Communication Interventions For Young Children Research Articles

Evaluating an early social communication intervention for young children with Down syndrome (ASCEND): results from a feasibility randomised control trial

BackgroundThis paper reports the results from a feasibility trial of an early parent-delivered social communication intervention for young children with Down syndrome (‘ASCEND’). The intervention focuses on developing children’s early social communication skills, in particular responding to shared attention. The aim was to inform the feasibility of running a full-scale trial through National Health Service (NHS) Speech and Language Therapy (SaLT) services, to assess whether the intervention is effective in improving language skills before children with Down syndrome start school.MethodsThis was a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site, comparing the intervention plus standard NHS SaLT provision with standard NHS SaLT alone. We recruited 20 children with Down syndrome aged between 11 and 36 months through 3 NHS SaLT services, 19 of whom were randomised (10 — intervention group, 9 —control group). Pre- and post-intervention and 6-month follow-up assessments included language, social communication skills, adaptive behaviour, quality of life (parents and children), parental anxiety and depression. The intervention was parent delivered with parents having access to SaLT services and the research team during the intervention. Data were collected on recruitment and retention, standard care, treatment fidelity, acceptability of the intervention by the parents and speech and language therapists, feasibility of collecting health economic measures and suitability of the primary outcome measure.ResultsThe sample was sufficient for a feasibility study. The intervention (manual, support, materials) was positively received by the participating parents. Speech and language therapists also evaluated the acceptability of the intervention positively. Treatment fidelity which was measured by completion of weekly parent diaries and two adherence phone call was acceptable as 100% of the parent diaries were returned, over 90% of the parental diaries were completed correctly and 100% of adherence phone calls were completed. Retention was acceptable at 84% overall. The preliminary health economic data suggest that this intervention will be low cost. The sample size calculation suggests that 290 participants would need to be recruited, with 228 having a complete data set, for a full RCT.ConclusionBased on recruitment, retention and treatment fidelity, as well as the acceptability of the intervention to parents and speech and language therapists, a full-scale trial would be feasible in order to assess the effectiveness of the intervention.Trial registrationISRCTN13902755, registered on 25th August 2020, http://www.isrctn.com/ISRCTN13902755

Implementation of an Early Communication Intervention for Young Children with Cerebral Palsy Using Single-Subject Research Design

The implementation of an intervention protocol aimed at increasing vocal complexity in three pre-linguistic children with cerebral palsy (two males, starting age 15 months, and one female, starting age 16 months) was evaluated utilising a repeated ABA case series design. The study progressed until the children were 36 months of age. Weekly probes with trained and untrained items were administered across each of three intervention blocks. Successive blocks targeted more advanced protophone production and speech movement patterns, individualised for each participant. Positive treatment effects were seen for all participants in terms of a greater rate of achievement of target protophone categories and speech movement patterns. Tau coefficients for trained items demonstrated overall moderate to large AB phase contrast effect sizes, with limited evidence of generalisation to untrained items. Control items featuring protophones and speech movements not targeted for intervention showed no change across phases for any participant. Our data suggest that emerging speech-production skills in prelinguistic infants with CP can be positively influenced through a multimodal intervention focused on capitalising on early periods of plasticity when language learning is most sensitive.

Telehealth Training in Naturalistic Communication Intervention for Mothers of Children with Angelman Syndrome.

Objectives Young children with Angelman syndrome have significant delays in expressive communication. Parents of children with Angelman syndrome require training to support their child’s communication development. Unfortunately, parent training focused on the needs of families of children with rare genetic syndromes is unavailable to many families. The purpose of this study was to evaluate a telehealth parent training program on naturalistic communication intervention for young children with Angelman syndrome.MethodsUsing two single-case multiple baseline designs across a total of six parent–child dyads, we evaluated the effects of a telehealth parent training program on parent implementation fidelity of a naturalistic communication intervention, child communication, and child engagement.ResultsWith the telehealth parent training program, parent implementation fidelity of naturalistic communication intervention improved, maintained and generalized to untrained home routines. Small effects on child communication and engagement were observed during the program.ConclusionsParents of children with Angelman syndrome were successfully taught via telehealth to implement a naturalistic communication intervention with their child at home. Additional research is needed to promote positive child communication outcomes through parent-mediated intervention.

