Common and Differing Elements Across Caregiver-Mediated Social Communication Programs Supporting Autistic Children: A Scoping Review With Content Analysis.

Abstract

Caregiver-mediated interventions are widely used to support social communication development in young autistic children. While many such interventions are evidence-informed, limited information exists about their shared and unique elements, making it challenging for caregivers and clinicians to tailor program selection to individual needs and preferences-an essential part of personalized care in autism. This scoping review with content analysis examined 18 commercially available, caregiver-mediated social communication interventions to identify similarities and differences in child skills targeted and caregiver-coached strategies. Data were extracted from program manuals, fidelity tools, published literature, and program websites for eight developmental social pragmatic (DSP) programs and 10 naturalistic developmental behavioral interventions (NDBIs). Programs varied in scope, with some supporting a broad range of child skills and others focusing on specific areas. Across all programs, 70 caregiver-coached strategies were identified, and then thematically grouped into eight categories aligned with the developmental skills the strategies aim to support. Although some strategies were common across all programs, some unique strategies were also identified. In addition, there were notable differences in how these strategies were operationalized despite using similar terminology, underscoring the need for more precise, clearly defined fidelity measures to enable accurate assessment of caregiver implementation and meaningful comparisons across programs. This study lays the groundwork for future research to identify active ingredients of interventions and supports more informed, individualized decision-making in clinical practice.Lay AbstractYoung autistic children may engage with others and communicate in ways that differ from non-autistic peers, and may need support to develop skills to communicate with, and navigate interactions with others. Many programs have been developed for this purpose, with a growing number of programs including caregivers in this process. In programs where caregivers play a primary role, professionals coach them to use certain techniques that can support social communication. Although many such programs exist, we still lack clarity on how these programs are similar or different, making it tough for families to choose among them. To address this gap, we reviewed 18 well-known caregiver-led programs to compare the skills they aim to support children with, and the specific techniques they teach caregivers. We gathered information from program resource materials, published research, and official program websites. We found that some programs focused on supporting a wide range of skills, whereas others targeted only certain developmental areas. In total, we identified 70 distinct caregiver-coached techniques, which we organized into eight categories. Many techniques were common across all programs, but others were unique to specific programs. Even among the shared techniques, there were differences in the way they were practiced, despite using the same strategy name. For example, a technique like "following the child's lead" could look quite different depending on the program. These findings show that having descriptions of how techniques should be used is important to understanding and comparing different programs. Overall, these findings provide families with information about program ingredients and can be used to guide clinicians toward programs that match individuals' needs and wants. This work also paves way for future research exploring how these social communication programs work, and evaluating which techniques are most effective for specific groups of children and families.