Promoting joint attention in toddlers with autism: a parent-mediated developmental model

Infant sensorimotor decoupling from 4 to 9 months of age: Individual differences and contingencies with maternal actions

Triadic interactions, wherein infants coordinate attention between caregivers and objects of shared focus, are believed to facilitate infant learning, and emerge around 9-12 months of age (Carpenter et al., 1998). Sensorimotor decoupling, wherein infants look at one percept while manipulating another, or use each hand for different actions, was hypothesized (de Barbaro et al., 2016) to contribute to triadic skills by allowing infants to smoothly shift attention between objects and social partners. We explored the development of Hand-Hand (H-H) and Gaze-Hand (G-H) decoupling in 38 infants at 4, 6, and 9 months. We also tested contingencies between maternal behaviors and infant decoupling: i.e., whether decoupling events followed maternal object-directed actions. Both overall and contingent infant decoupling increased from 4 to 9 months. Decoupling rates (both G-H and H-H) predicted variance in infants' fine and gross motor scores. Contingent G-H decoupling at 6 months predicted BSID-III communication scores at 18 months. Thus the development of infant sensorimotor skills, including decoupling, allows infants to smoothly shift attention and participate in triadic interactions.

Seeking Validation and Creating Meaningful Interactions: Perceptions of a Parent-Mediated Infant Intervention

Infancy, a formative period for development, has been identified as an advantageous time to provide family-centered support for children with delays. Families should be included as stakeholders during development of such interventions to ensure social value. We describe a preliminary randomized controlled trial evaluating Infant Achievements (IA), an 8-week (16-session) parent-mediated intervention for parents of infants 8-12 months old with social communication delays. This study reports our qualitative examination of the intervention's social validity. We conducted focus groups with 7 IA parent participants and analyzed their responses using conventional content analysis. Five themes emerged: (a) difficulty identifying resources to address concerns, (b) seeking validation of concerns, (c) seeking support to enhance children's development, (d) experiencing a supportive coaching relationship, and (e) creating meaningful interactions to support children's communication and social skills. Our results emphasize the necessity of partnering with families in the development of evidence-based family-centered interventions for infants with developmental delays to maximize their social value.

Brief Report: Assessment of a Caregiver-Implemented Intervention for Improving Social Communication Skills in Toddlers and Young Children with Autism

As early identification of autism improves, there is a critical need for interventions to support the development of social communication skills in toddlers. Caregiver coaching and parental involvement is crucial for improving outcomes and providing children with adequate hours of planned active engagement. This pilot study assessed a 4-week intervention for individual caregiver-child dyads. Eight toddlers 21- to 45-months of age participated. Standardized assessments were collected at four study visits to assess autism symptomatology, language development, and both caregiver knowledge and engagement. Results demonstrated the feasibility of the intervention. Social communication, receptive and expressive language all improved as measured by direct assessment. Caregiver knowledge and caregivers' subjective feelings of engagement with their toddlers also improved.

Examining Treatment Outcomes Across Contexts: How Do Child Baseline Characteristics Impact Measurement of Treatment Response?

The evaluation of the overlap between the ADOS BOSCC and Standard BOSCC as well as the exploration of child characteristics that may predict change are important steps in consolidating data-driven definitions of "improvement". Participants were seen between 2 and 5 times with Standard BOSCC and ADOS BOSCC observations over the course of early intervention trials (Grzadzinski et al. in J Autism Dev Disord 46:2464, 2016; Kim et al. in Autism 23:5, 2019). Results showed consistency between the Standard BOSCC and ADOS BOSCC, highlighting the utility of both as metrics of change and treatment outcome across contexts. Baseline characteristics may play a role in the tailoring of early intervention to maximize treatment outcome and may offer guidance when determining which outcome measures to use.

A Social Turn-Taking, Parent Mediated Learning Intervention for a Young Child with Autism: Findings of a Pilot Telehealth Study

Social turn taking, a preverbal social communication competency often difficult for young children with autism, may be foundational to joint attention when included as a component of interventions for children with autism. In this study, social turn-taking was promoted through a parent mediated learning approach to intervention in a telehealth setting. Following a mixed-methods design, the present study explored the results of this new intervention model for a toddler with autism. The study also sought to understand any changes in the parent-child relationship because of the intervention. Findings indicate that the intervention supported the child's social communication competencies, including social turn-taking, joint attention, and facial focusing. Qualitative data revealed improvements in the parent-child relationship. These preliminary results lend support for promoting social turn-taking in interventions for children with autism, as well as for following developmental, parent-driven approaches to intervention. Studies with larger sample sizes are needed to understand these findings further. Implications for practice and research in early intervention are presented.