From engagement to competency: The pathway to making disability naïve frontline workers competent in the delivery of an evidence-based autism intervention in New Delhi, India.

BackgroundAs countries like India improve access to maternal and infant care, the health systems need to develop services that enable all children to thrive. A key demographic which needs to be supported are children with disabilities, such as autism. With an estimated prevalence of one percent, there are over five million young children who need services to support their needs. However, the paucity of specialist care makes access to interventions difficult. In this context a public health research not-for-profit is evaluating the effectiveness of the task-sharing approach to support the delivery of an evidenced social communication intervention for young children with autism. This paper describes the process of engaging and training the non-specialist frontline Accredited Social Health Activists (ASHAs), who are embedded within the Ministry of Health and Family Welfare under the Delhi State Health Mission, to deliver a complex intervention for autism to inform the future scalability of services for neurodevelopmental disorders.MethodsThe present study describes the process which included (i) engagement meetings, (ii) recruitment, (iii) training, (iv) internship, and (v) competency evaluation. The shortlisted ASHAs received a 7-day classroom training followed by an internship period with practice cases. Finally, competency assessments, comprising of a test of knowledge and skills through role-plays, was administered.ResultsTwenty three Primary Urban Health Centers across seven districts of Delhi were approached and 408 ASHAs were engaged in initial meetings. Telephonic screening with 127 ASHAs resulted in 72 ASHAs being selected for in-person interviews. Of the 45 ASHAs who attended, 33 were shortlisted for training and 18 completed it. Fifteen ASHAs entered the internship of which 7 ASHAs achieved competency.Discussion and conclusionThere was significant attrition along the pathway to having a competent non-specialist worker deliver a complex autism intervention. The lessons learnt from this process can inform the possibility of developing a cadre of disability specific frontline health workers who can deliver evidence-based interventions for neurodevelopmental disorders under supervision.

An adapted social communication intervention at home and education to promote social communication change in children with severe autism: the PACT-G RCT

Background Prior evidence suggests that behaviours closely related to the intervention delivered for autism are amenable to change, but it becomes more difficult when generalising treatment effects beyond that immediate context. Objectives The objectives were (1) to test an early autism social communication intervention designed to promote child social communication change in the naturalistic contexts of both home and education, with an additive effect on overall child symptom outcomes, and (2) to conduct a mechanistic study investigating the transmission of treatment effects within and across contexts to an overall treatment effect. Design The trial was a three-site, parallel-group, randomised controlled trial of the experimental treatment plus treatment as usual and treatment as usual alone. The primary intention-to-treat analysis used analysis of covariance. The mechanism analysis used regression models to test mediation of the primary outcome by parent–child and education staff (learning support assistant)–child social interactions. Setting The study took place in three urban/semiurban regions in Manchester, Newcastle upon Tyne and London. Participants Children aged 2–11 years who met the criteria for severe autism. Interventions The Preschool Autism Communication Trial was adapted to parallel components within home and educational settings using in-person and remote delivery. Treatment as usual was the control condition. Main outcome measures The primary outcome was autism symptoms on the Autism Diagnostic Observation schedule-2. The secondary outcomes were Brief Observation of Social Communication Change, dyadic social interaction between child and parent or learning support assistant, reported language, functional outcome and reduction in child disruptive behaviour. Outcomes were measured at baseline and at the 12-month end point in all settings; interim mechanism measurements were taken at 7 months. Results Participants (n = 249; 122 in the PACT-G group and 127 in the treatment-as-usual group; 51 were female and 197 were male) received a median of 10 (interquartile range 8–12) sessions at home and 8 (interquartile range 5–10) sessions in an educational setting. We found no significant treatment effects on the end-point Autism Diagnostic Observation Schedule-2 primary outcome (–0.04, 95% confidence interval –0.26 to 0.18; p = 0.734), on the end-point Brief Observation of Social Communication Change secondary outcome (–0.03, 95% confidence interval –0.31 to 0.25; p = 0.85) or on language, repetitive behaviour, adaptive behaviour and child well-being. We did find significant treatment effects on dyadic interactions (increased parent synchronous response 0.54, 95% confidence interval 0.39 to 0.69; p = 0.001); child initiations with a parent (0.27, 95% confidence interval 0.12 to 0.41; p = 0.001); learning support assistant synchronous response (0.32, 95% confidence interval 0.14 to 0.49; p = 0.001); child initiations with a learning support assistant (0.21, 95% confidence interval 0.06 to 0.36; p = 0.005); and unblinded measures of improved parental well-being and child disruptive behaviour across home and educational settings. Adult (parent/learning support assistant) synchronous responsiveness in a home/education setting improved child dyadic social initiation. The child dyadic social initiation was also associated with child symptoms on researcher Brief Observation of Social Communication Change. Limitations The delivered sessional dosage was 83% of that planned in the home setting and 67% in the educational setting, with 5.5% of home sessions and 5% of educational sessions deemed ‘unacceptable’, particularly for remote delivery. A change of therapy learning support assistant was experienced by over one-third of children by the mid-point of the trial, by another third by the end point, and by one-fifth at both points. Conclusions The multicomponent Paediatric Autism Communication Trial – Generalised (PACT-G) treatment for a child in a home or educational setting did not produce the hypothesised improvement in child autism symptomatology or adaptive behaviour, but did produce significant improvements in proximal adult–child reciprocal dyadic communication. Future work Future work will involve building on these results towards a further understanding of delivery options, dosage and multicomponent extension of social communication interventions for young children with autism in naturalistic settings. Trial registration Current Controlled Trials ISRCTN25378536. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health and Care Research (NIHR) partnership. This was also part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.

