Centering Autistic Perspectives: Social Acceptability of Goals, Learning Contexts, and Procedures for Young Autistic Children
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| Title: | Centering Autistic Perspectives: Social Acceptability of Goals, Learning Contexts, and Procedures for Young Autistic Children |
|---|---|
| Language: | English |
| Authors: | Kate T. Chazin (ORCID |
| Source: | Journal of Autism and Developmental Disorders. 2025 55(3):812-831. |
| Availability: | Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ |
| Peer Reviewed: | Y |
| Page Count: | 20 |
| Publication Date: | 2025 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Autism Spectrum Disorders, Peer Acceptance, Young Children, Educational Objectives, Self Determination, Intervention, Learning Processes, Behavior Modification, Decision Making, Validity, Measures (Individuals), Special Education |
| DOI: | 10.1007/s10803-024-06242-4 |
| ISSN: | 0162-3257 1573-3432 |
| Abstract: | Despite the importance of centering autistic perspectives in educational decision-making for autistic children, few studies have directly assessed autistic perspectives on the social acceptability of early childhood practices. We conducted an online survey to recruit perspectives of autistic adults on a current, comprehensive range of educational practices typically employed with autistic children. We also extended the survey to caregivers and early childhood practitioners, to identify commonalities and discrepancies between shareholder groups. We conducted a descriptive survey study to assess social acceptability of goals, learning contexts, and procedures typically implemented with young autistic children. We received responses from 660 individuals, 226 of whom identified as autistic. For Likert scale and ranked items, we reported median rating and ranking for each item, by shareholder group. For open-ended questions, we conducted open and axial coding, to determine consistent themes within and across shareholder groups. Respondents reported (a) high acceptability for goals promoting self-determination and low social validity for goals promoting masking; (b) high acceptability for antecedent interventions and low social validity for some forms of extinction; (c) that appropriate learning environments are highly context dependent, varying with individual needs; and (d) that the child is the most important shareholder in educational decision-making. We make recommendations to practitioners in response to survey results, including (a) respecting autistic culture and characteristics in selecting goals; (b) considering social, emotional, and psychological needs in selecting procedures; and (c) individualizing goals, learning contexts, and procedures based on the child's perspectives and unique needs. |
| Abstractor: | As Provided |
| Entry Date: | 2025 |
| Accession Number: | EJ1460744 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwHV2qPKB2UweToJ1er5PT_sAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDCCwz1Uh_rikL02_hAIBEICBmo3ChkJAVv_BblzO9UxXtpnwp0RUaZxcvdjNTLe6aqeIhZOgdGJId8qcONNV1m4i7G6GoY3eydSXbNv-2pWNnj-4bf0Uip8plkm8Kb_y1k7HieBlbT5ksPSew76k-y6k-l0pCqoB1MWFNaO8NFaFYSMyMUcbRt8xEiEO2xymwlL5ZfpvFY3o5S7-gKBcX1GAGgvmv95huovOXV8= Text: Availability: 1 Value: <anid>AN0183072053;aut01mar.25;2025Feb19.02:51;v2.2.500</anid> <title id="AN0183072053-1">Centering Autistic Perspectives: Social Acceptability of Goals, Learning Contexts, and Procedures for Young Autistic Children </title> <p>Despite the importance of centering autistic perspectives in educational decision-making for autistic children, few studies have directly assessed autistic perspectives on the social acceptability of early childhood practices. We conducted an online survey to recruit perspectives of autistic adults on a current, comprehensive range of educational practices typically employed with autistic children. We also extended the survey to caregivers and early childhood practitioners, to identify commonalities and discrepancies between shareholder groups. We conducted a descriptive survey study to assess social acceptability of goals, learning contexts, and procedures typically implemented with young autistic children. We received responses from 660 individuals, 226 of whom identified as autistic. For Likert scale and ranked items, we reported median rating and ranking for each item, by shareholder group. For open-ended questions, we conducted open and axial coding, to determine consistent themes within and across shareholder groups. Respondents reported (a) high acceptability for goals promoting self-determination and low social validity for goals promoting masking; (b) high acceptability for antecedent interventions and low social validity for some forms of extinction; (c) that appropriate learning environments are highly context dependent, varying with individual needs; and (d) that the child is the most important shareholder in educational decision-making. We make recommendations to practitioners in response to survey results, including (a) respecting autistic culture and characteristics in selecting goals; (b) considering social, emotional, and psychological needs in selecting procedures; and (c) individualizing goals, learning contexts, and procedures based on the child's perspectives and unique needs.</p> <p>Keywords: Autistic-affirming practices; Autistic perspectives; Early Childhood Special Education; Neurodiversity; Preschool age; Social validity; Psychology and Cognitive Sciences Psychology Medical and Health Sciences Public Health and Health Services</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Although it is critical to know what works, for whom, and under what conditions when selecting evidence-based interventions for young autistic children (Wolery, [<reflink idref="bib34" id="ref1">34</reflink>]), early childhood special education (ECSE) practitioners and other adult shareholders must consider more than just efficacy in educational decision-making. They are also tasked with determining whether their educational decisions are socially valid. That is, they must determine whether the goals they develop are socially significant, the intervention procedures they choose are socially acceptable, and the outcomes of these choices are socially important (Wolf, [<reflink idref="bib33" id="ref2">33</reflink>]).</p> <p>The purpose of social validity measures is to determine "whether the focus of the intervention and the behavior changes that have been achieved meet the demands of the social community of which the individual is a part" (Kazdin, [<reflink idref="bib13" id="ref3">13</reflink>], p. 18). In determining whose perspectives in the social community matter in making these decisions, Schwartz and Baer ([<reflink idref="bib28" id="ref4">28</reflink>]) describe four groups of shareholders:</p> <p></p> <ulist> <item> <emph>Direct consumers</emph> are the individuals who directly receive intervention. It is critical to collect social validity data from direct consumers, as all individuals deserve the right to participate in decision-making about the interventions they receive (Bannerman et al., [<reflink idref="bib2" id="ref5">2</reflink>]; United Nations General Assembly). This includes the right to determine whether goals and procedures selected are acceptable to them. Although direct consumers may not be responsible for adopting intervention services (as is the case with young autistic children), their perspectives may still have influence on indirect consumers. For example, a caregiver may be more likely to implement (or discard) an intervention in response to their child's demeanor during its implementation. Further, assessing and implementing interventions deemed socially acceptable to direct consumers may improve their well-being, as evidenced by high rates of engagement and low rates of dissenting behaviors (Hanley, [<reflink idref="bib7" id="ref6">7</reflink>]; e.g., Rajaraman et al., [<reflink idref="bib24" id="ref7">24</reflink>], Staubitz et al., [<reflink idref="bib29" id="ref8">29</reflink>]).</item> <p></p> <item> <emph>Indirect consumers</emph> are the individuals who are directly involved in and impacted by intervention, but who are not direct recipients, such as caregivers, siblings, teachers, and other ECSE practitioners. Indirect consumers' perspectives are important because these shareholders are often intended to serve as end implementers in developed interventions. If indirect consumers find interventions to be feasible, useful, and aligned with personal values, they may be more likely to adopt them (McNeill, [<reflink idref="bib18" id="ref9">18</reflink>]). Further, in the case of young autistic children, indirect consumers (e.g., caregivers, teachers) are charged with educational decision-making on behalf of direct consumers.</item> <p></p> <item> <emph>Members of the immediate community</emph> are the individuals who regularly engage with direct and indirect consumers but are not directly connected to intervention use, such as school administrators, bus drivers, relatives living nearby, and community church members. The perspectives of these shareholders are useful because they may impact use of an intervention or be impacted by its outcomes. For example, a school principal is in a position to provide resources and support (or not) for a teacher in implementing certain interventions, and a bus driver may be unable to safely operate a vehicle if a student is engaging in dangerous challenging behavior.</item> <p></p> <item> <emph>Members of the extended community</emph> are the individuals who may not regularly interact with consumers directly, but who have some meaningful connection to consumers. For example, they might live in the same neighborhood, have the same race/ethnicity, or share a diagnosis with the direct consumer. The perspectives of extended community members are valuable in that they may provide additional insight into the lived experience of their common characteristic with the direct consumer. This may be particularly important when the direct consumer has communication challenges (e.g., due to young age or disability). They may also influence the decision-making of consumers, such as which intervention services to adopt.</item> </ulist> <p>Generally, social validity assessments in ECSE research have focused on only the second group (i.e., indirect consumers like teachers or caregivers; Ledford et al., [<reflink idref="bib14" id="ref10">14</reflink>]). Although this may seem reasonable given that caregivers make decisions about their young child's participation in intervention and educational activities, other shareholder groups are critically important. For example, in the case of interventions intended for young autistic children, autistic adults are part of the extended community whose perspectives may help inform socially valid care. Autistic perspectives may allow us to improve our ability to perspective-take with direct consumers, which in turn may allow us to make educational decisions more aligned with their preferences. Further, perspectives of autistic adults may help us identify ways typical educational practices are potentially problematic, ableist, or harmful. By incorporating autistic perspectives into educational decision-making, we can improve recommendations and practices so they are more autistic-affirming and socially valid. For example, autistic self-advocates have identified that stereotypy (i.e., forms of self-stimulation like hand flapping, body rocking, and humming) may improve self-regulation and sense of well-being for autistic individuals (Joyce et al., [<reflink idref="bib11" id="ref11">11</reflink>]; Kapp et al., [<reflink idref="bib12" id="ref12">12</reflink>]; Manor-Binyamini &amp; Schreiber-Divon, [<reflink idref="bib16" id="ref13">16</reflink>]; Ne'eman, [<reflink idref="bib21" id="ref14">21</reflink>]). This has led researchers and practitioners to challenge the propriety of reducing non-dangerous stereotypy (e.g., Ledford et al., [<reflink idref="bib15" id="ref15">15</reflink>]; Schuck et al., [<reflink idref="bib27" id="ref16">27</reflink>]). Similarly, pushback against the use of extinction procedures from autistic advocates and allies (e.g., Ram, [<reflink idref="bib25" id="ref17">25</reflink>]; Wilkenfeld &amp; McCarthy, [<reflink idref="bib32" id="ref18">32</reflink>]) may be connected to the recent surge in research assessing augmentative and alternative procedures (e.g., Chazin et al., [<reflink idref="bib5" id="ref19">5</reflink>]; Rajaraman et al., [<reflink idref="bib24" id="ref20">24</reflink>]; Trump et al., [<reflink idref="bib31" id="ref21">31</reflink>]). As a third example, increasing eye contact has been long held as a socially acceptable goal per indirect consumers (e.g., Carbone et al., [<reflink idref="bib3" id="ref22">3</reflink>]; Cook et al., [<reflink idref="bib6" id="ref23">6</reflink>]). However, reports from autistic individuals indicate that eye contact may be physically painful or make attending difficult (e.g., Robledo et al., [<reflink idref="bib26" id="ref24">26</reflink>]), calling into question whether this goal is socially acceptable per direct consumers, and whether it may be more appropriate to teach alternative ways to signal attending.