Theoretical Framework

Children with ASD require a comprehensive program that integrates evidence-based practices drawing from research on autism, early intervention, child development, and early childhood special education. Recent research, current federal and state legislation, and accumulated experience with young children with ASD have converged on the elements that were integrated into ESI. The ESI approach is guided by the following theoretical framework:

1. A family-centered approach to meet the family’s needs, concerns, and priorities throughout the assessment and intervention process. A family-centered approach holds the notion that parents and caregivers are the most knowledgeable source of information about the child, and are partners in the assessment and intervention process. Respecting family members’ priorities and preferences, planning for active family participation, sharing in decision-making, and building unity are key components of an effective family-centered program (Woods & Wetherby, 2003). A review of research by the National Research Council (NRC, 2001) on evidence-based practice for children with ASD identified family involvement as a key component of effective interventions.
   
   
2. Embedded intervention in natural environments for the child and family to enhance generalization. The NRC (2001) recommended that children with ASD need functional and meaningful opportunities for learning in their natural environment. Natural environments settings typical for the family in locations such as the home, child care, or other community locations such as the park or church. Daily activities such as dressing, mealtime, and play provide excellent opportunities to embed teaching of objectives that are functional and meaningful (Woods & Wetherby, 2003). Generalization of child and family outcomes is enhanced by embedding intervention in family preferred routines and contexts (Dunst et al., 2000; Kashinath, Woods, & Goldstein, 2006; Woods, Kashinath & Goldstein, 2004) and provides a context for the family and clinician to develop an active mutually respectful partnership (Koegel, 2000).
   
   
3. Parent-Implemented intervention. Families are maximally involved in the service delivery model for infants and toddlers with ASD by the simple fact of the child’s age and reliance on parents for nurturance. Parent implemented interventions necessitate systematic instruction for the parent by the interventionist. ESI incorporates the existing research that supports use of adult learning strategies that incorporate the adult’s experiences and interests, demonstration and specific feedback, problem-solving strategies to increase independent decision making and generalized use of information, self-assessment on effectiveness, and sequential instruction (Buysse & Wesley, 2005; McGee & Morrier, 2005).
   
   
4. Focus on the core deficits associated with autism—social communication, family and peer interaction, and play skills. It is critical to focus on the core social communication deficits of very young children with ASD, such as expanding the use of gestures, initiating communication, understanding and use of words, initiating and responding to joint attention, and reciprocity in interaction, because these skills predict later cognitive, social, and language outcomes. Intervention needs to focus not only on targeting goals to address core deficits of the child, but also targeting strategies for parents to use to support communication. ESI identifies goals and objectives and monitors progress with SCERTS (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2006). “SCERTS” refers to Social Communication (SC), Emotional Regulation (ER) and Transactional Support (TS). The SC and ER domains delineate goals and objectives for the child and are organized by communication stage. The TS domains delineate goals and objectives for the parent or other communicative partners to help the child meet his/her individualized goals and objectives. Enhancing a child’s development in social communication and emotional regulation through the strategic implementation of transactional supports, can lead to long-term positive effects on a child’s development in everyday activities and educational environments.
   
   
5. Intensity of programming for at least 25 hours of intervention per week. While the intensity of intervention necessary to provide optimal outcomes is not yet determined for infants and toddlers at risk for ASD, it has been shown that more time spent in active, positive engagement results in better outcomes for preschoolers (NRC, 2001). The NRC recommended a minimum of 25 hours per week of active engagement in intervention as soon as children are suspected of having ASD. In ESI, professionals work with parents for 3-4 hours per week to teach parents how to embed intervention strategies into ongoing daily activities, providing a means for achieving 25 hours of weekly intervention. This approach provides an efficient way to maximize intensity of intervention and minimize professional time and cost.
   
   
6. Systematic instruction and evaluation using individualized and evidence-based strategies (NRC, 2001). Individualizing services involves tailoring the intervention to fit both the child and family. Children with ASD can learn from everyday activities and experiences when learning opportunities are structured and systematic techniques are used to foster active engagement. Strategies that promote engagement are transactional supports that include teaching strategies and learning supports. ESI incorporates systematic instruction using evidence-based strategies that are developmentally sensible for toddlers and ongoing program evaluation with corresponding adjustments in programming.