Description:

Purpose: Deficits in social-communicative functioning are core diagnostic features of autism. Joint attention and symbolic play are theoretically posited to be pivotal skills that constitute the early foundations for social-communicative development. Researchers have found that the quality and quantity of young children's social communicative behaviors is highly predictive of long-term developmental and functional outcomes. Few school-based interventions have been developed and tested that target these two pivotal skills.

To address this need, researchers at the University of North Carolina at Chapel Hill are developing an intervention that targets joint attention and symbolic play in preschool-aged children with autism for use in public schools. The intervention program will have two primary content components (joint attention and symbolic play) and two primary context components (one-to-one intervention and classroom group activities). The purpose of this study is to develop and conduct an initial evaluation of this intervention.

Project Activities: The research team will use an iterative process to develop the intervention. In the first phase, input will be solicited from public school preschool teachers and related service personnel on the intervention goals and the usability and acceptability of the intervention materials. In the second phase, the researchers will conduct an initial evaluation of the one-on-one component of the intervention by randomly assigning children to receive the newly developed intervention or to receive existing practice (a "business as usual" control) at their schools. The results of this evaluation will be used to further revise the intervention as well as identify opportunities to expand the intervention to develop materials that can be used in naturally occurring classroom routines. In the next phase, the research team will evaluate the full intervention using a single-subject design to determine whether there are similar or additive intervention effects when the intervention is implemented in a one-to-one only setting or in combination with classroom activities. In the final phase, a quasi-experimental group comparison design will be used to evaluate whether the fully developed intervention compared to a business-as-usual control improves developmental and adaptive outcomes in preschool-aged children with autism.

Products: The expected outcomes from this study include a fully developed intervention program including a manual and DVD that illustrates components of the intervention for teachers and reports on the effects of the intervention on joint attention and symbolic play, as well as broader developmental outcomes, in children with autism.

Structured Abstract

Purpose: Deficits in social-communicative functioning are core diagnostic features of autism. Joint attention and symbolic play are theoretically posited to be pivotal skills that constitute the early foundations for social-communicative development. Researchers have found that the quality and quantity of young children's social communicative behaviors is highly predictive of long-term developmental and functional outcomes. Few school-based interventions have been developed and tested that target these two pivotal skills.

To address this need, researchers at the University of North Carolina at Chapel Hill are developing an intervention that targets joint attention and symbolic play in preschool-aged children with autism for use in public schools. The intervention program will have two primary content components (joint attention and symbolic play) and two primary context components (one-to-one intervention and classroom group activities). The purpose of this study is to develop and conduct an initial evaluation of this intervention.

Setting: Participating students will be from North Carolina school districts.

Population: Children with a clinical diagnosis of an Autism Spectrum Disorder (ASD) who are under the age of 5 at the beginning of the intervention, enrolled in classrooms administered by their public school system, and receiving speech-language therapy as a related service will participate. In Phase 1, 60 school personnel who provide classroom or individual therapy services to preschoolers with autism will participate. In Phases 2 and Phase 4, children will be recruited from classrooms serving at least three children with autism. Thirty children will participate in Phase 2 and 10 preschool classrooms serving a total of at least 30 children with autism will participate in Phase 4. For Phase 3, a total of four children with autism that are served in different classrooms will participate.

Intervention: An intervention for joint attention and symbolic play for children with autism that was developed for use in a clinic setting will be used as an initial foundation for developing a classroom-based intervention. The intervention will consist of two components: a one-to-one and classroom component. Newly emerging skills will be targeted initially in a one-to-one setting, and skills that are exhibited consistently in the one-to-one setting will be targeted in the classroom. Each one-to-one session will consist of the child being taught skills using a brief, discrete trials format followed by the opportunity to demonstrate the taught skills. The interventionist follows the child's lead, expands on emerging behaviors, and models as necessary to keep the child engaged. In order to assess mastery, the interventionist tracks skills (unprompted, prompted, or flexible) using a coding sheet and video. The classroom component will provide teachers and other service providers with strategies and activities that will promote joint attention and symbolic play behaviors in a typical classroom routine.

Research Design and Methods: The project consists of four phases. In Phase 1, the first draft of the one-to-one component of the manual will be created. In Phase 2, a randomized controlled trial will be conducted with random assignment of children to treatment or a "business as usual" (i.e., status quo educational services) comparison group to evaluate the one-to-one component of the program. Graduate speech-language pathology students will implement the intervention. In Phase 3, a multiple baseline design will be used to initially evaluate the implementation of the full intervention program by school-based personnel. Phase 4 will use a pre-test/post-test group comparison design. For this phase, implementation of the full intervention program by both preschool teachers and related services personnel will be compared to a business as usual group. Seven domains (joint attention, behavior requests, social interaction, structured play, cognition, social responsiveness, and adaptive behaviors) will be evaluated for intervention effects.

Control Condition: Children in the control condition will receive the standard educational services and therapy identified in their Individualized Education Plan.

Key Measures: The intervention will be evaluated using a battery of commercial and non-commercial measures. The Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale—Survey Edition, Early Social-Communication Scales, Structured Play Assessment, and Social Responsiveness Scale will be administered.

Data Analytic Strategy: In Phase 2 and Phase 4, a repeated measures regression model will be used to look at pre-test/post-test gains in outcome variables. In Phase 3, a multiple baseline design will be used to evaluate implementation of the full intervention program by school-based personnel. Data analysis will be based on visual inspection of the trend of data lines.

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

Products and Publications

Journal article, monograph, or newsletter

Dykstra Steinbrenner, J.R., Watson, L.R., Boyd, B.A., Wilson, K., Crais, E.R., Baranek, G.T., Flippin, M., and Flagler, S. (2015). Developing Feasible and Effective School-Based Interventions for Children With ASD: A Case Study of the Iterative Development Process. Journal of Early Intervention, 37(1): 23–43. doi:10.1177/1053815115588827

Dykstra, J.R., Boyd, B.A., Watson, L.R., Crais, E.R., and Baranek, G.T. (2012). The Impact of the Advancing Social-Communication and Play (ASAP) Intervention on Preschoolers With Autism Spectrum Disorder. Autism, 16(1): 27–44. doi:10.1177/1362361311408933 Full text

Kinard, J., Wilson, K., Dykstra, J., Watson, L., and Boyd, B. (2011). Advancing Social-Communication and Play (ASAP): Development of a Supplemental Intervention for Public Preschools Serving Children With Autism. Perspectives on School-Based Issues , 12: 91–100. doi:10.1044/sbi12.3.91

Wilson, K.P., Dykstra, J.R., Watson, L.R., Boyd, B.A., and Crais, E.R. (2012). Coaching in Early Education Classrooms Serving Children With Autism: A Pilot Study. Early Childhood Education Journal, 40(2): 97–105. doi:10.1007/s10643–011–0493–6 Full text

Nongovernment report, issue brief, or practice guide

Watson, L.R., Boyd, B.A., Baranek, G.T., Crais, E.R., and Odom, S. L. (2011). Advancing Social-Communication and Play (ASAP): An intervention program for preschoolers with autism. Chapel Hill, NC.