A systematic review of speech, language and communication interventions for children with Down syndrome from 0 to 6 years

AbstractBackgroundSpeech and language acquisition can be a challenge for young children with Down syndrome (DS), and while early intervention is important, we do not know what early interventions exist and how effective they may be.AimsTo systematically review existing early speech, language and communication interventions for young children with DS from birth up to 6 years, and to investigate their effectiveness in improving speech, language and communication outcomes in children with DS. Other outcomes are changes in parental behaviour and their responsivenessMethods & ProceduresWe conducted a systematic search of relevant electronic databases to identify early intervention studies targeting speech, language and communication outcomes in children with DS published up to May 2020. A total of 11 studies that met the inclusion criteria were synthesized and appraised for quality using the PEDro‐P scale. There were a total of 242 children. We identified three types of intervention: communication training and responsive teaching, early stimulation programme, and dialectic–didactic approach.Main contributionThe findings from nine out of the 11 studies reported positive outcomes for children's language and communication up to 18 months following the intervention. All nine studies reported interventions that were co‐delivered by parents and clinicians. However, there was also a de‐accelerated growth in requesting behaviours in the intervention group reported by one study as well as a case of no improvement for the intervention group. Three studies provided some evidence of improvements to parent outcomes, such as increased parental language input and increased responsiveness. However, there was a moderate to high risk of bias for all studies included.ConclusionsThe findings from this review suggest that interventions that have high dosage, focus on language and communication training within a naturalistic setting, and are co‐delivered by parents and clinicians/researchers may have the potential to provide positive outcomes for children with DS between 0 and 6 years of age. Due to the limited number of studies, limited heterogeneous data and the moderate to high risk of bias across studies, there is an urgent need for higher quality intervention studies in the field to build the evidence base.WHAT THIS PAPER ADDSWhat is already known on the subjectSpeech and language acquisition is usually delayed in children with DS, yet there are currently no standard interventions for children under 6. A number of research‐based interventions exist in the literature, yet it is unknown how effective these are.What this study adds to existing knowledgeThis is the first systematic review that specifically and exclusively focuses on parent‐ and non‐parent‐mediated speech, language and communication interventions for children with DS between 0 and 6 years of age. It complements three existing recent reviews, each of which has a slightly different focus. The previously published reviews have covered only parent‐mediated interventions, excluding interventions not mediated by parents, have reviewed interventions including children and adults, without any mention of what early interventions may be like or how effective these may be for young children with DS, have not always assessed risk of bias or have focused specifically on language interventions excluding those focusing on speech articulation or pre‐linguistic skills. The findings from the current review suggest that interventions that have high dosage focus on language and communication training within a naturalistic setting and are co‐delivered by parents and clinicians/researchers may have the potential to provide positive outcomes for children with Diwn syndrome from 0 to 6. We acknowledge that the current evidence base comes from studies with moderate to high risk of bias, hence our conclusions are not definitive.What are the potential or actual clinical implications of this work?Speech and language therapists will have synthesized information and a quick reference point on what type of interventions exist for children with DS under the age of 6, and evidence of which intervention approaches may be promising in terms of providing positive outcomes. However, it is acknowledged that, due to the limited number of studies and the moderate to high risk of bias inherent in the evidence, there is an urgent need for higher quality intervention studies in the field to build the evidence base.

