COMMENTARY

Implementing and Evaluating Early Intervention for Children with

Autism: Where Are the Gaps and What Should We Do?
Giacomo Vivanti , Connie Kasari, Jonathan Green, David Mandell, Melissa Maye, and Kristelle Hudry

Despite recent advances, the evidence base supporting early intervention for young children with autism spectrum disor-
der (ASD) remains relatively sparse. The International Society for Autism Research (INSAR) recently sponsored a Special
Interest Group (SIG) on Implementing and Evaluating Community-Based Early Intervention. Across three meetings, in 2015,
2016, and 2017, conveners of this SIG engaged >200 members to identify knowledge gaps and research priorities for
moving the field forward. Here, we summarize the perspectives that emerged from group discussion at the SIG meetings
as represented by scholars working actively in the field. Despite encouraging progress, critical gaps and research priorities
were identified across all the stages of intervention development and testing from conceptualization to community
implementation. Key issues include the need for (a) formal theories to guide early intervention development, evaluation,
and implementation; and alignment of intervention goals with scientific knowledge and societal changes that have
occurred in the decades since interventions were originally developed; (b) increased focus on feasibility of treatment pro-
cedures and alignment with stakeholder values during pilot evaluations; (c) use of research designs that allow for compar-
isons of different interventions and formats, analyses of active ingredients of treatment, and identification of moderators
and mediators of outcome; (d) use of community-partnered participatory research to guide adaptation of intervention
models to community settings; (e) inclusion of constructs related to implementation processes and outcomes in
treatment trials and; (f) an iterative approach to the progression of knowledge from intervention development to imple-
mentation. Autism Res 2018, 11: 16–23. V C 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Lay Summary: In this article, we summarize the themes discussed at the INSAR Special Interest Group (SIG) on
Implementing and Evaluating Community-Based Early Intervention. Priorities for moving the field forward identified in
the SIG included the need for (a) formal theories to guide the development and evaluation of interventions, (b) pilot
evaluations that investigate feasibility and acceptability of interventions, (c) methodologies that allow us to deter-
mine for whom different interventions bring most benefit and why this is so, (d) strategies to include community
members and other stakeholders in the process of developing and evaluating interventions, and (e) understanding of
factors that make interventions more likely to be adopted and successfully implemented in the real world.

Keywords: early intervention; autism; feasibility; efficacy; effectiveness; implementation; randomized controlled trials

While the past decade has witnessed steady growth in
autism spectrum disorder (ASD) early intervention
research, further research efforts are needed to ensure
practitioners and policy-makers have robust data on
intervention effectiveness and implementation to
secure optimal outcomes for children with ASD. To this
end, the International Society for Autism Research
sponsored a Special Interest Group (SIG) on Implement-
ing and Evaluating Community-Based Early Intervention,
aimed at stimulating discussion among groups working
on this topic around the world. The first SIG meeting,
held in 2015, initiated discussion and identified knowl-
edge gaps in early intervention research and practice.
In the subsequent SIG meetings in 2016 and 2017,
scholars in the field were invited to identify research
priorities to address such gaps through open debate and
collaborative problem solving. The present report is
based on the transcripts of discussions at each SIG,
summarized by the SIG co-chairs and scholars in the
field who presented at the 2016 SIG.
A scarcity of randomized controlled trials (RCTs) has
historically been identified as the key barrier to progress
in ASD early intervention [e.g., National Research
Council, 2001; Smith et al., 2007]. However, discussion
among SIG members highlighted that knowledge gaps
exist at every stage along the pathway from theoretical

From the A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA (G.V.); Center for Autism Research and Treatment, UCLA, Los Angeles,
CA (C.K.); University of Manchester, Manchester, UK (J.G.); Center for Mental Health Policy and Services Research, University of Pennsylvania,
Philadelphia, PA (D.M.); University of Massachusetts, Boston, MA (M.M.); Victorian Autism Specific Early Learning and Care Centre, and Olga
Tennison Autism Research Centre, La Trobe University, Melbourne, Australia (K.H.)
Received June 06, 2017; accepted for publication November 14, 2017
Address for correspondence and reprints: Giacomo Vivanti, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA.
E-mail: giacomo.vivanti@drexel.edu
Published online 05 December 2017 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.1900
C 2017 International Society for Autism Research, Wiley Periodicals, Inc.
V

