A key challenge for children with autism is the need to strengthen social communication, something that can be supported early in a child’s development. Dr. Hannah Schertz, professor at Indiana University Bloomington’s School of Education, has conducted a series of IES-funded projects to develop and evaluate the impact of early intervention, mediated through parents, for improving social communication in toddlers with or at risk for autism. We recently interviewed Dr. Schertz to learn more about the importance of guiding parents in the use of mediated learning practices to promote social communication, how her current research connects with her prior research, and what she hopes to accomplish.
Why is parental mediation in early intervention important for very young children with autism? How does it work and why do you focus this approach on improving children’s social communication development?
The intervention targets social communication because it is the core autism challenge and it’s important to address concerns early, as signs of autism emerge. Research has found that preverbal social communication is related to later language competency. Our premise is that this foundation will give toddlers a reason to communicate and set the stage for verbal communication. More specifically, joint attention—one preverbal form of social communication—is the key intervention target in our research. It is distinct from requesting/directing or following requests, which are instrumental communications used to accomplish one’s own ends. Joint attention, which takes the partner’s interests and perspectives into account, is an autism-specific challenge whereas more instrumental communication skills are not.
Our research team incorporates a mediated learning approach at two levels—early intervention providers supporting parents and then parents supporting their toddlers. The approach is designed to promote active engagement in the learning process and leverage the parent’s privileged relationship with the child as the venue for social learning. Early intervention providers help parents understand both the targeted social communication outcomes for their children (intervention content) and the mediated learning practices (intervention process) used to promote these child outcomes. As parents master these concepts, they can translate them flexibly into a variety of daily parent-child interactions. This understanding allows parents to naturally integrate learning opportunities with child interests and family cultural/language priorities and preferences. Over time, their accrued knowledge, experience, and increased self-efficacy should prepare them to continually support the child’s social learning even after their participation in the project ends.
How does your more recent work, developing and testing Building Interactive Social Communication (BISC), extend your prior research examining Joint Attention Mediated Learning (JAML)?
Both JAML and BISC address the same goal—supporting social communication as early signs of autism emerge. In JAML, researchers guided parent learning directly while parents incorporated social communication into interaction with their toddlers. BISC extends the intervention by supporting community-based practitioners in facilitating parent learning rather than parents learning directly from the research team. BISC also added a component to address cases in which parents identify child behaviors that substantially interfere with the child’s social engagement.
You recently completed a pilot study to test a new professional development framework for supporting early intervention providers in implementing BISC. Please tell us about the findings of this study. What were the impacts on the early intervention providers, parents, and toddlers?
We tested an early version of BISC to study its preliminary effects on early intervention provider, parent, and child outcomes for 12 provider/parent/child triads. In effect size estimates derived from single-case design data, we found large effects for early intervention provider fidelity (for example, mediating parent learning, guiding parents’ reflection on video-recorded interaction with their toddlers, and supporting active parent engagement) and parent application of mediated learning practices to promote toddler social communication. We also found large effects on child outcomes (social reciprocity, child behavior, and social play) and a small effect on joint attention.
As you begin your larger-scale trial to examine the efficacy of BISC on provider, parent, and child outcomes, what impact do you hope your work will have on the field of early intervention generally and the development of social communication in children with autism more specifically?
Approximately 165 community-based early intervention practitioners will have learned to support parent learning through direct participation or as control group participants who receive self-study materials. These providers will be equipped to bring this knowledge to their future work. We anticipate that practitioners will experience their implementation role as feasible and effective. Ultimately, toddlers with early signs of autism will have greater access to early, developmentally appropriate, and family-empowering early intervention that directly addresses the core social difficulty of autism. Forthcoming published materials will extend access to other providers, offering an intervention that is more specifically tailored to the needs of very young children with social communication challenges than other approaches.
Is there anything else you would like to share/add regarding your projects?
I would like to thank my colleagues and project co-principal investigators (Co-PIs) for their expertise and contributions to this work. For our current BISC efficacy project, Co-PI Dr. Patricia Muller (Director of the Center for Evaluation, Policy, and Research) is leading the randomized controlled trial and cost-effectiveness study, and Co-PI Dr. Jessica Lester (professor of Counseling and Educational Psychology) is overseeing the qualitative investigation of parent-child interactions using conversation analysis to explore potential influences on child outcomes. Kathryn Horn coordinates intervention activities, Lucia Zook oversees operational and assessment activities, and Addison McGeary supports recruitment and logistical activities.
This blog was authored by Skyler Fesagaiga, a Virtual Student Federal Service intern for NCSER and graduate student at the University of California, San Diego. The grants in this connected line of research have been managed by Amy Sussman (PO for NCSER’s early intervention portfolio) and Emily Weaver (PO for NCSER’s autism research portfolio).