Usual care for youth with autism spectrum disorder: Community-based providers’ reported familiarity with treatment practices

Abstract

ObjectiveTo examine patterns and predictors of familiarity with transdisciplinary psychosocial (e.g., non-pharmacologic) practices for practitioners treating youths with autism spectrum disorder (ASD) in the United States.MethodPractitioners (n = 701) from behavioral, education, medical, and mental health backgrounds who worked with youth (ages 7–22) with ASD completed the Usual Care for Autism Survey, which assessed provider demographics and self-reported familiarity with transdisciplinary treatment practices for the most common referral problems of ASD. We examined relations between provider-, setting-, and client-level characteristics with familiarity of key groups of the treatment practices (practice sets). Practice sets were identified using exploratory factor analysis (EFA), and demographic predictors of practice subsets were examined using generalized estimating equations (GEE).ResultsThe EFA yielded a three-factor solution: (1) environmental modifications/antecedent strategies; (2) behavior analytic strategies; and (3) cognitive strategies, with overall familiarity ranked in this order. Medical providers indicated the least familiarity across disciplines. More experience with ASD and treating those with intellectual disabilities predicted greater familiarity with only environmental modifications/antecedent strategies and behavior analytic, but not cognitive strategies. Experience treating low SES clients predicted familiarity with environmental modification and behavior analytic strategies while experience treating high SES clients predicted familiarity with behavior analytic and cognitive strategies.ConclusionThis is the first study to identify transdisciplinary, interpretable sets of practices for treating youth with ASD based on community providers’ reported familiarity. Results highlight factors associated with familiarity with practice sets, which is essential for mapping practice availability, and optimizing training and dissemination efforts for youth with ASD.

Community-based care for autistic youth: community providers’ reported use of treatment practices in the United States

“…Of the 55 practices that comprised the full UCAS survey inventory, we focused on a subset of 32 practices that were endorsed, based on expert consensus ( 38 ), as treatments for all three of the identified key treatment areas: social challenges, externalizing symptoms, and anxiety. As in Lerner et al ( 40 ), we did not include the remaining 23 practices in the analysis for this paper since they were identified by experts as specific (e.g., endorsed by experts in treating anxiety only), rather than transdiagnostic (endorsed for treating all 3 presenting problems). We included only these 32 transdiagnostic strategies because the purpose of the present study was to focus on coherent sets of intervention practices that are used by providers to treat autistic youth regardless of the treatment area.…”

“…We included only these 32 transdiagnostic strategies because the purpose of the present study was to focus on coherent sets of intervention practices that are used by providers to treat autistic youth regardless of the treatment area. As Lerner et al ( 40 ) noted in a previous study involving transdiagnostic practices on the UCAS, “If a practice was identified to be specific only to the treatment of anxiety, for instance, this would likely skew its relation to other identified practices.” Thus, including only these 32 transdiagnostic practices allowed us to identify the practices sets likely to be most generalized to all types of providers who serve autistic youth ( 40 ). First, participants rated their familiarity with each practice on a 4-point Likert scale (1 = never heard of/not at all familiar ; 4 = very familiar ) ( 40 ).…”

“…As Lerner et al ( 40 ) noted in a previous study involving transdiagnostic practices on the UCAS, “If a practice was identified to be specific only to the treatment of anxiety, for instance, this would likely skew its relation to other identified practices.” Thus, including only these 32 transdiagnostic practices allowed us to identify the practices sets likely to be most generalized to all types of providers who serve autistic youth ( 40 ). First, participants rated their familiarity with each practice on a 4-point Likert scale (1 = never heard of/not at all familiar ; 4 = very familiar ) ( 40 ). Providers who were somewhat or very familiar with a practice were then asked to report how often they utilized the practice to treat autistic youth in the past year (1 = not at all , 4 = very commonly ).…”

“…Thus, including only these 32 transdiagnostic practices allowed us to identify the practices sets likely to be most generalized to all types of providers who serve autistic youth (40). First, participants rated their familiarity with each practice on a 4-point Likert scale (1 = never heard of/not at all familiar; 4 = very familiar) (40). Providers who were somewhat or very familiar with a practice were then asked to report how often they utilized the practice to treat autistic youth in the past year (1 = not at all, 4 = very commonly).…”