</p> <p>Despite the critical importance of including autistic perspectives in ECSE, few studies have directly assessed autistic perspectives related to typical ECSE practices. Of those we were able to identify (e.g., Anderson, [<reflink idref="bib1" id="ref25">1</reflink>]; McGill &amp; Robinson, [<reflink idref="bib17" id="ref26">17</reflink>]), researchers asked autistic adults to reflect on experiences with behavior analytic therapies from their childhoods rather than a current, comprehensive range of educational practices. Further, these studies painted behavior analytic therapies in broad brush strokes, leaving practitioners unable to determine which behavior analytic practices (commonly used by teachers, paraeducators, and other autism professionals) are socially acceptable and unacceptable to autistic individuals within their practices. To bridge this knowledge gap and develop autistic-affirming recommendations for practitioners, we conducted a mixed-methods online survey of autistic adults. To our knowledge, this is the first survey study to recruit perspectives from autistic adults on a current, comprehensive range of educational practices typically employed with autistic children. To identify commonalities and differences between shareholder groups and ensure that recommendations were aligned with practices that felt feasible and useful to potential implementers, we also extended the survey to ECSE practitioners and caregivers of young autistic children. Research questions were as follows:</p> <p></p> <ulist> <item> What goals, learning contexts, and behavioral intervention procedures do autistic adults prioritize and deprioritize for young autistic children, and how do these perspectives compare to those of caregivers and practitioners?</item> <p></p> <item> Which shareholder perspectives do autistic adults consider to be most and least important in making decisions about the goals, learning contexts, and procedures implemented with young autistic children? How do these perspectives compare to those of caregivers and practitioners?</item> </ulist> <hd id="AN0183072053-2">Method</hd> <p></p> <hd id="AN0183072053-3">Survey Development and Design</hd> <p>We conducted a descriptive study, employing an online survey with autistic adults, ECSE professionals, and caregivers of young autistic children. The first author initially developed the survey using Research Electronic Data Capture (REDCap), a secure, web-based software platform (Harris et al., [<reflink idref="bib8" id="ref27">8</reflink>], [<reflink idref="bib9" id="ref28">9</reflink>]). Throughout the design process, she incorporated recommendations from Nicolaidis and colleagues ([<reflink idref="bib22" id="ref29">22</reflink>]) for creating accessible survey instruments for autistic adults. First, she screened the survey for potential barriers to access, such as inaccessible vocabulary and terms, and substituted broad, non-technical language that was not associated with any specific profession. She also added prefaces to each section and matrix to explain word meanings and provide additional context. Next, to reduce anxiety about imprecise response options and answering with complete accuracy, she added an open-ended item to each section where respondents could clarify responses. To further reduce anxiety, she added reminders to each section preface that the open-ended item would be available later. The REDCap platform did not support use of pictorial aids within Likert scales, one of the recommendations for improving survey clarity. However, she submitted a request to REDCap administrators that they add this feature for future survey projects. Finally, to address use of ableist language and concepts, she recruited feedback from a neurodivergent professional with interests in autistic-affirming practices (third author). She screened the survey for these issues and provided two rounds of feedback, which were incorporated into survey design.</p> <p>The first author sent a draft of the survey to one additional faculty member (the faculty advisor and second author) and ten graduate students affiliated with the Special Education (SPED) M.Ed. program at Vanderbilt University. Of these, the faculty member and four graduate students provided feedback. The reviewers were White women ages 22–41 who worked directly (e.g., providing direct instruction) or indirectly (e.g., supervising SPED graduate students) with young autistic children. One identified as neurodivergent and had a diagnosed disability. The first author revised the survey in response to feedback from each reviewer, primarily to correct typographical errors, increase clarity, and further improve the degree to which content was autistic affirming. The Institutional Review Board at Vanderbilt University reviewed and approved the study.</p> <p>The survey consisted of a preliminary page for reporting demographic information, followed by three sections for reporting perspectives on teaching young autistic children. These were (<reflink idref="bib1" id="ref30">1</reflink>) developing educational goals, (<reflink idref="bib2" id="ref31">2</reflink>) designing learning contexts, and (<reflink idref="bib3" id="ref32">3</reflink>) selecting intervention procedures to reduce challenging behavior. We did not operationally define challenging behavior for respondents but wrote in the survey preface that "[c]hallenging behavior can interfere with learning and making friends, and in some cases, can be dangerous for the child and others." Each section contained 1–4 matrices (with 5–28 items each) in which respondents rated the importance and acceptability of various goals, learning contexts, and procedures commonly used in ECSE settings. Respondents rated the importance of goals on a 6-point Likert scale, which included possible responses of <emph>very high priority, somewhat high priority, medium priority, somewhat low priority, very low priority</emph>, and <emph>should never teach.</emph> Respondents rated the acceptability of learning contexts and intervention procedures on a 5-point Likert scale, which included possible responses of <emph>always acceptable, often acceptable, sometimes acceptable, rarely acceptable</emph>, and <emph>never acceptable.</emph> Each subsequent section also contained one 5-item matrix in which respondents were asked to rate whose perspectives were most important in determining goals, learning contexts, or procedures: the child, the child's caregiver(s), the child's teacher(s), autistic adults, or other ECSE practitioners (e.g., speech-language pathologists, behavior analysts). These matrices used a forced ranking system, in which shareholder groups were ranked from <emph>1 (most important)</emph> to <emph>5 (least important)</emph> with each ranking required to be used once and only once. Finally, each section included an open-ended item in which respondents were invited to clarify responses and share anything else related to the section topic.</p> <hd id="AN0183072053-4">Positionality Statement</hd> <p>The first and second author completed all qualitative coding and data analysis. Both identified as White, cisgender women, and had 10 and 22 years of experience working with young autistic children, respectively. At the time of survey completion, the first author was a fourth-year doctoral student in SPED and held certification as a Board Certified Behavior Analyst (BCBA). She identified as neurodivergent with medically diagnosed disabilities and was the caregiver of a neurotypical 3-year-old. Her primary research interest was in developing a more person-centered approach to ECSE, particularly in designing effective interventions for young children that were socially acceptable, least restrictive, and neurodivergent-affirming. The second author was a faculty member in SPED who held a doctoral-level BCBA certification and identified as neurotypical. Her primary research interests were single case design methodology and appropriate instructional practices for young children. She regularly taught coursework related to instruction in ECSE, single case design, and ethical issues in applied behavior analysis.</p> <hd id="AN0183072053-5">Recruitment</hd> <p>Prior to recruitment, we reached out to neurodivergent and autistic online communities to determine most socially acceptable ways to recruit participation. We incorporated feedback into our subsequent recruitment plan wherever possible, including (<reflink idref="bib1" id="ref33">1</reflink>) messaging moderators prior to posting to autistic spaces that did not explicitly endorse research recruitment; (<reflink idref="bib2" id="ref34">2</reflink>) using the #ActuallyAutistic hashtag on Twitter; (<reflink idref="bib3" id="ref35">3</reflink>) posting primarily to neurodivergent-specific spaces, rather than autistic-specific spaces; and (<reflink idref="bib4" id="ref36">4</reflink>) posting to groups specifically recommended by autistic individuals. We also received feedback that community-based participatory research should be included in all aspects of research design. We were unable to implement this recommendation fully, as survey development was already complete. In response, we added an internal peer review process with a panel of autistic ECSE practitioners (see "Internal Peer Review" section below).</p> <p>To recruit respondents, we sent an e-mail with an attached flyer to 85 ECSE practitioners who qualified for the study and/or had contact with people who met inclusion criteria (e.g., professors who worked in teaching certification programs, preschool teachers who had regular contact with caregivers). We distributed the flyer online via Instagram, Facebook, and Reddit, on personal platforms and in shareholder-affiliated groups. This included groups related to early childhood education, autism, neurodivergence, parenting, applied behavior analysis, special education, speech-language pathology, research and survey distribution, and/or combinations of these topics such as parenting autistic children or ECSE. Across platforms, viewers were encouraged to distribute to others who might qualify, and publicly-shareable posts were made available. To maintain a relatively equal distribution of responses across shareholder groups, we targeted more heavily toward social media groups affiliated with underrepresented shareholder populations toward the end of the survey distribution period. The survey was open from June 17 to July 11, 2022. The survey was originally intended to be open for 1 month, but when the accrual goal (500 respondents) was met early, we closed the survey one week early to allow for additional time for data analysis before internal deadlines.</p> <hd id="AN0183072053-6">Participants</hd> <p>To be included, participants were required to (<reflink idref="bib1" id="ref37">1</reflink>) agree to participate in the survey; (<reflink idref="bib2" id="ref38">2</reflink>) report they were 18 years or older; and (<reflink idref="bib3" id="ref39">3</reflink>) report that they self-identified with at least one of the shareholder categories. If participants reported they did not meet any of these criteria, the survey automatically ended. Shareholder categories included: (<reflink idref="bib1" id="ref40">1</reflink>) autistic adults (including medical, educational, and self-diagnosis); (<reflink idref="bib2" id="ref41">2</reflink>) parents and legal guardians of young autistic children (i.e., ages 2–6); and (<reflink idref="bib3" id="ref42">3</reflink>) ECSE practitioners who work with young autistic children. Although we did not list inclusion criteria specific to prerequisite skills, it is likely that the survey was limited to participants with the skillset (e.g., literacy, technological fluency) to complete a multi-component, 15–25 min on-line survey.</p> <p>We received 660 completed surveys. Of these, 226 were autistic adults (34.2%), 168 were caregivers of young autistic children (25.5%), and 359 were ECSE practitioners (54.4%). These totals exceed the total number of participants because some respondents reported belonging to multiple shareholder groups (see Table 1). Seventy-six respondents (11.3%) identified with two shareholder groups (e.g., autistic caregivers of young autistic children), and 9 (1.4%) identified with three shareholder groups. We did not collect data specific to race/ethnicity, gender, education level, or income. This oversight is discussed in the "Limitations and Future Directions" section below.