Effects of a Parent-Coaching Component of a Developmental Intervention on Gesture Production Among Toddlers with Autism

Background:

Communicative gestures provide evidence of preverbal children’s emerging communication skills. Autism is characterized by a delay in verbal and non-verbal communication development. In Autism, early communication skill predicts long-term outcomes (Lord, Risi & Pickles, 2004; Mundy, Sigman & Kasari, 1990). Thus, an important goal of many early intervention programs, including the Early Start Denver Model (ESDM; Smith, Rogers, & Dawson, 2006), is to support the development of communication in toddlers and preschoolers. The ESDM is based on two treatment approaches: (1) the Denver Model (Rogers, Hall, Osaki, Reaven, & Herbison, 2000), and (2) Pivotal Response Training. Both approaches are supported by pre-post studies reporting improvements in behaviors across a range of developmental domains (e.g., Koegel, O'Dell, & Dunlap, 1988; Rogers & DiLalla, 1991; Rogers & Lewis, 1989;  Rogers, Hayden, Hepburn, Charlifue-Smith, Hall, & Hayes, 2006;  Schreibman & Pierce, 1993). A randomized treatment study of the ESDM is currently underway. Parents in the treatment group receive three months of weekly coaching in the application of ESDM principles to everyday family activities. It is not yet known whether this initial treatment phase facilitates children’s acquisition of nonverbal communicative signals.

Objectives:

Our objective is to assess whether three months of parent coaching, the initial component of an intensive at-home intervention, increases gesture use by 2-3 year olds, compared to a control group of toddlers whose parents do not receive coaching.

Methods:

The current study will include up to thirty-eight toddlers enrolled in a multisite intervention study. All met Autism criteria on the ADOS-T and ADI-R and were randomly assigned to either the ESDM treatment or a community control condition. ADOS assessments were conducted at baseline (T1) and approximately three months later (T2). Gestures were identified from video-taped ADOS sessions examined by coders blind to treatment status. Thus far, T1 and T2 sessions from five treatment subjects and two control subjects have been analyzed.

Results:

Preliminary analyses were conducted using two-tailed t-tests. At baseline there were no significant group differences in overall frequency of gestures produced per minute (t=.23, p>.10, d= -.22). At T2, children in the treatment group produced slightly, though not significantly, more gestures per minute (M=.72), compared to the control group (M=.21; t=1.47, p=.20, d=1.55). Similarly, the percent of gestures coordinated with eye contact did not differ between groups at T1 (t=.82, p>.10, d= .79). At T2, children in the treatment group coordinated a slightly higher proportion of their gestures with eye contact (M=.16), compared to controls (M=0.0; t=2.45, p=.07, d=1.55). Future analyses will examine additional features of these gestures, such as the communicative intent conveyed and the coupling of gestures and words.

Conclusions:

These preliminary results are consistent with the views that 1) parent coaching in ESDM principles can support gesture development among children with Autism, and 2) social and cognitive systems underlying communicative gestures are plastic during the second to third year of life for children with Autism.