Project Activities
The research team will iteratively develop the intervention for preschoolers with ASD, including decision rules for different intervention and augmentation options. They will then conduct a pilot sequential multiple assignment randomized trial (SMART) to determine feasibility, acceptability, the promise of the intervention for enhancing child language and early literacy outcomes, and the optimal sequence of interventions and types of augmentation options.
Structured Abstract
Setting
Development phase activities will take place in homes and schools and the pilot SMART will take place in homes, the intended setting for intervention implementation. All research activities will occur in Florida and Oklahoma.
Sample
Participants will include caregivers and their children with ASD who are between the ages of 4 and 5. A total of 70 adult-child dyads will participate in the development phase (20 researcher-child dyads in study 1, 20 researcher-child dyads in study 2, and 30 caregiver-child dyads in study 3). The pilot SMART will include an additional 70 caregiver-child dyads.
The adaptive shared reading intervention will be delivered by caregivers in the home. It will include two evidence-based shared reading practices as first-stage intervention options—dialogic reading (DR) and print referencing (PR). In DR, the adult asks questions to encourage the child to converse about the story with the goal of improving meaning-focused skills of vocabulary and listening comprehension. In PR, the adult explicitly draws the child's attention to print by asking questions, making comments, and nonverbally pointing to or tracking words while reading with the goal of improving print and alphabet knowledge. For children who are nonresponsive to the first-stage interventions alone, there are adaptations, or second-stage intervention options, to augment DR or PR and better support children's joint attention during book readings. These include caregivers embedding strategies to either increase their child's ability to respond to their questions about the book or their ability to initiate their own comments or questions during the reading activity.
Research design and methods
The development phase will consist of three studies. In study 1, the research team will conduct an observational study of shared reading among researcher-child dyads to determine the criteria that will be used to distinguish between responders and non-responders. In study 2, the team will conduct four single-case design studies to test each combination of intervention and augmentation options and refine these options. In study 3, the team will collect social validity and observational data of caregivers reading books with their children to curate a list of books to be used in the pilot study. In the pilot phase, they will conduct a SMART design to evaluate the adaptive intervention. To begin, caregiver-child dyads will be randomized to an initial intervention option of either DR or PR. At 4 weeks, children's joint attention during the final three sessions of their initial intervention will be used as the tailoring variable that determines the second-stage intervention option. Children who are identified as "responders" will continue with the initial intervention and children who are found to be non-responsive will receive augmented instruction added to their initially assigned condition, randomized to either the initiating joint attention or responding to joint attention condition for 4 weeks. In the final stage, children will receive the alternative base reading intervention for 4 weeks (dyads assigned to DR initially will receive PR and those assigned to PR initially will receive DR). The SMART design will allow the research to determine (a) caregiver perceptions of feasibility and acceptability, (b) whether it is best to start with DR or PR, (c) how caregivers should augment DR or PR to best support their child's joint attention, and (d) improvements in children's language and early literacy outcomes.
Control condition
Given the nature of SMART designs, the comparison group will vary during the course of the pilot study.
Key measures
Children will initially be screened for ASD risk using the Modified Checklist for Autism in Toddlers, Revised and then ASD diagnosis will be confirmed using the Autism Diagnostic Observation Schedule. To make decisions about each child's next stage of the SMART during studies 1 and 2, the research team will use continuous time sampling with a behavioral coding scheme to assess children's engagement with the reading. For study 3, they will use observations and questionnaires to refine the book list to be used in the pilot. For the pilot study, child outcomes will be assessed using the Comprehensive Evaluation of Language Fundamentals-Preschool, 3rd Edition (language), Test of Preschool Early Literacy (print knowledge and vocabulary), Preschool Word and Print Awareness (print knowledge), Assessment of Story Comprehension (listening comprehension), and Communication and Symbolic Behavior Scales Developmental Profile (nonverbal communication, including joint attention and engagement). Joint engagement will also be assessed using the observational coding scheme from the initial two studies. Language samples will also be collected during shared reading to evaluate children's language outcomes. Additional observational and survey measures will be used to collect data on social validity, feasibility, fidelity, and acceptability.
Data analytic strategy
For study 1, the research team will use descriptive statistics to analyze joint engagement data. Study 2 data will be analyzed using visual analysis and effect sizes will be calculated. Data from study 3 will be analyzed descriptively. For the pilot study, the research team will conduct descriptive analyses of social validity, feasibility, fidelity, and acceptability data. They will analyze outcome data to determine the proportion of children who respond to first-stage intervention and the direction and magnitude of effects on child outcomes, conducting a regression analysis of the mean differences in child outcomes between the initial-stage randomization groups and between the joint attention augmented conditions to determine the optimal order of first-stage interventions and type of augmentation.
Cost analysis strategy
Costs will be calculated based on the ingredients method. Data sources to capture costs will include caregiver surveys and interviews, coach logs and interviews, and documentation on project expenditures. The research team will use cost data to determine total program costs (using national prices and local prices) as well as the average cost per child.
People and institutions involved
Project contributors
Products and publications
Products: This project will result in a fully developed adaptive shared reading intervention, including manualized procedures and materials to support coaching and implementation, to improve language and literacy skills of preschool children with ASD. The project will also result in peer-reviewed publications and presentations as well as additional dissemination products that reach education stakeholders such as practitioners and policymakers.
ERIC Citations: Find available citations in ERIC for this award here.
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Questions about this project?
To answer additional questions about this project or provide feedback, please contact the program officer.