</p> <p>Table 1 Participant demographics</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;p&gt;Autistic adults&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Caregivers of young autistic children*&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;ECE practitioners&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" colspan="3"&gt;&lt;p&gt;&lt;italic&gt;n (%) or median (range)&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Shareholder identities&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Autistic adult&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;226 (100%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26 (15.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;51 (14.2%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Caregiver of young autistic child&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26 (11.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;168 (100%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26 (7.3%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;ECE professional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;51 (22.6%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26 (15.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;359 (100%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Diagnostic Information&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Child's age&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 (2&amp;#8211;7)**&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Medical diagnosis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;130 (57.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;146 (86.9%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Self-diagnosis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;109 (48.2%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Educational diagnosis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (3.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28 (16.7%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Other***&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9 (5.4%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Age of medical or educational diagnosis (if applicable)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.1 (2&amp;#8211;64)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Age of self-diagnosis (if applicable)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.3 (3&amp;#8211;55)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Services provided or received&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Mental health therapy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;90 (39.8%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;68 (40.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16 (4.5%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Speech-language therapy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;55 (24.3%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;112 (66.7%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49 (13.6%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Occupational therapy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 (11.9%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;87 (51.2%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9 (2.5%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Physical therapy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19 (8.4%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;48 (28.6%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (2.8%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Applied behavior analysis&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 (6.2%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;54 (32.1%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;BCBA&amp;#8212;141 (39.3%)&lt;/p&gt;&lt;p&gt;RBT&amp;#8212;50 (13.9%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Feeding therapy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10 (4.4%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 (14.9%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Other***&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20 (8.8%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9 (5.4%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38 (10.6%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;None&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;82 (36.3%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 (1.8%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Early childhood teacher&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;102 (28.4%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Early childhood paraprofessional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;23 (6.4%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Years working with young autistic children&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7 (1&amp;#8211;45)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Median self-rating as autism advocate&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Somewhat identify as an autism advocate&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Somewhat identify as an autism advocate&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Strongly identify as an autism advocate&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>∗Data for caregivers relates to information about caregivers' young autistic children; ∗∗Caregivers of young autistic children ages 2–6 were invited to participate, and were asked to round their child's age to the nearest whole number; thus, for children 6.5–6.999 years old, caregivers could report age 7; ∗∗∗To view self-reports for categories of "other," please see "Quantitative Survey Data" in Supplemental Materials (https://osf.io/g3rcd/)</p> <hd id="AN0183072053-7">Data Cleaning and Analysis</hd> <p>Because all Likert scale and ranking matrices were required to be completed prior to submission, we had no missing data (see "Quantitative Data Set" in Supplemental Materials [https://osf.io/g3rcd/]). We divided data by shareholder group. For participants belonging to multiple shareholder groups, data were included in all groups to which they belonged. For example, for an autistic caregiver of a young autistic child, their data were included in both the autistic adult and caregiver data sets.</p> <p>For Likert scale and ranked items, we calculated and reported median rating for each item, by subgroup. We then ranked items from most acceptable to least acceptable, for each matrix by subgroup. To determine ranking for multiple items with the same median rating, we calculated the number of respondents who scored the median rating or higher. The highest value resulted in the highest ranking within that median rating, the next highest value was assigned the next highest ranking, and so on.</p> <p>For open-ended items, we gathered all responses together on one spreadsheet, divided by section (across tabs) and shareholder group (within tabs). The first and second author used open coding, in which we derived codes (i.e., themes) from the data provided, then assigned codes to subsequent responses. Each response served as the unit of analysis and one or more codes could be assigned to the response. If multiple sentences within a response related to the same code, the code was only recorded once. We initially used consensus coding to create a code list for each section, coding a minimum of 30 responses together. Once our code list reached saturation within a section (i.e., we ceased to add new codes for several responses), we independently coded all remaining responses for that section. During independent coding, if a coder came across a response they believed required an additional category, they coded it as "new code needed." If either coder marked as response as "new code needed," the coding pair discussed the response and reached consensus on whether to add a new category.</p> <p>We consensus coded 16.5% of responses (<emph>n =</emph> 100) and independently coded the remaining 83.5% of responses. We collected interobserver agreement (IOA) data for all independently coded responses. That is, 100% of responses were coded by two observers, whether via consensus or independent coding. For independently coded data, IOA was determined by calculating [agreements/agreements + disagreements] × 100. Overall agreement was 77.2%, which included 79.0% IOA for goals, 76.0% IOA for learning contexts, and 75.9% for procedures. We discussed each disagreement and reached consensus on the most appropriate code. Following open coding of all qualitative data, we collaboratively conducted axial coding, in which codes were organized into related categories. These categories serve as the subheadings in the "Qualitative Results" section below. If a code did not fit into any axial category and was reported five times or fewer, it was not included in the analysis. To increase readability of the exemplar comments included below, we made minor typographical corrections that did not alter content or meaning.</p> <hd id="AN0183072053-8">Internal Peer Review</hd> <p>Following completion of the written manuscript, we recruited three peer reviewers who identified as autistic and served as ECSE practitioners. One peer reviewer withdrew due to difficulty completing the cumbersome university-required steps for receiving payment. We provided feedback to the university's financial managers that their systems were too complex to be fully accessible, and we are currently working to identify more accessible routes to payment within the university system. The first reviewer was a 41-year-old woman who identified as American Indian. She held a Ph.D. in SPED and applied behavior analysis, held certifications as a SPED teacher and BCBA, and had 19 years of experience working with young autistic children. At the time of peer review, she served as a CEO and clinical director. The second reviewer was a 28-year-old woman who identified as White. She held a B.A. in Early Childhood Education and an endorsement in SPED, and had 6 years of experience working with young autistic children. At the time of peer review, she served as a lead teacher in an inclusive preschool classroom. Both peer reviewers read the complete manuscript and provided feedback on each section within a REDCap survey. Following completion of internal peer review, both reviewers were asked for their publication recommendation for the manuscript with the following options: accept in its current form, accept following minor revisions, accept following major revisions, or reject for publication. One reviewer recommended acceptance in its current form, and the other recommended acceptance following minor revisions. We incorporated all revision suggestions from both peer reviewers. We asked reviewers to provide feedback on the revised draft, and both agreed that the revised draft was publication-ready without further revision. See Supplemental Materials (https://osf.io/g3rcd/) for peer reviewer comments, an itemized response letter to peer reviewers, and manuscript drafts before and after incorporating revisions. Reviewers were paid for their time and expertise.</p> <hd id="AN0183072053-9">Results</hd> <p></p> <hd id="AN0183072053-10">Quantitative Results</hd> <p>Results are divided below by section (i.e., goals, learning contexts, and procedures). We include one additional section on the ranked value of shareholder perspectives, as results were similar across goals, learning contexts, and procedures (see "Quantitative Survey Data" in Supplemental Materials (https://osf.io/g3rcd/).</p> <hd id="AN0183072053-11">Goals</hd> <p>See Fig. 1 for results related to goals. Highly-ranked items were similar across shareholder groups, with the same five highest ranked items across groups: decreasing self-injurious behavior, refusing non-preferred things, self-help skills, communicating using multiple modalities, and decreasing aggression. The next five highest ranked items were also similar across groups, with four of five in common: communicating with a device (when applicable), identifying emotions, navigating routines, and social-problem solving. Autistic adults also ranked eating foods that meet minimal nutritional needs in their top ten, while caregivers and practitioners ranked transitioning between activities in their top ten.