The ASCEND study: protocol for a feasibility study to evaluate an early social communication intervention for young children with Down syndrome

BackgroundDown syndrome is the most common cause of learning disability, affecting approximately 1 in every 700 babies. Children with Down syndrome have particular difficulties with speech and language. This makes it challenging for them to participate fully in life, access healthcare services and educational opportunities. Improving the language skills of young children with Down syndrome is vital for their future social and emotional well-being and behaviour, and consequently contribution to society. As Down syndrome is detected before or at birth, we can provide support from early on. There are currently no standard interventions for improving the language skills of children with Down syndrome under the age of 36 months. Evidence suggests that early parent-based interventions may be effective in improving language outcomes. In partnership with parents and speech and language therapists, we have co-developed an intervention focusing on early social communication skills and our preliminary work shows that it can lead to better language in children with Down syndrome. Our aim is to carry out a feasibility study which will inform a future pilot/full trial to test whether the intervention is effective in improving language skills before children with Down syndrome start school.MethodsThis is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site comparing the intervention (plus standard NHS speech and language therapy) with no intervention (standard NHS speech and language therapy only). We aim to recruit between 25 and 30 children with Down syndrome aged between 11 and 36 months. Sites are defined by the geographical boundaries of three National Health Service (NHS) Trusts. Recruitment is from NHS Speech and Language Therapist caseloads within the 3 Trusts, and self-referral. In the intervention arm, parents/guardians will receive brief training on the parent-based intervention and a manual to follow with their child for 10 weeks. The children’s language and early communication skills and family health outcomes will be assessed by a blinded assessor at baseline, post-intervention and 6 month follow-up. Questionnaire and semi-structured interviews will explore the acceptability of the intervention to parents and SLTs.DiscussionThe feasibility study’s outcomes will determine whether it would be viable to progress to a full-trial and whether adjustments need to made to the procedures, data collection methods, intervention delivery and the intensity of support needed. We want to assess whether our early intervention can be delivered and rolled out through NHS Speech and Language Therapy (SLT) Services. We anticipate that NHS SLT Services will need to make ongoing changes due to the COVID-19 pandemic, so it is likely that we will need to make adjustments for the definitive trial. We will also calculate descriptive statistics of the language outcome measure which we will use for any future sample size calculation.Trial registrationISRCTN13902755. Registered on 25 August 2020. http://www.isrctn.com/ISRCTN13902755

Exploring coaching and follow-up supports in community-implemented caregiver-mediated JASPER intervention.

The next step for communication interventions for young children with autism include coaching/teaching for caregivers that have been tested in university clinics and testing these interventions in real world systems with early intervention providers who serve children and families in their communities. However, there are few projects that have tested how well the intervention can be transferred to community providers and what types of progress children and caregivers make in these services. This project took place in partnership with a community early intervention agency in the province of Ontario, Canada. The agency provided government-funded public health services. The agency was funded to take part in a pilot program to try out one of four early intervention models that included coaching for caregivers and was designed to support children's social engagement, play, and communication skills. The team decided to test two ways to start the intervention: (a) begin with observation of the practitioner for 4 weeks and then start coached practice with the child and (b) start coaching immediately. The team also tested two ways to support families for 3 months after intervention: (a) group booster sessions and (b) individual visits. The practitioners delivered the intervention well (M = 83%), and overall, caregivers and children made significant gains by the end of intervention in both observation + coaching and coaching. Attendance for follow-up boosters was variable with fewer families attending groups. More research is needed to test different strategies and roles to individualize interventions for caregivers with a range of goals and learning styles.

A Systematic Review of Family-Mediated Social Communication Interventions for Young Children with Autism.

