated intervention (MMI)	81	52.3	60	38.7	14	9.0	155
Behavioral momentum intervention (BMI)	74	47.4	65	41.7	17	10.9	156
Extinction (EXT)	71	45.8	65	41.9	19	12.3	155
Time delay (TD)	66	42.9	69	44.8	19	12.3	154
Technology-aided instruction and intervention (TAII)	66	42.6	75	48.4	14	9.0	155
Video modeling (VM)	64	42.1	65	42.8	23	15.1	152
Discrete trial training (DTT)	63	40.6	67	43.2	25	16.1	155
Response interruption redirection (RIR)	62	40.0	64	41.3	29	18.7	155
Functional communication training (FCT)	61	39.4	73	47.1	21	13.5	155
Naturalistic intervention (NI)	61	39.4	62	40.0	32	20.6	155
Parent-implemented intervention (PII)	60	38.7	74	47.7	21	13.5	155
Exercise and movement (EXM)	59	38.3	71	46.1	24	15.6	154
Self-management (SM)	57	37.0	79	51.3	18	11.7	154
Peer-based instruction and intervention (PBII)	57	36.8	77	49.7	21	13.5	155
Antecedent based interventions (ABI)	55	35.7	69	44.8	30	19.5	154
Differential reinforcement of alternative, incompatible, or other behavior (DR)	55	35.7	74	48.1	25	16.2	154
Augmentative and alternative communication (AAC)	48	31.0	77	49.7	30	19.4	155
Social narratives (SN)	46	29.7	68	43.9	41	26.5	155
Task analysis (TA)	46	29.7	69	44.5	40	25.8	155
Social skills training (SST)	39	25.2	75	48.4	41	26.5	155
Functional behavioral assessment (FBA)	37	24.0	84	54.5	33	21.4	154
Direct instruction (DI)	34	22.1	68	44.2	52	33.8	154
Prompting (PP)	34	22.1	67	43.5	53	34.4	154
Visual supports (VS)	32	20.6	62	40.0	61	39.4	155
Modeling (MD)	30	19.5	70	45.5	54	35.1	154
Reinforcement (R)	29	19.0	68	44.4	56	36.6	153

Frequency

More than 70% of respondents reported that they had performed seven EBPs either never or only once in the last 6 months. Sensory Integration (83.8%) was the most frequent of these. The group included a variety of practices such as Music-Mediated Intervention (79.6%), Video Modeling (77.5%), and Behavioral Momentum Intervention (72.9%). Ten practices appeared between 60% and 70%. These include Functional Communication Training (69.0%), Discrete Trial Training (68.3%), Extinction (66.9%), Differential Reinforcement (63.8%), Response Interruption/Redirection (60.8%), and Antecedent Based Interventions (60.1%). These data appear in Table 4. Four practices were rated by more than 50% of respondents as those that they perform most frequently: Visual Supports (55.6%), Modeling (54.9%), Reinforcement (52.1%), and Prompting (50.7%). Please see Table 4.

Table 4.

Frequency of Reported Implementation of Evidence-Based Practices.

Evidence-based practice	Reported frequency of implementation of EBP						Total
	Never or once in last 6 months		More than once, not monthly in last 6 months		Monthly or weekly in last 6 months
	n	%	n	%	n	%
Sensory integration® (SI)	119	83.8	9	6.3	14	9.9	142
Music-mediated intervention (MMI)	113	79.6	5	3.5	24	16.9	142
Video modeling (VM)	110	77.5	19	13.4	13	9.2	142
Peer-based instruction and intervention (PBII)	105	73.4	17	11.9	21	14.7	143
Technology-aided instruction and intervention (TAII)	105	73.4	15	10.5	23	16.1	143
Behavioral momentum intervention (BMI)	102	72.9	17	12.1	21	15.0	140
Time delay (TD)	102	71.3	12	8.4	29	20.3	143
Functional communication training (FCT)	98	69.0	10	7.0	34	23.9	142
Discrete trial training (DTT)	97	68.3	13	9.2	32	22.5	142
Extinction (EXT)	95	66.9	19	13.4	28	19.7	142
Parent-implemented intervention (PII)	95	66.4	19	13.3	29	20.3	143
Self-management (SM)	92	65.2	16	11.3	33	23.4	141
Differential reinforcement of alternative, incompatible, or other behavior (DR)	90	63.8	16	11.3	35	24.8	141
Exercise and movement (EXM)	90	62.9	17	11.9	36	25.2	143
Naturalistic intervention (NI)	88	62.0	11	7.7	43	30.3	142
Response interruption/ redirection (RIR)	87	60.8	17	11.9	39	27.3	143
Antecedent based interventions (ABI)	86	60.1	19	13.3	38	26.6	143
Task analysis (TA)	79	55.6	26	18.3	37	26.1	142
Augmentative and alternative communication (AAC)	70	49.6	24	17.0	47	33.3	141
Functional behavioral assessment (FBA)	68	47.9	41	28.9	33	23.2	142
Social narratives (SN)	67	47.2	36	25.4	39	27.5	142
Social skills training (SST)	66	46.5	33	23.2	43	30.3	142
Prompting (PP)	54	38.0	16	11.3	72	50.7	142
Direct instruction (DI)	53	37.1	21	14.7	69	48.3	143
Modeling (MD)	51	35.9	13	9.2	78	54.9	142
Reinforcement (R)	50	35.2	18	12.7	74	52.1	142
Visual supports (VS)	44	31.0	19	13.4	79	55.6	142