</p> <p>Graph: Fig. 1 Importance of goals for young autistic children in ranked order, per autistic adults. A = median rating of autistic adults; C = median rating of caregivers, P = median rating of practitioners; data to the right of the y-axis indicate higher acceptability ratings, data to the left of the y-axis indicate lower acceptability ratings</p> <p>Lowest ranked items were similar across shareholder groups, with four of five lowest-ranked items the same across groups: staying seated, increasing eye contact, learning certain times and places to engage (and not engage) in stereotypy, and decreasing stereotypy overall. Autistic adults and caregivers also had tolerating loud sounds in their bottom five, while practitioners instead had manners in their bottom five; across all groups, these two goals were in the bottom ten. The next lowest five ranked items were also similar across groups, with three of five in common: communicating verbally (when applicable), staying within designated areas (e.g., staying on the circle time carpet during circle time), and eating new and/or different foods. Autistic adults and caregivers also included participating in group activities in their bottom ten, while practitioners did not. Caregivers and practitioners also included pre-academic skills in their bottom ten, while autistic adults did not.</p> <hd id="AN0183072053-12">Learning Contexts</hd> <p>See Fig. 2 for results related to learning contexts. Rankings were similar across groups. Respondents across groups reported that the most acceptable learning contexts were ones in which young autistic children (a) spent half or most of the day in group settings (as compared to one-on-one settings), (b) spent half or most of the day in inclusive settings, (as compared to self-contained settings), and (c) spent half or most of the day in child-led learning (as compared to adult-led learning). Within a learning environment deemed "most acceptable" to the respondent (i.e., ideal amount of time spent in group settings, in inclusive settings, and in child-led learning), respondents across groups agreed that it was most acceptable to receive 6–10 or 11–20 h of instruction per week, less acceptable to receive 1–5 or 20–30 h of instruction per week, and least acceptable to receive 0 h, 30–40 h, or <uline>≥</uline> 40 h of instruction per week</p> <p>Graph: Fig. 2 Social acceptability of learning contexts for young autistic children in ranked order, per autistic adults. A = median rating of autistic adults; C = median rating of caregivers, P = median rating of practitioners; data to the right of the y-axis indicate higher acceptability ratings, data to the left of the y-axis indicate lower acceptability ratings</p> <p>In contrast to the "Goals" and "Procedures" sections, shareholders rated nearly all items in the "Learning Contexts" section as <emph>sometimes</emph> or <emph>often acceptable</emph>. That is, few learning contexts were considered <emph>always, rarely, or never acceptable</emph> by any shareholder group. There were a few exceptions to this trend. Autistic adults, caregivers, and practitioners agreed that spending 0 or <uline>≥</uline> 40 h in ideal learning environments was rarely or never acceptable, with autistic adults reporting that 30–40 h in ideal learning environments is also rarely acceptable. Autistic adults and practitioners agreed that spending the entire day in adult-led learning was rarely acceptable, and practitioners indicated that spending the entire day in self-contained settings and/or one-on-one contexts was rarely acceptable.</p> <hd id="AN0183072053-13">Procedures</hd> <p></p> <hd id="AN0183072053-14">Antecedent Procedures</hd> <p>See Fig. 3 for results related to antecedent procedures (i.e., procedures used when challenging behavior is not presently occurring). Although rankings differed substantially between groups, acceptability ratings were similar across groups. For the majority of items (<emph>n</emph> = 19 of 24), respondents across all three groups reported that antecedent interventions were often or always acceptable.</p> <p>Graph: Fig. 3 Social acceptability of antecedent procedures for young autistic children in ranked order, Per Autistic Adults. A = median rating of autistic adults; C = median rating of caregivers, P = median rating of practitioners; data to the right of the y-axis indicate higher acceptability ratings, data to the left of the y-axis indicate lower acceptability ratings</p> <p>Highest-ranked antecedent procedures were similar across groups, with eight of the same ten highest ranked items: communication devices, sunglasses, teaching communication skills when child is calm, noise-cancelling headphones, teaching emotional regulation skills when child is calm, visual schedules, providing choices between appropriate options, and designating an area of the classroom for emotional regulation (e.g., "peace corner"). The remaining responses varied by group, with autistic adults also including alternative seating options and fidget toys and/or stress balls; caregivers including incorporating child's preferences into non-preferred activities and reading a story about an upcoming challenging situation; and practitioners including scheduling breaks into difficult or non-preferred activities and countdown warnings before transitions. Few antecedent strategies were ranked as <emph>never, rarely</emph>, or <emph>sometimes acceptable</emph>, with the same bottom five named across groups: an area of classroom designed to be away from others (e.g., time out), providing tokens for participation, providing small edible items for participation, class-wide reinforcement-based systems, and class-wide punishment-based systems.</p> <hd id="AN0183072053-15">Consequent Procedures</hd> <p>Rankings were similar across groups for consequence-based interventions (see Fig. 4). In responding to challenging behavior maintained (at least in part) by access to attention, respondents across groups agreed that the most acceptable responses were to show the child strategies for regulating emotions; help the child ask for attention and provide it; label the child's emotions; and remind the child of classroom expectations. They agreed that it was somewhat less acceptable to immediately soothe the child, reprimand the child, or provide praise or extra attention to other children following expectations. They agreed that it was least acceptable to withhold attention during challenging behavior (i.e., planned ignoring).</p> <p>Graph: Fig. 4 Social acceptability of consequent procedures for young autistic children in ranked order, per autistic adults. A = median rating of autistic adults; C = median rating of caregivers, P = median rating of practitioners; data to the right of the y-axis indicate higher acceptability ratings, data to the left of the y-axis indicate lower acceptability ratings</p> <p>In responding to challenging behavior maintained (at least in part) by access to preferred toys or activities, respondents across groups agreed that it was most acceptable to help the child ask for the toy/activity and provide it. They agreed that it was somewhat less acceptable to provide a different toy/activity or to wait until the child stops engaging in challenging behavior to provide the preferred toy/activity. They agreed that it was least acceptable to immediately provide the toy/activity or to make the toy/activity completely unavailable.</p> <p>In responding to challenging behavior maintained (at least in part) by access to escape, respondents across groups agreed it was most acceptable to help the child ask for a break and then provide it; give the child a "first-then" reminder; provide non-physical prompts to finish the activity; guide the child back to the activity if they leave; or use a token board to signal activity progress and reinforce activity completion. They agreed that it was relatively unacceptable to immediately let the child leave the non-preferred activity; wait until the child stops engaging in challenging behavior to provide a break; physically prompt the child to finish the activity; or keep the child within a non-preferred contained area with others. They agreed that it was least acceptable to keep the child within a non-preferred contained area by themself or to use restrictive seating.</p> <hd id="AN0183072053-16">Ranked Value of Shareholder Perspectives</hd> <p>When determining goals, learning contexts, and procedures for a young autistic child, all three groups agreed that the child's perspectives were most important, the child's caregivers were next most important, and the child's teacher was more important than other ECSE practitioners (see Fig. 5). Differences took place in the third, fourth, and fifth place rankings, with the child's teacher most often ranked third across shareholder groups. In general, teachers and other ECSE practitioners ranked themselves above autistic adults, while autistic adults ranked themselves above other teachers (sometimes) and other ECSE practitioners (always).</p> <p>Graph: Fig. 5 Rankings in response to the question, "Whose perspectives matter most when determining goals, learning contexts, and procedures for young autistic children?" in ranked order, per autistic adults. A = median rating of autistic adults; C = median rating of caregivers, P = median rating of practitioners; 1 indicates highest priority and 5 indicates lowest priority; data to the right of the y-axis indicate higher median rankings, data to the left of the y-axis indicate lower median rankings</p> <hd id="AN0183072053-17">Qualitative Results</hd> <p>Respondents recorded 608 total comments (see "Qualitative Survey Data" in Supplemental Materials (https://osf.io/g3rcd/), including 257 on goals, 187 on learning contexts, and 164 on procedures. Of these, 105 comments were coded partially or completely as non-codable/unrelated. Non-codable comments were variations of "no," "N/A," combinations of nonsensical letters and numbers, or comments not related to the section topic. Three codes trended similarly across sections—context dependence, relative importance of shareholders, and survey feedback. Counts for these codes were combined across sections and are described first. Following discussion of these codes, we discuss comments by section (i.e., goals, learning contexts, procedures).</p> <hd id="AN0183072053-18">Context Dependence</hd> <p>Context dependence was the most frequently observed code, with 191 responses (<emph>n</emph> = 60 for goals, 88 for learning contexts, and 43 for procedures). Across groups, respondents consistently emphasized that selection of goals, learning contexts, and procedures varies for each child, given their distinct characteristics and contexts. In considering context dependence, respondents typically discussed the child's unique characteristics including age, skills, interests, preferences, strengths, and sensory and psychological needs. Some respondents also discussed familial cultural beliefs, familial priorities, background of relevant shareholders, and the environments the child participates in. As an example, one practitioner wrote, "Based on different children's strengths and needs, as well as the environments that they need to use certain skills in, and the support they receive from their team of caregivers, so much of what should be prioritized is variable and individual." Context dependence was most often discussed by practitioners (<emph>n</emph> = 136), and less by autistic adults (<emph>n</emph> = 79) or caregivers (<emph>n =</emph> 29).</p> <hd id="AN0183072053-19">Relative Importance of Shareholders</hd> <p>Respondents discussed children as shareholders nearly three times as frequently as any other shareholder group, with 141 comments (as compared to 56 for autistic adults, 54 for caregivers, and 42 for practitioners). Respondents primarily wrote about the relative importance of children as shareholders (<emph>n</emph> = 108), as compared to the challenges (<emph>n</emph> = 20) or relative unimportance (<emph>n</emph> = 13) of children as shareholders. Respondents typically wrote about the need to include child's preferences in all aspects of educational decision-making, and reported that their perspectives mattered more than those of other shareholders. For example, one autistic caregiver wrote, "[T]he goals should center around what the student wants to do or needs to do to be happy and safe. Not what will make it 'easier' for the teachers or caregivers or based on the biases of what these individuals may think is 'appropriate' based on neurotypical standards." Respondents pointed out that it can be challenging to include the perspectives of young children in decision making, either because they may lack the communication skills to effectively convey their perspectives, or because they lack the cognitive capacity and situational awareness to engage in complex decision-making. Respondents wrote about alternative ways to include children in the decision-making—for example, honoring indicators of assent/dissent, building on strengths, identifying and incorporating preferences, and prioritizing teaching communication such that children can more effectively self-advocate. For example, one practitioner wrote that "very few children aged 2–4 are going to have the skills to prioritize these kinds of decisions (independent of diagnosis). We consider assent/non-assent as a type of advocacy, and we absolutely take that into account when helping set/modify goals, but it doesn't make sense to me to say that the child's 'opinion' of the goal is what drives it."