meeting the needs of young hispanic autistic children

Conditions: Autism

Summary: purpose of the study: the goal of this clinical trial is to find out if a technique called the "mutual gaze procedure" used in a culturally and linguistically responsive adaptation of pathways early intervention (clr-pathways) is the key to improving social communication, language, and everyday skills in young (18-42 months) hispanic autistic children experiencing low income. what will happen: researchers will compare two versions of clr-pathways. * version 1: includes mutual gaze strategies. * version 2: does not include mutual gaze strategies. what to expect: participants will: * attend 16 sessions (or 18 weeks if there are cancellations) of pathways intervention, each lasting 1.5 hours. * come to the clinic for a developmental check-up three times: before starting pathways, right after completing pathways, and three months after finishing pathways.

study description: * participants: 200 hispanic autistic children experiencing low income and their caregivers will be randomly assigned to one of two groups in parallel: 1. group 1: clr-pathways intervention with mutual gaze strategies. 2. group 2: clr-pathways intervention without mutual gaze strategies. * intervention sessions: participants will attend 16 sessions, each lasting 1.5 hours, over approximately 18 weeks (allowing for possible cancellations) of parent-mediated intervention in their homes or another convenient location. assessments: to track progress and evaluate long-term effects, participants will undergo several culturally and linguistically appropriate assessments at three time points: 1. baseline: within two weeks before starting the intervention. 2. post-intervention: within two weeks after completing the intervention. 3. three-month follow-up: 12-15 weeks after completing the intervention. each evaluation will take approximately 2-3 hours and will include: * child assessments: * autism diagnostic observation schedule, second edition (ados-2; lord et al., 2012): researchers will use the ados-2 to assess communication, social interaction, play, and restricted/repetitive behaviors and to confirm a research diagnosis of autism (administered only at baseline) * bayley scales of infant and toddler development, fourth edition (bayley-4; bayley \& aylward, 2019): researchers will use the bayley-4 to measure cognitive and motor skills (administered only at baseline) * preschool language scales, fifth edition (pls-5; zimmerman et al., 2011): researchers will use the english or spanish version of the pls-5 to assess receptive language age (administered only at baseline) * communication and symbolic behavior scales-developmental profile (csbs-dp; wetherby \& prizant, 2002): researchers will use the csbs-dp to evaluate social communication. * caregiver questionnaires: * phenx toolkit core measures (phenx; hamilton et al., 2011): researchers will use the phenx to collect family and child demographic information, including parents' and grandparents' place of birth. * vineland adaptive behavior scales, third edition (vabs-iii; sparrow et al., 2016): researchers will use the vabs-iii to assess adaptive functioning. * post-intervention social validity questionnaire (rollins et al., 2016): researchers will use a questionnaire from a previous intervention efficacy study to assess the social validity of the intervention. the csbs-dp and vabs-iii have been validated as appropriate measures for determining meaningful changes in children with or at high risk for autism, based on previous research. • video-recorded measures: * adult-child interactions (acis): twelve-minute recordings will be transcribed and coded for social orienting, the fluency and connectedness and joint engagement measures of the joint engagement rating inventory (jeri; adamson et al., 2020), intentional communication (ec indicator; greenwood et al., 2006), and expressive language. * parent-child interactions (pcis): twelve-minute naturalistic recordings will be coded for the parent calm authority and child affiliative obedience measures of the jeri.

Eligibility criteria:
inclusion criteria: * children must be from a hispanic family experiencing low income, defined as having an income-to-needs ratio of \< 200% of the federal poverty level, determined by their household size * children must be between 18-42 months old at the start of the study * children must have no other known neurological or genetic concerns or disorders determined by parent report * children must receive a calibrated severity score (css) of 4 or higher on the autism diagnostic observational schedule-2 (ados-2) administered by a qualified bilingual assessment associate * families must have a primary home language of english and/or spanish exclusion criteria: * children who are from a family that is not hispanic and/or does not have an income-to-needs ratio of \< 200% of the federal poverty level, determined by their household size * children younger than 18 months or older than 42 months at the start of the study * children whose parents report they have any other known neurological or genetic concerns or disorders * children who receive a calibrated severity score (css) lower than 4 on the ados-2 * families who do not have english or spanish as a primary home language

Keywords: autism intervention cultural and linguistic responsivity social development social communication hispanic