Evaluation of Active Engagement In Toddlers with Autism Spectrum Disorder

Background:  The National Research Council (2001) recommended that children with autism spectrum disorder (ASD) should be actively engaged in interactions and activities for a minimum of 25 hours per week. Although active engagement has been a focus of educational research for school-age children, active engagement has yet to be operationalized and evaluated in very young children with ASD. An understanding of the dimensions of active engagement in toddlers with ASD can provide a common metric by which to monitor progress in intervention. 

Objectives:  The purpose of this study from the FIRST WORDS^® Project was 1) to describe three dimensions of active engagement (i.e., productivity, emotional regulation, flexibility, and directed communication) in a sample of toddlers identified with ASD, and 2) to examine the relationship among dimensions of active engagement, and autism symptoms. 

Methods:  Participants were recruited by the FIRST WORDS^® Project, a prospective longitudinal study. Children were diagnosed with ASD (n=60) before 24 months of age and completed a diagnostic battery that included the Autism Diagnostic Observation Schedule-Toddler Module (ADOS-T: Luyster et al., 2009), Vineland Adaptive Behavior Scale (Sparrow, Balla, Cicchetti, 1984), Mullen Scales of Early Learning (MSEL; Mullen, 1995) and a videotaped home observation of the child and caregiver. Observational data consisted of a 15-minute video sample across five different activities of three minutes each. Samples were coded using the Observer^® Video-Pro software by Noldus Information Technology. 

Results:  Preliminary analyses were conducted on a subset of participants (n=29) between 16 and 21 months (M=18.9, SD=1.15). Large significant correlations were observed between the amount of time spent in a productive and flexible state, r = 0.67, p<0.01, the amount of time spent in a productive and well-regulated state, r = 0.56, p<0.05 as well as the amount of time spent in a productive state and the amount of directed communication, r = 0.51, p<0.01. After controlling for MSEL nonverbal developmental quotient, a significant, negative correlation was observed between the ADOS social affect and restricted and repetitive behavior total algorithm scores and all 4 dimensions of active engagement. The observed correlations were moderate for time spent in a productive, r = -.38, p<0.05 and flexible state, r = -.43, p<0.05, and large for time spent in a well-regulated state, r = -.57, p<0.01, and frequency of directed communication, r = -.52, p<0.01.

Conclusions:  This study showed that toddlers who spent more time in a productive state also spent more time well-regulated and flexible and used more directed communication during samples of everyday activities at home. Relationships between these dimensions and the ADOS indicated that toddlers with more autism symptoms on the ADOS were more likely to spend less time in a well-regulated, productive, and flexible state and use less directed communication in the home environment. These preliminary results provide important implications for early detection based on home observations and for important dimensions of active engagement to monitor intervention outcomes for toddlers with ASD.