Robot dramas may improve joint attention of Chinese-speaking low-functioning children with autism: stepped wedge trials

INTRODUCTION

Children with autism spectrum disorder (ASD), especially those with low cognitive functioning, have deficits in joint attention. Previous research has found that these children are interested in engaging with social robots.

PURPOSE

In the present study, we designed a robot drama intervention for promoting responses to joint attention abilities (RJA) of children with low-functioning autism (IQs < 70).

MATERIALS AND METHODS

Using a stepped wedge design, Chinese-speaking children aged six to eight were randomly assigned to three tiers (N = 18). Children of all three tiers had comparable autism severity, language and cognitive function, and joint attention abilities. Tier 1 first received intervention, followed by Tiers 2 and 3. They watched six dramas in which social robots demonstrated RJA behaviours.

RESULTS

The RJA of children of all tiers improved after intervention and such improvement was maintained over time. Despite initiation of joint attention (IJA) not being explicitly taught, IJA of all children was found to improve after intervention.

CONCLUSIONS

It was, therefore, concluded that a robot drama could enhance the joint attention of children with low-functioning ASD.Implications for rehabilitationIn comparison to typically developing children, children with autism spectrum disorder (ASD), especially those with low cognitive functioning, have deficits in joint attention.Robot-based drama intervention program was developed to promote responses to joint attention (RJA) abilities of children with low-functioning autism (IQs < 70).Modelling RJA in robot dramas can promote RJA abilities in these children.An improvement in RJA also yielded an increase in the initiation of joint attention (IJA) abilities.Children with low-functioning autism might be able to extract the initiation of joint attention skills from the drama, even though these behaviours were not explicitly taught.

Cascades in language acquisition: Re-thinking the linear model of development

The first 5 years of life are characterized by incredible growth across domains of child development. Drawing from over 50 years of seminal research, this chapter contextualizes recent advances in language sciences through the lens of developmental cascades to explore complexities and connections in acquisition. Converging evidence-both classic and contemporary-points to the many ways in which advances in one learning system can pose significant and lasting impacts on the advances in other learning systems. This chapter reviews evidence in developmental literature from multiple domains and disciplines (i.e., cognitive, social, motor, bilingual language learning, and communication sciences and disorders) to examine the phenomenon of developmental cascades in language acquisition.

Effects of Parental Involvement in Robot-Assisted Autism Therapy

Parental involvement in traditional autism therapy is key to the effective treatment of children with ASD. Little is known about parental involvement in robot-assisted autism therapy (RAAT)-novel therapeutic support for children with ASD. Our study investigates the effect of parental presence on multiple-session RAAT conducted with 16 children with ASD. They interacted with the social robot in the presence or absence of their parents. We measured children's socio-behavioral outcomes and conducted semi-structured interviews with parents. Parents did not necessarily affect the children's outcomes during the interventions. However, children's autism-related symptoms resulted in different socio-behavioral outcomes between sessions with and without parents. Most parents have reported positive changes in their children's behaviors when interacting with the robot.

Early intervention for very young children with or at high likelihood for autism spectrum disorder: An overview of reviews

AIM

To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes.

METHOD

We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered.

RESULTS

From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified.

INTERPRETATION

While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base.

WHAT THIS PAPER ADDS

Naturalistic developmental behavioral interventions, as well as developmental and behavioral interventions, improve child outcomes in autism spectrum disorder (ASD). If only randomized controlled trials are considered, guidelines for early intensive behavioral intervention in younger children should be revisited. The greatest intervention impacts were on proximal, intervention-specific outcomes. Inadequacies in the quality of the early ASD intervention evidence base were observed.

Effects of Rhythmic Gymnastics on Joint Attention and Emotional Problems of Autistic Children: A Preliminary Investigation

The adaptive rhythmic gymnastics (ARG) course has been specially designed for children with autism spectrum disorders (ASD). The purpose of this study is to discover the influence of the course on the joint attention and emotional problems of ASD children. This study adopted A-B-A cross-subject multibaseline design in a single case research design. The joint attention behaviour of two 6-year-old ASD children was examined. The experiment process was recorded and coded, and the results were analysed. The results illustrated the following: (1) ARG is effective in promoting the development of joint attention in ASD children, but it has a better effect on increasing responding joint attention, and (2) to a certain extent, ARG can boost the classroom participation of ASD children and improve their emotional problems.

