Early intervention in autism: Joint attention and symbolic play

Abstract

In both intervention case examples, substantial gains were made in the targeted goals in a very short period of time, 31 intervention sessions for Child A and 21 intervention sessions for Child B. Therefore, in reference to our first question of whether joint attention and symbolic play skills can be taught, our answer is yes. Evidence exists that—at least in these two cases—children with autism can indeed be successfully taught skills related to their core deficits. Our second question concerned the specificity of our intervention. Although each child improved on his targeted goals over the course of the intervention, neither child improved in the nontargeted skills of joint attention and symbolic play. Moreover, the control child did not change in either play or joint attention skills. Thus, we have some evidence that changes were made only in the targeted developmental skills. When replicated across the 60 children we will have in our intervention project, we will be able to better assess the specificity of our direct teaching approach. Third, both intervention children made some significant language gains over the course of intervention, whereas our control child did not change. Thus, based on these initial two children, there does not appear to be a specific effect on language based on the type of intervention—joint attention or symbolic play, but there are changes in language. A test of the benefit of these gains will be in the longitudinal data that we are currently collecting and the replication of randomized children in each of the interventions. Finally, an important caveat is in order. The cases presented are merely examples and must be replicated over a number of children with similar pretreatment characteristics. Indeed, all three boys had mental ages just over 20 months, some limited joint attention skills, few behavior problems, and a general interest in objects. Thus, our intervention may be most effective with children who share these pretreatment characteristics. Indeed, this is one line of questioning we will be addressing in our continued data collection. Since we are randomizing children to different treatments, we will ultimately include children who function lower and higher than those described here. These data will be critical in determining who benefits most from which treatment and whether there are long-term effects of treatment.