Joint Attention during an ABA Intervention Session Can Predict Progress of Preschoolers with Autism Spectrum Disorder

Background: Although the positive effect of ABA has repeatedly been demonstrated, it remains unclear how variations in techniques affect the results. Moreover it is poorly understood why a substantial subgroup of children with ASD does not improve with ABA. Possibly features of the interaction between therapist and child during intervention account for part of the variability in outcome.

Objectives: This study performed a descriptive analysis of the variability in the joint attention interaction sequences between therapists and children. Second,  the study focused on the extent to which these observational data predicted the progress which children made during 6 months of intervention.

Methods: 16 children with ASD participated. They were between 30 and 75 months old. The children received an ABA intervention. They were followed-up during a period of 6 months and their joint attention and language skills were tested both before and after this period. After three months we videotaped one intervention session of each child. Both the imperative and declarative joint attention behaviours of the children, as well as their antecedents (prompts) and consequences (rewards) provided by the therapist were coded. We calculated the frequency of imperative and declarative joint attention bids that were either prompted or spontaneous and rewarded or unrewarded. 

Results: Children who showed more spontaneous imperative than declarative joint attention were 1.93 times more rewarded for imperative than declarative joint attention, while children who mainly showed spontaneous declarative joint attention were 1.62 times more rewarded for declarative compared to imperative joint attention The majority of the children showed more or less the same amount of prompted and spontaneous imperative joint attention.

We conducted four backward stepwise regression analyses with the joint attention interaction sequences as predictors and progress in imperative joint attention, declarative joint attention, receptive and expressive language as dependent variables. The first regression analysis showed that the progress in imperative joint attention could be predicted by the number of rewarded declarative joint attention bids, β = .59, t(15) = 2.36, p = .04. over and above the number of imperative joint attention bids and the number of unrewarded declarative joint attention bids. Progress in declarative joint attention on the other hand, was negatively related to the number of prompted unrewarded imperative joint attention bids, β = -.55, t(15) = -2.43, p = .03, which was the only significant predictor. Progress in receptive language was predicted by a model with spontaneous unrewarded declarative joint attention, β = .54, t(15) = 2.84, p = .01 and prompted rewarded imperative joint attention, β = .48, t(15) = 2.52, p = .03. Progress in expressive language could only be predicted by the number of spontaneous declarative joint attention bids, β = .73, t(15) = 3.99, p = .001. 

Conclusions:  Joint attention behaviours that are rewarded seem to occur more frequently, even within one session. Moreover the interaction between therapist and child within this session after three months of intervention can predict the amount of progress children make in a period of 6 months on joint attention and language.