Joint Attention and Its Relationship with Autism Risk Markers at 18 Months of Age

(1) Joint attention is the ability to coordinate attention to share a point of reference with another person. It has an early onset and is a clear indicator of understanding the representations of others, and it is essential in the development of symbolic thought and the acquisition of language. Deficiencies in this prelinguistic early communication skill are strong markers of the risk of autism spectrum disorder (ASD); (2) this longitudinal study aimed to evaluate joint attention skills in a group of 32 infants at two developmental moments (8 and 12 months) in order to explore whether their performance on this skill was related to the presence of early signs of ASD at 18 months. Logistic multiple regressions were carried out for the data analysis; (3) results of the analysis showed that the variables of initiating joint attention at 8 months and responding to joint attention at 12 months were linked to the risk of ASD at 18 months of age; (4) in conclusion, early joint attention skills had a pivotal role in defining early manifestations of ASD.

Ultra-Light Clay Intervention Improves Responsiveness and Initiates the Communication of Children With ASD

The barriers to responsiveness and the initiation of communication are the two key problems encountered by children with autism spectrum disorders (ASD). Prior interventions based on behavioral reinforcement have had an obvious effect on responsive communication but a weak effect on the initiation of communication. Based on psychological development theory, we designed ultra-light clay interventions involving hands-on production or multi-interaction around key concepts and themes, teaching children about basic concepts, relationships, and logic, making abstract knowledge concrete and experience. Two studies (Study 1: N = 3, one-to-one intervention; Study 2: N = 8, one-to-two intervention) showed that ultra-light clay intervention improved both the initiation of and response to communication among children with ASD, but that such improvements show a peer-generalization effect in initiation communication, not in responsive communication. These findings provide a set of ultra-light clay interventions for communication in children with ASD and suggest a relationship between endogenous interventions and the initiation of communication.

Enhancing Joint Attention Skills in Children on the Autism Spectrum through an Augmented Reality Technology-Mediated Intervention

In the present study, the effects of an intervention based on an augmented reality technology called Pictogram Room were examined. The objective of the intervention was to improve the responding to joint attention (RJA) skills of gaze following and pointing in six children on the autism spectrum between 3 and 8 years old. A multiple baseline single-subject experimental design was conducted for 12 weeks in a school setting. Results indicated that all of the participant children improved performance in RJA following the intervention. Improvements were maintained over time and generalised to real-world situations. These findings demonstrate that autistic children can improve their RJA skills with a targeted and engaging intervention based on an accessible augmented reality technology tool.

Parents' application of mediated learning principles as predictors of toddler social initiations

LAY ABSTRACT

Little is known about what parents can do to promote initiating joint attention for their toddlers with autism. Initiating joint attention is important because it is an indicator of social motivation and is associated with later communication ability. In this study, parents applied mediated learning principles to help their toddlers engage with them socially. The principles included helping their child focus on social interaction, giving meaning to the social elements of interaction (and de-emphasizing nonsocial elements), and helping their toddlers understand their own social ability by encouraging. At the end of the intervention period, we compared two groups. One group received the Joint Attention Mediated Learning intervention and the other received community-based early intervention services. We found that the Joint Attention Mediated Learning participants applied mediated learning principles more often than the other group. Then, we explored how parents' application of mediated learning principles related to toddler initiating joint attention and found that parents who were successful in applying the principles had toddlers who were more likely to show initiating joint attention. Our findings indicate that the mediated learning process shows promise as a way to promote early social learning, although other elements of the Joint Attention Mediated Learning intervention, such as actively engaging parents in the learning process, may have also contributed to both child and parent learning.

Effectiveness of Responsivity Intervention Strategies on Prelinguistic and Language Outcomes for Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Group and Single Case Studies

We conducted a systematic review to identify randomized controlled trials (RCTs) and single case research design (SCRD) studies of children with autism spectrum disorder that evaluate the effectiveness of responsivity intervention techniques for improving prelinguistic and/or language outcomes. Mean effect sizes were moderate and large for RCTs (33 studies; g = 0.36, 95% CI [0.21, 0.51]) and SCRD (34 studies; between-case standardized mean difference = 1.20, 95% CI [0.87, 1.54]) studies, respectively. Visual analysis (37 studies) revealed strong evidence of a functional relation for 45% of the opportunities and no evidence for 53%. Analyses of moderator effects and study quality are presented. Findings provide support for responsivity intervention strategies with more robust support for context-bound outcomes than more generalized outcomes.

Pre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda

Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).

