Developing a Clinically Practical Tool to Evaluate Directed Caregiver Communication in Early Intervention: A Pilot Study of the Tool's Reliability and Validity.

Early intervention (EI) relies heavily on directed caregiver communication (DCC), yet most clinical tools focus primarily on the child. This pilot study examined the reliability and validity of the Directed Caregiver Communication Assessment Tool (DCC-AT), which was developed by the authors to describe caregiver communication during naturalistic caregiver-child interactions. This study used secondary data from the Early Communication Indicator for Autism (ECI-A), a naturalistic, 6-min play-based assessment during caregiver-child interaction. Participants included 10 autistic and 10 non-autistic children, all 36 months of age or younger, with test-retest videos for the autistic group resulting in 30 ECI-A videos. Coders used the DCC-AT to assess the types and frequencies of DCC strategies across four primary categories using partial interval coding. Analyses showed that the DCC-AT captured observed variation in DCC and demonstrated strong interrater reliability. Compared to caregivers of non-autistic children, caregivers of autistic children used fewer interactive strategies that built directly on the child's communication and more redirect strategies that shifted the child's attention. Across groups, higher child communication was associated with higher levels of caregivers' interactive strategies. Within the autistic group, lower child communication scores were associated with greater use of directive strategies. The DCC-AT begins to address a gap in EI by providing a structured way to describe DCC during naturalistic interactions. Findings offer preliminary support of interrater reliability and highlight the context-sensitive nature of DCC. Future work will expand the sample and refine the tool and examine its use in supporting caregiver coaching.