Engaging Peers in Play: Community Partnered Adaptation of a Social Communication Intervention to Support Pairs of Toddlers with Autism

Background: Community Partnered Participatory Research can support the adoption of research-based practices in real world settings. To match the needs and context of a community center-based toddler program, the current project focused on adapting a one-to-one social communication intervention for children with autism, to include a peer in play based interactions. A randomized controlled trial was conducted where paraprofessionals in half the classrooms were taught to deliver the adapted peer intervention while half continued to deliver the original one-to-one model, both designed to target children’s social communication and play skills.

Objectives: First, to explore paraprofessional teaching assistants’ (TAs) implementation of a naturalistic developmental behavioral intervention- Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER: Kasari et al., 2008; 2014) adapted to include a peer (referred to as jasPEER). Second, to examine children’s social communication and play skills for those randomized to the novel jasPEER sessions (including a TA and two children) versus one-to-one TA-child JASPER sessions.

Methods:

Forty-eight TAs, and 113 toddlers (mean age=32.28 months) across 4 classrooms were randomized to JASPER with a peer present (jasPEER) or one-to-one JASPER waitlist control. Children had received an autism spectrum disorder (ASD) diagnosis (n=1 with Down Syndrome). All but two TAs, and two children were members of an ethnic minority group.

Intervention. Significant effects of JASPER over treatment as usual on joint engagement, joint attention gestures, play skills, and language were demonstrated with this center in a prior trial (Shire et al., 2017). Building upon TAs’ knowledge of one-to-one JASPER, they were provided with two weeks of in-vivo training and ongoing video feedback from the research team to learn the jasPEER adaptation. Children in waitlist classrooms received JASPER for 30 minutes a day for 11 weeks, while children in immediate jasPEER received the adapted peer version during this time.

Measures. Ten-minute video recorded TA-child interactions at entry, midpoint, and exit were coded for children’s joint engagement (JE), and TAs’ implementation. Independent assessors also administered the Short Play and Communication Evaluation, a brief semi-structured measure of play, and joint attention.

Results: TAs in jasPEER demonstrated significant gains in implementation scores from entry to exit (f(1,74)=10.23, p=0.002), with average exit scores of 72%. Children in jasPEER started with significantly lower JE in session with TA and peer (f(1,246)=2.95, p<.01). However, the children made significant gains in JE to exit (f(1,246)= 5.14, p<.01), such that the groups were not significantly different in JE by exit (p=.64). Overall, children in both groups demonstrated significant gains in initiations of joint attention (f(1,162)=52.71, p<0.001) and play diversity across levels (simple: f(1,162)=5.56, p=0.019; combination: f(1,162)=7.68, p=0.006; pre-symbolic: f(1,162)=24.42, p<0.001; symbolic: f(1,162)=29.24, p<0.001). No significant between group differences were found.

Conclusions: TAs learned to implement a peer adaptation of JASPER well by exit. Limited child JE at entry in jasPEER may be influenced by the learning curve required of TAs for the adaptation while JASPER TAs could continue with existing skills and strategies. Overall, children in both groups made significant gains in core skill domains including social communication and play.