Balancing Standardization and Ecological Validity in the Measurement of Social Communication Intervention Outcomes

Caregiver-mediated communication intervention outcomes are inconsistently measured, varying by assessment settings, materials, and activities. Standardized materials are often used for measuring outcomes, yet it remains unknown whether such standardized contexts equitably capture caregiver and child intervention outcomes representative of dyads' typical interactions. This within-subject study investigates how intervention outcomes differ between family-selected and standardized interactional contexts for autistic toddlers and their caregivers.

Following an 8-week caregiver-mediated telehealth intervention delivered to 22 dyads, caregiver outcomes (fidelity of using responsive communication facilitation strategies) and child outcomes (total spontaneous directed communicative acts) were measured during two interactional contexts using (a) family-selected activities and (b) a standardized toy set. A routines checklist surveyed the activities dyads value, enjoy, complete frequently, and/or find difficult with their child.

Caregiver outcomes and child outcomes did not significantly differ between the family-selected and standardized interactional contexts. Descriptive results suggest that the types of toys commonly included in standardized toy sets are representative of the materials many families choose when playing with their child at home. However, during the family-selected interactional context, the majority of dyads also chose materials or activities that were not available to them during the standardized context.

It is necessary to carefully consider a more expansive approach to standardization in which intervention outcomes are measured in ecologically valid contexts, which meaningfully, accurately, and equitably capture caregiver and child functional outcomes, and the translation of interventions to families' everyday routines.