Assessment of Early Social Communication and Play Skills in Toddlers with Autism By Community Teaching Professionals: The Short Play and Communication Evaluation

Background:   Children with autism experience delays in the development of nonverbal social communication gestures to request and to share (joint attention) as well as play skills such that intervention is required. Therefore, community stakeholders require valid and reliable tools to assess students’ skill level in order to set appropriate intervention targets. The Short Play and Communication Evaluation (SPACE) is a brief measure delivered by community professionals to capture the presence of children’s play and social communication skills in order to set communication goals for intervention.

Objectives:   First, to examine the degree to which teachers and paraprofessionals can accurately administer the SPACE with toddlers with autism. Second, to examine agreement between the SPACE and established research protocols when identifying children’s target joint attention, requesting, and play skills. 

Methods:  

Participants.  Sixty-five toddlers with autism who were enrolled in a larger intervention study were included. Children were developmentally and ethnically diverse with expressive language age-equivalent scores on the Mullen Scales of Early Learning ranging from 2-33 months (mean= 16 months) and all families reporting a non-Caucasian ethnicity. Children attended a public early intervention center-based program in two underserved and under-resourced communities of a major metropolitan center. Two classroom teachers and four paraprofessionals were trained to administer the SPACE.

Measures. Three assessments were administered including two well-established protocols: the Early Social Communication Scale (ESCS: Mundy et al., 2003) and Structured Play Assessment (SPA: Ungerer & Sigman, 1981) delivered by trained clinicians. Teaching professionals administered the SPACE, a brief tool combining elements of the ESCS and SPA. Teachers administered the SPACE one-on-one using a standard set of toys and a structured protocol.

 Outcomes. Children’s spontaneous initiations of joint attention (including coordinated joint looks, points, shows, and gives), requesting (give and point), and four levels of play skills (simple, combination, pre-symbolic, and symbolic) were examined.

Results:   Teaching professionals in under-served communities learned to deliver the SPACE with high fidelity (mean= 90.34%). Chi squared test of proportions indicated agreement was not significantly different from expected proportions of 80% agreement and 20 % disagreement between: (a) SPACE and ESCS- joint attention skill target (p=0.29), (b) SPACE and ESCS- requesting skill target (p=0.65), and (c) SPACE and SPA- play skill target (p=0.50). Therefore, the joint attention, requesting, and play targets selected based on students’ performance on the brief teacher-administered SPACE, were the same as those selected from the research protocols approximately 80% of the time. 

Conclusions:   Findings indicate that teachers and paraprofessionals in under-resourced settings can deliver the SPACE with high fidelity with a developmentally diverse group of toddlers with autism. This study extends prior SPACE findings with preschool-age children with autism and indicates that toddlers’ early social communication and play skills are also accurately captured using the SPACE. The brief teacher-implemented SPACE led to the same profile of mastered and target skills found using the long research protocols delivered by highly trained clinicians indicating that this short protocol delivered by community stakeholders in real-world settings provides an accurate characterization of children’s early social communication and play skills.