Autism Severity and Language Improvements Using a Social Engagement Intervention for Toddlers with ASD

Background: Early language learning is strongly dependent upon the frequency and consistency of social interaction and engagement (Kuhl, 2015). Young children with autism demonstrate significant vulnerabilities in early engagement skills, such as social orienting and joint attention behaviors, which are found to be significant predictors of later language ability (Dawson et al., 2004). It is logical that early autism interventions that prioritize social interaction and engagement over the use of repetitive learning paradigms will result in superior improvements in core areas of development, including language acquisition. Research suggests that early interventions that integrate social elements into reinforcement paradigms can dramatically improve collateral levels of interpersonal engagement (Vernon, 2014; Vernon et al., 2012; Koegel et al, 2009). This study will report on the status of ongoing research efforts to optimize social engagement between adult and child as a means to bolster receptive and expressive language communication skills in children with autism. 

Objectives: The study’s objective was to evaluate the effectiveness of this 6-month social engagement intervention as an effective means for targeting social engagement and language skills. 

Methods: Participants were 10 toddlers (ages 18-48 months) with ASD who had completed an ongoing randomized controlled trial. Participants were age-matched and randomly assigned to treatment or waitlist conditions. The active treatment group received early intervention using a modified Pivotal Response Treatment paradigm in which language efforts were reinforced using engaging social activities derived from each child’s pre-existing (but non-social) interests. Comprehensive developmental assessment batteries were completed to thoroughly characterize participants and assess treatment effects.  The measures of interest used for this preliminary investigation included the Autism Diagnostic Observation Schedule-2 and Mullen Scales of Early Learning.  A multivariate analysis of variance test was conducted to assess for differences in autism symptom severity and language abilities between groups at post time-points.

Results: The treatment group demonstrated significant decrease in autism symptom severity (ADOS Social Affect and Restricted Repetitive Behaviors Score: pre = 16.2, post= 10.6) compared to the waitlist control group (pre=15.4, post=15.2; p=.036). Additionally, participants in the treatment condition demonstrated significant improvements on standardized language assessments in comparison to waitlist controls. Significant improvements in receptive language skills were evidenced in the treatment group (Mullen Receptive Language t-score: pre=35.4, post=52.0) that were not replicated in the waitlist group (pre=28.4, post=28.4; p=0.030), The treatment condition also demonstrated a trend toward improvement in expressive language (Mullen Expressive Language t-score pre=32.6, post=39.2) that was not observed in the waitlist condition (pre=28.8, post-test=28.8), although this finding was not significant given the preliminary nature of the data and small n. 

Conclusions: Study results suggest that toddlers receiving an embedded social-reinforcement intervention demonstrate significant improvements in receptive and possibly expressive language skills not observed in wait-list controls. It also suggests that overall autism symptom severity can improve dramatically after six months of engaging intervention that combines their pre-existing interests with social elements. These preliminary findings suggest that efforts to target social engagement in a larger cohort of children with autism may have similar transformative effects to early single subject design empirical findings.