A Randomized Controlled Trial of Preschool-Based Joint Attention Intervention for Children with Autism

Background: Deficits in joint attention (JA) and joint engagement (JE) represent a core problem in young children with autism (Adamson, Bakeman, Deckner, & Romski, 2009; Chiang, Soong, Lin, & Rogers, 2008; Mundy, Sigman, & Kasari, 1994), as these affect language (Charman et al., 2003; Loveland & Landry, 1986; Thurm, Lord, Lee, & Newschaffer, 2007), and social development (Sigman & Ruskin, 1999). Targeting core social skill deficits at an early point may set off small improvements, altering long term prognosis. Therefore, intervention aiming to increase JA and JE might be essential. Studies of parent-mediated and specialist-mediated JA-intervention suggest that such intervention may be effective (Kasari, Gulsrud, Wong, Kvon, & Locke, 2010; Green et al., 2010; Kasari et al., 2006). Still, little is known about the success of the intervention when done in preschools.

Objectives: Assess the effects of a preschool-based JA-intervention in increasing JA and JE in interaction with preschool teachers as well as generalization to interaction with mothers.  

Methods: This study used a randomized controlled trial. Sixty-one children (48 males) with autistic disorder (29–60 months) were randomized to either 8 weeks of JA-intervention, in addition to their preschool programs (n=34), or to preschool programs only (n=27). The intervention was done by preschool teachers with weekly supervision by trained counselors from Child and Adolescent Mental Health Clinics (CAMHC). Changes in JA and JE were measured by blind independent testers using Early Social Communication Scale (ESCS) and video taped preschool teacher–child and mother–child play at baseline and post-intervention.

Results: Intention-to-treat analysis using ANCOVA's and Quasi Poisson regression showed significant difference between the intervention and the control group, with the intervention group yielding more JA initiation during interaction with the preschool teachers. The effect generalized to significantly longer duration in JE with the mothers. Chronological age, language age, and developmental level did not moderate the intervention effect.  

Conclusions: The results of the study are expanding the knowledge from earlier specialist-mediated and parent-mediated studies. The relatively short preschool-based intervention of 8 weeks by preschool teachers with no prior experience with JA-intervention was improving some core behavioral signs of autism. Thus, JA-intervention might be a valuable addition in established preschool programs for children with autism.