</p> <p>Responses included a mix of comments on the relative importance (<emph>n</emph> = 31), relative unimportance (<emph>n</emph> = 19), and challenges (<emph>n</emph> = 6) of including autistic adults as shareholders. Autistic adults were most likely to report relative importance rather than challenges or unimportance (63.2% of comments), when compared to practitioners (54.8% of comments) or caregivers (45.5% of comments). When shareholders discussed relative importance, they commonly shared that autistic adults can provide valuable insight into experiencing the world through an autistic lens, and offer richer perspectives than young children are able to communicate. For example, one autistic caregiver-practitioner wrote, "There is so much information available now from Autistic adults, who openly share their experiences from childhood to adulthood. Their experience and wisdom are so valuable when setting goals for children now, particularly when young children are not yet able to communicate what kinds of goals they would like to meet. It is vitally important for Autistic voices to get their time at the podium as their perspectives are often neglected or pushed aside by family members, educators, and paraprofessionals." Similarly, another autistic adult wrote, "I don't think that it's fair to ask if unfamiliar autistic adults should have their opinions prioritized over a child's familiar adults. However, historically, autistic adults have not ever been listened to, and they can provide useful insights and advice about goals."</p> <p>When respondents discussed challenges or relative unimportance of autistic adults as shareholders, they commonly described the autistic community as diverse, with a wide range of skills, challenges, and needs. They noted that the broad perspectives of autistic adults may be inappropriate to apply to any given individual. For example, one caregiver wrote, "Autistic adults or others who can verbalize have a very different set of skills than my child who is minimally verbal and engages in unsafe behaviors, has difficulty eating and sleeping, and becomes very upset at slight changes in his day. It is upsetting to think that strangers to my child who do not share his reality could decide what he works on." Further, respondents across groups cited the importance of prioritizing perspectives of adults familiar with the individual child, whether or not they identify as autistic. For example, one practitioner wrote, "I also respect the perspective that autistic adults can provide regarding goal appropriateness overall, but each child's goals should be individualized, so I do not think it is necessarily appropriate for the perspective of any given autistic adult to override the perspectives of the family, child, or professionals who know the child well."</p> <p>When respondents discussed caregivers as shareholders, they primarily reported their relative importance as shareholders (<emph>n</emph> = 38), with fewer respondents noting relative unimportance (<emph>n</emph> = 10) or challenges (<emph>n</emph> = 6). Similarly, respondents primarily reported the relative importance of practitioners as shareholders (<emph>n</emph> = 29), with fewer noting challenges (<emph>n</emph> = 7) or relative unimportance (<emph>n</emph> = 6). Overall, respondents noted that these adults (particularly caregivers) are most likely to know the child well and be able to effectively advocate on behalf of the child's wants and needs. Conversely, respondents cited concerns that caregivers and practitioners may not always understand the child's experience with autism, or may value their own interests over the interests of the child. For example, one autistic practitioner wrote, "Sometimes BCBAs want to focus on a goal because it's important to the way they do things but may not be important to the child (or even harmful), but sometimes the BCBA really knows what the child needs. Sometimes caregivers have expectations that are not reasonable for the child or are based in their own convenience, and that would lower their score of whose opinion matters." Similarly, another autistic practitioner wrote, "We need to learn from the autistic community about what is important to them. Caregivers often need an education on what it's like to be autistic if they are not. They often focus on making their child fit in with others, which I believe is so wrong."</p> <hd id="AN0183072053-20">Survey Feedback</hd> <p>Sixty-nine responses included comments about some aspect of the survey itself (<emph>n</emph> = 25 for goals, 25 for learning contexts, and 19 for procedures). Most commonly, respondents noted that the survey was difficult to complete, given ways responses might vary based on the needs and preferences of the individual child. Respondents also indicated that the system for ranking shareholder importance was difficult, confusing, or problematic.</p> <hd id="AN0183072053-21">Goals</hd> <p>Respondents submitted 257 comments about goals, including 110 comments from autistic adults, 61 from caregivers, and 146 from practitioners. In addition to comments about context dependence (<emph>n</emph> = 60), relative importance of shareholders (<emph>n</emph> = 210), and survey feedback (<emph>n</emph> = 25), comments also fell into two major categories discussed below: considerations when selecting goals (<emph>n</emph> = 164) and acceptability of specific goals (<emph>n</emph> = 104).</p> <hd id="AN0183072053-22">Considerations When Selecting Goals</hd> <p>Out of 257 comments about selecting goals, 65 respondents (66.2% of whom identified as autistic) reported that shareholders should choose goals that celebrate autistic culture and/or do not require the child to mask their autistic characteristics (defined by one autistic adult as "making the child seem more neurotypical"). For example, one autistic adult wrote, "Goals that are only oriented towards making the children less 'visibly' autistic should be the lowest priority." Respondents reported several goals that fell into this "masking" category should be avoided, including increasing eye contact, increasing sensory tolerance, and decreasing stereotypy. One autistic adult wrote, "I feel like diversity should be celebrated, and things like hand flapping or not using eye contact shouldn't be 'punished', redirected, or looked down upon." Several respondents also wrote about the importance of educating non-autistic classmates on autistic characteristics and diversity acceptance.</p> <p>Thirty-two respondents (46.9% of whom identified as autistic) reported that health and safety should be a consideration when selecting goals. Primarily, respondents reported they would prioritize goals that they would not otherwise target (e.g., increasing compliance, reducing stereotypy) if failing to target these would impact the health or safety of the child or others.</p> <p>Eighteen respondents (77.8% of whom identified as autistic) reported that sensory needs should be considered when selecting goals. Respondents reported that certain goals may be physically painful or reduce a child's ability to self-regulate. For example, one autistic practitioner wrote, "If health is not in danger, always take into consideration the child's opinion for goals that go into sensory issues (loud sounds, toothbrushing, eye contact, stereotypy, eating foods), because those goals might hurt more than you think and the child might not be ready to work on that, because he already has a lot of things to cope with." Fewer respondents (<emph>n</emph> = 16, 37.5% of whom identified as autistic) reported that there are limited contexts in which it is appropriate to target stereotypy or sensory tolerance, including health and safety concerns or when aversive contexts are unavoidable.</p> <p>Eighteen respondents (72.2% of whom identified as autistic) reported that shareholders should consider targeting goals that assist autistic children in navigating a world designed for neurotypical people. For example, one autistic practitioner wrote, "No autistic person should be taught to hide their autistic traits, but do need help in learning coping skills because the real world is not fair and they will have to deal with a lot." These comments typically focused on teaching the "social codes" of neurotypical culture and coping mechanisms to tolerate a world that was not primarily built by or for autistic individuals.</p> <hd id="AN0183072053-23">Acceptability of Specific Goals</hd> <p>Forty respondents (45% of whom identified as autistic) discussed the importance of targeting communication. Twenty-nine (55.2% of whom identified as autistic) discussed the importance of targeting skills that increase autonomy, independence, and self-determination. Fifteen (80% of whom identified as autistic) discussed the importance of teaching emotional regulation skills. Twelve (25% of whom identified as autistic) discussed the complexities of targeting compliance. Overall, respondents noted that compliance should not be targeted for the sake of it, but should be taught when necessary for safety or other reasons (e.g., to prevent elopement into dangerous spaces). For example, one autistic caregiver wrote, "It is VERY important that my kids learn to stay within a designated area for safety reasons (e.g., with a parent, on a playground, not wandering into the road or away from supervision). But staying on a carpet for circle time isn't a safety issue, it's a compliance issue." Fewer respondents discussed the importance of targeting challenging behavior (<emph>n</emph> = 12) or social skills (<emph>n</emph> = 8).</p> <hd id="AN0183072053-24">Learning Contexts</hd> <p>Respondents submitted 187 comments about learning contexts; this included 84 comments from autistic adults, 44 from caregivers, and 103 from practitioners. Comments fell into two major categories discussed below: considerations when selecting learning contexts (<emph>n</emph> = 29) and acceptability of specific learning contexts (<emph>n</emph> = 62).</p> <hd id="AN0183072053-25">Considerations When Selecting Learning Contexts</hd> <p>Nine respondents (44.4% of whom identified as autistic) discussed the importance of designing learning contexts in ways that promote autistic culture and avoid prioritizing neurotypical norms. Nine respondents (66.7% of whom identified as autistic) indicated that children should not spend long amounts of time in non-ideal learning contexts. For example, an autistic practitioner wrote, "We do need to recognize societal/economic pressures that make it necessary for children to be in care of others while caregivers work, but high hours at high intensity are not appropriate." Five respondents (80% of whom identified as autistic) discussed the importance of "letting children be children," or designing contexts in ways that allow autistic children to have typical childhoods (e.g., maximizing time spent in play, minimizing time spent doing desk work or worksheets). Fewer respondents discussed the importance of considering sensory needs (<emph>n =</emph> 1), psychological needs (<emph>n =</emph> 1), health and safety (<emph>n =</emph> 1), and autistic-specific supports (<emph>n</emph> = 1).</p> <hd id="AN0183072053-26">Acceptability of Specific Learning Contexts</hd> <p>Twenty-eight responses were on the topic of inclusive versus self-contained environments. Comments primarily discussed inclusion as positive (<emph>n =</emph> 11). Autistic adults were less likely to talk about positives (36.4% of their comments) than caregivers and practitioners (55% of their comments). On positives of inclusion, one practitioner wrote, "I believe that inclusive education is important because modeling is such a big part of learning. Kids can learn from peers and peers can learn to be kind to those with disabilities in an inclusive setting." Despite its benefits, respondents also pointed out challenges (<emph>n</emph> = 9). For example, one autistic practitioner wrote, "Inclusion is ideal, but many 'inclusive' environments are set up in ways that are too stressful for young autistic children including too many people in a classroom making too much noise, and too much adult-led time with classroom expectations that are easier for neurotypical kids to meet." Another autistic caregiver-practitioner wrote, "In an ideal world, every classroom would be fully inclusive and inviting of disabled children/children with disabilities. Unfortunately, our current systems don't allow for this." Remaining responses discussed the negatives (<emph>n</emph> = 4), positives (<emph>n =</emph> 2), and challenges (<emph>n</emph> = 1) of self-contained contexts, as well as the negatives of inclusive contexts (<emph>n</emph> = 1).