Association of turn-taking functions with joint attention in toddlers with autism

LAY ABSTRACT

Back-and-forth interaction, or turn taking, may support later joint attention, a more complex form of interaction, when promoted in interventions for young children with autism, especially depending on the child's intent when interacting. In the present study, we observed videos of 20 toddlers with autism engaging in turn taking with their caregivers during an intervention designed to support children's joint attention. We sought to identify when the children displayed turn taking socially and when they were using it for nonsocial purposes in the intervention videos. We also observed videos after the intervention was complete to identify when children used joint attention when interacting with their caregivers. After these observations, we used these video data to explore the relationship of social turn taking to joint attention, and the relationship of nonsocial turn taking to joint attention. We found a significant relationship between social turn taking and joint attention, but not between nonsocial turn taking and joint attention. These findings support the importance of considering social turn taking in interactions between young children with autism and their caregivers.

A Qualitative Evidence Synthesis of Parental Experiences and Perceptions of Parent-Child Interaction Therapy for Preschool Children With Communication Difficulties

Purpose Parent-child interaction therapy refers to a number of interventions mediated by trained parents to treat developmental difficulties, including speech, language, and communication. Understanding the experiences of parents who take part in parent-child interaction therapy is a key aspect of determining how this intervention can be implemented successfully. However, to date, there has been limited work on synthesizing parental views of this intervention. Method We used qualitative evidence synthesis that involved searching the literature for qualitative studies addressing the experiences and perceptions of parent-child interaction therapy for parents of preschool children with communication difficulties. We identified 27 studies (from 32 publications) and synthesized the data using thematic synthesis. We appraised the quality of included studies using Critical Appraisal Skills Programme (CASP) and assessed our confidence in the review findings using GRADE Confidence in the Evidence from Reviews of Qualitative research (CERQual). Results At the beginning of this intervention, parents may have competing demands and varied expectations about the intervention. Their engagement is facilitated when the intervention is tailored to their individual family, their preferences for learning, and when they have a trusting relationship with the clinician. At the end of the intervention, although most parents perceive an improvement in their child's communication and feel empowered to facilitate this, they have concerns about their child's future needs. Conclusions It is important that clinicians explore parents' readiness for this intervention by discussing their needs and preferences openly, and that they facilitate their engagement through a supportive relationship. They also need to consider how parents will transition out of the intervention and continue to support their child's language development. Supplemental Material https://doi.org/10.23641/asha.14978454.

Long-Term Treatment Outcomes of PEERS® for Preschoolers: A Parent-Mediated Social Skills Training Program for Children with Autism Spectrum Disorder

Although parent-assisted social skills interventions may reduce early social challenges in preschool-aged children with autism spectrum disorder (ASD), limited research has explored whether intervention gains maintain several years after treatment. This study examined the durability of PEERS^® for Preschoolers, a parent-mediated social skills training program for preschool-aged children with ASD and other social challenges. Twenty-nine parents reported on child and family outcomes 1–5 years following treatment. Results demonstrated maintenance of treatment gains on measures of ASD-related social impairments including social communication, social responsiveness, social motivation, and peer engagement. Post-treatment improvements in problem behaviors and parenting stress were not maintained at long-term follow-up. Implications of these results are discussed.

Brief Report: Analysis of the Relationship Between Turn Taking and Joint Attention for Toddlers with Autism

The relationship between turn taking (i.e., back-and-forth preverbal communicative exchanges) and joint attention has not been studied in interactions between children with autism and caregivers. In joint attention, a form of preverbal social communication, young children socially share attention with a partner about objects, a competency that is difficult for toddlers with autism. Video data of interactions between caregivers and 61 toddlers with autism who received joint attention-focused intervention were analyzed to determine associations between turn taking and joint attention. Results indicate a positive relationship between the two forms of social communication. Further study is needed to determine the extent to which turn taking may play a foundational role in supporting joint attention development for toddlers with autism.

Infants at Risk for Autism Spectrum Disorder: Frequency, Quality, and Variety of Joint Attention Behaviors

Initiation of joint attention is a critical developmental function related to further social communicative development in infancy. Joint attention appears to be impaired very early in life for children with autism spectrum disorder (ASD), well before a formal diagnosis is established. To observe the early development of joint attention, we prospectively followed infant siblings at high risk for ASD (HR) and low-risk (LR) infants. Initiations of joint attention behaviors were coded with respect to frequency, quality, and variety from videos taken during the administration of the Autism Observation Schedule for Infants. Participants were further stratified based on the presence of ASD (n = 17) or language delay (n = 19) at 3 years of age. Our results revealed that initiations of joint attention are impaired from 12 months of age in both children with ASD and those with language delay, especially for use of gestures (i.e., showing and pointing). At 18 months, fewer initiations of joint attention in all three dimensions distinguished infants with ASD, compared to infants with language delay and HR and LR infants without a diagnosis. Beyond the definition of initiation of joint attention as an early sign for ASD, clinical implications of these results concern the importance of intervening on frequency, quality, and variety of joint attention as early as possible in infants at heightened risk for ASD.