Role Differences

To determine whether there were differences between the groups of respondents according to their role in education (n = 125), mean scores were calculated for each of the respondents for their training in EBPs, for the confidence they had to implement EBPs, and for the frequency with which they implemented EBPs. The groups included special education teachers (n = 45), general education teachers (n = 25), early intervention providers (n = 22), administrators (n = 21), and related services personnel (n = 8) and other (n = 4). There were no significant differences between the role groups on training (p = .26) or on confidence (p = .20). Not surprisingly, there was a significant difference between groups on the frequency with which they implemented the practices (p = .02). Mean scores were the greatest for special education teachers (x = 2.82), followed by related services personnel or other, early intervention providers, administrators, general education teachers, and other, in that order. Post hoc comparisons were run to determine which groups were significantly different: given the large number of comparisons and small numbers in most of the groups, there was only one comparison exceeding an exploratory alpha of .1 (p = .057): general education teachers’ mean frequency scores (x = 2.03, SD = 0.97) were lower than special education teachers’ mean scores (x = 2.85, SD = 0.99).

Chi-Square Results: Reported Training and Confidence

The frequency of reported levels of training in the 27 EBPs (no training, more than 0–6 hr, more than 6 hr) and the confidence with which professionals report they can perform them (cannot, can with support, can independently) were subjected to chi-square analyses to determine whether levels of confidence were dependent on the training reported received on specific EBPs. For all EBPs, the chi-squares were significant at p < .001. To determine the effect sizes of the chi-square statistics, Cramér’s V was run for each. These data appear in the supplemental material. The chi-squares ranged between 56.90 (Visual Supports (X²(4, N = 154)) and 121.58 (Naturalistic Intervention (X²(4, N = 155)), and the effect sizes ranged between 0.787 (Social Skills Training) and 0.430 (Visual Supports). These also appear in supplemental material. With 4 degrees of freedom, effect sizes for chi-squares are considered large if they exceed 0.25 (Kim, 2017). For each of these analyses, all effect sizes are considered large.

For each EBP, levels of confidence and training were found to be associated or dependent upon each other. To illustrate, please see the observed percentages of Naturalistic Intervention in Figure 1. If the variables were unassociated, the bars or distributions of cases across levels of confidence would look exactly the same. However, in this case, there are clear differences between the number of individuals in the different levels of training by confidence. For this survey of early childhood professionals, all responses reported for confidence and training data for EBPs display similar characteristics to that of Naturalistic Intervention.

Figure 1.

Observed percentages of cases for naturalistic intervention: Training by confidence.

Discussion

This study used survey methodology to obtain information about the level of training, confidence, and frequency of implementation of 27 of 28 EBPs identified for children with ASD between the ages of 0 to 5 years by Steinbrenner et al. (2020). Consistent with previous studies (e.g., Gevarter et al., 2022; Hamrick et al., 2021; Layden et al., 2022), our findings indicated greater training is needed for early childhood professionals overall. Over half of participants reported that no training had been received in 16 of the 27 EBPs, with more than a third reporting no training in the remaining EBPs, with the exception of Visual Supports, in which 26.6% of respondents reported they had received no training. No EBP had more than a third of respondents reporting 6 or more hours of training with most under 20%. Compared with Layden et al. (2022), early childhood/early intervention providers reported less training overall, many noting receiving no training. This is also consistent with other findings (e.g., Hendricks, 2011) that reported teachers sharing concerns around training for working with students with ASD. If lack of training is coupled with the modification of EBPs reported by Suhrheinrich et al. (2013), the potential outcomes promised by those EBPs will likely not be realized.

In the area of confidence of implementation, an average of 19.76% (range 7.10% to 39.40%) of participants indicated they were confident in independently implementing the EBPs. More than one third of participants indicated they did not feel confident in implementing 17 of the 27 EBPs. In the remaining EBPs, participant reports of not being confident in implementing EBPs ranged between 19.0% and 31.0%. This is of particular concern as preschool special educators were reported to select instructional approaches based on their positive perception and implementation ability (Hugh et al., 2022). If early childhood professionals do not report feeling confident in their abilities to implement EBPs, they are less likely to do so. This impacts child outcomes even further when considering Nahmias et al. (2019) who reported better outcomes for programs that used EBPs at a higher rate.

