Asynchronous Social Communication Development in Autism: A Component-Level Analysis

Early social communication in autistic children is multidimensional and often develops asynchronously, with relative strengths in goal-directed communication and challenges in socially mediated behaviors. Composite outcome measures may obscure component-level effects. This exploratory secondary analysis examined component-level effects of the Pathways Early Autism Intervention (Pathways) on social communication. Data were drawn from a randomized controlled trial in which autistic children were stratified by age (< 3 years; ≥3 years) and randomized to receive Pathways or services as usual (SAU). Social communication was assessed using the Communication and Symbolic Behavior Scales–Developmental Profile (CSBS-DP) Social Composite. Weighted raw scores from six components were analyzed using regression models to examine effects of group and age, and age-by-intervention interactions. Significant interactions were probed in follow-up analyses, whereas reduced models were estimated for non-significant interactions. Children receiving Pathways showed higher post-intervention scores in five of six components. Age-by-intervention interactions were observed at the nominal level for behavior regulation and communication rate but were not significant after false discovery rate correction. For other components, group-related differences were observed without evidence of age moderation. Component-level analyses suggest that intervention effects are not uniformly observed across domains of social communication. However, the study was not powered to test differences in effects across components; therefore, observed patterns should be interpreted as descriptive and exploratory. Findings further suggest that socially mediated components may remain responsive to intervention into the preschool years, although this interpretation should be considered in light of the exploratory nature of the analyses.