A Nexus Model of Restricted Interests in Autism Spectrum Disorder

Restricted interests (RIs) in autism spectrum disorder (ASD) are clinically impairing interests of unusual focus or intensity. They are a subtype of restricted and repetitive behaviors which are one of two diagnostic criteria for the disorder. Despite the near ubiquity of RIs in ASD, the neural basis for their development is not well understood. However, recent cognitive neuroscience findings from nonclinical samples and from individuals with ASD shed light on neural mechanisms that may explain the emergence of RIs. We propose the nexus model of RIs in ASD, a novel conceptualization of this symptom domain that suggests that RIs may reflect a co-opting of brain systems that typically serve to integrate complex attention, memory, semantic, and social communication functions during development. The nexus model of RIs hypothesizes that when social communicative development is compromised, brain functions typically located within the lateral surface of cortex may expand into social processing brain systems and alter cortical representations of various cognitive functions during development. These changes, in turn, promote the development of RIs as an alternative process mediated by these brain networks. The nexus model of RIs makes testable predictions about reciprocal relations between the impaired development of social communication and the emergence of RIs in ASD and suggests novel avenues for treatment development.

Promoting social attention in 3-year-olds with ASD through gaze-contingent eye tracking

Young children with autism spectrum disorder (ASD) look less toward faces compared to their non-ASD peers, limiting access to social learning. Currently, no technologies directly target these core social attention difficulties. This study examines the feasibility of automated gaze modification training for improving attention to faces in 3-year-olds with ASD. Using free-viewing data from typically developing (TD) controls (n = 41), we implemented gaze-contingent adaptive cueing to redirect children with ASD toward normative looking patterns during viewing of videos of an actress. Children with ASD were randomly assigned to either (a) an adaptive Cue condition (Cue, n = 16) or (b) a No-Cue condition (No-Cue, n = 19). Performance was examined at baseline, during training, and post-training, and contrasted with TD controls (n = 23). Proportion of time looking at the screen (%Screen) and at actresses' faces (%Face) was analyzed. At Pre-Training, Cue and No-Cue groups did not differ in %Face (P > 0.1). At Post-Training, the Cue group had higher %Face than the No-Cue group (P = 0.015). In the No-Cue group %Face decreased Pre- to Post-Training; no decline was observed in the Cue group. These results suggest gaze-contingent training effectively mitigated decreases of attention toward the face of onscreen social characters in ASD. Additionally, larger training effects were observed in children with lower nonverbal ability, suggesting a gaze-contingent approach may be particularly relevant for children with greater cognitive impairment. This work represents development toward new social attention therapeutic systems that could augment current behavioral interventions. Autism Res 2020, 13: 61-73. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, we leverage a new technology that combines eye tracking and automatic computer programs to help very young children with ASD look at social information in a more prototypical way. In a randomized controlled trial, we show that the use of this technology prevents the diminishing attention toward social information normally seen in children with ASD over the course of a single experimental session. This work represents development toward new social attention therapeutic systems that could augment current behavioral interventions.

A Pilot Study of Early Storybook Reading With Babies With Hearing Loss

Purpose This pilot study explored the effectiveness of an early storybook reading (ESR) intervention for parents with babies with hearing loss (HL) for improving (a) parents' book selection skills, (b) parent-child eye contact, and (c) parent-child turn-taking. Advancing research into ESR, this study examined whether the benefits from an ESR intervention reported for babies without HL were also observed in babies with HL. Method Four mother-baby dyads participated in a multiple baseline single-case experimental design across behaviors. Treatment effects for parents' book selection skills, parent-child eye contact, and parent-child turn-taking were examined using visual analysis and Tau-U analysis. Results Statistically significant increases, with large to very large effect sizes, were observed for all 4 participants for parent-child eye contact and parent-child turn-taking. Limited improvements with ceiling effects were observed for parents' book selection skills. Conclusion The findings provide preliminary evidence for the effectiveness of an ESR intervention for babies with HL for promoting parent-child interactions through eye contact and turn-taking.

