How Beginning to Speak Alters Early Parent-Child Interactions in Autism

Background:  The language development of young children with autism spectrum disorder (ASD) is quite unpredictable. Although onset is almost always delayed, outcome is remarkably heterogeneous. This heterogeneity is likely rooted in infancy when ASD-related joint attention deficits affect the child’s access to language during parent-child interactions. Studies indicate that early joint engagement predicts language outcome. However, the evidence base is still too narrow to document how joint attention deficits hamper word learning as well as how partners might compensate for a child’s difficulties.

Objectives:  Our aims were 1) to broaden the view of joint engagement during interactions to characterize the partner’s supportive role and the overall dynamics of the dyadic exchange as well as the child’s joint engagement, and 2) to discern if beginning to speak transforms interactions.

Methods:  144 toddlers participated: 58 with ASD, 46 with non-ASD developmental delay (DD), and 40 typically developing (TD). Two 30 min parent-child interactions were video recorded, first at an initial visit that occurred before diagnosis (mean age = 24.4 m) and, for 46 in the ASD and 32 in the DD groups, in a follow-up visit approximately a half-year later (M age = 31.6 m). Reliable ratings were made using the 8 items from the Joint Engagement Rating Inventory (JERI) for child’s joint engagement, affective communication, parent’s scaffolding and following in of child’s interests, and the interaction’s fluency and connectedness. Children were classified as not speaking or speaking during the interaction at each visit.

Results:  During the initial visit, all rating-item means were significantly lower for the ASD than for the DD and TD groups and all diagnostic group effects were significant with a median effect size of .34 (range = .24–.42; see Table 1). Moreover, all rating-item means were significantly lower for the not-speaking than for the speaking group (median effect size =.26, range = .18–.57) across both the ASD and DD groups. To determine whether beginning to speak altered interactions, we categorized those children with ASD and DD who completed the follow-up visit as: (a) remained not speaking, (b) became speakers, and (c) remained speakers. Changes in the rating items from initial to follow-up visits were most marked for children who became speakers. Notably, compared to children who remained not speaking, significant changes occurred in parent’s scaffolding and the interaction’s fluency and connectedness as well as in child’s joint engagement and affective communication (see Table 2).

Conclusions:  Our findings indicate that early parent-child interactions are negatively impacted by ASD even before early diagnosis, especially when the child is not speaking. However, if the child begins to speak, several aspects of interactions change significantly. This finding complements the claim that joint attention plays a pivotal role in early word learning by demonstrating the impact of language use on parent-toddler interactions. This work highlights the importance of transactional processes between social interactions and language use both for theories of early developmental processes in ASD and for early interventions.