Abstract
BackgroundPoint OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords.MethodologyWe aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed.DiscussionPoint OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism.Trial registrationISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019.
Highlights
Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism
As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly
The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism
Summary
Point OutWords was developed in collaboration with children with autism and their therapists and caregivers [30], to include engaging jigsaws, high-contrast graphics, and exogenous cues to help capture and maintain attention, and customisable reinforcement prompts. For children with autism who have motor impairment and greater receptive than expressive communication, our new intervention could fill this gap in services were it shown effective in a full-scale RCT Before such a large-scale study can be framed, a feasibility trial is a necessary step to evaluate recruitment and retention rates and identify actions for reducing attrition. As the acceptability of the control apps is a likely predictive factor in reducing attrition in the control group, with advice from parents of autistic children we have selected iPad apps that are enjoyable and fun for children and families These control apps were selected based on the absence of Point OutWords skills and tasks, as the inadvertent involvement in similar therapy or training in a control group can confound results as recently reported in one large-scale trial [12].
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