A Sibling-Mediated Intervention for Children with Autism Spectrum Disorder: Using the Natural Language Paradigm (NLP)

We taught three typically developing siblings to occasion speech by implementing the Natural Language Paradigm (NLP) with their brothers with autism spectrum disorder (ASD). A non-concurrent multiple baseline design across children with ASD and sibling dyads was used. Ancillary behaviors of happiness, play, and joint attention for the children with ASD were recorded. Generalization of speech for the children with ASD across setting and peers was also measured. During baseline, the children with ASD displayed few target speech behaviors and the siblings inconsistently occasioned speech from their brothers. After sibling training, however, they successfully delivered NLP, and in turn, for two of the brothers with ASD, speech reached criterion. Implications of this research suggest the inclusion of siblings in interventions.

Variability in Verbal and Nonverbal Communication in Infants at Risk for Autism Spectrum Disorder: Predictors and Outcomes

Early communication impairment is among the most-reported first concerns in parents of young children with autism spectrum disorder (ASD). Using a parent-report questionnaire, we derived trajectory groups for early language and gesture acquisition in siblings at high risk for ASD and in children at low risk, during their first 2 years of life. Developmental skills at 6 months were associated with trajectory group membership representing growth in receptive language and gestures. Behavioral symptoms also predicted gesture development. All communication measures were strongly related to clinical and developmental outcomes. Trajectory groups further indicated slowest language/gesture acquisition in infants with later ASD diagnoses, in particular when associated with language delay. Overall, our results confirm considerable variability in communication development in high-risk infants.

Clinical Decision Making in Speech-Language Intervention for Toddlers With Autism and Other Social Communication Delays

Purpose

This study investigated current speech-language intervention practices with young children with social communication delays including autism and the educational experiences that shape these practices.

Method

A 25-item web-based survey was completed by 264 speech-language pathologists who worked with children under the age of 3 years.

Results

A majority of respondents reported targeting a variety of areas of social communication across daily activities, regularly utilizing the parent as the primary agent, and often providing in-home services; however, a minority of respondents reported only using materials available in families' homes. Previous clinical experiences and continuing education were reported to most influence clinical decision making. Results indicated the incorporation of many aspects of evidence-based naturalistic interventions into practice and the use of continuing education opportunities to expand clinical knowledge.

Conclusion

Although speech-language pathologists reported promising directions toward recommended best practices, further research and training are needed to optimize services provided to young children and their families.

Initiation of joint attention and related visual attention processes in infants with autism spectrum disorder: Literature review

Autism spectrum disorder (ASD) represents a group of neurodevelopmental disabilities that can be difficult to identify before the age of 2 or 3 years, the age when the full range of behavioral symptoms has emerged in most cases. Initiation of joint attention is an important developmental function in which impairments are already observable before the second birthday and can predict children's ASD symptomatology. In the first part of this review, we summarize results pertaining to retrospective studies of initiation of joint attention in children with ASD and prospective studies of infants at high risk for ASD during the first 2 years, when this behavior is becoming more complex in terms of frequency, quality, and variety. We will also discuss the implications of impairments in dyadic engagement, a precursor of joint attention behavior, for the early development of joint attention. Finally, the early development of initiation of joint attention has been related to specific visual attention mechanisms such as social orienting and visual disengagement. In the second part of this review, we provide an overview of the relationship between those visual attention mechanisms and subsequent social-communication impairments. Clinical and research implications of these findings for both early detection and early intervention will be discussed.

Parent-Mediated Intervention for One-Year-Olds Screened as At-Risk for Autism Spectrum Disorder: A Randomized Controlled Trial

Theoretically, interventions initiated with at-risk infants prior to the point in time a definitive autism spectrum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efficacy of a parent-mediated early intervention called Adapted Responsive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identified by community screening with the First Year Inventory as at-risk of later ASD diagnoses. We found minimal evidence for main effects of ART on child outcomes. However, ART group parents showed significantly greater increases in responsiveness to their infants than control group parents. Further, significant indirect (mediation) effects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change.

The effect of caregiver-delivered social-communication interventions on skill generalization and maintenance in ASD

BACKGROUND

Although caregiver-delivered social communication interventions have been considered scientifically proven practices for individuals with autism spectrum disorders, it is not well examined if these types of intervention modes are truly effective in promoting skill generalization and maintenance within those individuals with autism spectrum disorders.

AIMS

The purpose of this meta-analysis was to evaluate the status of the extant literature regarding the measures on generalization and/or maintenance of effects of caregiver-delivered communication interventions for children with autism spectrum disorders.

