Development of a Social and Communication Intervention for Preschoolers with Autism
Purpose: The special educational needs of children with autism spectrum disorders (ASD) are extensive. Educators face practical problems such as targeting the core social and communication deficits of children with ASD in group instructional settings. For example, children with ASD exhibit problems with interpersonal synchrony, which requires socially appropriate initiations and responsivity to others. To address these concerns, there is a need for evidence-based, cost-effective educational and service delivery models to treat these children. The purpose of this research is to develop and document the feasibility and promise of a social and communication curriculum supplement, Early Achievements.
This intervention will be adapted for preschoolers from an intervention originally targeting toddlers. The ultimate aim of the project is to develop a preschool supplementary intervention targeting core social and communication deficits of ASD that can be integrated with existing academic curricula throughout the school day. It will include guidelines for intervention materials, activities, and instructional strategies based on Pivotal Response Training paired with strategies that promote interpersonal synchrony and engagement. The research will also examine the feasibility of the intervention, the promise of the intervention for changing instructional practices and child skills, and whether the results are impacted by the inclusiveness of the classroom placement or the severity of the of the child's impairment.
Project Activities: The intervention will be developed over two years through an iterative process of modifications based on input from educators, speech-language pathologists, parents, researchers, and administrators, as well as data collected through implementation in classrooms. To assess the promise of the intervention during the third year, there will be a comparison of educator practices and child social and communication behavior between classes with and without the intervention. In the final phase, the intervention manual will be finalized.
Products: The products of this project will include a fully developed intervention to be used as a supplemental curriculum for targeting social and communication skills in children with ASD, peer-reviewed publications, and presentations.
Setting: The research will take place in public preschools in Maryland, including both inclusive and non-inclusive classrooms.
Sample: During the iterative development phase, a total of 9 educators (teachers and teacher aides) and up to 30 preschool children (ages 3 to 5 years) will participate. The pilot study will include an additional 12 educators and 30 children with ASD. The participating children will have a diagnosis of ASD with minimal to moderate intellectual impairment.
Intervention: Early Achievements is intended to supplement existing preschool curricula to focus on improving the core social and communication deficits in preschool children with ASD throughout the school year. There are three components to the intervention: (1) the Interpersonal Synchrony and Communication (ISC) curriculum supplement (i.e., planning guide for daily teaching schedule, teaching activities, ISC and academic goals, targeted vocabulary, and targeted action schemas); (2) guidelines for a strategically engineered learning environment to enhance social and communication development (e.g., theme-based instructional materials, ecologically valid learning activities linked to the ISC curriculum); and (3) use of evidence-based instructional strategies involving Pivotal Response Training to promote interpersonal synchrony during classroom group activities.
Control Condition: In the pilot study, the control condition will consist of the ASD treatment typically provided by the district's preschool classrooms.
Key Measures: The Autism Diagnostic Observation Schedule-Generic and the Early Learning Composite of the Mullen Scales of Early Learning will be used to select child participants. Proximal student outcomes will be measured during the development and pilot study phases using a curricular goal summary assessment to evaluate whether curriculum goals are targeted or have been reached. Social and communication behavior will be rated monthly during observations of classroom activities. During the pilot study, receptive and expressive language skills will be assessed with the New Reynell Developmental Language Scales IV. Additional measures of interpersonal synchrony will also be used during the pilot: joint attention (including initiations and affective responses) will be measured through a modified semi-structured play probe task and imitation will be measured through a previously developed spontaneous interaction task with the child. Developmental quotient, as a measure of cognitive impairment, will be assessed with the Mullen Scales Early Learning Composite. Discussions with educators will be transcribed for qualitative data analysis, and educators will complete self-efficacy and perceived barriers scales. Fidelity of implementation will be measured through a researcher-created rating scale to be used with videotaped observations of classroom practice.
Research Design and Methods: During the first two years of this project, Phase I, the research team will focus on development and feasibility testing. Educators and preschool children with ASD in three classrooms will participate, with one of these classrooms participating across both years. Through meetings with an advisory committee (research team, parents of children with ASD, educators, a speech-language pathologist, and a school administrator) and focus groups with educators, development of the intervention and associated fidelity measures will be informed by an iterative input process. During this phase, a professional development program will be prepared, implemented, and revised based on feedback, and intervention implementation and feasibility will be assessed. Data will be collected monthly on fidelity of implementation, teacher's self-efficacy, teacher's perceived barriers, and student's ISC-related social and communication skills. In the third year of the project, Phase 2, four classrooms will be randomly assigned to intervention and control conditions to examine the promise of the intervention and further investigate feasibility and implementation fidelity. For educators in the treatment group, data will be collected monthly; for educators in the control group and all students, data will be collected at the start and end of the school year to examine pre- and post-treatment differences between groups in fidelity of implementation, children's communication and social development, and whether severity of cognitive impairment moderates the impact of the intervention on student outcomes. At the end of the final year, Phase 3, the intervention manual will be finalized with input from consultants, committee members, and educators who implemented the intervention during the pilot study.
Data Analytic Strategy: For the iterative development phase (Phase 1), qualitative data from focus group discussions will be analyzed using a grounded theory approach that determines themes and codes for them, and interviews with educators will be coded and categorized for main concepts. Teacher practices and student outcomes will be analyzed descriptively and growth (change) over the school year will be analyzed using a variety of basic analytic techniques (e.g., paired t-test). For data with more than two time points, change in instructional practices and student outcomes will be analyzed using mixed models (hierarchical linear models or random effects models), with classroom type (inclusiveness) tested as a moderator. For the pilot study (Phase 2), the primary analyses will use hierarchical linear modeling to test for growth over time in teacher and student outcomes, differences in growth between treatment and control groups, and severity of impairment as a moderator. Due to the small sample size, robustness of results will be checked with more simple tests (t-test and chi-square).