16 Autism Research 11: 16–23, 2018 INSAR

 19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Box 1. Stages and processes in developing, evaluating and implementing interventions
Traditionally, the path from intervention development to implementation is articulated in a series of hierarchical steps. The first involves
the development of a treatment theory which underscores and clearly articulates the rationale for a given approach. Thereafter, evaluat-
ing an intervention typically begins with proof-of-concept work to ascertain preliminary evidence in support of the approach, including
evidence of feasible delivery and safety/acceptability to key stakeholders. With initial support for a model, evaluation typically proceeds to
pilot testing with larger numbers of participants, and then to full-scale test of efficacy with a sufficiently-sized sample to yield a
well-powered evaluation of whether or not the intervention can achieve its aims with the target population. Efficacious interventions are
then subject to tests of effectiveness, evaluating the extent to which putative benefits are maintained when delivery is within normative
contexts (rather than artificial settings, such as highly resourced University labs). Finally, implementation science addresses how to
ensure the successful adoption and implementation of a target program within relevant community settings.
Early intervention science may benefit from a more iterative approach, with various stages addressed in parallel and multidirectional
knowledge exchange between different levels [Stahmer, Aranbarri, Drahota, & Rieth, 2017]. For example, both careful theorizing and con-
sideration of resources and stakeholders’ beliefs should inform the development and evaluation of interventions, and moving directly from
treatment theory to community-based effectiveness trials might accelerate the pace of treatment development and testing.

conceptualization to community implementation of
early intervention. A framework for this pathway is
detailed in Box 1. Here, we follow this framework to
summarize the discussion points raised at the SIG,
highlighting gaps and priorities for furthering the
knowledge base around effective intervention for chil-
dren with ASD. Importantly, none of the research prior-
ities discussed at the SIG was free from debate, and the
framework presented here might not be unanimously
endorsed in the ASD research community. In the inter-
est of parsimony, the current report focuses on the
areas where consensus was reached among the article’s
authors.
Key Gaps and Research Priorities in
Implementation and Evaluation of ASD Early
Intervention
Gaps in Intervention Theory
Formal theories elucidating the hypothesized factors
leading to the problem being targeted and the hypothe-
sized processes of treatment change are critical to guide
intervention development and evaluation [Kazdin,
1999; Rapport, 2001]. However, in the field of ASD early
intervention research, theory lags behind practice
[Vivanti, 2017]. Therefore, a key priority in the field is
the formulation and/or refinement of formal theories to
guide hypothesis-driven examinations of all aspects of
how interventions work: the utility and usability of par-
ticular models; the mechanisms underlying their effec-
tiveness; and how these interact with particular
characteristics of the child, implementation context,
and other interventions the child is receiving concur-
rently. Additionally, as new early interventions for ASD
are introduced with growing frequency, and limited
information is offered about their differences and over-
lap with existing approaches, a precise delineation of
the unique and shared theoretical underpinnings
informing intervention models is critical to bring clarity
and parsimony to the field. To this aim, proponents of
new models should articulate the rationale dictating
treatment procedures and clarify the theoretical distinc-
tiveness of the new approach relative to existing ones,
thus providing a road-map for hypothesis-driven evalu-
ation. A test of these hypotheses should then be
reflected in a pre-specified analytic plan which is final-
ized before unblinding and analysis. Importantly, inter-
ventions might work for reasons that differ from those
theorized by their developers, raising the question of
‘why bother’ with intervention theories if the treatment
is beneficial anyway. However, as even the most prom-
ising interventions produce different levels of success
across individuals [Schreibman, 2000] and contexts
[Mandell et al., 2013], theory-driven efforts to under-
stand how interventions work are critical to our capac-
ity to adapt, optimize, and customize interventions
without diluting their active ingredients [Onken et al.,
2014].
Additionally, many intervention models in current use
were originally conceptualized decades ago. Therefore, a
key priority for the field is to evaluate whether contempo-
rary knowledge about ASD can be accommodated within
existing early intervention theories, or requires that treat-
ment concepts and protocols be updated or reformulated.
Early intervention approaches for ASD are designed to
facilitate the acquisition of novel skills—thus, interven-
tions should evolve as our knowledge advances on how
children with ASD learn. There are encouraging efforts in
this direction. For example, neuroscience research on the
social reward system and abnormal cortical connectivity
in ASD is beginning to inform teaching practices and
hypothesized mechanisms of action in some early inter-
vention models [Dawson, 2008; Odom, 2016; Sullivan,
Stone, & Dawson, 2014]. However, historical difficulties
with cross-disciplinary dialogue and insufficient transla-
tional efforts to bridge basic science, theory and applied
knowledge in the field are significant barriers to the
agenda of aligning treatment theories to current

