Keywords: ASD, early intervention, toddlers, parent-mediated intervention, communication, positive affect, smiling, social orientingBackground : The Social ABCs is a parent-mediated intervention (Brian et al., 2016) based on empirically supported Pivotal Response Treatment (PRT; Koegel & Koegel, 2006). The main targets of the Social ABCs are functional early (vocal/verbal) communication and positive affect sharing between child and caregiver among infants/toddlers who have suspected or diagnosed Autism Spectrum Disorder (ASD). Our positive affect target is motivated by evidence of reduced or declining positive affect, in high-risk infants, predictive of ASD outcomes (e.g., Bryson et al., 2007; Filliter et al., 2015; Landa et al., 2013; Ozonoff et al., 2010); this highlights the importance of positive affect as an early intervention target for toddlers with ASD, particularly given its importance in developing social relationships and learning generally.
Objectives : Bolstered by evidence of increased shared smiling between child and caregiver following participation in theSocial ABCs intervention (p =.017; Brian et al., under revision; Bryson et al., IMFAR, 2015), we sought to further explore the impact of our intervention on person- vs. object-oriented smiling.
Methods : 62 parent-toddler dyads were randomized into the Social ABCs (treatment) group or received treatment as usual (control) across 2 Canadian research sites (Toronto and Halifax). Parents of toddlers aged 16 to 30 months received 12weeks of in-home, live coaching, followed by 12-week parent implementation. Here, we compare groups (treatment vs. control) on changes from baseline to post-training (week 12) in three key video-coded behaviours: (1) child smiling to caregiver, (2) parent smiling to child, and (3) child smiling at objects/activities.
Results : Paired samples t-tests (with Bonferroni correction) revealed: (1) parents in the Social ABCs group (but not controls) smiled significantly more to their children post-training relative to baseline (p=.002); (2) children in the Social ABCs group (but not controls) smiled significantly more to their caregivers following intervention (p=.02); and (3) children in the control (but not treatment) condition smiled significantly more to objects at the end of the 12-week period (p=.007) compared to baseline.
Conclusions: Significant gains were observed, only for the treatment group, in person-oriented smiling. Conversely, controls spent increasingly more time smiling at objects/activities, with no change in person-oriented smiling, over the same time period. In order to further investigate the role of positive affect, we will explore relationships between smiling and child communication, parent self-efficacy, fidelity, and stress. Next steps involve further elucidating the relevance of smiling as a treatment target in ASD, with discussion about the importance of positive affect in the development of social relationships and in learning more generally. Finally, we consider whether child smiling increased because the behaviour (smiling) itself was reinforced by caregivers, or whether it is better understood as an index of ‘feeling good’ in the context of the intervention.
