Randomized Controlled Caregiver Mediated Joint Engagement Intervention for Toddlers with Autism

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Abstract

This study aimed to determine if a joint attention intervention would result in greater joint engagement between caregivers and toddlers with autism. The intervention consisted of 24 caregiver-mediated sessions with follow-up 1 year later. Compared to caregivers and toddlers randomized to the waitlist control group the immediate treatment (IT) group made significant improvements in targeted areas of joint engagement. The IT group demonstrated significant improvements with medium to large effect sizes in their responsiveness to joint attention and their diversity of functional play acts after the intervention with maintenance of these skills 1 year post-intervention. These are among the first randomized controlled data to suggest that short-term parent-mediated interventions can have important effects on core impairments in toddlers with autism. Clinical Trials #: NCT00065910.

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Most cited references 26

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Joint attention and early language.

Michael Tomasello, Michael Jeffrey Farrar (1986)

This paper reports 2 studies that explore the role of joint attentional processes in the child's acquisition of language. In the first study, 24 children were videotaped at 15 and 21 months of age in naturalistic interaction with their mothers. Episodes of joint attentional focus between mother and child--for example, joint play with an object--were identified. Inside, as opposed to outside, these episodes both mothers and children produced more utterances, mothers used shorter sentences and more comments, and dyads engaged in longer conversations. Inside joint episodes maternal references to objects that were already the child's focus of attention were positively correlated with the child's vocabulary at 21 months, while object references that attempted to redirect the child's attention were negatively correlated. No measures from outside these episodes related to child language. In an experimental study, an adult attempted to teach novel words to 10 17-month-old children. Words referring to objects on which the child's attention was already focused were learned better than words presented in an attempt to redirect the child's attentional focus.

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Coordinating attention to people and objects in mother-infant and peer-infant interaction.

R Bakeman, L Adamson (1984)

In a longitudinal study, infants 6-18 months of age were observed in their homes playing with their mothers and with peers. Of primary concern was how they coordinated their attention to people and objects. Observations were coded using a state-based scheme that included a state of coordinated joint engagement as well as states of person engagement, object engagement, onlooking, and passive joint engagement. All developmental trends observed were similar regardless of partner: person engagement declined with age, while coordinated joint engagement increased. Passive joint engagement, object engagement, and onlooking did not change with age. However, the absolute amount of some engagement states was affected by partner: both passive and coordinated joint engagement were much more likely when infants played with mothers. We conclude that mothers may indeed support or "scaffold" their infants' early attempts to embed objects in social interaction, but that as attentional capabilities develop even quite unskilled peers may be appropriate partners for the exercise of these capacities.

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Joint attention and symbolic play in young children with autism: a randomized controlled intervention study.

Tanya Paparella, Connie Kasari, Stephanny Freeman (2006)

Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism. These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts (see Kasari, Freeman, & Paparella, 2001). In this study, we examine the efficacy of targeted interventions of joint attention and symbolic play. Participants were 58 children with autism aged 3 and 4 years (46 boys). Children were randomized to a joint attention intervention, a symbolic play intervention, or control group. Interventions were conducted 30 minutes daily for 5-6 weeks. Both structured assessments of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors. Results indicate that both intervention groups improved significantly over the control group on certain behaviors. Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction. The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers. This randomized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism. Future studies need to examine the long-term effects of these early interventions on children's development.

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Author and article information

Contributors

: +1-310-8258342 , kasari@gseis.ucla.edu

Journal

Journal ID (nlm-ta): J Autism Dev Disord

Title: Journal of Autism and Developmental Disorders

Publisher: Springer US (Boston )

ISSN (Print): 0162-3257

ISSN (Electronic): 1573-3432

Publication date (Electronic): 10 February 2010

Publication date PMC-release: 10 February 2010

Publication date (Print): September 2010

Volume: 40

Issue: 9

Pages: 1045-1056

Affiliations

[1 ]Division of Psychological Studies in Education, University of California Los Angeles, 3132 Moore Hall, UCLA, Los Angeles, CA 90095 USA

[2 ]Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90024 USA

[3 ]Division of Early Childhood Special Education in Teacher Education, Cleveland State University, Cleveland, OH 44115 USA

Article

Publisher ID: 955

DOI: 10.1007/s10803-010-0955-5

PMC ID: 2922697

PubMed ID: 20145986

SO-VID: 0a708b33-9bbd-4c38-af15-05abf519775a

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ScienceOpen disciplines: Neurology

Keywords: autism,joint attention,joint engagement intervention

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ScienceOpen disciplines: Neurology

Keywords: autism, joint attention, joint engagement intervention

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Randomized Controlled Caregiver Mediated Joint Engagement Intervention for Toddlers with Autism

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Karger: Neurology and Neuroscience

Most cited references 26

Joint attention and early language.

Coordinating attention to people and objects in mother-infant and peer-infant interaction.

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study.

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Cited by 153

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