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Published in final edited form as: Autism. 2025 Nov 13;30(2):412–425. doi: 10.1177/13623613251388627 Search in PMC Search in PubMed View in NLM Catalog Add to search The SUN Collaborative: co-designing a program to enhance educator knowledge and efficacy supporting children with neurodevelopmental disabilities Kelly B Beck Kelly B Beck 1 Department of Psychiatry, School of Medicine, University of Pittsburgh, 406 Sterling Plaza, 201 North Craig Street, Pittsburgh, PA 15213 Find articles by Kelly B Beck 1 , Amy Ionadi Amy Ionadi 2 Department of Psychiatry, School of Medicine, University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213 Find articles by Amy Ionadi 2 , Timothy Wagner Timothy Wagner 3 Upper St. Clair School District, 1825 McLaughlin Run Road, Pittsburgh, PA 15241 Find articles by Timothy Wagner 3 , Daniel Beck Daniel Beck 4 Upper St. Clair School District, 1825 McLaughlin Run Road, Pittsburgh, PA 15241 Find articles by Daniel Beck 4 , Rachel Harris Rachel Harris 5 Department of Psychiatry, School of Medicine, University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213 Find articles by Rachel Harris 5 , Stephen Edwards Stephen Edwards 6 Fox Chapel Area School District, 611 Field Club Road, Pittsburgh, PA 15238 Find articles by Stephen Edwards 6 , Donna Westbrooks-Martin Donna Westbrooks-Martin 7 ACLD Tillotson School, 4900 Girard Road, Pittsburgh, PA 15227 Find articles by Donna Westbrooks-Martin 7 , Jamie Upshaw Jamie Upshaw 8 Autism Urban Connections, Inc Find articles by Jamie Upshaw 8 , Andre Rhone Andre Rhone 9 Pittsburgh, PA Find articles by Andre Rhone 9 , Taylor Kesich Taylor Kesich 10 Pittsburgh Public Schools, 341 S. Bellefield Ave., Pittsburgh, PA 15213 Find articles by Taylor Kesich 10 , Allie Kleinschmidt Allie Kleinschmidt 11 Penn Trafford School District, 1100 Randall Court, Export, PA 15632 Find articles by Allie Kleinschmidt 11 , Carla A Mazefsky Carla A Mazefsky 12 Department of Psychiatry, School of Medicine., University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213 Find articles by Carla A Mazefsky 12 Author information Article notes Copyright and License information 1 Department of Psychiatry, School of Medicine, University of Pittsburgh, 406 Sterling Plaza, 201 North Craig Street, Pittsburgh, PA 15213 2 Department of Psychiatry, School of Medicine, University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213 3 Upper St. Clair School District, 1825 McLaughlin Run Road, Pittsburgh, PA 15241 4 Upper St. Clair School District, 1825 McLaughlin Run Road, Pittsburgh, PA 15241 5 Department of Psychiatry, School of Medicine, University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213 6 Fox Chapel Area School District, 611 Field Club Road, Pittsburgh, PA 15238 7 ACLD Tillotson School, 4900 Girard Road, Pittsburgh, PA 15227 8 Autism Urban Connections, Inc 9 Pittsburgh, PA 10 Pittsburgh Public Schools, 341 S. Bellefield Ave., Pittsburgh, PA 15213 11 Penn Trafford School District, 1100 Randall Court, Export, PA 15632 12 Department of Psychiatry, School of Medicine., University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213 Author Contributions: Several co-authors of this manuscript received an honorarium payment to be instructors of the SUN program in the pilot study (TW, DWM, SE, JU, AR, TK, AK). This is consistent with our participatory approach to involve community members as paid team members of this project. There are no additional financial disclosures to report. ✉ Corresponding Author : Kelly B. Beck, Ph.D., Department of Psychiatry, School of Medicine, University of Pittsburgh, 406 Sterling Plaza, 201 North Craig Street, Pittsburgh, PA 15213, [email protected] Issue date 2026 Feb. PMC Copyright notice PMCID: PMC12616365 NIHMSID: NIHMS2115564 PMID: 41230624 The publisher's version of this article is available at Autism Abstract Autistic and other neurodivergent youth face social, sensory, and environmental challenges at school that negatively impact learning and wellbeing. Yet, most educators are not trained in neurodevelopmental disabilities, leaving them with outdated knowledge and limited confidence about how to support neurodivergent youth at school. In a two-phase project, we sought to (1) co-design a comprehensive professional development training for school educators and (2) pilot test this training in one United States (U.S.) public school district. First, we used community-based participatory research (CBPR) methods to form an interdisciplinary team of neurodivergent educators and autistic community members. We then used human-centered design methods to iteratively design the Schools Unified in Neurodiversity (SUN) professional development training for US K-12 educators. In Phase 2, we demonstrated feasibility and acceptability of the resulting training in a sample of 192 educators, grades K-12. Significant improvements were noted in educator knowledge and self-efficacy in pre-to-post assessments. Together, CBPR and human centered design provided a promising community-driven approach to development, resulting in a training that was well received and conducive to implementation. Future work will test the effects of the SUN training on youth outcomes and explore the role of professional learning communities to support implementation and sustain change. Keywords: Autism, neurodiversity, teacher education, school inclusion, human centered design, community based participatory research Plain Language Summary Neurodivergent children are children that have neurodevelopmental or cognitive disabilities (e.g. autism spectrum disorder, attention deficit hyperactivity disorder; ADHD, brain injury, dyslexia, Tourette’s, and other neurological disorders). Neurodivergent children have heightened risk for mental health problems and poor learning outcomes compared to their peers. Sadly, school experiences contribute to these poor outcomes. Every day, neurodivergent children face a multitude of barriers and negative events at school that exacerbate their neurocognitive, sensory, and social communication differences, and even make them feel unsafe. Educators do not have the knowledge of how to support neurodivergent children and cannot practically provide individualized supports to each neurodivergent child in their classroom. A new approach is needed to ensure that school is a positive, enriching experience instead of the stressful, negative experience that it is for most neurodivergent students. This project aimed to transform schools for neurodivergent children by giving public school educators the knowledge they need to create a safe and inclusive school climate for all children. We developed the Schools Unified in Neurodiversity (SUN) training with a group of researchers, teachers, counselors, principals, administrators, and advocates all with personal connections to neurodiversity. The SUN training program teaches a series of practical tools to design classrooms and instruction in ways that eliminate unnecessary barriers and set neurodivergent children up for success at school. We tested the SUN