Social communication deficits are a core symptom of autism spectrum disorder (ASD). The present paper reviews 54 studies evaluating social communication interventions delivered by parents and siblings to children with ASD under 6 years old. Fifty studies evaluated parent-mediated intervention, and four studies evaluated sibling-mediated intervention. Fourteen studies evaluated interventions using telehealth. Treatment effects and research strength were variable across studies. Treatment modality, setting, and dosage had inconclusive impact on treatment effect. Parent-implemented intervention packages, Pivotal Response Treatment (PRT), Early Start Denver Model (ESDM), and Joint Attention, Symbolic Play, Engagement & Regulation (JASPER), qualified as established evidence-based practice for this population. Most studies reported successful generalization of skills for some, but not all, children. Telehealth and sibling-mediated intervention are promising areas of further research and clinical practice.

Helping Optimize Language Acquisition (HOLA) Online Parent Training Modules for Latinx Parents of Toddlers at Risk for ASD: Protocol for a Pilot Funded by the Organization for Autism Research.

BackgroundCulturally competent parent training in evidence-based intervention for autism spectrum disorder (ASD) can provide young Latinx children from underserved communities with early interventional support while they wait for professional services, thus reducing the impact of intervention delays. Providing parents with brief bilingual training in Pivotal Response Treatment (PRT) is a strategy that can overcome these barriers and is inexpensive to disseminate. Brief PRT training has been shown to significantly improve joint attention, expressive language, responsivity, and adaptive skills in young children with ASD. However, it is unknown whether an interactive, culturally competent online parent training in PRT is effective in a Latinx population.ObjectiveTo this end, we will recruit 24 children (16-36 months old) at risk for ASD and their parent(s) from East and South Los Angeles and provide them with a series of 6 online learning modules in their choice of Spanish or English.MethodsThis pilot study will utilize a single-group, pilot, pre-post design with follow-up assessments 6 weeks later. Linear mixed-effects model analysis will be used to explore most parent-reported and coded outcomes.ResultsBrief online parent training in evidence-based treatments has the capacity to increase access to culturally competent early communication interventions for young children at risk for ASD.ConclusionsThe results of this trial may have particular salience in additional underresourced communities where children have limited access to interventions prior to entering school.International Registered Report Identifier (IRRID)PRR1-10.2196/18004

Current Trends in Telehealth Applications to Deliver Social Communication Interventions for Young Children with or at Risk for Autism Spectrum Disorder.

Purpose of ReviewEarly, intensive, and high-quality interventions can often improve social communication outcomes for children with autism spectrum disorder (ASD). Many children experience barriers to intervention, resulting in significant delays to intervention onset or missed opportunities for intervention altogether. With constant advances in technology, the field is experiencing a rapid increase in investigation of telehealth applications to intervention delivery. This article highlights the current trends in social communication intervention via telehealth used in early intervention practices for children with ASD over the past 5 years, including a brief review of studies (from 2014 to January 2020) and our team’s experiences in this area.Recent FindingsBased on our experience and the 22 studies we identified in this area, we describe the current trends in telehealth applications used and how interventions were delivered. We also provide recommendations, limitations, and future directions on this topic.SummaryTelehealth offers innovative intervention delivery options by increasing intervention access, overcoming barriers such as geography and costs of service delivery for young children with ASD.

Peer-Mediated Augmentative and Alternative Communication Interventions for Young Children With Autism Spectrum Disorder and Limited to No Spoken Communication

Purpose Increasingly, research has identified effective approaches to improve communication and social engagement of preschool-age children with autism spectrum disorder (ASD) with limited spoken communication during interactions with peer partners. These include teaching peers to use the same augmentative and alternative communication (AAC) system, along with direct instruction (Thiemann-Bourque et al., 2018 ). The purpose of this research note is to summarize the author's contributions to this literature and provide clinicians with evidence-based strategies to support communicative interactions between children with ASD and peers without disabilities. Method This research note describes a series of studies conducted by the author and her colleagues with a focus on peer-mediated and direct AAC instructional approaches, defining target skills and how to measure effects on children's social communication competence, and the potential benefits of integrating approaches for preschool children with ASD who have significant social and communication needs. Results Outcomes summarized include fidelity of treatment implementation, improved rates of augmented and spoken communication, increased functional communication using different modalities, and enhanced reciprocal communication between children with ASD and peers during routine activities. Study limitations and directions for future intervention research are also discussed. Conclusions Together, the research reviewed shows that peers can be taught to be responsive AAC communication partners at a young age, with high fidelity of strategy implementation by peers and by speech-language pathologists or other early intervention staff. Providing children with increased social learning opportunities within the context of shared AAC activities allows both partners to become more competent in their social communicative interactions.