</p> <p>Twenty-five responses were on the topic of adult- vs. child-led contexts. Comments primarily discussed child-led contexts as positive (<emph>n =</emph> 10), but also acknowledged challenges (<emph>n</emph> = 5). For example, one autistic adult wrote, "I think that autistic children learn really well with child-led learning, but I also think that effective child-led learning requires a very good teacher and a very low student to teacher ratio." Another autistic adult wrote, "There has to be a balance between child-led and adult-led. Some children would choose to sit in front of a screen eating chocolate all day (which sounds awesome) but doing that daily would not be in the best interest of the child." Remaining responses discussed positives (<emph>n =</emph> 3), negatives (<emph>n =</emph> 2), and challenges (<emph>n =</emph> 1) of adult-led contexts, the negatives of child-led contexts (<emph>n =</emph> 1), and the importance of balancing adult- and child-led instruction (<emph>n</emph> = 3).</p> <p>Nine responses were on the topic of group vs. one-on-one contexts for learning, including the positives of group learning (<emph>n =</emph> 4), as well as the positives (<emph>n</emph> = 2), negatives (<emph>n</emph> = 2), and challenges (<emph>n =</emph> 1) of one-on-one learning. When discussing challenges and drawbacks to inclusive and group learning, respondents discussed differing sensory needs as a factor to consider, citing group settings as potentially overstimulating or unpredictable.</p> <hd id="AN0183072053-27">Procedures</hd> <p>Respondents submitted 163 comments about procedures; this included 81 comments from autistic adults, 28 from caregivers, and 86 from practitioners. Comments fell into two major categories discussed below: considerations when selecting procedures (<emph>n</emph> = 147) and acceptability of specific procedures (<emph>n</emph> = 79).</p> <hd id="AN0183072053-28">Considerations When Selecting Procedures</hd> <p>Forty-two respondents (69% of whom identified as autistic) indicated the importance of considering the child's emotional and psychological needs when selecting procedures. For example, one autistic adult wrote, "Trauma needs to be taken into consideration with behaviours that challenge. When in fight, flight, or freeze mode, their prefrontal cortex is not in control to think out their actions. Restricting access to reinforcement or persisting with a task that may have triggered their amygdala, for a child in survival mode, some behavioural strategies would be very unethical and cruel. However, if trauma is not an issue, then the typical behavioural strategies mentioned above in the survey would be great." Similarly, one autistic adult wrote, "Always be thinking about the 'hidden curriculum': are you teaching the material, or are you teaching compliance? Is this procedure requiring a child to mask signs of distress? Will this compromise the trust the child has in me? Does this procedure make them feel heard, validated, and valued—even if they can't get the thing they want?"</p> <p>Nineteen respondents (42.1% of whom identified as autistic) indicated the importance of considering health and safety when selecting procedures. Most commonly, respondents noted they would choose procedures they might not otherwise use if someone's health or safety were under threat. For example, one autistic practitioner wrote, "A lot of my answers depend on how dysregulated a child is and whether or not there are safety concerns."</p> <p>Eighteen respondents (55.5% of whom identified as autistic) indicated that shareholders should consider the purpose served by challenging behavior when selecting procedures. Respondents frequently noted that challenging behavior might indicate sensory overwhelm or emotional dysregulation, that practitioners should use discretion to understand when this is happening, and that practitioners should not persist with interventions in these cases. For example, one autistic adult wrote, "I think it helps to pinpoint why the child is behaving negatively. If they feel overwhelmed (on the verge of a panic attack, meltdown, shutdown, etc.) then they should be allowed to remove themselves from the situation until they are calm, but understand the task must be completed and why (as well as guidance if they find it difficult). However, some children can use challenging behaviour to avoid doing something boring, and they must understand that sometimes we have to do things that bore us but are important, and they cannot use this behaviour to get out of completing tasks." Another autistic adult wrote, "All these points are completely beside the point and meaningless without understanding WHY the child behaves in a challenging way. Wants-based challenging behaviour (i.e. hitting another child to get a preferred toy) isn't okay and needs intervention. But behaviour that's designed to make something stop MUST be respected. I was forced to stay in sensorially painful, humiliating and terrifying situations as a child and now I have CPTSD on top of everything else."</p> <p>Eleven respondents (54.5% of whom identified as autistic) indicated that shareholders should consider limited circumstances under which challenging behavior should be reinforced. Responses were similar to those considering functionality, in that respondents reported that it may be appropriate to reinforce challenging behavior in cases of emotional dysregulation or distress. For example, one autistic practitioner wrote, "[If the child is] already escalated and won't be calm anytime soon or does not yet have the communication skills, it is more appropriate to give what they are needing right away and practice communicating or calming down later." Similarly, a practitioner wrote, "In general, if the child is distressed, I may reinforce the behavior by providing access/escape once, and then try to determine better prevention strategies to try/skills to teach and avoid additional instances of challenging behavior when possible."</p> <p>Remaining comments were similar to considerations for selecting goals and learning contexts, including considering sensory needs (<emph>n</emph> = 9), choosing procedures that maximize autonomy and promote consent (<emph>n</emph> = 8), choosing procedures that respect autistic characteristics and avoid neurotypical norms (<emph>n =</emph> 6), making choices that are developmentally appropriate (<emph>n</emph> = 6), promoting skills needed to navigating a world designed for neurotypical people (<emph>n</emph> = 3), and allowing autistic children to have a "typical childhood" (<emph>n</emph> = 1). Additionally, 10 comments discussed miscellaneous challenges in addressing challenging behavior in typical early childhood settings.</p> <hd id="AN0183072053-29">Acceptability of Specific Procedures</hd> <p>Thirty-two responses were on the topic of extinction (53.1% from autistic respondents), and primarily discussed the negatives of extinction procedures (<emph>n</emph> = 23), with fewer comments discussing the challenges (<emph>n</emph> = 5) or positives (<emph>n</emph> = 4) of extinction procedures. Most respondents wrote about the unacceptability of using escape extinction procedures that limit bodily autonomy. For example, an autistic practitioner wrote, "Procedures used should be trauma informed. When challenging behaviors occur, emphasis should be on co-regulation/de-escalation whereas procedures such as planned ignoring, hand over hand, restraints, and withholding often escalate the situation." Similarly, one practitioner wrote, "With regard to physical guidance/prompting it is extremely important to note this is only acceptable when the child requires assistance, not as a compliance tool.... If they resist at all it should be ended." Another practitioner wrote, "In most quality early learning contexts, there are very few tasks that should be considered non-negotiable. As a BCBA I really wish my training emphasized the child's perspective more than the adult's [perspective] so that I didn't feel the need to use so much escape extinction and other harmful, rigid procedures in my early years." Respondents also discussed the importance of assent. For example, an autistic practitioner wrote, "I would not block a child from leaving an instructional space unless the place they're trying to go is dangerous, etc. Also, it matters whether the child is giving consent/assent to these procedures. If the child is on board with a token board, ok. If it feels demeaning to them and they don't want to use it, the[n] not ok." When discussing challenges, respondents primarily cited that these procedures may be necessary sometimes, particularly for health or safety reasons. For example, one practitioner wrote, "I don't feel comfortable doing hand-over-hand or blocking children from leaving an area; it would definitely be the last resort. I have had to physically prompt children to wash their hands, which has been necessary during COVID-19 times."</p> <p>Twenty-two responses were on the topic of restraint and seclusion (59.1% from autistic respondents), with most comments discussing the negatives of these procedures (<emph>n</emph> = 14), and fewer discussing the challenges (<emph>n =</emph> 4) or positives (<emph>n</emph> = 4) of these procedures. Most respondents indicated that restraint and seclusion were inappropriate to use, unless they were for the immediate physical safety of the child or others. For example, an autistic practitioner wrote, "Restraint or response blocking should only be used to prevent harm or safety concerns, especially with self-injurious behavior." Another autistic adult wrote, "I don't think it's ever, ever, ever okay to physically trap someone somewhere, unless it's for their immediate physical safety."</p> <p>Fourteen respondents (85.7% of whom identified as autistic) discussed the importance of teaching communication, self-regulation strategies, and other alternatives to challenging behavior. For example, one autistic practitioner wrote, "Often modeling appropriate communication and sensory strategies can aid in reducing these behaviors, as there almost always is a reason they're exhibiting these 'behaviors' and resolving the differences or breakdowns in communication or sensory [needs] for the child will resolve these."</p> <p>Eleven respondents (54.5% of whom identified as autistic) discussed the use of contrived reinforcement, with most participants indicating negatives of these procedures (<emph>n =</emph> 7), and fewer indicating positives (<emph>n =</emph> 2) or challenges (<emph>n</emph> = 2). For example, an autistic adult wrote, "Reward systems can cause people to compare themselves to others, potentially resulting in feelings of inadequacy and self-hatred." An autistic practitioner wrote, "Rewards and punishments decrease intrinsic motivation and are harmful in the long term even if they appear effective in the short term. Food rewards are especially dangerous given the prevalence of eating disorders in autistic people."</p> <p>Fewer respondents discussed the importance of incorporating antecedent interventions (<emph>n</emph> = 8), as well as the negatives (<emph>n</emph> = 5) and challenges (<emph>n</emph> = 1) of using punishment procedures.</p> <hd id="AN0183072053-30">Discussion</hd> <p>In this study, we surveyed 660 individuals, 226 of whom identified as autistic, to learn more about social acceptability of typical early childhood practices for autistic children. Although responses were variable and many respondents discussed the importance of individualization of service provision, there were several recurring themes that can aid adult shareholders in making educational decisions about goals, learning contexts, and procedures. For goals, respondents reported high acceptability for goals promoting self-determination and low social validity for goals promoting masking. For learning contexts, respondents reported high acceptability for spending half or most of educational time in child-led, inclusive environments with peers. They also reported low social acceptability for too many (e.g., <uline>≥</uline> 30 h) or too few hours (e.g., 0 h) spent in even ideal learning contexts. For procedures, respondents reported high acceptability for antecedent interventions and low social validity for procedures that include some forms of extinction.</p> <p>Additional themes emerged across sections for goals, learning contexts, and procedures. First, respondents consistently reported that the child and their caregiver(s) were the first and second most important shareholders in determining goals, learning contexts, and procedures; that is, the child's perspectives are the most important when making educational decisions. Second, respondents (particularly autistic adults) noted that educational decisions should celebrate autistic culture and accommodate autistic characteristics (e.g., engaging in stereotypy, avoiding eye contact, avoiding sensory overwhelm). Third, respondents indicated that sensory, psychological, and emotional needs should be prioritized in educational decision-making, both teaching skills that promote self-regulation and adapting the environment to ensure the child is able to regulate their nervous system.