Description:

Co-Principal Investigator: Linda Watson

Purpose: Core diagnostic features of autism include deficits in social-communicative functioning. Two pivotal skills for young children with autism include joint attention and pretend play, which constitute early foundations upon which later social-communicative skills are built. Joint attention (characterized by behaviors such as pointing, showing, and coordinated looking to share attention toward objects or events with another person) and symbolic play (characterized by the ability to pretend), play important roles in language development and social engagement with peers. Children with autism show deficits in these skills. Advancing Social-Communication and Play (ASAP) is an intervention that has recently been developed to help preschool children with autism learn and practice these important skills.

The purpose of this research is to conduct a cluster randomized trial to evaluate the efficacy of ASAP. The major goals of the project include investigating whether children experiencing the intervention, when compared to those who do not, demonstrate greater gains in the proximal child outcomes of social-communication and play skills as well as the more distal outcomes of language development and engagement with classroom objects and peers. The study will also examine whether child-level (i.e., developmental level, problem behaviors) and teacher-level (i.e., teacher burnout, general classroom quality) characteristics moderate the impact of the intervention, and whether the level of implementation fidelity mediates its impact on child outcomes.

Project Activities: For each cohort, classrooms are randomly assigned to the ASAP or control group. Baseline (pre-test) data will be collected on all child and teacher/classroom measures. For the treatment group, coaches (trained by ASAP staff) at each of the four study sites will train and provide ongoing support for the local educational teams implementing the intervention. For the duration of the school year, the treatment group will experience the ASAP intervention, which includes group activities and one-to-one teaching sessions on social-communication and play skills, and the control group will experience business-as-usual conditions. At three additional points in time, including during the post-test at the end of the year, the investigators will collect data on the social-communication and play skills of all children. At the end of each school year, the investigators will also collect post-treatment data on child language and engagement skills. Intervention fidelity will be measured in all classrooms several times each year.

Products: Products from this project will include published reports and presentations on the efficacy of the ASAP intervention.

Structured Abstract

Setting: The research will take place in public preschool classrooms serving at least one child with autism in North Carolina, Florida, Minnesota, and Oregon.

Population: Children participating in this study will be preschool children, below the age of 5 years, with an autism spectrum disorder. There will be 80 classrooms randomly assigned to intervention and control conditions, with an average of three children with autism per classroom.

Intervention: The recently developed and piloted ASAP intervention is based on two core content components, social-communication and play skills. More specifically, the program works on three key areas of social-communication skills—joint attention, social interaction, and requesting behaviors—and four primary levels of play skills—exploratory, relational, functional, and symbolic. ASAP is implemented directly by the children’s educational team, comprised of the children’s classroom teacher, teaching assistant, and at least one related service provider if children in the classroom are receiving such services. The intervention takes place in two core contexts. The one-to-one context is believed to promote more efficient skill acquisition, and the children will receive 40 minutes of this type of intervention distributed across each week. The group context is believed to foster better generalization and maintenance of skills, and will consist of at least three group activities per day in which there are embedded opportunities to learn and practice the skills targeted in the one-to-one sessions. Overall, the intervention will continue throughout one school year.

Research Design and Methods: This research is a cluster randomized trial, with children nested within classrooms. Classrooms will be randomly assigned to the ASAP intervention or the control (business-as-usual) condition. Baseline (pre-test) data will be collected on all child and teacher/classroom measures. At three additional points in time, including during the post-test at the end of the year, the investigators will collect data on the social-communication and play skills of the children. At the end of each school year, the investigators will also collect post-treatment data on child language and engagement skills. Intervention fidelity will be measured in all classrooms three times per year.

Control Condition: The control group will be comprised of children with autism in business-as-usual classrooms (no special intervention is introduced beyond the typical services).

Key Measures: The Autism Diagnostic Observation Schedule (ADOS) will be administered to each child at the beginning of the study to confirm the diagnosis of autism. Proximal child outcome measures include the ADOS (for social-communication skills) and Structured Play Assessment (for symbolic play). Distal outcomes will be measured with the Individual Child Engagement Record-Revised and the Preschool Language Scale, 5th Edition. Child-level moderators include the Child Behavior Checklist (for behavior problems) and Mullen Scales of Early Learning (for developmental level). In addition, there will be rating scales and checklists to assess teacher burnout, quality of classrooms serving children with autism, and instructional strategies used to educate children with autism. Fidelity of intervention (knowledge of social-communication and play goals, instructional delivery, dosage, team planning, and progress monitoring) will be measured with audiotape interviews, videotape coding, and document review.

Data Analytic Strategy: Data on proximal outcomes, and potential moderators, will be analyzed using multilevel or mixed growth models to account for repeated outcome measures as well as clustering of individuals within classrooms. For the distal outcomes measured at pre-test and post-test, multiple level analysis of covariance will be utilized to examine intervention impact and potential moderators. Fidelity of implementation as a mediator will be examined through a parallel-process growth model.

Project Website: https://www.med.unc.edu/ahs/asap/

Related IES Projects: Social Communication and Symbolic Play Intervention for Preschoolers With Autism (R324B070056)

Products and Publications

Journal article, monograph, or newsletter

Dykstra, J., Watson, L.R., Boyd, B.A., Crais, E.R., Wilson, K., Baranek, G.T., Flippin, M., and Flagler, S. (in press). The Iterative Development of a School-Based Intervention: A Researcher-Rractitioner Partnership. Journal of Early Intervention, 37: 23–43.