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IES Grant

Title: An Efficacy Trial of J-EMT: Enhanced Milieu Teaching Language Intervention plus Joint Attention, Engagement and Regulation Intervention for Toddlers with Autism
Center: NCSER Year: 2015
Principal Investigator: Kaiser, Ann Awardee: Vanderbilt University
Program: Early Intervention and Early Learning      [Program Details]
Award Period: 4 years (7/1/2015-6/30/2019) Award Amount: $3,499,197
Type: Efficacy and Replication Award Number: R324A150094

Co-Principal Investigator: Megan Roberts (Northwestern University)

Purpose: This project will evaluate the efficacy of an early social communication and language intervention, the J-EMT, on toddlers with autism spectrum disorders (ASD). Social communication skills are particularly important for this population, as a deficit in this area constitutes a core characteristic of ASD. The intervention is aimed at toddlers because the majority of children with ASD can be identified accurately by 24 months and acquisition of communication skills by 36 months is a significant predictor of long-term language outcomes. This study will investigate the impact of J-EMT on the social communication skills, receptive and expressive language, symbolic play, and symbol-infused joint engagement on toddlers with ASD and on parental use of language support strategies. The use of symbols (communicative gestures, words, or signs) during engagement with a partner is a critical transition into fluent social spoken language. In addition to examining outcomes immediately after the intervention and 6 months later, the study will explore which children may benefit most from J-EMT and whether fidelity of implementation moderates the relationship between the intervention and child outcomes.

Project Activities: A randomized controlled trial will be used to determine the efficacy of J-EMT. Approximately 120 children, age 24–36 months, with ASD and their parents will participate in this research project. Children will be randomly assigned to the treatment or business-as-usual control condition, and they will participate in their services (intervention or typical community services) for 6 months. Primary data-collection points include before, immediately after, and 6 months after the intervention period. Data will be analyzed to examine the impact of J-EMT on measures of children's social communication, language, and related skills, as well as potential moderators of the impact.

Products: The products of this project include understanding the efficacy of J-EMT on the social communication outcomes for toddlers with ASD and their parents, as well as peer-reviewed publications and presentations.

Structured Abstract

Setting: The study will take place in the homes of toddlers with ASD in metropolitan areas of Tennessee and Illinois.

Sample: Approximately 120 toddlers, age 24–36 months, diagnosed with ASD and their parents will participate in this study, as well as the therapists delivering the intervention.

Intervention: The J-EMT blends two evidence-based interventions, Enhanced Milieu Teaching (EMT) and Joint Attention, Symbolic Play and Regulation (JASPER). EMT is a naturalistic language intervention designed to teach spoken language in the context of every day interactions with parents and teachers. JASPER is designed to teach the social foundations of communication in the context of social play. The combined J-EMT intervention is implemented by both parents and therapists as an integrated intervention package for children with ASD. The intervention will be implemented as 48 1-hour sessions with toddlers over a 6-month period and includes teaching parents to implement J-EMT in daily activities at home.

Research Design and Methods: Using a randomized controlled trial, children will be assigned to the treatment or business-as-usual control condition. Approximately 40 toddlers with ASD and their parents will participate in the study annually for each of the 3 years of data collection. Children in both groups will receive services (J-EMT or their usual community services) for 6 months. Data on services received and parent use of intervention strategies will be assessed for both groups. There will be three primary assessment points for most of the child outcome data—pre-intervention, post-intervention, and 6 months after the intervention ends. Social communication and expressive language will be assessed monthly. Data will be analyzed to examine the immediate and longer-term efficacy of J-EMT on children's language, communication, symbolic play, symbol-infused joint attention, parents' use of language support strategies, and growth in children's language skills over time. The researchers will also explore whether child characteristics and fidelity of parental strategy use moderates child outcomes.

Control Condition: The control condition consists of toddlers with ASD receiving typical community and early intervention services. Use of services will be documented. Parents will also receive reports of their children's communication progress and assistance in advocating for community services.

Key Measures: Children will be screened for participating using the Autism Diagnostic Observation Schedule — Second Edition (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R). Communication and language outcome measures include the following: children's social communication in observed language samples; expressive language using language samples, parent report, Preschool Language Scale-Fifth Edition (PLS-5), and MacArther-Bates Communicative Development Inventories; home communication using Language Environment Analysis (LENA); and receptive language using the PLS-5. Additional outcome measures include the Structured Play Assessment (symbolic play), Early Social Communication Scales (joint attention), and coding of observational parent-child interactions for joint engagement. The team will also collect data on moderators, including parent use of language support strategies, services received, family characteristics, and additional child skills (mental age, imitation skills, and expressive vocabulary).

Data Analytic Strategy: To examine the impact of the intervention on most of the outcomes, the research team will use linear ordinary least squares regression. To examine growth in social communication and expressive language over time, as well as the impact of moderators, multi-level growth modeling will be used.

Related IES Projects: An Efficacy Trial of Milieu Teaching Language Intervention in Preschoolers with Language Disorders (R324A090181)

Products and Publications

Book chapter

Kaiser, A. P., Hampton, L. and Roberts, M. Y. (2016). Parents as Partners in Effective Communication Intervention. Communication Interventions for Children with Severe Disabilities. Brookes Publishing Co. Retrieved from

Book chapter, edition specified

Kaiser, A. P. and Hampton, L. H. (2016). Enhanced Milieu Teaching.

Journal article, monograph, or newsletter

Hampton, L. H., and Kaiser, A. P. (2016). Intervention Effects on Spoken-Language Outcomes for Children with Autism: A Systematic Review and Meta-Analysis. Journal of Intellectual Disability Research, 60(5): 444–463. doi:10.1111/jir.12283 Full text