training program in one school district with 192 educators. Results suggest that this program is agreeable to teachers and improves their knowledge and confidence in supporting their neurodivergent children. Future work will test how the SUN training program helps neurodivergent youth directly and if teachers can sustain these positive changes in knowledge and confidence. Background Neurodivergent youth are children that have neurodevelopmental or cognitive disabilities (e.g. autism spectrum disorder, attention deficit hyperactivity disorder; ADHD, brain injury, dyslexia, Tourette Syndrome, other neurological conditions, and/or multiple disabilities) with unique learning needs due to differences in neurocognitive processes, social communication, and sensory processing ( Pellicano & den Houting, 2022 ). Current population estimates suggest that approximately 15-20% of school-aged youth are neurodivergent ( Maciver et al., 2023 ). As such, schools and educators are likely to work with many neurodivergent students. Despite this, many educators have limited confidence and understanding of how to best support neurodivergent learners ( Anglim et al., 2018 ; Lindsay et al., 2013 ). In the United States (U.S.), public school districts serve children starting in Kindergarten (K, age 5) through 12 th grade (typically age 18 but can extend to 21 depending on state laws). U.S. laws have been passed to protect and support students with disabilities and other unique learning needs. The Individuals with Disabilities Education Act (IDEA), originally passed in 1975 and later renamed and reauthorized multiple times, is a U.S. federal law requiring that students with a disability are entitled to a tailored education in the least restricted environment at no cost to the families ( Zigmond & Kloo, 2017 ). Students identified or diagnosed with a neurodivergent condition are protected by IDEA and supported by Individualized Education Plans (IEPs), which detail any unique accommodations, learning classrooms, or other educational supports needed for that student to succeed. U.S. schools are run by a complex and multidisciplinary workforce with distinct professional backgrounds and expertise, including general education teachers, special education teachers, teachers with a specialized focus (e.g. early childhood, gifted education, English as a Second Language), school counselors and psychologists, and administrators (e.g. principals and superintendents) that all play a critical role in supporting children through grades K-12. In alignment with U.S. disability protection laws and policies, U.S. public schools employ special education teachers, a school psychologist, contract with rehabilitation professionals (e.g. occupational therapy, physical therapy, speech and language pathologists, low vision specialists), and a director of special education to oversee required disability services. However, most school personnel are general education teachers. General education teachers are trained to teach a broad range of children and abilities in a typical classroom setting, with a focus on delivering academic content with standards in subjects ( Zigmond & Kloo, 2017 ). General education teachers often specialize in subject areas and age groups (i.e. elementary school/primary school, middle school, high school/secondary school). In contrast, special education teachers are trained to support children with disabilities and others with unique learning needs, often with individualized interventions and learning plans ( Zigmond & Kloo, 2017 ). School counselors and psychologists conduct psychological and academic assessments and support students’ social-emotional and behavioral needs through counseling and individualized supports. School administrators specialize in educational leadership and are responsible for establishing academic curriculum standards, managing school budgets, supervising teachers and staff, creating a school culture, and implementing school policies across teachers and students. Ultimately, the structure of U.S. school systems is highly complex with multiple layers of professionals and significant variation across states in terms of school size, policies, and availability of specialized supports ( Zigmond & Kloo, 2017 ). Given this complex educational system structure, ensuring that educators are equipped to support neurodivergent students is challenging for schools. Most U.S. school educators are not prepared with the training and knowledge to support neurodivergent youth or children with disabilities ( Anglim et al., 2018 ; Cook, 2024 ; Lindsay et al., 2013 ). General education teachers receive two or less courses in their training on supporting children with disabilities, leaving them with outdated information about these disabilities and limited confidence in ways to support neurodivergent children ( Anderson et al., 2024 ; Cook, 2024 ; Cook & Ogden, 2022 ). General educators, however, are regularly responsible for the learning and emotional needs of neurodivergent students in a general education classroom due to the IDEA requirement to teach students with disabilities in the least restrictive environment (which is a general education classroom). This knowledge gap is increasingly problematic with the rise in identification of neurodivergent children. ( Maciver et al., 2023 ) While general educators may be open-minded and interested in supporting neurodivergent students in their classroom, these educators often do not know the details of a child’s condition and operate with a paucity of appropriate instructional strategies for the needs of 15-20% of children in their classroom ( Anglim et al., 2018 ; Lindsay et al., 2013 ; Tiwari, 2024 ). Understandably, the lack of best practice guidelines and adequate teacher training for these educators also has the potential to become evident to students and parents, further intensifying the issue ( Bottema-Beutel et al., 2020 ; Leifler et al., 2022 ). Ultimately, this leaves many educators underprepared, without the skills to support neurodivergent children in classrooms, and a school climate that exacerbates their differences. Educational outcomes for neurodivergent children are concerning and many have negative social experiences at school ( Kurowski et al., 2022 ; Maïano et al., 2016 ). Further complicating the issue, research to date has largely been siloed to specialties of each of these distinct neurodivergent conditions with work focusing on developing individualized interventions. This siloed approach, though useful to understanding unique characteristics and mechanisms of each disability, is impractical for general education classrooms. It is not feasible to solely rely on individualized interventions and specialized learning plans in a general education classroom when teachers are managing up many children and have limited training in this disability ( Kurowski et al., 2022 ; Wilson et al., 2024 ). Further, there are many instances where teachers do not know specific diagnoses of neurodivergent children in their classroom, a child has not yet been identified as neurodivergent, or