INSAR Vivanti et al./Gaps and priorities for intervention research 17


knowledge [Critchfield, Doepke, & Campbell, 2015;
Kohls, Chevallier, Troiani, & Schultz, 2012; Smith, 2012].
Similar considerations apply with respect to the socie-
tal changes that have occurred in the decades since
intervention programs were originally developed,
including the growing emphasis on social models of
disability focused on removing barriers to self-
determination, and inclusion [United Nations, 2006].
Formalized treatment theories would create the oppor-
tunity to explicitly clarify the relevance of intervention
rationales and treatment targets (e.g., changes in cogni-
tive functioning) to the core concepts of empowerment
and social participation that underlie contemporary
societal views on disability and priorities of advocacy
movements.
Gaps in Proof-of-Concept and Pilot Evaluation Studies
Once the theoretical rationale for an intervention is
established, proof-of-concept work using small scale
studies (e.g., single-subject designs, case series, and pilot
controlled trials) should be conducted to ascertain pre-
liminary evidence in support of the feasibility and
potential utility of the new treatment, in particular for
trials that require many resources or comprise novel
approaches. Although there is no shortage of proof-of-
concept and pilot evaluations in ASD early interven-
tion, guidelines on what can be learned from such stud-
ies [e.g., Craig et al., 2008; Kratochwill et al., 2010] are
not utilized consistently. In particular, pilot studies in
this field often focus on drawing inference regarding
evidence for the treatment benefits (even though the
study was not designed or adequately powered to pro-
vide this information), and neglect critical information
on treatment feasibility, and social validity/acceptabil-
ity to key stakeholders (a critical step for moving
towards tests of effectiveness). This might reflect the
historical emphasis on demonstrating intervention suc-
cess over documenting the relevance of treatment goals
to stakeholders in the ASD field [Dingfelder & Mandell,
2011]. However, ASD intervention research would bene-
fit from an increased appreciation of the scope of proof-
of-concept studies and pilot evaluations. This should
include indication of feasibility and acceptability of
treatment procedures and alignment with stakeholder
values, as well as preliminary indication—but not con-
clusive claims—of whether any signal of effect presents
in the anticipated direction, thereby providing justifica-
tion for moving toward a fully-powered clinical trial
[see e.g., Bearss, Johnson, Handen, Smith, & Scahill,
2013; Brookman-Frazee, Drahota, & Stadnick, 2012].
Gaps in the Evaluation of Efficacy
Well-powered clinical trials are the gold-standard for
evaluating treatment efficacy, allowing us to estimate
18 Vivanti et al./Gaps and priorities for intervention research
19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
the potential benefits of a specific manualized interven-
tion and to explore additional factors, such as for
whom the intervention is beneficial, and how/why this
is the case. The need for more RCT-based evidence as a
key research priority in ASD has been discussed in the
field for decades [Kasari, 2002; Rogers, 1996] and in
recent years, significant gains have been made in
scaling-up intervention studies from pilot- to full-scale
trials. For example, while Diggle and McConachie
[2002] found only two very small RCTs (n < 40) in a sys-
tematic review of parent-mediated early interventions
for ASD conducted 15 years ago, Oono, Honey, and
McConachie [2013] more recently identified 17 such
studies, at least 5 of which were fully powered to detect
their anticipated effects. Despite such an encouraging
trend, RCT evidence in the field of ASD treatment con-
tinues to be meager compared to that for other mental
health diagnoses [McGrew, Ruble, & Smith, 2016], pos-
sibly reflecting practical barriers (e.g., logistical chal-
lenges with carrying out RCTs on resource intensive
interventions), and cultural ones [e.g., historical skepti-
cism on the appropriateness of RCTs in the context of
the multifaceted and comprehensive nature of interven-
tion programs for individuals with ASD, e.g., Mesibov &
Shea, 2011; Keenan & Dillenburger, 2011].
RCT studies allow us to understand the average effect
of a particular intervention model or format for a par-
ticular target population, and can provide information
on how/why such approaches confer benefit for young
children with ASD [if powered to permit tests of media-
tion; Gulsrud, Hellemann, Shire, & Kasari, 2015; Pickles
et al., 2015], and factors that predict greater versus
more limited gains from intervention, including charac-
teristics of individuals for whom an approach may be
particularly well suited [tests of moderation; Kaale,
Fagerland, Martinsen, & Smith, 2014]. Such informa-
tion is critical in the ASD field, as the etiological and
clinical heterogeneity of this population might result in
different sub-groups of children responding differently
to different treatments [Stahmer, Suhrheinrich, & Man-
dell, 2016].
We have yet to fully exploit the potential of RCT
designs to thoroughly test the comparative efficacy of
interventions, active therapeutic ingredients, and sub-
group variation in treatment response. Further progress
in this area requires increasing sophistication in trial
methodology (e.g., factorial designs, comparative effi-
cacy trials) and adaptive treatment designs to provide
information on how and when to introduce adapta-
tions in response to the child’s treatment progress over
the course of the intervention [see Almirall & Chronis-
Tuscano, 2016; and Lei et al., 2012 for an overview on
adaptive designs, and Kasari et al., 2014, for an applica-
tion in ASD early intervention].
INSAR