</p> <p>Respondents spoke more about context dependence than any other topic, with 191 comments related to context dependence in some way (31.4% of all comments). Comments about context dependence were most often from practitioners (55.7% of related comments), likely because practitioners regularly serve children with a wide range of strengths, needs, and challenges. Respondents consistently reported that the child's individual characteristics and context should be a primary driver in educational decision-making. As such, we have interpreted our results conservatively, limiting discussion to practices deemed strongly acceptable or unacceptable. We encourage readers to consider the shareholder perspectives shared here as one limited factor to help inform educational decision-making, in conjunction many other contextual variables that impact these choices.</p> <hd id="AN0183072053-31">Goals</hd> <p>Across shareholder groups, respondents reported high social validity ratings for goals that promote communication and autonomy, and cite these practices as socially acceptable ways to reduce challenging behavior. All three shareholder groups rated eight of the same ten goals as highest priority, which all fell into three categories—promoting communication (refusing non-preferred things, communicating using multiple modalities, communication with a device, identifying emotions), increasing autonomy (self-help skills, navigating routines), and decreasing challenging behavior (decreasing self-injurious behavior, decreasing aggression). Goals and the procedures used to address them were related, with procedures that limited bodily autonomy rated poorly. These results indicate that shareholders believe learning contexts should be designed in ways that promote autonomy, as well as teach the child how to more effectively self-determine.</p> <p>Across groups, respondents reported low social validity ratings for goals and procedures that promote masking. Across quantitative and qualitative results, autistic adults in particular promoted a shift away from practices that require children to hide autistic traits or appear more neurotypical. For example, in ranking goals, the bottom five goals ranked by autistic adults are all aimed at ecological congruence with neurotypical peers: tolerating loud sounds, staying seated, increasing eye contact, learning certain times and places to engage in stereotypy, and decreasing stereotypy overall. Conversely, autistic adults rated many antecedent interventions with high social validity, including those that may cause autistic children to look different from their peers (e.g., sunglasses, headphones, alternative seating). In comments, respondents consistently indicated that the sensory and psychological needs of the child should take priority, rather than desires of adult shareholders that the child appear neurotypical or fit in with their peers.</p> <hd id="AN0183072053-32">Learning Contexts</hd> <p>Results indicated that appropriate learning environments are highly context dependent, varying with the needs of the child. Respondents across shareholder groups reported that nearly all learning contexts were sometimes or often acceptable. These results indicate that shareholders should make these determinations based primarily based on the child's particular needs and preferences. There were a few exceptions, as shareholders across groups agreed that long (<uline>≥</uline> 30 h) or short (0 h) amounts of time in ideal learning environments, and/or spending the entire day in adult-led learning, was unacceptable. Autistic adults rated self-contained settings and one-on-one contexts as more acceptable than practitioners or caregivers. In comments, autistic adults noted that inclusive and group contexts may be overstimulating or overwhelming for some autistic children. These results may be surprising to neurotypical practitioners, given that the Individuals with Disabilities Education Act ([<reflink idref="bib10" id="ref43">10</reflink>]) defines least restrictive environments as those in which, "to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled" and the subsequent push in special education toward provision of Part B services within inclusive and group contexts. These results indicate the importance of future research understanding "least restrictive environment" from multiple perspectives, particularly those of neurodivergent and autistic consumers.</p> <hd id="AN0183072053-33">Procedures</hd> <p>Across shareholder groups, respondents wrote more about the negative aspects of extinction (particularly escape extinction), restraint, and seclusion than any other procedures. Similarly, in the quantitative data, extinction procedures received the lowest social validity ratings across shareholder groups, particularly attention extinction (i.e., withholding attention while a child is engaging in challenging behavior) and tangible extinction (i.e., withholding toy/activity while a child is engaging in challenging behavior, putting away a toy or blocking access to an activity permanently). For escape extinction, respondents provided the lowest social validity ratings for procedures that directly restricted bodily autonomy (i.e., physically prompting the child to finish activity, keeping the child within a non-preferred contained area, using restrictive seating). However, other less restrictive procedures which are typically paired with escape extinction (e.g., giving 'first-then' reminders, non-physically prompting activity completion, using token boards for activity completion) were given higher acceptability ratings. These results seem to indicate that attention extinction, tangible extinction, and escape extinction procedures that restrict bodily autonomy are all considered least acceptable ways of responding to challenging behavior. These data support previous reports from key shareholders, including autistic adults, that extinction may lack social validity (e.g., Anderson, [<reflink idref="bib1" id="ref44">1</reflink>]; Ram, [<reflink idref="bib25" id="ref45">25</reflink>]; Wilkenfeld &amp; McCarthy, [<reflink idref="bib32" id="ref46">32</reflink>]). Conversely, less physically intrusive forms of escape extinction may have some social validity; thus, practitioners should consider both the functionality of the child's challenging behavior <emph>and</emph> the topography of the implementer's response. While only a handful of studies have assessed the intentional use of less physically intrusive forms of escape extinction (e.g., Rajaraman et al., [<reflink idref="bib24" id="ref47">24</reflink>]; Tarbox et al., [<reflink idref="bib30" id="ref48">30</reflink>]), this is an important area of future research given that there may be situations where escape extinction may be essential (e.g., taking medication, crossing a busy street).</p> <p>Shareholder groups reported highest social validity ratings for antecedent interventions, with a higher percentage of <emph>always</emph> and <emph>often acceptable</emph> ratings than for any other category (79.2–83.3% by group). Although relatively few comments discussed the importance of antecedent interventions (<emph>n</emph> = 9), more respondents wrote about meeting the child's emotional and psychological needs (<emph>n</emph> = 42) than any other procedural consideration. Antecedent strategies may promote emotional and psychological regulation, in that they may prevent behavioral escalation and associated stress.</p> <p>Importantly, these data indicate that some procedures considered to be behavior analytic (e.g., antecedent interventions, non-intrusive forms of escape extinction) may be considered socially valid to autistic adults and other shareholders, while others (e.g., tangible extinction, attention extinction, physically intrusive escape extinction) may lack social validity. These results contrast with earlier qualitative studies (e.g., Anderson, [<reflink idref="bib1" id="ref49">1</reflink>]; McGill &amp; Robinson, [<reflink idref="bib17" id="ref50">17</reflink>]), in which behavior analytic therapies were considered broadly to be socially invalid. These results indicate that the conversation surrounding behavior analytic intervention may require increased nuance, to determine which aspects are problematic or traumatic, and to create or modify interventions to be autistic affirming.</p> <hd id="AN0183072053-34">Limitations and Recommendations for Future Research</hd> <p>A non-trivial proportion of respondents (<emph>n</emph> = 85, 12.9%) identified with multiple shareholder groups. These data are not surprising given that respondents with multiple connections to autism and ECSE may be particularly motivated to participate in related research. In key ways, we believe that high prevalence of respondents belonging to multiple shareholder groups is a strength of the study. Autistic caregivers and practitioners are uniquely qualified to understand both the experience of being autistic and the realities of providing care to young children. Thus, their perspectives provide additional insight into what is both socially acceptable to autistic adults and feasible to incorporate into home or educational settings. Despite the overall strength of inclusive overlapping perspectives, we recognize that this may have decreased between-group differences; data from respondents with overlapping identities were included in all qualifying shareholder groups, and respondents with overlapping identities may skew the median of all groups in which they participate. For example, autistic caregivers may respond more similarly to autistic adults than the average caregiver, and more similarly to caregivers than the average autistic adult. Further, we recognize that the percentage of respondents with overlapping identities may be higher than is present in the general population. Researchers may consider using additional qualitative methods (e.g., interview, focus groups) with multiply-identified shareholders to understand the unique contributions of each lens.</p> <p>Another limitation of this survey is that we did not collect demographic information from participants on race/ethnicity, gender, education level, or income. Thus, we do not know to what degree historically underrepresented voices are included here (e.g., Black, Indigenous, and People of Color [BIPOC], respondents from low-income backgrounds). Dr. Mari-Luci Cerda, an internal peer reviewer on this paper, wrote, "The results of these surveys will provide insight into goals and needs the fit best for a majority group with significant levels of privilege that make those kinds of goals possible to achieve. These are often not feasible goals for BIPOC families and individuals." She also described the importance of including respondents with intersectional identities: "Masking for [W]hite Autistics versus masking for BIPOC Autistics is a very different phenomenon and 'celebrating autistic culture' may not pertain to the BIPOC community due to significant differences in levels of privilege. To promote Autistic culture without a deeper dive into what that means for intersectioned groups may lead to further 'therapeutic colonization' of [W]hite norms." We endorse Dr. Cerda's recommendations to replicate this study with a focus on caregivers who are BIPOC and/or from diverse socioeconomic backgrounds, including (a) inviting diverse researchers to participate in survey and recruitment design, including researchers who speak additional languages and have the same racial or cultural identities as potential respondents; (b) designing and distributing the survey and recruitment materials in multiple languages; and (c) recruiting respondents through free and public resources, including in-person recruitment methods for respondents who may lack internet access. This would also allow for a more comprehensive representation of autistic perspectives, as those who participate in autistic-oriented communities online (i.e., our primary recruitment method) may be more likely to share perspectives with one another that are not held by autistic adults broadly.