an IEP is not yet in place. Partnering with schools to address these knowledge gaps may lead to more effective and sustainable changes that improve the school experience for neurodivergent children. The Present Study This development project aimed to provide educators with the knowledge and tools to improve the school environment for neurodivergent children. The idea for this research project was generated and ranked as the top priority by our established group of autistic community partners, Pittsburgh Adult Autism Research Community Collaborative (PAARCC), who proposed that addressing challenges at school will target lifelong trajectories of poor mental health and suicidality (Mazefsky et al., 2025). As such, our team first used a community-based participatory research (CBPR) approach to co-design a professional development program, the SUN Program, for school educators (Phase 1). We selected a CBPR approach because interventions developed with limited community input often result in programs that are not sustainably implemented in the community ( Beidas et al., 2023 ; Lyon & Koerner, 2016 ). Co-designing with the end-users (in this case educators) and people with lived experience produces interventions that have a higher probability of sustainable implementation, especially within the complexity of a school system ( Chen et al., 2020 , 2021 ; Lyon & Koerner, 2016 ). In Phase 2, we pilot tested this program in a U.S. public school district. We hypothesized that educator’s knowledge of neurodiversity and self-efficacy in supporting neurodivergent students would be significantly higher after completing the SUN Program. We also hypothesized that educators would report that the tools learned in the SUN Program would be feasible, acceptable, and appropriate for implementation in their school. We present methods and results of each phase in consecutive order. This study was approved by the University of Pittsburgh Institutional Review Board (STUDY23010093), and the data and materials from this study are available upon request. Phase 1 Methods SUN Collaborative Members: Consistent with CBPR principles ( Israel et al., 2010 ), we formed an interdisciplinary collaborative of educators, neurodivergent community members, and researchers with shared decision making in all phases of this research project. We identified SUN Collaborative members by connecting with local school district leaders for recommendations of educational leaders with personal connections to neurodiversity. The study PI met individually with each potential member to ensure that it was a good fit for lived experience, professional experience, and project goals. All nine members of the SUN Collaborative are either neurodivergent themselves or parent/family member of a neurodivergent child. Neurodivergent conditions represented in the Collaborative include autism, ADHD, brain injury, multiple sclerosis, dyslexia, intellectual disability, and other neurological conditions. Members of the SUN Collaborative identify as male (30%), female (50%), non-binary (20%), white (70%), and Black or African American (30%). SUN Collaborative members included educators employed at 5 school districts in Pennsylvania. Specifically, the SUN Collaborative included 2 building-level administrators (i.e. Principal, Assistant Principal), district administrators (i.e. assistant superintendent, director of student instruction), director of an approved private school for neurodivergent children, special education teacher, general education teacher, school counselor, two neurodivergent adult advocates, and the executive director of a non-profit organization dedicated to supporting Black autistic families. One member was also a standing board member of a statewide association for school administrators that focuses on informing legislation, policy, and development of elementary, middle, and high school principals. The nine members of the SUN Collaborative members partnered with 3 researchers (2 of which are also neurodivergent) to co-design the SUN Program (totaling 12 members and authors in this manuscript). Phase 1 SUN Program Development: The Collaborative aimed to “create better schools for neurodivergent learners through a professional development program”. The Collaborative addressed this goal through a series of 8 team meetings, ranging from 2-6 hours long each. Group meetings fused HCD with CBPR methods to rapidly produce and refine the program and reach consensus across members ( Table 1 ; Chen et al., 2020 ). HCD is a proven method for leading teams to develop innovative and sustainable products with an interdisciplinary group ( Chen et al., 2020 ; Norman et al., 2021 ). We further enhanced traditional CBPR and HCD methods with our own expertise in accommodating neurodivergent people with varied communication and sensory needs (e.g. detailed meeting agendas, sensory breaks, sensory rooms, intentional and predictable discussion groups, multiple modes of sharing information and communication). Table 1 details the HCD methods and steps for each activity, and further information for replication can be found in the Luma Institute HCD handbook that we utilized ( Luma Institute, 2012 ). Table 1. Human centered design (HCD) methods to co-design the SUN Program Meeting HCD Activity Name HCD Activity Steps HCD Activity Outcome 1 What’s on your radar? ( Figure 1 ) • 5-minute individual rapid generation of ideas across 6 areas • Rank ideas of importance • Add ideas to group radar Idea generation for key domains of the [name] program Rose, thorn, bud • 15-minute presentation on latest science • Identify positive, negative, and areas for improvement in the science Shared understanding of latest research Affinity clustering • 2 small groups to identify themes and patterns in research reflections • Group similar reflections together to identify themes across members Shared understanding of latest research Vote • Voting on top 3 domains for [name] program • Tally votes and group consensus discussion Consensus on 4 key domains of [name] program 2 – 4 Concept mapping • Generate ideas • Sort ideas • Rank ideas • Identify clusters of ideas and relationships between clusters Initial set of ideas for [name] tools Creative matrix • Determine key question: “how might we foster safe relationships with neurodivergent children at school?” • Create 5 x 5 grid with columns of solution domains (e.g. build on personal interests and talents; classroom arrangement) and rows detailing context (e.g. classroom, hallway) • Refine ideas and organize into the set grid Specific ideas based on school context Importance difficulty matrix ( Figure 2 ) • Plot ideas onto graph by importance (x-axis) and difficulty (y-axis). • Categorize ideas based on plotting location ○ Quick wins = low difficulty, low importance ○ Save for later = high difficulty, low importance ○ Needs strategy = high difficulty, high importance ○ High value = low difficulty, high importance Prioritized final set of [name] tools for each of the 4 program domains 5 – 6 Storyboarding • Form 3 small groups (i.e. elementary, middle, high) • Use low-cost materials (e.g. papers, markers, sticky notes, computer) to draft story lines and characters for learning activity of [name] tools. • Present storyboards to larger team for feedback Initial model for [name] materials and learning activities Rapid prototyping (multiple times) • Use low-cost materials (e.g. papers, markers, sticky notes, computer) to create protype of [name] materials • Present initial prototypes to larger team for feedback and edits Initial prototypes of [name] learning videos, materials, and activities. 