Lucie Wheeler, ARU and CEO RECAP Ltd
Dr Theodora Papatheodorou, Independent scholar and researcher
Tracy Pepper, CEO Transforming Autism
Introduction
This paper presents key findings of the evaluation of the ‘First Steps – An early autism support programme’ for young children (up to the age of 4 years) and their parents/primary caregivers (Papatheodorou and Prescott, 2021). First Steps is informed by the latest scientific evidence, and it is based on knowledge co-construction, involving paediatric occupational therapists, child psychotherapists, autism experts and parents of autistic children to ensure that its implementation is based on the realities of families and professional practice (Papatheodorou and Prescott, 2025).
Autism, referred to as Autism Spectrum Disorder (APA, 2013), is understood as a complex neurological and brain development condition, caused by complex genetic, environmental and epigenetic factors (Das et al., 2020), characterised by excessive neural connections/synapses, and/or disruptive synchronisation between the two hemispheres (Courchesne et al., 2007; Dinstein et al., 2011). Autism is a lifelong condition, but its developmental trajectory can be altered if signs of autism are detected early in life and appropriate support is provided (Alonim et al., 2021)
The programme is premised on scientific evidence showing (i) the reciprocity between sensory sensitivity/motor coordination and emotional and affective expression, and social interaction (Trevarthen and Delafield-Butt, 2013; 2020), better understood as a subtle unconscious process and response to environmental stimuli and interactions with others (Porges, 2018); and (ii) the role of early experiences in shaping the developmental trajectory of young children and especially the brain synaptic development and pruning, during the first four years of life.
The interplay between sensorimotor and affective experiences is particularly significant during infancy and toddlerhood, when children’s experiences are largely sensory and non-verbal, while early experiences such as shared reciprocal interactions between parents/primary caregivers and their child through playful and expressive (non-verbal and verbal) communication provide the appropriate context for shaping the brain architecture and determine the developmental trajectory of young autistic children (Papatheodorou and Prescott, 2025). Thus, First Steps implementation takes a strengths-based, and playful relational approach. It is implemented by trained paediatric occupational therapists and child psychotherapists in the family home. First Steps is aimed at both the child and primarily parents/primary caregivers, intending to identify and acknowledge their strengths and build upon them to enhance their capacities and strengths (Papatheodorou and Prescott, 2025).
Methodology
For the evaluation of First Steps, a multiple case study methodology was followed (Yin, 2017), involving analysis of documentary evidence, and interviews with parents and therapists, who were involved in the programme implementation. Documentary evidence included various child and family assessments, and semi structured interviews were conducted with parents and therapists. A sequential approach was followed to data gathering and analysis (Cresswell and Plano Clark, 2007). Documentary analysis was conducted first, following an inductive thematic analysis, while interviews with parents and therapists followed a hybrid thematic analysis (Proudfoot, 2022). The evaluation objectives were:
1. Identify and assess the progress made in the child and parent outcomes, related to programme goals
2. Identify elements of the programme influencing goal progress, including restrictive or inhibiting elements.
Key findings
The documentary analysis revealed that the therapists assessed several areas, considering strengths and challenges for goal setting for both the child and parents/primary caregivers. For the child, assessments areas included:
· Motor coordination and sensory sensitivity
· Affective, emotional expression and behaviour
· Communication and language
· Social interactions
· Play interactions and engagement
· Transitions outside the home
For parents areas assessed included.
· Relationships and interactions with the child
· Play and engagement with the child
· Parents’ personal and family experiences and challenges
· Parent and therapist relationship and interactions
· Support availability
Analysis of interviews showed that for children, measurable progress was observed in communication, regulation, and play -manifested through new words or signs, greater participation in imaginative activities, and improved adaptability during transitions.
For therapists, the dual-lens model fostered professional growth as occupational and clinical practitioners learned from one another and from the families they supported.
At a broader level, the programme’s influence extended into educational settings, where embedded strategies informed staff practice and strengthened EHCP applications, amplifying its systemic impact.
The value of the programme was described by parents/primary caregivers as transformational, deepening their understanding of their child’s needs, enhancing confidence, and equipping them with practical, sustainable strategies for everyday life.
The therapists’ professional practices reflected five interrelated themes. Play-based, child-focused support positioned play as the primary medium for connection, communication, and emotional growth. Sensory-motor regulation approaches, stabilising children’s bodies and nervous systems to enable engagement and learning. Through in-the-moment parent coaching, therapists modelled responses and narrated their reasoning during sessions, equipping parents with practical tools and confidence to support their children at home. A strengths-based framing of behaviours helped reframe challenges, fostering parental hope and resilience. Finally, systemic integration extended support into early years settings, ensuring continuity across home, nursery/school.
Recommendations for strengthening and enhancing the programme implementation were: therapists’ consistent use of the First Steps recommended assessment and review documents to ensure that child and family strengths and needs are comprehensively identified and tracked; enhancing the therapists’ interprofessional collaboration for setting measurable goals and micro-goals, linking them directly to daily routines, enabling families to observe and celebrate incremental progress; improving systems of reporting and feedback to parent/primary caregivers to promote shared understanding, sustain engagement and reinforce transparency of programme implementation; and the introduction of a monitoring and evaluation system to measure progress and programme effectiveness; ,
Conclusion
The First Steps programme has demonstrated itself to be a powerful model for family support, blending the practical expertise of paediatric occupational child psychotherapists. Families consistently described the programme as life-changing, highlighting transformational gains in children’s communication, regulation, play, and independence, alongside increased parental confidence, understanding, and hope. Parents and therapists valued the professional growth and holistic outcomes made possible through the dual-lens approach, which also generated wider impact across nurseries and early education settings. Consistent documentation, clearer goal setting, regular feedback to parents, and the introduction of a monitoring and evaluation system were recommended as ways of strengthening further the programme’s relational ethos and collaborative practice.
Declarations
· Funding for the evaluation of First Steps was received by Open University, Societal Challenge
· The evaluation of First Steps was undertaken by Lucie Wheeler (RECAP Ltd) and it was supported by Dr Claudi Thomas and Dr. Collette Christiansen (Open University), all independent to the programme development and implementation.
· Carla O’Sullivan, Fizza Hasan and Eloise Crowson (Transforming Autism), undertook tasks as requested by the researchers
· Dr Theodora Papatheodorou, First Steps programme lead developer and author, and advisor to programme evaluation in this capacity.
· Tracy Pepper, Transforming Autism CEO had the oversight of the programme evaluation
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