Gaps in the Evaluation of Effectiveness
Research on effectiveness evaluates the extent to which
benefits documented in efficacy trials are maintained
when early intervention is implemented in “the real
world”. Such research is critical in the field of ASD, as
community practitioners often question the utility of
recommended evidence-based interventions in the con-
text of the complex needs of this heterogeneous client
group, the large caseload and the low resources avail-
able in community settings [Stahmer, Suhrheinrich,
Reed, & Schreibman, 2012]. As we learn more about
implementation challenges, we can hone intervention
strategies to fit the context within which they need to
be delivered, and work towards sustainability. By way
of illustration, Preschool Autism Communication Ther-
apy (PACT), a parent-mediated approach originally
developed and tested in the UK [Green et al., 2010;
Pickles et al., 2016], was recently adapted for delivery in
rural communities in South Asia [Divan et al., 2015].
The original efficacy trial was designed in a way that
made it possible to identify the therapeutic mechanism
[Pickles et al., 2015], so as to preserve ‘active ingre-
dients’ while adapting procedures and concepts to the
specific parenting cultures, resources, and other contex-
tual factors in rural South India and Pakistan. The adap-
tation process was based on focus groups and
workshops conducted with local stakeholders, which
resulted in an adapted, manualized treatment proce-
dures and, in turn, provided the foundation for an RCT
that replicated key findings from the original UK effi-
cacy trial [Rahman et al., 2016].
Despite the recent growth of ASD intervention studies
using community-based participatory research [e.g.,
Mandell et al., 2013], there remains a paucity of studies
based on a community-partnered participatory research
(CPPR) approach [Jones & Wells, 2007], which empha-
sizes community-academic collaborations where
researchers and community stakeholders are equal part-
ners in the development of research aims, design,
implementation, and outputs. Using CPPR as a comple-
mentary effort to large scale effectiveness trials, recent
studies have introduced adaptations for teachers work-
ing with children in preschool settings in the context
of randomized controlled hybrid implementation
designs, where teacher implementation and child out-
comes are both considered [Chang, Shire, Shih, Gel-
fand, & Kasari, 2016; Shire et al., 2017].
Challenges associated with CPPR include identifying
the trade-off between adaptations to improve treatment
usability (e.g., making the treatment shorter) and pres-
ervation of elements that promote effectiveness (e.g.,
treatment intensity), as well as negotiating and relin-
quishing power on research methods and products.
Addressing this challenge requires clinical scientists to
INSAR Vivanti et al./Gaps and priorities for intervention research
19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
gain a sophisticated understanding of the context in
which the implementation is taking place through basic
descriptive research and thoughtful piloting, and to cre-
ate imaginative adaptations of intervention procedures
so as to preserve effectiveness in the novel (and often
complex) setting [Smith, Iadarola, Mandell, Harwood,
& Kasari, 2017].
Gaps at the Level of Implementation
When early intervention models for children with ASD
are implemented in the community, a number of chal-
lenges arise, including issues with organizational leader-
ship, infrastructure and resources, lack of motivation/
commitment from staff, or commitment in the control
group that results in their learning the intervention on
their own, thereby contaminating the results. While a
full description of implementation science is beyond
the scope of this commentary [see Eccles et al., 2009;
Green, 2012, for an overview], a critical focus of this
discipline concerns the features of organizations (e.g.,
preschool settings, early intervention programs) that
influence the adoption and successful deployment of
efficacious interventions. Through the lens of imple-
mentation science, factors such as organizational sys-
tems, processes and cultures, and the ‘buy-in’ of
professionals involved in the intervention, are not
merely ‘noise’ inherent in the evaluation of a carefully
controlled trial, but rather are critical factors of interest
that deserve evaluation in their own right. Ultimately,
it is incumbent upon the ASD research community to
understand not just whether a particular intervention is
effective, but how to make that intervention viable
within a particular context.
To achieve this aim, studies should include measure-
ment of ‘implementation outcomes,’ such as (a) adop-
tion, the commitment from individuals and
organizations to using a particular intervention; (b) fea-
sibility, whether community workers have the necessary
skills/training and desire/intention to do what an inter-
vention approach stipulates; and (c) penetration, the
extent to which an approach is implemented with all
children vs. selectively implemented with some but not
others, for reasons which may be logical for the individ-
ual in question but not otherwise apparent. Another
important implementation construct is fidelity, or
adherence to the treatment protocol. While interven-
tion fidelity has received more research attention com-
pared to other implementation constructs, in a solid
evaluation of effectiveness, fidelity should be allowed to
vary as it would in usual community practice, as it is
important to understand the reasons for and conse-
quences of sub-threshold implementation, as well as
effects on subsequent child outcomes. Investigation of
factors such as interventionists’ attitudes (whether they
19