Parent-Implemented Early Social Communication Intervention for Young Children with Autism Spectrum Disorder

Numerous developmental difficulties differentiate children with autism from typically developing children, including delays in social communication skills. In this study, we used a multiple baseline design across three behaviors (i.e., imitation, behavioral requests, and response to joint attention) for two parent–child dyads to investigate the effectiveness of a parent-implemented social communication intervention. Parents received training on least to most prompting, and coaching while practicing with their child until they reached the intervention fidelity criterion. Results indicated increased parent fidelity for one parent in two strategies and in all strategies for one parent. Environmental arrangement training was not provided for one parent due to increases in baseline. In addition, all child behaviors increased. The results and implications for future research and practice are discussed.

Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism.

Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation ‘difficulties’ associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506–522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.Lay SummaryIt is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.

Commentary: Parental Broad Autism Phenotype and the Language Skills of Children with Autism Spectrum Disorder

In considering how best to implement parent-delivered communication interventions for young children with autism spectrum disorder (ASD), there is a growing body of evidence supporting the need to examine children’s pre-treatment factors (e.g., verbal skills, joint attention skills, imitation skills) as potentially influential variables on intervention efficacy

Family Leisure as a Context to Support Augmentative and Alternative Communication Intervention for Young Children with Complex Communication Needs.

AbstractFamilies are often the most significant communication partners for children who require augmentative and alternative communication (AAC). Because family-centered approaches are recommended practice in speech-language pathology, a primary role for speech-language pathologists (SLPs) serving children who require AAC is to support families in integrating communication into highly valued, existing family activities. Family leisure activities can provide a naturally supportive context for AAC, because they provide multiple opportunities for children to interact and practice using AAC with natural communication partners. This article aims to guide SLPs in utilizing family leisure as a context for AAC intervention. We describe the benefits and constraints of engaging in leisure for families with children with disabilities. We define family leisure, which includes two distinct types of leisure activities: core and balance. Finally, we provide a case example of a family that highlights the integration of AAC into both types of leisure activities.

Advanced Social Communication Skills for Young Children with Autism: a Systematic Review of Single-Case Intervention Studies

The extant literature on social communication interventions for young children with autism spectrum disorder (ASD) has been well reviewed. However, current reviews of the literature indicate more research is needed on advanced social skills for young children with ASD. These more complex social skills, such as sustaining a conversation, showing empathy, or telling a joke, are critical for peer acceptance in the elementary school years. In the current paper, we reviewed the existing single-case literature on social communication interventions for advanced social skills for young (4–12-year-old) children with ASD. We define advanced social skills using the task analysis of the Social Behavior and Social Play—Level 3 subsection of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). Electronic database searches of Education Resources Information Center (ERIC), Academic Search Premier, and PsycINFO were conducted. Results revealed a library of useful interventions for a specific set of social communication skills; however, some crucial skills for children with ASD were missing from the results. Directions for future research and practice are discussed.

Understanding Communication Intervention for Young Children with Autism and Their Parents: Mixing Behavioral and Social Validity Findings

We retrospectively analyzed data from a pilot study that examined the impact of the Internet-based Parent-implemented Communication Strategies (i-PiCS) program (Meadan et al. in Journal of Early Intervention, 2016) on two families whose children primarily used unaided augmentative and alternative communication (AAC). The purpose of this analysis was to explore possible explanations for discrepant findings between behavioral data and social validity data in single-case research. These divergent findings were revealed when we attempted to mix two methods to make assertions about intervention effectiveness. Guided by two hypotheses, we recoded the original pilot study video recordings by introducing new dependent variables that were linked to information gleaned from the social validity assessment (i.e., self-reports by the parents and interventionist). After assessing these new dependent variables, we found support for improvement produced by the i-PiCS program that had not been identified in the original observational recording. We present the methods and results of this secondary analysis and discuss the potential value of using mixed methods to combine observational behavioral data with self-report social validity data in behavioral research.