7 - 8 Vote • Final review of [name] program, [name] tools, and [name] materials • Tally votes and group consensus discussion Final [name] Program materials and activities Open in a new tab Meeting 1. We first set group rules and processes for working together and reaching consensus. The Collaborative identified four group rules: (1) respectful engagement (e.g. supportive, language matters, agree to disagree); (2) enable participation (e.g. clear instructions, transparent norms, and provide the right tools); (3) trust; and (4) play (e.g. have fun with creative ideas). We then used a series of HCD activity protocols, designed by the LUMA Institute ( Coulter et al., 2021 ; Luma Institute, 2012 ) to identify the key components of what would comprise the SUN Program (see Table 1 for an explanation of the goal and process of each HCD activity). In the first “What’s on your Radar” activity, collaborative members independently generated ideas of topics and skills that educators needed to learn to improve schools for neurodivergent children ( Luma Institute, 2012 ). Collaborative members generated ideas across 6 areas (i.e. school environment, self-advocacy, emotional distress, student to student interactions, instruction, miscellaneous) and ranked the importance of their ideas onto a group radar, which we used to organize the ideas ( Figure 1 and Supplemental Table ). Figure 1. Open in a new tab Human centered design ‘What’s on your radar?’ activity Following this activity, researchers presented a literature review of the latest research on instruction, school culture, sensory barriers at school, inclusivity training, and life outcomes among neurodivergent people ( Alcorn et al., 2022 ; Beheshti et al., 2020 ; Biederman & Faraone, 2006 ; Brede et al., 2017 ; Clément et al., 2022 ; Hirvikoski et al., 2016 ; Howlin & Magiati, 2017 ; Huntjens et al., 2023 ; Kurowski et al., 2022 ; L. Pellicano et al., 2018 ; Schwartzman et al., 2024 ). SUN team members used the “rose-thorn-bud” HCD activity, which is uses a color-coding system to positives (rose), negatives (thorn), and opportunities for growth (bud), to synthesize the literature presented ( Coulter et al., 2021 ; Luma Institute, 2012 ). Using this, Collaborative members generated the following themes from the research to integrate into ideas: importance of understanding models of disability, key role of teacher-student relationships, need for safe sensory spaces, and lack of teacher training in disability. These concepts were integrated together with the radar to form a full set of ideas of topics for an educator training on neurodiversity. Collaborative members then considered the ideas and voted on their top topics that should be included in a professional development program ( Luma Institute, 2012 ). These four highest ranked domains became the core models of the SUN Program. Between meeting 1 and 2, SUN Collaborative members sought feedback from other teachers and neurodivergent students on these domains through informal interviews. Meetings 2 – 4. The Collaborative members used a series of HCD activities, including “concept mapping”, “creative matrix”, “importance difficulty matrix”, and “storyboarding” to iteratively generate and refine specific ideas and tools for each of the four domains. First, we used concept mapping (See Table 1 ) to create a diverse set of ideas for each of the four key domains ( Dopp et al., 2020 ; Luma Institute, 2012 ). Concept mapping is a systematic process to first generate and rank ideas and then identify relationships between different ideas ( Dopp et al., 2020 ; Luma Institute, 2012 ). Next, we created creative matrixes for each of the 4 domains. Creative matrixes are a way to visually organize and refine ideas by considering how to operationalize and implement each idea in a variety of contexts (e.g. in classroom, hallway, extracurricular). The matrixes ensured that each idea was practical for teachers to use in a variety of school contexts. For example, for domain 3 environments, we refined the initial idea of “improve learning activities and classroom arrangement” into several specific tools based on school context (e.g. seating guidelines for classrooms; sensory room guidelines for each building). This activity resulted in specific tools that were practical in various school contexts. We then used the “importance difficulty matrix” to select and prioritize a final set of ideas for the SUN tools ( Figure 2 ; ( Luma Institute, 2012 ). The “importance difficulty matrix” involves plotted ideas onto a graph organized by importance (x-axis) and difficulty (y-axis). The graph is then be interpreted by 4 quadrants, including: low difficulty/low importance (quick wins), high difficulty/low importance (save for later), high difficulty/high importance (needs strategy), and low difficulty/high importance (high value). See Figure 2 for an example matrix with a set of ideas generated in our development process. For example, we determined that “using predictable, assigned learning groups” was low difficulty for teachers and high impact in supporting neurodivergent learners. On the other hand, “matching neurodivergent students with preferred teachers” was determined to be likely high impact but high difficulty for a school to implement. SUN Collaborative members conducted informal interviews with a total of 27 teachers and neurodivergent children between meetings to refine aspects of the professional development program based on interview feedback. Consistent with HCD, these interviews were not formal research or qualitative interviews. The team conducted brief interviews with educators to gather feedback on the selected training domains and ideas from Meeting 1. Specifically, SUN Collaborative members asked the following questions in interviews: “What are ways to be responsive to emotional distress in a neurodivergent learner?”, “What can teachers do to connect with neurodivergent students”, and “What does ‘safe’ look like in the classroom?” Interviews with neurodivergent learners repeatedly highlighted the importance of educators listening and providing opportunities to connect on interests. A few themes emerged among educator interviews, including: lack in confidence in basic knowledge on disability; unsure how to build a relationship with neurodivergent student; unsure if a behavior is intentionally ‘disruptive’ or not; unsure if they should be teaching basic social skills and eye contact to neurodivergent students. The SUN Collaborative team used these themes to improve the didactic content on disability, added content on the