32081
Joint Engagement in Minimal Verbal Children with Autism
Joint engagement (JE) is the state where children interact with an object and a social partner, providing a rich context for social communication. Children with autism have difficulties sustaining JE (Adamson et al., 2009) but can make gains through developmental interventions (e.g., Kasari et al., 2014). Therefore, this construct of JE haspreviously applied in interactions focused on spontaneous bidirectional interaction versus adult led instruction. The study will examine the proof-of concept for exploring engagement in Discrete Trial Teaching (DTT).
Objectives:
The study will examine: 1) the construct of engagement within DTT intervention, 2) whether children who participated in DTT made gains in JE at intervention weeks 3 and 6, and 3) whether JE predicts responder status at week 6.
Methods:
Participants. The sample is a from a subset of a social communication intervention trial. Children were randomized to either Joint Attention Symbolic Play Engagement Regulation (JASPER) or DTT. Twenty-seven minimally verbal (less than 20 spontaneous words) children with autism, ages 4.6-8 years (mean age=6.32; SD = 1.18) received DTT.
Intervention. Each child received 30-minute DTT sessions 5x/week (or 40-minute sessions 4x/week) conducted 1:1 at school, home, or other community locations.
Interventionist-Child interactions (ICX).Engagement was coded from 10-minute videos between the interventionist and child from weeks: 1 (first session), 3, and 6. Children’s engagement state (Joint Engagement, Object, Person, Onlooker, and Unengaged) were coded in seconds. JE was also coded either child initiated or adult-directed. Proportion of time spent in each state was analyzed.
Clinical Global Impression-Improvement. Responder status was measured by the CGI-I, which measured children’s improvement of social communication on a likert scale of 1-7. Children with a rating of a 1 (very much improved) and 2 (much improved) were categorized as responders. Children with a rating of 3 (minimally improved) to 7 (very much worse) were categorized as slow responders.
Results:
The proportion of time that children spent in adult-initiated JE significantly increased at week 3 (F(1,52)=14.8, p=0.0003) and at week 6 (F(1,52)=14.5, p=0.0004). There were 9 responders and 18 slow responders to the intervention at week 6. Changes in adult-initiated JE from baseline to week 3 (Z=-0.646, p=0.52) and to week 6 (Z=-1.168, p=0.243) did not predict response.
Conclusions:
Children in DTT increased the time spent in adult-directed JE over six weeks of intervention. However, the increase in adult-directed JE did not predict responder status which measured children’s spontaneoususe of social communication. This suggests that children in DTT were more attentive and responsive to instruction over time but did not necessarily increase their use of spontaneoussocial communication. Therefore, this result did not capture the mechanism for change in social communication that one would expect in developmental interventions. This may be due to the nature of DTT instruction, where children are expected to be more responsive to the interventionists’ prompts and may have fewer opportunities to initiate. Future research should further examine the quality of joint engagement (adult versus child-led) across instructional models.