# Multimodal Communication Outcomes for Hispanic Autistic Preschoolers Following Coached Student Clinician and Caregiver-Led NDBIs

## TL;DR

This study shows that coaching student clinicians and caregivers improves communication in autistic preschoolers, including using various communication methods like gestures and signs.

## Contribution

The study introduces cascading coaching programs with culturally responsive NDBI techniques for Hispanic families and reports child multimodal communication outcomes.

## Key findings

- All five children showed increased targeted communicative responses after NDBI coaching.
- Children used diverse communication forms like gestures and signs beyond their preferred mode.
- Communication rates were higher during student clinician-led sessions compared to caregiver-led ones.

## Abstract

This study examined child outcomes for five minimally verbal (or non-speaking) autistic preschoolers who participated in cascading coaching programs in which naturalistic developmental behavioral intervention (NDBI) techniques were taught to graduate student clinicians and Hispanic caregivers (three who primarily spoke English, and two who spoke Spanish). While prior studies reported on adult participant outcomes, this study analyzed child multimodal communication outcomes, using multiple baselines/probes single case experimental designs across contexts. Neurodiversity-affirming and culturally responsive principles were embedded within the intervention procedures. Following the introduction of a coached NDBI, all five children (three who received the intervention in English and two who received the intervention in Spanish) demonstrated increased use of (a) the total targeted communicative responses and (b) the targeted unprompted communicative responses, across both student clinician-led and caregiver-led play sessions. The Tau-U effect size measures revealed large-to-very large effects across all of the variables. Overall, higher rates of communication responses were observed during student clinician-led sessions than in caregiver-led sessions. Additionally, behavioral coding of the multimodal response forms (e.g., gestures, aided augmentative and alternative communication, signs, vocal words) using the Communication Matrix revealed that the children used a variety of response topographies during the intervention sessions beyond their preferred communication mode (e.g., signs for three participants). Four of the five children used symbolic communication forms consistently across both caregiver and student clinician-led sessions. Importantly, adults’ reinforcement of pre-symbolic or less advanced communication forms during the intervention did not inhibit the use of more advanced forms.