METHODS AND PROCEDURES

This systematic literature review and meta-analysis evaluated peer-reviewed research regarding the effects of caregiver-implemented interventions on the maintenance and generalization of the social-communication skills for children with autism spectrum disorders. A total of 34 articles were included following a systematic search. Articles were summarized according to the following categories: (a) generalization dimension, (b) generalization assessment design, (c) maintenance assessment design, (d) generalization/maintenance teaching strategy, and (e) latency to maintenance probes. After application of design standards, aggregate Tau-U and non-overlap of pairs effect sizes were calculated with a total of 67 separate contrasts across seven studies.

OUTCOMES AND RESULTS

Overall, effect size scores ranged from small to large effects across all comparisons. On average, most of the baseline to maintenance and generalization comparisons produced moderate to large effects. Whereas, small to moderate or even deteriorate effects were found in most of the intervention to maintenance and generalization comparisons.

CONCLUSIONS AND IMPLICATIONS

The findings in this review suggest that caregiver-delivered social-communication interventions are likely to result in mixed effects on skill generalization and maintenance within children with autism spectrum disorders. Implications for future research and practice are discussed.

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

With advances in the field's ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.

Capitalizing on technology for developing communication skills in autism spectrum disorder: a single case study

PURPOSE

In this case study, we discuss the application of a patient-centred clinical approach that led to the use of an assisted communication platform to combat severe communicative deficit in a child with autism spectrum disorder (ASD).

METHODS

Initial assessment at four years of age revealed that the patient had rudimentary communication skills, with significant sensory integration dysfunction manifested as oral, olfactory, and tactile seeking behaviours; self-stimulatory behaviour; and complete dependence on caregiver for activities of daily living. Intensive, multi-disciplinary intervention resulted in minimal improvement in communicative skills and sensory seeking over six months. Subsequently, a tailor-made picture-assisted communication training with the mother as the communication facilitator was adopted. This approach was abandoned due to the patient's poor response and mother's low acceptance of picture-based interaction. A preference for printed material was observed in the patient. Accordingly, further management was focused on employing a computer-based interactive platform that the patient was taught to use over the course of a few months as a part of augmentative and alternative communication (AAC) intervention program. This resulted in a remarkable improvement in the child's skills that now allowed for a better intentional communication of his thoughts and needs.

CONCLUSIONS

This study highlights the importance of revisiting conventional rehabilitation strategies for communicative deficits and tailoring them according to the patient's needs and preferences. It also emphasises that besides excellent observation skills, clinicians must be willing to consider technology based approaches in patients responding poorly to traditional approaches in order to develop effective interventional programmes. Implication for Rehabilitation The current study highlights the importance of exploring the application of technology based intervention for building communication skills in the early stages of rehabilitation for persons with communicative deficit. It also emphasises the need for excellent observation skills among clinicians so that the peculiar interests of children with ASD may be applied in designing training programmes to overcome communication barriers. Additionally, clinicians should familiarise themselves with the latest assistive technology-based rehabilitation approaches and be willing to explore newer approaches if traditional ones fail to yield satisfactory outcomes. Use of technology-based interventions to reduce dependence among persons with disability would be beneficial, both socially and economically, in developing countries with limited resources.

Young adolescents with autism show abnormal joint attention network: A gaze contingent fMRI study

Behavioral research has revealed deficits in the development of joint attention (JA) as one of the earliest signs of autism. While the neural basis of JA has been studied predominantly in adults, we recently demonstrated a protracted development of the brain networks supporting JA in typically developing children and adolescents. The present eye-tracking/fMRI study now extends these findings to adolescents with autism. Our results show that in adolescents with autism JA is subserved by abnormal activation patterns in brain areas related to social cognition abnormalities which are at the core of ASD including the STS and TPJ, despite behavioral maturation with no behavioral differences. Furthermore, in the autism group we observed increased neural activity in a network of social and emotional processing areas during interactions with their mother. Moreover, data indicated that less severely affected individuals with autism showed higher frontal activation associated with self-initiated interactions. Taken together, this study provides first-time data of JA in children/adolescents with autism incorporating the interactive character of JA, its reciprocity and motivational aspects. The observed functional differences in adolescents ASD suggest that persistent developmental differences in the neural processes underlying JA contribute to social interaction difficulties in ASD.

•

Gaze-contingent fMRI task to study joint attention in a developmental sample with autism

•

JA in the autism group elicited abnormal activation in social cognition related areas.

•

The interaction partner's familiarity modulated brain activity in the autism group.

•

In the autism group frontal activation is related to the severity of communication deficits.

