Project Activities
A randomized controlled trial was used to determine the efficacy of J-EMT with toddlers with ASD on their social communication, language, and related skills, as well as the impact of training on their caregivers and potential moderators of the impact.
Structured Abstract
Setting
The study took place in the homes of toddlers with ASD in metropolitan areas of Tennessee and Illinois.
Sample
Children (n=120), ages 24–36 months, with ASD and their parents participated in this research project. Child inclusion criteria included (a) diagnosis of ASD based on the Autism Observation Schedule (ADOS-2), (b) chronological age of less than 36 months, (c) a level of language that met the criteria for use of the ADOS-2 for “Pre- Verbal/Single Words” rather than “Phrase Speech,” (d) a caregiver who was willing to learn intervention strategies, and (e) English as the primary language spoken in the home.
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 was implemented as 48 1-hour sessions with toddlers over a 6-month period and included teaching parents to implement J-EMT in daily activities at home.
Research design and methods
The research team used a multi-site parallel randomized controlled trial design study with repeated measures. Caregiver-child dyads were randomly assigned to the J-EMT group or to a behavior management control group immediately following determination of eligibility using a 1:1 allocation ratio. Participants were randomized in blocks of 10 in order for feasibility scheduling research therapists. Randomization was stratified by site and level of language on the ADOS-2 to ensure equal distribution of children across experimental conditions. Children participated in their services for 6 months. Primary data-collection points included before, immediately after, and 6 months after the intervention period. Data were 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. The effects of training on caregivers were also examined. Fidelity of implementation data were collected and reliability of key measures was assessed.
Control condition
Participants assigned to the control (behavior management) group received training related to teaching their child a non-language-related skill of their choice (e.g., using the toilet, sleeping, reducing tantrums, eating) during 2-hour home sessions immediately after baseline assessments and monthly check-in phone consultations throughout the 6-month period of the intervention.
Key measures
Children were screened for participation using the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Communication and language outcomes were measured with observed language samples (number of socially communicative acts), Preschool Language Scale-Fifth Edition (PLS-5), and MacArther-Bates Communicative Development Inventories (MCDI). Additional outcome measures included the Structured Play Assessment (symbolic play) and the Brief Observation of Social Communication Change (autism symptom change).
Data analytic strategy
Prior to conducting any main effects analyses, baseline data were analyzed for differences by site, experimental condition, and participants with and without outcome data. All analyses were conducted using R, with all models including baseline outcome scores as covariate. Multilevel growth models with random intercepts nested for each child were used to model social communication and expressive vocabulary from the MCDI. All other main effects were modeled using multiple regression models.
Key outcomes
The main findings of this project, as reported by the principal investigator, are as follows:
- There were no differences between experimental conditions at baseline; however, there were differences between at baseline on several child and caregiver variables.
- There were significant differences favoring the intervention group for caregiver use of all J-EMT strategies immediately after intervention and 6 months later, with the exception of responsiveness and matched responsiveness, which favored the control group.
- Using the primary measure of language (observed child language samples), children in the intervention group did not have significantly more socially communicative acts than children in the control group immediately following intervention or at the 6-month follow up.
- There were no differences between experimental conditions for any of the secondary child outcomes.
- Overall fidelity was high across all intervention sessions (96% for therapist use of J-EMT strategies, 92% for therapist use of caregiver instructional strategies).
People and institutions involved
IES program contact(s)
Project contributors
Products and publications
Study registration:
Publications:
ERIC Citations: Find available citations in ERIC for this award here.
Available data:
The final dataset will be accessible from July 1, 2021 until June 30, 2031. External researchers wishing to gain access to the database will request a REDCap user account through the Vanderbilt University Office of Research by emailing redcap@vanderbilt.edu. A copy of this request must be sent to the Vanderbilt PI who will facilitate access to the database. Researchers wishing to access the data set must provide the following information: (a) name, (b) affiliation, (c) email address, and (d) name of REDCap project (IES grant number).
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