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The Role of Supported Joint Engagement and Parent Utterances in Language and Social Communication Development in Children with ASD
In young children with autism spectrum disorder (ASD), social communication and language abilities in early childhood impact adult social functioning, independence, and adaptive behavior (Gillespie-Lynch, Sepeta, & Wang et al., 2012). Many of these children do not develop language (Klinger, Dawson, & Renner, 2002), and are at risk for poor adult outcomes. Social communication difficulties are endemic to ASD, and persist through adulthood regardless of language abilities (Tager-Flusberg, Joseph, & Folstein, 2001). Previous research has shown early parent-child interactions play an important role in language and social communication development. Supported joint engagement (SJE), in which the parent scaffolds play so that the child is not required to manage the interaction through eye contact, predicts later expressive and receptive language in children with ASD (Adamson et al., 2009). Additionally, parent utterances that follow the child’s focus of attention also predict expressive language, receptive language, and social communication (McDuffie & Yoder, 2010; Siller & Sigman, 2002). In this study, we extend this literature by dividing SJE into higher order (HSJE) and lower order (LSJE) variants, with HSJE involving some degree of reciprocity from the child. We also examined follow-in utterances that co-occurred with object engagement, HSJE and LSJE.
Objectives: 1) To determine if HSJE is the superior predictor of expressive language, receptive language, and social communication, as compared to LSJE or object engagement, 2) To determine if follow-in utterances that co-occur with HSJE predict language and social communication to a greater extent than follow-in utterances that co-occur with LSJE or object engagement.
Methods: At time one, seventy-nine initially nonverbal preschoolers ASD were administered a video recorded parent- child interaction procedure and were assessed for mental age. Eight months later, participants were assessed for expressive language, receptive language, and social communication. Videos were coded for engagement states and parent follow-in utterances. Multiple linear regressions were used to determine significant predictors for each outcome.
Results: Only HSJE predicted social communication and expressive language, while object engagement and mental age predicted receptive language. In a separate set of regressions that include each engagement state combined with follow-in utterances, HSJE combined with follow-in utterances and mental age predicted all three outcomes. In three final regression models that included the total proportion of HSJE and HSJE combined with follow in utterances, only HSJE combined with follow-in utterances predicted receptive language, while only the total proportion of HSJE predicted expressive language and social communication.
Conclusions: Supported joint engagement can be meaningfully separated into HSJE and LSJE, and only HSJE predicts expressive language and social communication. The engagement framework during the provision of follow-in utterances is also important, with the HSJE framework solely predicting each outcome. Lastly, total HSJE has importance above and beyond follow-in utterances provided during this state for expressive language and social communication, highlighting the importance of scaffolded engagement that involves some degree of reciprocity from the child. Receptive language is influenced by follow-in utterances provided during HSJE, even when controlling for total HSJE, highlighting the importance of optimal linguistic input for this outcome.