Co-Principal Investigators: Samuel Odom (University of North Carolina, Chapel Hill) and Kathleen Baggett (University of Kansas)

Purpose: The prevalence of autism spectrum disorders (ASD) has grown dramatically in recent years, with advances in early identification now resulting in an influx of toddlers to the early intervention system. Although early intervention providers are required to implement evidence-based practices for this population, few models are available that target social communication, the core difficulty in ASD, at the preverbal stage when neurological development is most malleable. The proposed project directly addresses this need through an efficacy study of Joint Attention Mediated Learning (JAML), an intervention practice for toddlers with ASD that directly targets foundational preverbal social communication competencies from within the parent-child relationship at a critical juncture (by 30 months of age). Specifically, this study will determine the efficacy of JAML on the early preverbal and verbal social communication development of toddlers with ASD and the self-efficacy of their caregivers, assess factors that mediate and moderate intervention effects, and address the feasibility and acceptability of JAML.

Project Activities: Researchers will conduct a randomized controlled trial that compares the JAML intervention to a business-as-usual condition. The research team will recruit 126 toddlers, aged 30 months or younger, with ASD. Assessments will be conducted prior to the intervention (pre-test), post-intervention (post-test), and 6 months after the post-test to measure the sustainability of any intervention effects.

Products: The products of this project include evidence of the efficacy of the JAML intervention on the social communication of children with autism and the self-efficacy of their caregivers, published reports, and presentations.

Structured Abstract

Setting: This study will take place in family homes in rural, suburban, and urban areas in Indiana, Kansas, and North Carolina.

Sample: Participants will include 126 toddlers with ASD aged 30 months or younger and their primary caregivers who represent diverse socioeconomic and ethnic/racial groups.

Intervention: JAML will be implemented over 8 months in three phases that promote increasingly complex social communication outcomes. The intervention focuses on the distinctly social functions of preverbal communication and targets engagement at a level just beyond the toddler's current capabilities. In the first of three phases, Focusing on Faces (FF), the child is helped to look freely and often to the parent's face. In the second phase, Turn-Taking (TT), the child engages with the parent in reciprocal repetitive play that requires tacit acknowledgment of the partner's shared interest (e.g., when the child waits for the parent's turn). TT is a more complex level of social engagement than FF and is intended to help the child move toward the reciprocal social interaction that occurs in the third phase, Joint Attention (JA). In the JA phase, the child is helped to visually share attention to an external focus (i.e., a toy), either by responding to the parent's bid for attention to the toy or initiating a bid. Each phase is structured around five mediated learning principles that promote active involvement in the learning process for the child: (1) sharpening attentional focus, (2) internalizing a sense of self-regulation and order to communicate, (3) developing self-confidence, (4) discerning nuances of social interaction, and (5) engaging more frequently in varied settings and with different people. Interventionists use multiple media to introduce JAML's components and to support parents' understanding as they embed intervention activities in daily planned and routine encounters.

Research Design and Methods: The research team will conduct a randomized controlled trial with random assignment of toddlers with ASD and their families to the JAML treatment or the business-as-usual control conditions. Assessments will be conducted when the child enters the study (pre-test), after the 8-month intervention (post-test), and 6 months after post-test (to measure maintenance of treatment effects).

Control Condition: Control group participants will receive early intervention services available in their communities. After final data are collected, they will receive three intervention sessions to introduce JAML self-guided materials, with each session focused on a JAML phase.

Key Measures: Eligibility for study participation will be determined by the Autism Diagnostic Observational Scale-Toddler Version. Primary outcomes will be assessed through observations of preverbal social communication and standardized measures of general language and social outcomes (including the Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales, Second Edition). Secondary outcomes will be assessed using measures of parent self-efficacy, ASD severity, and parent sensitivity. Social validity will be assessed through a Likert-type acceptability rating scale completed by parents. Implementation fidelity will be assessed through independent ratings for both parent-child and provider-parent intervention activities.

Data Analytic Strategy: A repeated measures analysis of variance will be used to assess JAML's effects on child and caregiver outcomes.

Products and Publications

Book chapter

Schertz, H. H. & Horn, K. (in press). Facilitating toddlers' social communication from within the parent-child relationship: Application of family-centered early intervention and mediated learning principles.

Siller, M., Morgan, L., Wetherby, A. M., Turner-Brown, L., Baranek, G. T., Crais, E. R., Odom, S. L., Reznick, J. S., Watson, L. R., Baggett, K. M., Brian, J., Roberts, W., Bryson, S. E., Smith, I. M., Carter, A. S., Estes, A., Kasari, C., Landa, R. J., Lord, C., Messinger, D. S., Mundy, P., Rogers, S. J., Schertz, H. H., Stone, W. L., Yoder, P., & Zwaigenbaum, L. (2013). Designing Studies to Evaluate Parent-Mediated Interventions for Toddlers With Autism Spectrum Disorder.

Journal article, monograph, or newsletter

Schertz, H. H., & Horn, K. (2017). Family capacity-building: Mediating parent learning through guided video reflection.

Schertz, H. H., Call-Cummings, M., Horn, K., Quest, K., & Steffan, R. ( (in press). Social and instrumental interaction between parents and their toddlers with autism: A qualitative analysis. Journal of Early Intervention.

Schertz, H. H., Horn, K., Lee, M., & Mitchell, S. (2017). Supporting parents to help toddlers with autism risk make social connections..

Schertz, H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2016). Parent-reported repetitive behavior in toddlers on the autism spectrum.