Maximizing the use of practice-based clinical data to track social communication development in autistic preschoolers

Evaluating caregiver-delivered programs in clinical settings is necessary to generate practice-based evidence. One challenge of such research is the burden placed on clinicians to complete additional measurement tools. This exploratory study examined the validity of clinical forms already completed as part of the standard delivery of the More Than Words® (MTW) program and explored whether this clinical data would reveal distinct clinical and outcome profiles in real-world contexts.

The Social Communication Checklist (SCC), a MTW program-specific form completed by the speech-language pathologist, was collected for 36 autistic preschoolers during publicly funded delivery of MTW. We assessed the concurrent validity of autistic preschoolers' social communication stage and skills rated on the SCC pre- and post-program with two of their scores on reliable, validated tools: the Communication Function Classification System (CFCS) and the Focus on the Outcomes of Communication Under Six (FOCUS-34). We also explored autistic preschoolers' communicative participation outcome profiles on the FOCUS-34 with their assigned social communication stages on the SCC.

Autistic preschoolers' pre-program social communication stage on the MTW SCC correlated with their pre-program CFCS communication level and FOCUS-34 score. Most children showed positive social communication changes post-program according to the SCC, and two-thirds showed meaningful or possibly meaningful clinical change on the FOCUS-34; however, scores on these measures did not correlate. Autistic preschoolers at different pre-program SCC stages showed distinct communicative participation outcome profiles on the FOCUS-34.

Program-specific clinical forms like the SCC can be valuable for classifying autistic preschoolers' social communication skills, exploring differences in outcomes, capturing novel outcomes, and generating practice-based evidence.