Initial Efficacy of Project ImPACT: A Parent-Mediated Social Communication Intervention for Young Children with ASD

Project ImPACT is a parent-mediated social communication intervention for young children with ASD that was developed in community settings to encourage dissemination. A single-subject, multiple-baseline design was conducted across 8 preschoolers with ASD and their mothers to examine the efficacy of the model for improving parent intervention fidelity and child spontaneous language. Multilevel modeling was used to examine the relationship between parent fidelity and child language within session. All parents increased their use of the intervention techniques. Improvements in spontaneous use of language targets were observed for 6 of the 8 children. There was a significant association between parents' use of the intervention strategies and their child's spontaneous language use.

Commentary: Glass half full or half empty? Testing social communication interventions for young children with autism - reflections on Landa, Holman, O’Neill, and Stuart (2011)

Impairments in social communication are the corediagnostic features of autism spectrum disorders(ASD). In the past two decades findings from impor-tantclinical research studies(manypublishedin thisjournal) have translated into improvements inunderstanding and practice, for example leading to areductionintheageatwhichautismiscommonlyfirstrecognised and diagnosed in many communities.One area of research that has not, perhaps sur-prisingly, progressed as much as would have beenexpected is that of psychological interventions. How-ever, it was not the case that intervention was notdiscussed by practitioners and researchers. To cut along story short, there has been an ongoing (and notalways civilised or fair-minded) debate over severaldecades about the effectiveness or otherwise of oneparticular approach - ‘applied behavioural analysis’(ABA), sometimes now called ‘early intensivebehavioural intervention’ (EIBI). There is not space toreview this sorry saga but I do think that the greenshoots of a rapprochement might be visible. What isclear is that both sides were debating a handful ofsmall, mostly poor-quality studies and almost norandomised controlled trials (RCTs) (Ospina et al.,2008). This contrasts with many other areas of childpsychiatryandpsychologywherethetrialliteratureofpsychological interventions is considerably moresecure. These are not mere esoteric considerationssince parents ask clinicians to be referred to treat-ments that ‘work’ and service commissioners andinsurance companies ask the same question too.One paper (Landa, Holman, O’Neill, & Stuart,2011) in the current issue of the Journal is thereforenotable in that it forms part of a ‘new wave’ ofintervention studies that are characterised both by afocus on specifically enhancing social communica-tion outcomes and by using an RCT design. Landaand colleagues compared two kindergarten pro-grammes for 29-month-olds with an ASD. The pro-grammes differed only in that one focused on‘interpersonal synchrony’ (IS) more than the other(N = 50, two groups). IS includes a range of socialcommunication activities and constructs, includingjoint attention, imitation, turn-taking, non-verbalsocial communicative exchanges, affect sharing andengagement. The programme was delivered bytrained kindergarten staff and delivered for2.5 hours per day, 4 days per week for 6 months(overall around 200 hours of intervention). Parentsalso attended education classes focusing on thesame strategies implemented in the kindergarten(38 hours) and a monthly home coaching visit.Landa et al. found that the IS group differed from thenon-IS group on one variable only: ‘socially engagedimitation’, defined as the proportion of imitationspaired with eye contact to the examiner across aseries of modelled actions (which more than doubledfrom 17% to 42%). The groups did not differ inamount of initiated joint attention or shared positiveaffect when interacting with an examiner; nor didtheir scores on a standardised language measureimprove. This introduces the first note of cautionafter my congratulations to the authors for havingrun and reported a fine study. What are the limits tothe effects we might expect for time-limited inter-ventions aiming to improve social communicativeoutcomes for young children with autism?In another recent trial Kasari and colleagues con-ductedashort-termkindergartentherapist-deliveredintervention.Threegroupsofchildren(N = 58intotal;mean age 42 months) were randomised to daily 30-minute sessions for 5 to 6 weeks where activitiesfocused on promoting either joint attention or sym-bolic play skills (and a control group). After 6 weeksthere were improvements in both the interventiongroups in aspects of child joint attention and play ininteraction with experimenters and with their moth-ers (Kasari, Freeman, & Paparella, 2006). One yearlater, both intervention groups had significantlyhigher scores on structural language measures thanthe controls (Kasari, Paparella, Freeman, & Jahromi,2008).Both the Landa and the Kasari studies focused onpromoting early social communication skills butused a wide range of techniques in the delivery of thetherapy (‘from ABA to milieu teaching’ in Kasari et al.and ‘a continuum of adult-imposed structure fromdiscrete trail teaching … to pivotal response training… to routines-based interactions’ in Landa et al.)