Autism's Pervasive Effect on Early Parent-Child Communication

Background:   Joint attention deficits may greatly constrain a young child with autism’s social interactions.   For example, during the developmental period when a child often begins to speak, children with autism are less likely than typically developing (TD) toddlers to sustain periods of coordinated and supported joint engagement when interacting with their parents that in turn may limit their introduction to language and its use.

Objectives:   This study uses a newly crafted set of rating scales to document how autism affects early parent-child interactions.  In addition to replicating well-documented effects on joint engagement, we sought to gain a wider view of how autism affects other aspects of the child’s communication, the parent’s communicative actions and the characteristics of shared topics of communication.   Moreover, we probed how the relations between joint engagement and aspects of communication varied between groups.

Methods: Children (56 typically-developing children [TD] at 18 months; 23 children with autism [AU] at 30 months) were observed interacting with a parent during six 5-minute Communication Play Protocol scenes that afforded a range of communicative functions including interacting, requesting, and commenting.   For each scene, reliable observers rated items related to child joint engagement (4 items), child communication (5 items), parent communication (4 items), and their shared topic (4 items) on a 1–7 scale. 

Results:  Consistent with prior findings based on moment-by-moment state coding, supported (SJ) and coordinated (CJ) joint engagement were rated lower in the AU group than in the TD group (p < .001).  In both groups, symbol-infused joint engagement was rated low, (M = 2.2), indicating that most children were not yet integrating language into the interactions.  Autism also significantly and negatively affected the child communication items, including responsiveness to and initiation of communication, affective communication, and quality of behavior (p < .001).  Moreover, topics within the AU group were less sustained and conversations were less fluent and connected (p < .001).  The parents’ contribution was also affected; scaffolding and following-in were rated lower (p < .05) and symbol highlighting higher (p < .001) in the AU group.  Correlations between the items assessing SJ and CJ and other items indicated that in both groups parent scaffolding and following in was related to SJ but not to CJ.   Within the AU group, but not within the TD group, correlations of child communication items and shared topic items with SJ and CJ were often strong (>.50). 

Conclusions: Rating scales can help document the pervasiveness of autism’s effect on early parent-child communication. In this study, they detail how, during the developmental period when language is emerging, parents interacting with a child with autism may have more difficulty than parents of typically developing children scaffolding communication and following in on the child’s focus of attention.  Shared topics may also be constrained in scope and relatively difficult to sustain.   Furthermore, the level of joint engagement may be tightly associated with aspects of communication, underscoring the relation between children’s problems sustaining shared attention and communication difficulties.