• Balance Fidelity and Flexibility: Follow intervention guidelines but adapt responsively to family needs and contexts.

• Prioritize Alliance: Building trust and collaboration with caregivers may be as critical as technical fidelity.

• Support Caregiver Confidence: Provide coaching that enhances caregiver self-efficacy, as this predicts sustained strategy use.

• Use Video Feedback: Behavioral coding of sessions can help providers reflect on both fidelity and adaptations.

• Focus on Everyday Routines: Embed strategies into natural family routines to increase relevance and sustainability.

This study shows that bringing evidence‑based interventions into everyday early intervention programs is more complicated than it might seem. It also suggests that following a model “by the book” doesn’t automatically lead to strong caregiver engagement or a positive working relationship. What seems to matter just as much is the ability to adapt in thoughtful, responsive ways that help families feel supported and understood. These findings highlight the importance of approaches that balance fidelity with the realities of each family, provider, and community setting, so that interventions can work well in real life—not just in research studies.

Simple Play (Sensorimotor & Exploratory)

These activities focus on cause-and-effect, sensory exploration, and basic motor skills—like banging, mouthing, or dropping—just to see what happens.

• Press & Poke- Offer a small ball of playdough and model pressing your finger into it. Invite the child to poke, press, tap, or squeeze.
  What it works: Builds finger strength, supports early fine‑motor control, and gives immediate sensory feedback.
  Interaction tip: Copy the child’s actions (“You poked it! I poke too!”) to build reciprocity without directing.
  
• Pull‑Apart Play- Give the child a larger piece of dough and let them stretch, tear, and squish it.
  What it works: Encourages bilateral coordination and exploration of how materials change shape.
  Interaction tip: Narrate (or name and describe) what the child does and sensory experience (“So stretchy… now squishy…”) to support language without interrupting play.
  
• Hide‑and‑Find- Hide a small pom‑pom, bead, or button inside a ball of dough and invite the child to dig it out.
  What it works: Strengthens persistence, problem‑solving, and hand strength.
  Interaction tip: Pause with anticipation as they search — shared excitement builds engagement.
  
• Rolling Sensations- Model rolling dough into snakes or balls using hands or a small rolling pin.
  What it works: Supports motor planning and introduces early tool use.
  Interaction tip: Offer choices (“Roll with hands or roller?”) to support autonomy.
  
• Imprint Hunt- Provide textured objects (leaves, blocks, shells, toy animals) and invite the child to press them into the dough. 
  What it works: Encourages exploration of patterns, shapes, and cause‑and‑effect.   
  Interaction tip: Follow their discoveries — if they repeat one imprint, join them and expand.

Combination Play (Functional & Constructive)

These activities involve using materials together with intention—building, matching, or organizing.

• Cutting & Snipping- Offer child‑safe scissors or plastic knives and encourage the child to cut dough into pieces.
  What it works: Supports hand strength, bilateral coordination, and purposeful tool use.
  Interaction tip: Keep language simple (“Cut… open… small piece… big piece”) to support sequencing.

• Stamp & Build- Use cookie cutters, stamps, or lids to create shapes, then arrange them into patterns or simple structures.
  What it works: Encourages planning, combining shapes, and early constructive thinking.
  Interaction tip: Let the child choose the order or pattern — follow their lead.

• Dough Roads- Flatten dough into roads or paths and invite the child to drive cars or animals along them.
  What it works: Supports spatial awareness and purposeful combination of materials.
  Interaction tip: Comment on the child’s actions (“Your car is going around the curve!”) rather than directing.
• Container Play- Offer muffin tins, small cups, or jars and invite the child to fill them with dough.
  What it works: Strengthens functional routines like filling, packing, and serving.
  Interaction tip: Pause before the child “serves” you to build anticipation and shared joy.

• Layered Creations- Encourage the child to stack dough pieces to make simple towers, sandwiches, or layered patterns. 
  What it works: Supports sequencing, planning, and combining multiple steps.
  Interaction tip: Celebrate their choices (“You added another layer!”) to reinforce agency.

Symbolic Play (Pretend & Representational)

These activities support imagination, role play, and storytelling.

• Pretend Bakery- Invite the child to make cookies, cupcakes, or pizza using dough and simple tools.
  What it works: Supports familiar routines, early narratives, and symbolic representation.
  Interaction tip: Follow their pretend storyline — don’t introduce new themes unless they invite it.
  
• Animal World- Help the child create simple animals (snakes, worms, turtles) or build habitats like nests or ponds.
  What it works: Encourages imaginative thinking and combining materials into meaningful scenes.
  Interaction tip: Mirror their animal sounds or actions to deepen shared engagement.
  
• People & Feelings- Make simple faces or figures and explore emotions by changing expressions.
  What it works: Supports emotional literacy and representational thinking.
  Interaction tip: Keep it playful (“This one looks surprised!”) rather than instructional.
  
• Small World Scenes- Use dough to create trees, rocks, food, or furniture for toy animals or figures.
  What it works: Encourages storytelling and combining symbolic elements into a scene.
  Interaction tip: Let the child direct the story — you follow and scaffold.
• Magic Potions- Invite the child to mix dough “ingredients” with beads, glitter, or small objects to create pretend potions.
  What it works: Supports creativity, sequencing, and imaginative role play.
  Interaction tip: Add playful anticipation ("What do you put in next?" "What will your potion do?") while letting them lead.