think that using the intervention is good or bad thing
to do), norms (the extent with which interventionists
feel they are expected to use the intervention, or
believe that their peers are using it) and self-efficacy
(the extent to which they think that, if they wanted to,
they could deliver the intervention), are critical to iden-
tifying markers of whether an intervention will be
implemented, and to what degree of fidelity [see for
example Dingfelder & Mandell, 2011; Locke et al.,
2015, 2016].
Implementation science is characterized by many
constructs, but few formal theories. Therefore, the study
of these factors borrows from theories of motivation,
leadership, organizational dynamics, supply and
demand that arise from other disciplines, such as eco-
nomics, and social and organizational psychology.
Crossing disciplinary boundaries to engage other fields
in collaboration is challenging, and requires measuring
and making predictions on factors and constructs
which traditionally sit outside of ASD intervention
research. Nevertheless, considering implementation
outcomes is critical from the initial stages of interven-
tion development. Just like a software developer will
never create a program without the end-user in mind,
intervention developers must consider the caregivers,
teachers, and clinicians who will deliver the interven-
tion with children with ASD, and ensure they will be
able and willing to implement it as intended, or a
highly promising approach might be destined for
failure.
Need for an Iterative Approach in Intervention Development
and Evaluation
The path from constructing treatment rationales to
implementing interventions in the ‘real world’ involves
a sequence of hierarchically organized stages, with
knowledge gained in each step providing a foundation
for the following step. However, the process should not
be limited to a unidirectional linear progression, but
also include multidirectional exchange between differ-
ent levels, where knowledge generated at each stage
informs both the following and the preceding stages
[Kazdin, 2001; Stahmer et al., 2017]. For example,
knowledge generated in an efficacy RCT study might
indicate the appropriateness of moving toward effec-
tiveness trials and implementation studies, while also
indicating the need for adjustments in the conceptuali-
zation of treatment rationale (e.g., if the treatment
appears to be beneficial but mechanisms and domains
of change differ from those hypothesized). Similarly,
both the hypothesized mechanisms of treatment
change, and stakeholders’ goals related to the treatment
should inform the evaluation of interventions (e.g.,
choice of outcome measures that reflect meaningful
20 Vivanti et al./Gaps and priorities for intervention research
19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
change on factors important to stakeholders). In turn,
the result of a trial will inform both theory of treatment
change and the relevance of treatment outcomes to
stakeholders’ goals. Such iterative approach might
accelerate the pace of treatment development and test-
ing in ASD.
Conclusions
Several “calls to action” have been made to improve
ASD intervention development research [Lord et al.,
2005; Maglione et al., 2012; Smith et al., 2007; Stahmer
et al., 2016]. The key priorities that emerged from the
INSAR SIG on Implementing and Evaluating Community-
Based Early Intervention expanded on the previously
identified scarcity of efficacy and effectiveness trials and
need for characterizing ASD intervention by indicating
the presence of gaps and priorities at each stage of the
process from intervention theory development to
implementation, and highlighting the way in which an
iterative approach—involving both top-down and
bottom-up dynamics of knowledge exchange between
different stages—might accelerate the pace of work in
this field. Gaps and research priorities included the
need for formal theories on mechanisms of treatment
change and adoption of interventions by individuals
and organizations to guide implementation and evalua-
tion. On a related point, intervention theories should
be aligned with current knowledge and societal views
on ASD, which differ considerably from those held at
the time when many interventions were originally
developed. Second, pilot evaluations of interventions
should devote greater attention to indicators of feasibil-
ity and acceptability of treatment goals and alignment
with stakeholder values. Third, efficacy trials should use
research designs that allow comparison of the benefits
of different approaches, analyze mechanisms of effect,
and identify prerequisites for interventions to benefit
particular children, given the substantial heterogeneity
evident in this condition. Fourth, community-
partnered participatory research is needed to guide the
adaptation of existing approaches and to develop new
models with a focus on targets and procedures relevant
to end-users. Fifth, intervention trials should include
constructs related to implementation processes and out-
comes. Importantly, numerous barriers to this research
agenda exist, reflecting the heterogeneity of strengths
and needs within the ASD population, conflicting views
on intervention research goals and priorities among dif-
ferent stakeholders [including self-advocacy groups; Pel-
licano, Dinsmore, & Charman, 2014], and the logistical
challenges associated with flexible and rigorous imple-
mentation of early interventions for ASD. However,
efforts towards these goals have the potential to
INSAR