</p> <p>Finally, these results are necessarily limited to respondents with the skillset (e.g., literacy, technological fluency) to complete a multi-component, 15–25 min on-line survey. Although steps were taken to increase survey accessibility (e.g., simplifying language and sentence structure), this survey was still likely inaccessible to autistic adults with greater support needs. For example, 69.5% of autistic respondents indicated that they received an autism diagnosis or began self-identifying as autistic as adults (i.e., ages 18 or older). Although these data do not account for reduced access to assessment measures when respondents were children, these data may still indicate that the survey results do not adequately represent the views of autistic adults across the full spectrum of perspectives, challenges, and experiences. We encourage researchers to intentionally seek out perspectives of autistic individuals with greater support needs. For example, researchers might intentionally employ recruitment methods to access perspectives from autistic adults who do not have computer or Internet access, such as recruiting within group homes and/or through groups for caregivers and practitioners who care for individuals requiring greater support. Researchers might also employ data collection measures that do not require advanced literacy or language skills. For example, they might conduct interviews or focus groups in which participants are not required to read and can more readily engage in augmentative and alternative methods of communication. For autistic individuals without the requisite communication skills to participate in interviews or focus groups, researchers might conduct case studies, ethnographies, or preference assessments for individuals actively receiving services. Given the varying degree of support needs across the spectrum, we do not believe that a subset of autistic voices (e.g., those capable of completing an online survey) should stand completely for all autistic individuals. However, we believe there is value in listening to autistic adults with expanded vocal repertoires; their lens may help allistic practitioners better understand the perspectives and experiences of those with greater support needs, given overlap in experience across the spectrum (Mitchell et al., [<reflink idref="bib20" id="ref51">20</reflink>]; Milton, [<reflink idref="bib19" id="ref52">19</reflink>]).</p> <hd id="AN0183072053-35">Additional Recommendations for Researchers</hd> <p>Survey results indicate that, although the autistic community is diverse, trends and commonalities exist across autistic respondents that may help guide educational decision-making. For example, these survey results provide some insight into autistic experience that may be used in guiding decision-making, allowing practitioners to better (a) understand the sensory, psychological, and emotional needs of autistic individuals, and (b) identify possible internalized ableism present in commonly-held goals for young autistic children (e.g., targeting stereotypy or tolerating loud sounds when these do not pose threats to health or safety). Researchers should continue to conduct qualitative research with autistic adults (e.g., surveys, interviews, focus groups) to better understand autistic perspectives and better inform the ways we make educational decisions for young autistic children.</p> <p>We also recommend researchers adopt community-informed practices in all aspects of autism-focused research, to center the perspectives of autistic individuals in the research development process. We believe this paper makes novel contributions toward community-informed research design, in that we (a) included recommendations made by autistic researchers in our survey design (Nicolaidis et al., [<reflink idref="bib22" id="ref53">22</reflink>]), (b) recruited two rounds of feedback on survey design from a neurodivergent professional with interests in autistic-affirming practices (c) consulted with autistic and neurodivergent communities online to refine our recruitment plan, (d) collected survey design feedback from open-ended items (see "Qualitative Data" in Supplemental Materials [https://osf.io/g3rcd/]), and (e) conducted an internal peer review process with a panel of autistic ECSE practitioners (see "Internal Peer Review" section above). Additionally, we recommend future researchers incorporate formative evaluation to a greater extent. This includes integrating autistic perspectives into all aspects of research development, including survey design, recruitment procedures, data analysis, and writing. Researchers can partner with autistic researchers and/or recruit formative feedback from the broader autistic community.</p> <hd id="AN0183072053-36">Recommendations for Practitioners</hd> <p>First, respondents consistently reported that the child should be the primary shareholder, and that their perspectives should be prioritized in all aspects of educational decision-making. To ensure that the child is "in the driver's seat" of these decisions to the extent possible, practitioners should honor indicators of assent/dissent; build on strengths; follow the child's interests; and intentionally teach skills related to self-advocacy and autonomy. Practitioners may consider intervention procedures such as the enhanced choice model (e.g., Rajaraman et al., [<reflink idref="bib24" id="ref54">24</reflink>]) and concurrent chains preference assessments (e.g., Chazin &amp; Ledford, [<reflink idref="bib4" id="ref55">4</reflink>]; Owen et al., [<reflink idref="bib23" id="ref56">23</reflink>]) as ways to center learner perspectives, particularly for individuals with limited vocal repertoires. Second, respondents emphasized the importance of respecting autistic characteristics and culture in all aspects of decision-making, particularly in setting goals. Practitioners can avoid developing goals that require children to mask autistic characteristics (e.g., reducing stereotypy, increasing eye contact, increasing sensory tolerance), instead focusing on teaching peers to celebrate neurodiversity and autistic culture. Third, respondents reported that practitioners should always strive to meet sensory, emotional, and psychological needs when making educational choices on the child's behalf. This may include providing accommodations to prevent sensory overwhelm (e.g., headphones, fidget toys), avoiding goals and procedures that cause psychological distress (e.g., restraint, seclusion), responding promptly to emotional dysregulation and distress, and teaching emotional regulation skills. Finally, practitioners should consider incorporating practices with consistently high social acceptability ratings, and avoiding practices with consistently low social acceptability ratings, whenever possible. Goals that promote communication and autonomy were considered most appropriate to target, while goals that promote masking of autistic characteristics were considered least appropriate to target. Learning contexts with fully adult-led learning or with very short or long amounts of time in ideal learning contexts were rated unacceptable. Procedures that included antecedent interventions were consistently rated as highly acceptable. Some consequent procedures were consistently rated as unacceptable, including attention extinction, tangible extinction, and forms of escape extinction that restricted bodily autonomy (e.g., restraint, physical prompting). When considering these recommendations, respondents consistently reported that decisions will vary according to the child's unique context and characteristics. Practitioners should engage in collaborative decision-making with all relevant shareholders, particularly the child, and use all relevant variables to arrive at decisions that center the child's perspective and experience.</p> <hd id="AN0183072053-37">Acknowledgments</hd> <p>We would like to thank our internal peer review board, Dr. Mari-Luci Cerda and Julie Soisson, for their meaningful feedback on this iteration of the manuscript. We would like to thank Drs. Johanna L. Staubitz, Erin E. Barton, and Ann P. Kaiser for their meaningful feedback on an early iteration of the manuscript.</p> <hd id="AN0183072053-38">Funding</hd> <p>Funding for this research was provided by the Peabody Dean's Fellowship at Vanderbilt University. The Institutional Review Board (IRB) at Vanderbilt University provided ethical approval prior to conducting this research.</p> <hd id="AN0183072053-39">Data Availability</hd> <p>No materials in this manuscript are the copyrighted work of another individual or organization.</p> <hd id="AN0183072053-40">Declarations</hd> <p></p> <hd id="AN0183072053-41">Conflict of interest</hd> <p>There are no conflicts of interest to disclose.</p> <hd id="AN0183072053-42">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0183072053-43"> <title> References </title> <blist> <bibl id="bib1" idref="ref25" type="bt">1</bibl> <bibtext> Anderson, L. K. (2022). Autistic experiences of applied behavior analysis. Autism, 13623613221118216.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref5" type="bt">2</bibl> <bibtext> Bannerman DJ, Sheldon JB, Sherman JA, Harchik AE. 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| Items | – Name: Title Label: Title Group: Ti Data: Centering Autistic Perspectives: Social Acceptability of Goals, Learning Contexts, and Procedures for Young Autistic Children – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Kate+T%2E+Chazin%22">Kate T. Chazin</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-8619-7702">0000-0001-8619-7702</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jennifer+R%2E+Ledford%22">Jennifer R. Ledford</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-2392-7103">0000-0002-2392-7103</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jane+M%2E+Wilson-Moses%22">Jane M. Wilson-Moses</searchLink><br /><searchLink fieldCode="AR" term="%22Adithyan+Rajaraman%22">Adithyan Rajaraman</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-3671-8327">0000-0002-3671-8327</externalLink>)<br /><searchLink fieldCode="AR" term="%22A%2E+Pablo+Juárez%22">A. Pablo Juárez</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(3):812-831. – Name: Avail Label: Availability Group: Avail Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 20 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Acceptance%22">Peer Acceptance</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Objectives%22">Educational Objectives</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Determination%22">Self Determination</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Learning+Processes%22">Learning Processes</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+Making%22">Decision Making</searchLink><br /><searchLink fieldCode="DE" term="%22Validity%22">Validity</searchLink><br /><searchLink fieldCode="DE" term="%22Measures+%28Individuals%29%22">Measures (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education%22">Special Education</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s10803-024-06242-4 – Name: ISSN Label: ISSN Group: ISSN Data: 0162-3257<br />1573-3432 – Name: Abstract Label: Abstract Group: Ab Data: Despite the importance of centering autistic perspectives in educational decision-making for autistic children, few studies have directly assessed autistic perspectives on the social acceptability of early childhood practices. We conducted an online survey to recruit perspectives of autistic adults on a current, comprehensive range of educational practices typically employed with autistic children. We also extended the survey to caregivers and early childhood practitioners, to identify commonalities and discrepancies between shareholder groups. We conducted a descriptive survey study to assess social acceptability of goals, learning contexts, and procedures typically implemented with young autistic children. We received responses from 660 individuals, 226 of whom identified as autistic. For Likert scale and ranked items, we reported median rating and ranking for each item, by shareholder group. For open-ended questions, we conducted open and axial coding, to determine consistent themes within and across shareholder groups. Respondents reported (a) high acceptability for goals promoting self-determination and low social validity for goals promoting masking; (b) high acceptability for antecedent interventions and low social validity for some forms of extinction; (c) that appropriate learning environments are highly context dependent, varying with individual needs; and (d) that the child is the most important shareholder in educational decision-making. We make recommendations to practitioners in response to survey results, including (a) respecting autistic culture and characteristics in selecting goals; (b) considering social, emotional, and psychological needs in selecting procedures; and (c) individualizing goals, learning contexts, and procedures based on the child's perspectives and unique needs. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2025 – Name: AN Label: Accession Number Group: ID Data: EJ1460744 |
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