Caregiver collaboration on virtual Communication and Symbolic Behavior Scales (Franco et al., 2026)

Purpose: While telepractice interventions for social communication have been more widely studied, research on telepractice-based assessments, particularly for toddlers, remains limited. Telepractice assessments offer a range of potential benefits, including improved accessibility for families facing logistical challenges such as geographic distance or scheduling conflicts. This study explored the use of the Communication and Symbolic Behavior Scales (CSBS) in a telepractice context, administered by caregivers with virtual coaching. Key research questions examined fidelity of administration, scoring reliability, and caregiver perceptions of the assessment process.Method: Thirty infant/toddler younger siblings of autistic children and their caregivers were recruited from an ongoing clinical trial. Participants completed virtual CSBS assessments at three intervals over a 6-month period. Assessment materials were provided through kits mailed to participants’ homes. Caregivers, guided by trained assessors via telepractice, administered the assessments with their children. Video recordings of the sessions were analyzed to evaluate caregiver implementation fidelity and assessor coaching fidelity using standardized criteria. Scoring reliability was examined through interrater comparisons, with a subset of assessments independently rated to ensure agreement. Caregiver feedback on the telepractice process was collected through surveys, capturing both satisfaction and reported challenges.Results: Caregivers administered the CSBS with a high level of fidelity (M = 95.61%), and assessors demonstrated strong fidelity in their coaching and support during the assessments (M = 91.14%). Scoring reliability between raters was robust (intraclass correlation coefficient = .85). While caregivers generally reported positive experiences with the telepractice format, some noted difficulties in maintaining their child’s engagement and adjusting to the structured nature of the assessment process.Conclusions: The findings suggest that virtual administration of the CSBS is a feasible and reliable method for assessing social communication in young children. This approach has potential to increase accessibility for families facing barriers to in-person services, though further research is needed to refine protocols and address caregiver feedback.Supplemental Material S1. CSBS parent coaching script.Supplemental Material S2. A fidelity checklist for administering the CSBS via telepractice.Supplemental Material S3. An example completed fidelity checklist of a single telepractice administration of the CSBS.Franco, J. H., Butler, J. M., Garza, A., Glickman, A., Lidov, E., Hobson, A., Schmitgen, E. M., & Hampton, L. H. (2026). Administering the Communication and Symbolic Behavior Scales in collaboration with caregivers in a virtual environment: Reliability, fidelity, and lessons learned. American Journal of Speech-Language Pathology, 35(3), 969–982. https://doi.org/10.1044/2025_AJSLP-25-00160