generate a wealth of ‘usable’ knowledge to improve out-
comes for children with ASD in community settings
globally.
Acknowledgments
We would like to thank Cathy Bent, Heather Nuske, the
INSAR SIG Committee Co-Chairs Mayada Elsabbagh
and Laura Anthony, and the SIG attendees. A special
thank also to the invited speakers in the 2017 SIG
panel, Evdokia Anagnostou, Bhismadev Chakrabarti,
Isabel Smith, Aubyn Stahmer, Fred Volkmar, and those
who participated in the 2015 SIG forum, Alice Carter,
Ya-Chih Chang, Blythe Corbett, Annette Estes, Marie-
Maude Geoffray, Victoria Grahame, Anders Nordahl-
Hansen, Suzannah Iadarola, Lisa Iban ~ ez, and Brian
Reichow.
Conflict of Interest
The authors declare no conflict of interest.
References
Almirall, D., & Chronis-Tuscano, A. (2016). Adaptive interven-
tions in child and adolescent mental health. Journal of
Clinical Child and Adolescent Psychology, 45, 383–395.
Bearss, K., Johnson, C., Handen, B., Smith, T., & Scahill, L. (2013).
A pilot study of parent training in young children with autism
spectrum disorders and disruptive behavior. Journal of Autism
and Developmental Disorders, 43, 829–840.
Brookman-Frazee, L.I., Drahota, A., & Stadnick, N. (2012). Train-
ing community mental health therapists to deliver a package
of evidence-based practice strategies for school-age children
with autism spectrum disorders: A pilot study. Journal of
Autism and Developmental Disorders, 42, 1651–1661.
Chang, Y.C., Shire, S.Y., Shih, W., Gelfand, C., & Kasari, C.
(2016). Preschool deployment of evidence-based social com-
munication intervention: JASPER in the classroom. Journal
of Autism and Developmental Disorders, 46, 2211–2223.
Critchfield, T.S., Doepke, K.J., & Campbell, R.L. (2015). Origins
of clinical innovations: Why practice needs science and
how science reaches practice. In Autism Service Delivery
(pp. 1–23). New York, NY: Springer.
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., &
Petticrew, M. (2008). Developing and evaluating complex
interventions: The new Medical Research Council guidance.
British Medical Journal, 337, a1655.
Csibra, G., & Gergely, G. (2007). ‘Obsessed with goals’: Func-
tions and mechanisms of teleological interpretation of
actions in humans. Acta Psychologica, 124, 60–78.
Dawson, G. (2008). Early behavioral intervention, brain plastic-
ity, and the prevention of autism spectrum disorder. Devel-
opment and Psychopathology, 20, 775–803.
Dawson, G., & Bernier, R. (2007). Social brain circuitry in
autism. In D. Coch, G. Dawson, & K. Fischer (Eds.), Human
behavior and the developing brain. New York, NY: Guilford
Press.
INSAR Vivanti et al./Gaps and priorities for intervention research
19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Diggle, T.T., & McConachie, H.H. (2002). Parent-mediated
early intervention for young children with autism spectrum
disorder. The Cochrane Library, 1, CD009774.
Divan, G., Hamdani, S.U., Vajartkar, V., Minhas, A., Taylor, C.,
Aldred, C., . . . Patel, V. (2015). Adapting an evidence-based
intervention for autism spectrum disorder for scaling up in
resource-constrained settings: The development of the PASS
intervention in South Asia. Global Health Action, 3, 272–278.
Dingfelder, H.E., & Mandell, D.S. (2011). Bridging the
research-to-practice gap in autism intervention: An applica-
tion of diffusion of innovation theory. Journal of Autism
and Developmental Disorders, 41, 597–609.
Eccles, M.P., Armstrong, D., Baker, R., Cleary, K., Davies, H.,
Davies, S., . . . Logan, S. (2009). An implementation research
agenda. Implementation Science, 4, 18.
Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V.,
Howlin, P., . . . Barrett, B. (2010). Parent-mediated
communication-focused treatment in children with autism
(PACT): A randomised controlled trial. Lancet, 375, 2152–2160.
Green, J. (2012). Editorial: Science, implementation, and
implementation science. Journal of Child Psychology and
Psychiatry, 53, 333–336.
Gulsrud, A.C., Hellemann, G., Shire, S., & Kasari, C. (2015).
Isolating active ingredients in a parent-mediated social
communication intervention for toddlers with autism spec-
trum disorder. Journal of Child Psychology and Psychiatry,
57, 606–613.
Heyes, C. (2016). Born pupils? Natural pedagogy and cultural
pedagogy. Perspectives on Psychological Science, 11, 280–295.
Insel, T.R., & Fernald, R.D. (2004). How the brain processes
social information: Searching for the social brain. Annual
Review of Neuroscience, 27, 697–722.
Jones, L., & Wells, K. (2007). Strategies for academic and clini-
cian engagement in community-participatory partnered
research. Journal of the American Medical Association, 297,
407–410.
Kaale, A., Fagerland, M.W., Martinsen, E.W., & Smith, L.
(2014). Preschool-based social communication treatment
for children with autism: 12-month follow-up of a random-
ized trial. Journal of the American Academy of Child &
Adolescent Psychiatry, 53, 188–198.
Kasari, C. (2002). Assessing change in early intervention pro-
grams for children with autism. Journal of Autism and
Developmental Disorders, 32, 447–461.
Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa,
R., . . . Almirall, D. (2014). Communication interventions
for minimally verbal children with autism: A sequential
multiple assignment randomized trial. Journal of the Ameri-
can Academy of Child & Adolescent Psychiatry, 53(6), 635–
646.
Kazdin, A.E. (1999). Current (lack of) status of theory in child
and adolescent psychotherapy research. Journal of Clinical
Child Psychology, 28, 533–543.
Kazdin, A.E. (2001). Progression of therapy research and clini-
cal application of treatment require better understanding of
the change process. Clinical Psychology: Science and Prac-
tice, 8, 143–151.
Keenan, M., Dillenburger, K. (2011). When all you have is a
hammer. . .: RCTs and hegemony in science. Research in
Autism Spectrum Disorders, 5, 1–13.
21

