Using the Theory of Change framework to map active ingredients and mechanisms of change underlying an early parent-implemented intervention for autism spectrum disorder

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PROJECT SUMMARY Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability that affects 1 in 59 children in the United States. Early intervention is crucial for improving outcomes in this population. A growing body of early intervention research supports the use of Naturalistic Developmental Behavioral Interventions (NDBIs), which integrate developmental and behavioral techniques. A focus on caregiver involvement in early intervention led to the development of parent-implemented NDBIs (PI-NDBIs), in which parents are taught to deliver NDBI techniques with their children. However, more research is needed to understand how best to support caregivers in promoting their children’s learning at home. While PI-NDBIs have a growing evidence base for improving child outcomes, these complex interventions have not been widely adopted in community settings. The long-term goal of this research is to inform the optimization of PI-NDBIs in order to maximize efficacy, enable more widespread community implementation, and support planned adaptation of these interventions in community settings. These align with NICHD research priorities to promote the development, dissemination, and implementation of treatments for developmental disabilities that will impact clinical care in community settings and improve quality of life. Recent advances in the evaluation of complex interventions emphasize the utility of mixed method approaches for understanding how complex treatments work. The study objective is to use a mixed methods approach to elucidate potential active ingredients and associated mechanisms of change of an empirically supported early intervention which addresses core deficits of ASD. First, interviews with key stakeholders and subsequent qualitative analysis will be used to develop a comprehensive Theory of Change describing the potential active ingredients and mechanisms of change underlying Project ImPACT, an evidence-based PI-NDBI. This will clarify how parent- and provider-level factors may impact intervention outcomes. Next, a triangulation protocol will be used to integrate theory and research evidence with data from stakeholders. These results will be visualized in a Theory of Change model. Last, we will provide proof-of-concept of the Theory of Change by testing select pathways using archival data from intervention trials of Project ImPACT. The proposed research and multifaceted training plan include ongoing mentorship with experts in intervention and implementation science, advanced training in qualitative and mixed methods research, exposure to the field of evaluation science, supervised clinical experience, and experience engaging community stakeholders in research. Identification of active ingredients and associated mechanisms of change has the potential to optimize effectiveness and streamline interventions to increase access for those with limited resources and the greatest need for high fidelity treatments. This would help address the long-term public health impacts of early social communication deficits in ASD.