harms of masking, created training videos on emotion dysregulation and how it is often misperceived as intentional disruption, and created a lesson planning activity to help educators find time to listen and form relationships with neurodivergent learners. Figure 2. Open in a new tab Importance difficulty matrix to prioritize final set of SUN Program Tools Meetings 5 – 6. Collaborative members created materials and applied learning activities for each of the four SUN Program domains, with attention to each level at school (i.e. elementary, middle, high school). We then used rapid prototyping and storyboarding to design the SUN Tool materials, which are methods to produce step by step visuals of a problem or product for iterative feedback and refinement ( Chen et al., 2020 ; Kia-Keating et al., 2017 ; Luma Institute, 2012 ). We also partnered directly with neurodivergent high school students to create SUN Program materials that incorporate the student perspective. Specifically, we filmed a series of student voice videos with five neurodivergent students and two neurodivergent adults. We also worked with high school students to program an interactive game that demonstrates the impact of cognitive load for neurodivergent students (Domain 1: Neuroscience of neurodiversity). Meetings 7 -8. Between session 7 and 8, we delivered the prototyped program content and materials with 20 general education teachers to elicit feedback and any necessary iterative changes. In the final meetings, the group reviewed the full SUN Training Program. This included the educator training schedule, SUN Tools, program materials, and the applied learning activities. The group discussed and voted to reach final consensus on each aspect of the training. Phase 1 Results All SUN Collaborative members reported to be “extremely satisfied” with the development process. The final SUN Program is a 6-hour professional development training for public school educators (K-12). It is designed to be implemented to an entire school district or school building to create a collective understanding across the school system for widespread changes. Thus, the SUN Program is designed for general education teachers, special education teachers, support staff, paraprofessionals, principals, and central administrators (e.g. school psychologist, director of student services, superintendents). Program materials are tailored to each level in school (i.e. elementary, middle, high) within the context of the United States education system. The SUN Program has 4 distinct modules based on the selected content domains: (1) Scientific advances and neuroscience of neurodiversity; (2) Supporting safe relationships at school; (3) Creating an inclusive environment; (4) Preventing and responding to emotional distress. Each module has an objective and a specific set of recommended best practices. Table 2 details the modules, objectives, best practices, and materials for each module. Table 2. Key elements and strategies of the SUN program Module Objective Recommended Best Practice Tool or Strategy Neurodiversity, neuroscience & advances in research The educator will explain neurodiversity and ways neurodivergent brains process information. Multi modal instruction Checklist for instructional design (unit and lesson) Classroom environment The educator will identify ways to intentionally design the classroom and instruction for neurodivergent students. Clear, visible expectations for student engagement, movement, participation, & asking for help Adapting classroom environment for sensory needs Sensory checklist and example PBIS system Fostering Safe Relationships The educator will identify specific ways to be clearly communicate and support neurodivergent students. Personal acknowledgement of all students in a class period Clear & pre-established learning group (based on social, emotional, and academic needs) Example lesson plan with these skills Preventing and Responding to Emotional Distress The educator will identify specific steps to prevent and respond to emotional distress among neurodivergent students. Consistent positive reinforcement Shared language & visuals for emotions across school Check-ins with students (self-assessment on cognitive and emotional needs) Intentional area of classroom for regulation Provided communication cards, self-assessments, tools to assess emotional intensity, and plans for designing a classroom area to support regulation Open in a new tab The modules are taught by SUN trainers using multi modal instruction, including: (a) a brief didactic presentation to introduce new background information and SUN Tools, (b) review of the information and Tools using multimedia, and (c) an applied group learning activity. The SUN Program provides educators with a workbook that includes a variety of educational materials and tools for implementation. The workbook includes infographics on sensory processing, emotion regulation, and environmental barriers to learning. The SUN workbook also includes sensory checklists, communication cards for students to use when in distress, storyboards depicting common challenges and solutions that occur across a school day. The SUN materials also include many high-quality training videos detailing the differences in cognitive and sensory processing in neurodivergent learners as well as videos detailing emotion regulation needs and recommended supports. All the best practices and materials were designed during the HCD process to have a high impact and practical to implement across school contexts (e.g. classroom, hallway, lunchroom). Phase 2 Methods In phase 2, we conducted a single arm trial of the SUN Program in one school district serving ~4,000 students (K-12). District superintendents worked with our team to dedicate one in-service professional development day to the SUN Program. Participants: Participants were: 1) 18 years of age or older; 2) educators and other personnel employed by the participating district (e.g. teacher, special education teacher, school psychologist, school administrator, paraprofessional, school counselor, support staff); 3) willing to complete data collection. A total of 204 educators participated in the study. Educators from 3 elementary schools, two middle schools, and one high school received the developed training and provided pre- and post-assessments. Data from 12 participating educators were excluded from the final analyses: a small set of participants (n =9) did not complete post surveys, and a few participants (n=3) used the wrong participant ID at post-assessment, preventing our ability to use in t-test analyses. A final sample of 192 educators was analyzed and data is available upon request. Table 2 details the educator roles and grade level assignment of participating educators. Participating educators identified as female (71%), male (28%), and transgender (1%). The sample predominantly identified as White (91%) and non-Hispanic (97%), with few participants identifying as Black (1%), Asian (1.5%), American indigenous (.5%), and other (5.5%). The mean age of participating educators was 44 ( SD = 