Kohls, G., Chevallier, C., Troiani, V., & Schultz, R.T. (2012).
Social ‘wanting’ dysfunction in autism: Neurobiological
underpinnings and treatment implications. Journal of Neu-
rodevelopmental Disorders, 4, 10.
Kratochwill, T.R., Hitchcock, J., Horner, R.H., Levin, J.R.,
Odom, S.L., Rindskopf, D.M., & Shadish, W.R. (2010).
Single-case designs technical documentation. Retrieved May
22, 2017, from: https://ies.ed.gov/ncee/wwc/Document/229
Kuhl, P.K. (2011). Early language learning and literacy: Neuro-
science implications for education. Mind, Brain, and Educa-
tion, 5, 128–142.
Lei, H., Nahum-Shani, I., Lynch, K., Oslin, D., & Murphy, S.A.
(2012). A “SMART” design for building individualized treat-
ment sequences. Annual Review of Clinical Psychology, 8,
21–48.
Locke, J., Olsen, A., Wideman, R., Downey, M.M., Kretzmann,
M., Kasari, C., & Mandell, D.S. (2015). A tangled web: The
challenges of implementing an evidence-based social
engagement intervention for children with autism in urban
public school settings. Behavior Therapy, 46, 54–67.
Locke, J., Beidas, R.S., Marcus, S., Stahmer, A., Aarons, G.A.,
Lyon, A.R., . . . Mandell, D.S. (2016). A mixed methods
study of individual and organizational factors that affect
implementation of interventions for children with autism
in public schools. Implementation Science, 11, 135.
Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M.,
Charman, T., . . . Harris, S. (2005). Challenges in evaluating
psychosocial interventions for autistic spectrum disorders.
Journal of autism and developmental disorders, 35, 695–
708.
Maglione, M.A., Gans, D., Das, L., Timbie, J., & Kasari, C.
(2012). Nonmedical interventions for children with ASD:
Recommended guidelines and further research needs. Pedi-
atrics, 130(Supplement 2), S169–S178.
Mandell, D.S., Stahmer, A.C., Shin, S., Xie, M., Reisinger, E., &
Marcus, S.C. (2013). The role of treatment fidelity on out-
comes during a randomized field trial of an autism inter-
vention. Autism, 17, 281–295.
National Research Council. (2001). Educating children with
autism. Washington, DC: National Academies Press.
McGrew, J.H., Ruble, L.A., & Smith, I.M. (2016). Autism spec-
trum disorder and evidence-based practice in psychology.
Clinical Psychology: Science and Practice, 23, 239–255.
Mesibov, G.B., & Shea, V. (2011). Evidence-based practices and
autism. Autism, 15, 114–133.
Nielsen, M., & Carpenter, M. (2008). Reflecting on imitation in
autism: Introduction to the special issue. Journal of Experi-
mental Child Psychology, 101, 165–169.
Odom, S.L. (2016). The role of theory in early childhood spe-
cial education and early intervention. In Handbook of early
childhood special education (pp. 21–36). Cham: Springer.
Onken, L.S., Carroll, K.M., Shoham, V., Cuthbert, B.N., &
Riddle, M. (2014). Reenvisioning clinical science: unifying
the discipline to improve the public health. Clinical Psy-
chological Science, 2, 22–34.
Oono, I.P., Honey, E.J., & McConachie, H. (2013). Parent-
mediated early intervention for young children with autism
spectrum disorders (ASD). Evidence-Based Child Health: A
Cochrane Review Journal, 8, 2380–2479.
22 Vivanti et al./Gaps and priorities for intervention research
19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Pellicano, E., Dinsmore, A., & Charman, T. (2014). What
should autism research focus upon? Community views and
priorities from the United Kingdom. Autism, 18, 756–770.
Pickles, A., Harris, V., Green, J., Aldred, C., McConachie, H.,
Slonims, V., . . . Charman, T. (2015). Treatment mechanism
in the MRC preschool autism communication trial: Implica-
tions for study design and parent-focused therapy for chil-
dren. Journal of Child Psychology and Psychiatry, 56, 162–
170.