The growing prevalence rate of children with ASD should be of particular concern to early childhood professionals. With more children being identified with ASD, more services will be required to support them. The increased demand for high-quality EI services reported by Suhrheinrich (2015), will only continue to grow and that high-quality is linked to implementation of EBPs. Yet, for frequency of implementation, our findings show more than half of respondents reported they have never implemented 18 of the 27 EBPs with approximately another third reporting never implementing the remaining 9 of 27 EBPs. Conversely, over half of respondents indicated they implemented prompting, modeling, reinforcement, and visual supports at least weekly. In the Layden et al. (2022) study, 22.7% of responses indicated at least weekly implementation of the EBPs with 77.3% of responses indicating the frequency of implementation was less than once per week or not at all.

We looked further at the reported levels of training and the confidence participants indicated they had in implementing the EBPs. Using the chi-square analysis, we had significant findings with large effect sizes for all 27 EBPs. Specifically, we found the level of confidence was highly dependent upon the training participants reported they had received for each specific EBP. This appears to indicate that training increases participants’ perceived ability to implement EBPs, even though the frequency of implementation was low overall.

We were interested in a variety of professionals working with young children with ASD. While no significant differences existed between groups of participants for training and confidence, there was significant differences for frequency. General education teachers were significantly different in terms of frequency of implementation. This may be due to having fewer children with ASD in their classrooms as well as less pre-service and in-services training targeted to them specifically. Also, there were 21 participants who indicated they were acting in an administrative capacity. While their mean score was lower than special education teachers, related service personnel, and early intervention providers, there was not a significant difference found. Even so, the relatively low levels of training and confidence indicated are still critical information as these administrators are likely involved in programmatic decisions and ensuring their teachers and staff are effectively implementing EBPs for their students.

Limitations

The findings of this study should be considered with the following limitations. First, these findings are based on self-reported survey data. Participants may not accurately report their levels of training, confidence, or implementation frequency. However, our findings suggest a need for improvement in all areas; even if the score were inflated, the overall outcome still suggests greater need for training to improve confidence and implementation. Additionally, just because participants report they are implementing an EBP does not necessarily indicate the extent to which they do implement or the quality of implementation. It was beyond the scope of this study to determine if EBPs are actually implemented with fidelity or if training was effectively delivered. Second, those who participated in the survey did so voluntarily. Those who participated may have a greater interest in children with ASD which may have impacted the results. Though again, based on our findings, even if that is the case, the need for improvement in training and implementation of EBPs is still apparent. Additionally, due to limited participants, generalizability of our findings may be impacted to some extent. We had just under 200 total participants and many of these were somewhat concentrated in the mid-Atlantic area.

Implications for Future Research

Future research should examine several factors. First, if training is occurring, what is the quality of that training including presentation and follow-up opportunities? Considering the wide variety of settings in which early childhood and EI providers work (Cate & Peters, 2018), it would be helpful to understand types of training that would be most beneficial by setting. For example, do teachers working in a Head Start environment need different training than those working in private, or home-based settings? Second, do early childhood and EI providers value EBPs for children with ASD? Asking these professionals to rate the importance of the EBPs may also provide insight into future efforts for training priorities. Third, researchers should consider whether early childhood and EI providers are implementing the EBPs with fidelity. Though there was some reported implementation, we did not measure the fidelity of that implementation.

Implications for Practitioners

Children with ASD require supports and services to meet their unique needs. Practitioners need to be equipped to provide such supports and services and, according to our findings, there is both a knowledge and implementation gap related to EBPs and young children with ASD. Practitioners need to be aware of and trained in the EBPs for children with ASD with whom they work. Systematic training focused on early childhood providers and their unique and varied environments that also considers factors such as education level or varying mandates in early childhood settings should occur to ensure all practitioners are capable of and confident in implementing EBPs. Measures to support fidelity of consistent implementation of EBPs should be considered and implemented to promote the effective use of these practices. With the consideration of varying settings of implementation, professionals who oversee practitioners should consider how to provide not only training but coaching and oversight as well. Practitioners may also be required to take a more active role in their own learning and implementation of EBPs for those with ASD.

Conclusion

Services for young children with disabilities, particularly those with ASD are critical. If professionals who are responsible for implementing services, whether EI or ECSE, are not able to implement EBPs consistently, children with ASD may not have their needs met and may not realize improved outcomes. The findings of our study indicate early childhood providers need greater training opportunities in EBPs specific to children with ASD. Additionally, these professionals need access and support to improve their implementation of EBPs in a consistent and more frequent manner.

Supplemental Material

sj-docx-1-tec-10.1177_02711214231219281 – Supplemental material for Discovering Practitioners’ Knowledge and Use of Evidence-Based Practices for Autism Early Childhood Interventions

Supplemental material, sj-docx-1-tec-10.1177_02711214231219281 for Discovering Practitioners’ Knowledge and Use of Evidence-Based Practices for Autism Early Childhood Interventions by Selena J. Layden, Heather Coleman, Kristin A. Gansle and Jessica Amsbary in Topics in Early Childhood Special Education

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Selena J. Layden

Supplemental Material

Supplemental material for this article is available on the Topics in Early Childhood Special Education website with the online version of this article.

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Supplementary Material

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