9.7). Notably, 33% of the sample identified as neurodivergent and/or as the primary caregiver (i.e. biological parent, foster parent, grandparent) of a neurodivergent child. The most common neurodivergent diagnoses included autism and/or ADHD, with most neurodivergent children of participating educators younger than 21 (See Table 3 ). Table 3. Participating educator role and grade level assignment Educator role n (%) Building administrator (i.e. principal, vice principal) 3 (1.6%) District-wide administrator (e.g. assistant superintendent, director of student support services) 3 (1.6%) School counselor 9 (4.7%) General education teacher 113 (59%) K-12 Special education teacher 21 (11%) K-12 Support staff / aide 41 (21.4%) General Education Teacher Grade-Level n (% of N=113) Mixed across buildings 3 (2.6%) Middle School 56 (49.6%) High School 54 (47.8%) Open in a new tab Recruitment & Procedures: We recruited participants through the partnering school district. Research staff distributed the pre-surveys and post-surveys electronically. Pre-surveys were distributed 3 days prior to the scheduled SUN Program and were required to be completed before the training began. Post-surveys were made available at the completion of the training and had to be completed within 2 weeks of completing the SUN Program, with most participants having completed them immediately after the program. Participants were compensated $15 for completing both surveys. Measures: Demographics: Participating educators filled out a questionnaire pre-training that included information about their role in school and grade level, age, gender identity, ethnicity, and race. Demographic surveys also included questions about self-reported neurodivergent diagnoses and diagnoses of any neurodivergent family members. Knowledge: The SUN Knowledge Survey was completed pre- and post-training. It is a 10-item survey developed for this study to assess educator’s knowledge about the specific educational skills taught during the SUN Training Program. Two items were derived from each of the domains of the program (i.e. scientific advances and neuroscience of neurodiversity; supporting safe relationships at school; creating a supportive environment; preventing and responding to emotional distress). The items were developed by a subset of the Collaborative members with the research team. The final two items focused on communication with neurodivergent children given that communication was embedded throughout all 4 modules. Each item used a 5-point Likert response scale. Scores range from 10 to 50, with higher scores reflecting greater knowledge in how to support neurodivergent children in school. Internal consistency for the SUN Knowledge Survey was high across items (α=.965). Self-Efficacy: The AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale ( Nicolaidis et al., 2021 ) was completed pre- and post-training. It was adapted for this study to assess educator’s self-efficacy in teaching neurodivergent students. The original scale includes 6 items on provider’s self-efficacy in providing care to autistic people, including the following domains: communication, examination procedures, diagnosing and treating, helping autistic patients stay calm, identifying accommodations, and implementing accommodations. The scale uses a 5-point Likert response scale. The scale also has 2 items on level of difficulty and reward treating autistic patients, with a response scale of 1-10. We chose this scale to adapt for this study given that many of the items included topics covered in SUN Program. We adapted the scale to state “neurodivergent students” instead of “autistic patients”. We also adapted the two medical items on the scale by replacing the “diagnosing and treating” item with “identifying your neurodivergent students”, and by replacing the “examination procedures” item with “structuring learning for neurodivergent students”. Finally, at the suggestion of our Collaborative, we added two items on a culture of safety, which include “creating a safe environment for your neurodivergent students” and “modeling that differences are welcome in your classroom”. We retained the original 5-point Likert response scale, and retained the original difficulty and rewarding items. The final scale included 8 items, with scores ranging from 8 to 40, with higher scores reflecting greater self-efficacy in supporting neurodivergent children in school. Internal consistency for this adapted Educator Self-Efficacy Scale was high across items (α=.958). Feasibility & Acceptability of Implementation: Participants completed the Acceptability of the Intervention Measures (AIM), Intervention Appropriateness Measures (IAM) & Feasibility of Intervention Measures (FIM) ( Weiner et al., 2017 ) at post-training. These are widely used 4-item implementation scales developed to use with practitioners learning a new intervention. Two optional questions on implementation supports were added to the scale. The first, “what supports would help you successfully use the SUN training tools and suggestions?” had select options: follow-up training, digital reminders, aligning evaluation standards to SUN Tools, peer groups to share ideas, successes, and challenges using SUN Tools, and teams at school focused on supporting change in SUN domains. The second question asked, “if applicable, how would you like to receive any consultation or coaching” with virtual and in person response items. One open-ended question on implementation supports (i.e., What supports, if any, would you want to successfully use the tools?) was included to identify future implementation supports, Analyses: Descriptive statistics were computed on demographic questionnaires to characterize the sample (means, standard deviations, frequency counts, percentages). Primary outcomes of self-efficacy and knowledge were first characterized with descriptive statistics (mean, standard error with confidence intervals). Paired sample t-tests and Cohen’s d effect sizes were computed to determine changes between pre and post outcome surveys. Subsequently, we conducted a mixed ANOVA to assess for any differences between neurotypical participants and participants personally connected to neurodiversity (i.e. parent of neurodivergent child, self-identified as neurodivergent) over time. Feasibility and acceptability of implementation measures were characterized with descriptive statistics. Phase 2 Results Pre-surveys indicated that educators had low knowledge ( M = 24.8, SD = 9.97; highest score possible = 50) and self-efficacy ( M = 24.3, SD = 7.44; highest score possible = 40) prior to the SUN training, with no educators beginning the program at the ceiling of either measure. On the self-efficacy survey, educators reported that neurodivergent children are both difficult to teach ( M = 6.24, SD = 2.14) and rewarding to teach ( M = 7.65, SD = 2.38), with responses of 10 being the most difficult and most rewarding. The subgroup of participants personally connected to neurodiversity (i.e. parents, self) had significantly higher ( p<.05 ) baseline knowledge (M=27.56) compared