Pickles, A., Le Couteur, A., Leadbitter, K., Salomone, E., Cole-
Fletcher, R., Tobin, H., . . . Green, J. (2016). Long term
symptom reduction following preschool autism interven-
tion. Lancet, 388, 2501–2509.
Rahman, A., Divan, G., Hamdani, S.U., Vajaratkar, V., Taylor,
C., Leadbitter, K., . . . Patel, V. (2016). Effectiveness of the
parent-mediated intervention for children with autism
spectrum disorder in south Asia in India and Pakistan
(PASS): A randomised controlled trial. The Lancet Psychia-
try, 3, 128–136.
Rapport, M.D. (2001). Bridging theory and practice: conceptual
understanding of treatments for children with attention
deficit hyperactivity disorder (ADHD), obsessive-compulsive
disorder (OCD), autism, and depression. Journal of clinical
child psychology, 30, 3–7.
Rogers, S.J. (1996). Brief report: Early intervention in autism.
Journal of Autism and Developmental Disorders, 26, 243–
246.
Schreibman, L. (2000). Intensive behavioral/psychoeducational
treatments for autism: Research needs and future directions.
Journal of autism and developmental disorders, 30(5), 373–
378.
Shire, S.Y., Chang, Y.C., Shih, W., Bracaglia, S., Kodjoe, M., &
Kasari, C. (2017). Hybrid implementation model of
community-partnered early intervention for toddlers with
autism: A randomized trial. Journal of Child Psychology
and Psychiatry, 58, 612–622.
Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., Odom,
S., . . . Wagner, A. (2007). Designing research studies on psy-
chosocial interventions in autism. Journal of Autism and
Developmental Disorders, 37, 354–366.
Smith, T. (2012). Evolution of research on interventions for
individuals with autism spectrum disorder: Implications for
behavior analysts. The Behavior Analyst, 35, 101–113.
Smith, T., Iadarola, S., Mandell, D.S., Harwood, R., & Kasari, C.
(2017). Community-partnered research with urban school
districts that serve children with Autism Spectrum Disorder.
Academic Pediatrics, 17, 614–619.
Stahmer, A.C., Aranbarri, A., Drahota, A., & Rieth, S. (2017).
Toward a more collaborative research culture. Extending
translational science from research to community and back
again. Autism, 21, 259–261.
Stahmer, A.C., Suhrheinrich, J., & Mandell, D.S. (2016). The
importance of characterizing intervention for individuals
with autism. Autism: The International Journal of Research
and Practice, 20, 386.
Stahmer, A.C., Suhrheinrich, J., Reed, S., & Schreibman, L.
(2012). What works for you? Using teacher feedback to
inform adaptations of pivotal response training for class-
room use. Autism Research and Treatment, 2012, 709861–
709861.
INSAR

Sullivan, K., Stone, W.L., & Dawson, G. (2014). Potential neu-
ral mechanisms underlying the effectiveness of early inter-
vention for children with autism spectrum disorder.
Research in Developmental Disabilities, 35, 2921–2932.
United Nations. (2006). United Nations Convention on the
Rights of Persons with Disabilities (UNCRPD). Strasbourg:
Assembly of European Regions. Retrieved May 22, 2017,
from www.un.org/esa/socdev/enable/rights/convtexte.htm
INSAR Vivanti et al./Gaps and priorities for intervention research
19393806, 2018, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/aur.1900 by Drexel University, Wiley Online Library on [24/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Vivanti, G. (2017). Individualizing and combining treatments
in autism spectrum disorder: Four elements for a theory-
driven research agenda. Current Directions in Psychological
Science, 26, 114–119.
Vivanti, G., Dawson, G., & Rogers, S.J. (2017). Early learning and
autism. In G. Vivanti, E. Duncan, G. Dawson, & S.J. Rogers
(Eds.), Implementing the group-based early start Denver
model for preschoolers with autism. New York: Springer.
23