Synchrony Detection of Linguistic Stimuli in the Presence of Faces: Neuropsychological Implications for Language Development in ASD

Children with autism spectrum disorders (ASD) may be impaired in their ability to detect audiovisual synchrony and their ability may be influenced by the nature of the stimuli. We investigated the possibility that synchrony detection is disrupted by the presence of human faces by testing children with ASD using a preferential looking language-based paradigm. Children with low language abilities were significantly worse at detecting synchrony when the stimuli include an unobscured face than when the face was obscured. Findings suggest that the presence of faces may make multisensory processing more difficult. Implications for interventions are discussed, particularly those targeting attention to faces.

Evidence-Based Social Communication Interventions for Children with Autism Spectrum Disorder

Impairments in social communication skills are a core feature of autism spectrum disorder (ASD) and include deficits in social-emotional reciprocity, non-verbal communicative behaviors used for social interaction, and developing, maintaining, and understanding relationships. In order to improve outcomes for children with ASD, much research has been focused on developing effective interventions to treat these social communication deficits. The purpose of this paper is to highlight the evidence-based practices found within the intervention literature that specifically targets social communication impairments and provide an overview of these strategies. Four relevant themes regarding evidence-based social communication interventions are considered and discussed: (a) social communication outcomes and practices relevant to different stages of development, (b) practices that both reduce interfering behaviors and improve social communication skills,

Outcome of Home-Based Early Intervention for Autism in Sri Lanka: Follow-Up of a Cohort and Comparison with a Nonintervention Group

This paper presents the outcome of a home-based autism intervention program (HBAIP) in 18- to 40-month-old children newly diagnosed and treatment naïve. Intervention was exclusively implemented at home. Outcome was measured at 3 months and 6 months after intervention and compared with a group of newly diagnosed children with autism who were >40 months at intake but had not received any autism specific clinical management. Aim was also to estimate whether natural development would contribute to gain in skills and compare with the effect of intervention. Five selected parameters of behavior representing social interaction and social communication were used to assess outcome. Results showed a statistically significant improvement between preintervention and postintervention in all the measured parameters. The effect size was large when compared to preintervention and gains were indicated by changes in mean scores and p values within a narrow confidence interval. Highest gains were in first 3 months of postintervention which continued up to 6 months. Although the comparison group was more advanced in the measured skills at intake, they were significantly below the level reached by experimental group at 3 months and 6 months after intervention. This study was registered in the Sri Lanka Clinical Trials Registry (SLCTR/2009/011).

A Pilot Study Promoting Participation of Families with Limited Resources in Early Autism Intervention

BACKGROUND

Relatively little research about autism early intervention has occurred in families of low socioeconomic status. Barriers to participation for under-resourced families (i.e., families with low incomes or limited education), pose a significant problem. The purpose of this pilot study was to apply empirically supported methods promoting participation of families with low-income and low-education levels to an established intervention for children with autism spectrum disorder (ASD).

METHOD

Participant recruitment specifically targeted families whose income was equal to or below two times the federal poverty line and whose caregiver(s) had no more than two years of college attendance. An evidence-based intervention was modified to be more accessible to participating families. Adaptations focused on decreasing access barriers, decreasing attrition, and promoting positive change within families. Success of the program was measured quantitatively and qualitatively.

RESULTS

Twenty-seven families were referred to the project, 13 of which did not meet eligibility requirements. Eight families enrolled, maintained participation for the majority of the project and provided positive qualitative feedback of their experiences. Project and treatment attrition were calculated at 62% and 12.5%, respectively. Treatment attendance was high, but length of time to complete treatment was greatly influenced by the number of session cancellations.

CONCLUSIONS

The exploratory project demonstrated that practical modifications to standard early intervention protocols can promote engagement in families with limited resources. Recommendations for programs seeking to implement interventions in under-resourced communities are discussed.

Maternal experience of Lego Therapy in families with children with autism spectrum conditions: What is the impact on family relationships?

This study aimed to explore mothers' experience of implementing Lego Therapy at home within the family. Following a Lego Therapy training session, mothers carried out hourly sessions with their child with an autism spectrum condition and the child's sibling, once a week, for 6 weeks. Mothers were interviewed following the intervention, and the data were analysed using interpretative phenomenological analysis. Themes emerged around improved family relationships, a positive impact on the child as an individual, and changed maternal, sibling and child perspectives. Challenging and facilitative aspects also emerged, as did some ambivalence about the impact of the intervention in the wider context. The findings are supportive of previous Lego Therapy studies and have implications for strengths-based service provision.

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on "teachable moments," and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.