to the subgroup of neurotypical participants (M=23.57) , though there were no significant differences between groups at post-assessments. Both knowledge ( M = 43.4, SD = 5.95) and self-efficacy ( M = 34.8 SD = 4.63) improved following the training. Specifically, t-tests indicated statistically significant and large effect size changes in improved educator knowledge ( t ( 191) = −27.7, p <0.001; d = 9.54) and self-efficacy ( t (191)=−20.7, p <0.001; d =7.02). Feasibility and acceptability of implementation was high, with educators reporting that the SUN Tools were acceptable ( M = 4.2; SD =.71; 86% agreed or strongly agreed), appropriate (M = 4.35; SD =.63; 92% agreed or strongly agreed) and feasible ( M = 4.29; SD =.59; 93% agreed or strongly agreed) to implement in their classrooms and school. In the implementation supports questions, two responses stood out as key ongoing implementation support needs. Educators indicated that “peer groups to share ideas, successes, and challenges” would be helpful implementation supports, which was endorsed by 97 participants (47.5%). Similarly, “teams at school focused on supporting change in SUN Program domains” was also endorsed by 97 participants (47.5%). A smaller group of participants suggested that follow-up trainings to practice the SUN Tools would be helpful (n=55; 27%). The other responses, which were suggested by 20% or less of the sample included: digital reminders, on call support or coaching, and aligning supervisor evaluations with use of SUN Tools. Discussion This project was driven by community priorities since its inception. The idea of the SUN Program came directly from another CBPR group of autistic adults with a mission to improve mental health in autistic and other neurodivergent communities. We acted on that idea by fusing CBPR and HCD methods together to create a teacher training program that targets educator knowledge and self-efficacy in supporting neurodivergent children. Our community-driven approach produced a high-quality program that was well-received by educators in one U.S. public school district, significantly improved educator knowledge and self-efficacy, and perceived as feasible, appropriate, and acceptable for implementation by participating educators. Our CBPR approach ultimately enhanced our science and resulted in a program that has a higher probability for successful implementation. The traditional intervention development process where researchers develop interventions with limited community input or in a consultation capacity often results in interventions that are a poor fit for real life contexts, in this case schools ( Beidas et al., 2023 ; Lyon et al., 2020 ; Lyon & Koerner, 2016 ). Our SUN Collaborative team had diverse representation, including people from varied neurodivergent populations (e.g. autism, ADHD, brain injury, dyslexia, Tourette Syndrome), professions (e.g. neuroscience, speech language pathology, rehabilitation science, general education, special education, rehabilitation counseling), roles in education (e.g. district administrators, general education teacher, special education teacher, assistant principal, principal, school counselor, parents), and those identifying with multiple, intersecting marginalized groups (e.g. persons with disability, Black community, sexual and/or gender minority). The diversity of perspectives in our Collaborative team was intentional and was essential to the success of the project, as our collective ideas were more creative, novel, and representative of many communities that are often excluded from science. While HCD methods are most often used in the development of digital tools and technology, HCD was an ideal approach for this study. Both CBPR and HCD research methods prioritize the needs, experiences, and voices of people who are directly impacted by the research outcome ( Chen et al., 2020 ). HCD allowed our team to quickly develop, iteratively refine, and prioritize ideas collectively across a diverse team. This process was useful to reach consensus across members quickly and offered a flexible approach to iteratively create the SUN Program and materials. While CBPR often takes several years, HCD typically occurs quickly over a shorter period of time (months) ( Chen et al., 2020 ). The entire SUN Program was developed in less than 6 months. This was ideal for our project given that public school educators have limited availability during the academic year, and we were able to co-create this program over their summer breaks. This rapid development ultimately allowed us to dedicate more time to navigate logistical challenges in facilitating a district-wide implementation of the SUN Program for our pilot test (e.g. adhering to federal and state standards for professional districts, scheduling the training within their constrained schedule; space constraints for training all faculty and staff). Ultimately, our partnering approach allowed us to navigate these complex logistics in a reasonable timeframe while also designing a program primed for implementation, which may serve as a promising model for other school-based intervention development studies. Further, our CBPR and HCD approach resulted in a high-quality program that directly addresses longstanding challenges faced by neurodivergent youth. Extant literature highlights the multitude of learning and environmental barriers at school for neurodivergent learners ( Kurowski et al., 2022 ). For example, loud, unstructured, and cluttered classrooms make it difficult for neurodivergent children to learn new information and successfully collaborate with their peers ( Clément et al., 2022 ; Mallory & Keehn, 2021 ). The school day can be full of unpredictable challenges and, in many cases, there are few sensory friendly spaces ( Clément et al., 2022 ). Recent work suggests that unaccommodating sensory environments and adverse social experiences at school led to emotion dysregulation with serious consequences, such as exclusionary discipline (e.g. suspension, alternative placements), school refusal, and involvement of school police, all of which are risk factors for mental health disorders and suicidality ( Beck et al., 2024 ; So et al., 2024 ). The SUN program provides knowledge and tools to reduce these challenges while increasing success in establishing relationships with adults and peers at school, which is a well-established as a protective factor for students ( Marraccini & Brier, 2017 , 2017 ). The SUN Program takes a macro approach to train all employees of a school district (e.g. general education teachers, special education teachers, counselors and psychologists, support staff, administrators) in best practices to support neurodivergent learners and systemic changes to remove environmental barriers at school. This systemic approach has the potential to shift long-term negative trajectories among neurodivergent people and change the school culture to be more accepting and inclusive of students with differences. Future work will measure the impact of the SUN program on child outcomes and overall school culture. The SUN Program is a feasible and acceptable program that provides useful and practical information to educators in how to better support neurodivergent children. Educators had low confidence and knowledge of how to support neurodivergent students in pre-surveys. This low baseline knowledge may be because existing teacher training programs and curriculums lack adequate coursework to prepare educators to work with neurodivergent learners. For some SUN Program participants, this training was their first interaction with content related to neurodiversity. The SUN Program improved participant’s knowledge to a substantial degree. This is promising given that professional development for teachers has long focused on curriculum, instruction, and assessment, but lacked a focus on development or advances in special education. The SUN Program fills these gaps and demonstrated significant changes in educator’s confidence supporting neurodivergent children. An unexpected result of our study was the number of participating educators with personal connections to neurodiversity. Over 30% of the educators that engaged in the SUN Program were either neurodivergent themselves or parents of neurodivergent children, which is consistent with current population estimates of neurodivergent children ( Maciver et al., 2023 ). Interestingly, participants connected to neurodiversity had significantly higher knowledge scores at baseline but there were no group differences following the training. This suggests that the SUN Program is helpful for those with and without connections to neurodiversity. Following the training, we received many consultation requests for mental health resources, advice on school accommodations, and recommendations for their children. This occurred despite being in a resource-rich area near several large healthcare systems. This highlighted the lack of support for families of neurodivergent children and the shared confusion among families in how to navigate the complexity of structural systems designed to support families and children with disabilities. Several methodological limitations should be considered when interpreting these findings. This was a community-engaged development study and not a clinical trial. We conducted the Phase 2 pilot study in a United States suburban school district with limited racial and ethnic diversity among both the student body and school personnel, thus limiting the generalizability of our findings. It is unclear how well this program would translate to other international contexts, though we anticipate that the topics and strategies taught in the SUN program are universal across contexts. Researchers and educators interested in taking a similar macro-level approach to changing schools might consider using our CBPR and HCD method as a model for partnering with schools to implement this program in a different context. Our pilot trial methods were limited to pre and post self-report measures from educators and other school personnel, without objective assessment of implementation, fidelity, or sustainable implementation. It is also unclear if improving educator knowledge, skill, and self-efficacy would impact learning, social, and mental health outcomes for neurodivergent children, which was not measured in this study. Given that our initial partners group advised this would be important for mental health trajectories, we plan to explore the effect of the program on child outcomes in future trials. Further, we were not powered in this study to analyze for subgroup differences (i.e. grade level) across educators. Future work will test educator knowledge, self-efficacy, and fidelity of implementation over a school year and with a larger sample to explore differences across subgroups. In conclusion, CBPR and HCD offer a promising approach to designing effective programs that are conducive to implementation, which may serve as an ideal intervention development model for autism research. Our SUN Program demonstrated strong feasibility, acceptability, and appropriateness among a large sample of public-school educators. Most importantly, research related to the future well-being of autistic and neurodivergent children — if they are not supported appropriately in schools — has troubling implications. Applying the practical and usable information taught in the SUN Training Program is a way that educators can effectively attend to the healthy development of their students, a critical charge that well-informed educators take seriously. Future work will test the impact on neurodivergent children’s outcomes and test implementation supports to promote sustained use of the SUN Program. Supplementary Material 1 NIHMS2115564-supplement-1.pdf (73.7KB, pdf) Table 4. Participating educator relationship to neurodiversity Relationship to neurodiversity n (% of total sample) Self neurodivergent only 2 (1%) Both self neurodivergent and family member 7 (4%) Family member neurodivergent 54 (28%) Neurodivergent diagnoses – Self Autism 1 (.5%) Attention Deficit Hyperactivity Disorder 6 (3%) Other 2 (1%) Neurodivergent diagnoses – Family Member Autism 23 (12%) Attention Deficit Hyperactivity Disorder 41 (21.3%) Dyslexia 7 (3.6%) Brain Injury 6 (3%) Tourette’s 6 (3%) Other 7 (3.6%) Open in a new tab Acknowledgments: We are grateful to all our research participants. We thank our community partners in the Pittsburgh Adult Autism Research Community Collaborative (PAARCC) who ranked this project as a top priority for improving the lives of neurodivergent students. We thank Ian Dvorin for designing an interactive game that demonstrates the impact of cognitive load for neurodivergent students. We thank Eli Kurs-Lasky, Sam Jaglowski, Michael Pollett, Aaron Gerster, and Eugene Johnson for sharing their lived experiences and filming a series of student voice videos for the SUN program. Funding Statement: This project was supported by the Pennsylvania Department of Human Services under Award Number 4100092055. The manuscript was also supported by NICHD under Award Number L30HD109969 (Author: KBB) and NIMH under Award Numbers 5P50MH130957-03 (Author KBB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Author KBB was also supported by the Supporting Our Scientists program funded by the University of Pittsburgh and Doris Duke Charitable Foundation (2021382-OF). Contributor Information Kelly B. Beck, Department of Psychiatry, School of Medicine, University of Pittsburgh, 406 Sterling Plaza, 201 North Craig Street, Pittsburgh, PA 15213 Amy Ionadi, Department of Psychiatry, School of Medicine, University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213. Timothy Wagner, Upper St. Clair School District, 1825 McLaughlin Run Road, Pittsburgh, PA 15241. Daniel Beck, Upper St. Clair School District, 1825 McLaughlin Run Road, Pittsburgh, PA 15241. Rachel Harris, Department of Psychiatry, School of Medicine, University of Pittsburgh, Sterling Plaza Suite 400, 201 North Craig Street, Pittsburgh, PA 15213. Stephen Edwards., Fox Chapel Area School District, 611 Field Club Road, Pittsburgh, PA 15238. 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