Skip to main content
SpringerLink
Log in

Mediating Parent Learning to Promote Social Communication for Toddlers with Autism: Effects from a Randomized Controlled Trial

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

A randomized controlled trial was conducted to evaluate effects of the Joint Attention Mediated Learning (JAML) intervention. Toddlers with autism spectrum disorders (ASD) aged 16–30 months (n = 144) were randomized to intervention and community control conditions. Parents, who participated in 32 weekly home-based sessions, followed a mediated learning process to target preverbal social communication outcomes (social visual synchrony, reciprocity, and responding and initiating forms of joint attention) throughout daily interactions. The analysis found post-intervention effects for all outcomes, with all except initiating joint attention sustaining 6 months post-intervention. Findings support the value of very early intervention targeting explicitly social functions of preverbal communication and of promoting active engagement in the learning process for both toddlers and parents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. Hereafter referred to as “autism.”

  2. For all tests that include time the degrees of freedom were (2, 221).

References

  • Adamson, L. B., Bakeman, R., Deckner, D., & Romski, M. (2009). Joint engagement and the emergence of language in children with autism and Down syndrome. Journal of Autism & Developmental Disorders, 39(1), 84–96 13. https://doi.org/10.1007/s10803-008-0601-7.

    Article  Google Scholar 

  • Adamson, L. B., McArthur, D., Markov, Y., Dunbar, B., & Bakeman, R. (2001). Autism and joint attention: Young children’s responses to maternal bids. Journal of Applied Developmental Psychology, 22, 439–453. https://doi.org/10.1016/S0193-3973(01)00089-2.

    Article  Google Scholar 

  • Bagnato, S. J. (2005). The authentic alternative for assessment in early intervention: An emerging evidence-based practice. Journal of Early Intervention, 28(1), 17–22.

    Article  Google Scholar 

  • Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism & Developmental Disorders, 30(3), 237–243.

    Article  Google Scholar 

  • Bottema-Beutel, K. (2016). Associations between joint attention and language in autism spectrum disorder and typical development: A systematic review and meta-regression analysis. Autism Research, 9(10), 1021–1035. https://doi.org/10.1002/aur.1624.

    Article  PubMed  Google Scholar 

  • Bradshaw, J., Steiner, A., Gengoux, G., & Koegel, L. (2015). Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 45(3), 778–794. https://doi.org/10.1007/s10803-014-2235-2.

    Article  PubMed  Google Scholar 

  • Burchinal, M. R., Nelson, L., & Poe, M. (2006). Growth curve analysis: An introduction to various methods for analyzing longitudinal data. Monographs of the Society for Research in Child Development, 71(3), 65–87.

    Google Scholar 

  • Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘more than words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 52(7), 741–752. https://doi.org/10.1111/j.1469-7610.2011.02395.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Charman, T. (2003). Why is joint attention a pivotal skill in autism? Philosophical Transactions of the Royal Society of London, 358, 315–324.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chawarska, K., Macari, S., & Shic, F. (2013). Decreased spontaneous attention to social scenes in 6-month-old infants later diagnosed with autism spectrum disorders. Biological Psychiatry, 74(3), 195–203.

    Article  PubMed  PubMed Central  Google Scholar 

  • Curcio, F. (1978). Sensorimotor functioning and communication in mute autistic children. Journal of Autism & Childhood Schizophrenia, 8, 281–292.

    Article  Google Scholar 

  • Dawson, G., Rogers, S. J., Munson, J., Smith, M., Winter, J., Greenson, J., ..., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125(1), e17-e23.

    Article  Google Scholar 

  • Division for Early Childhood. (2014). DEC recommended practices in early intervention/early childhood special education 2014. Retrieved January 7, 2015 from http://www.dec-sped.org/recommendedpractices.

  • Elsabbagh, M., Bruno, R., Wan, M., Charman, T., Johnson, M., & Green, J. (2015). Infant neural sensitivity to dynamic eye gaze relates to quality of parent–infant interaction at 7-months in infants at risk for autism. Journal of Autism and Developmental Disorders, 45(2), 283–291. https://doi.org/10.1007/s10803-014-2192-9.

    Article  PubMed  Google Scholar 

  • Enders, C. K. (2010). Applied missing data analysis. New York: Guilford.

    Google Scholar 

  • Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 580.

    Article  PubMed  PubMed Central  Google Scholar 

  • Feldman, R. (2007). Parent-infant synchrony: Biological foundations and developmental outcomes. Current directions in Psychological Science, 16(6) 340–345.

    Article  Google Scholar 

  • Feuerstein, R. (1980). Instrumental enrichment: An intervention program for cognitive modifiability. Baltimore: University Park Press.

    Google Scholar 

  • Freeman, S. F. N., Gulsrud, A., & Kasari, C. (2015). Linking early joint attention and play abilities to later reports of friendships for children with ASD. Journal of Autism and Developmental Disorders, 45(7), 2259–2266. https://doi.org/10.1007/s10803-015-2369-x.

    Article  PubMed  Google Scholar 

  • Gillespie-Lynch, K., Sepeta, L., Wang, Y., Marshall, S., Gomez, L., Sigman, M., & Hutman, T. (2012). Early childhood predictors of the social competence of adults with autism. Journal of Autism and Developmental Disorders, 42(2), 161–174. https://doi.org/10.1007/s10803-011-1222-0.

    Article  PubMed  Google Scholar 

  • Guimond, A. B., Wilcox, M. J., & Lamorey, S. G. (2008). The early intervention parenting self-efficacy scale (eipses): Scale construction and initial psychometric evidence. Journal of Early Intervention, 30(4), 295–320.

    Article  Google Scholar 

  • Hampton, L. H., & Kaiser, A. P. (2016). Intervention effects on spoken-language outcomes for children with autism: A systematic review and meta-analysis. Journal of Intellectual Disability Research 60(5), 444–463. https://doi.org/10.1111/jir.12283.

    Article  PubMed  Google Scholar 

  • Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71(2), 165–179.

    Article  Google Scholar 

  • Ingersoll, B. (2008). The social role of imitation in autism implications for the treatment of imitation deficits. Infants & Young Children: An Interdisciplinary Journal of Special Care Practices, 21(2), 107–119.

    Article  Google Scholar 

  • Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504(7480), 427. https://doi.org/10.1038/nature12715.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554–563. https://doi.org/10.1037/a0039080.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kasari, C., Siller, M., Huynh, L. N., Shih, W., Swanson, M., Hellemann, G. S., & Sugar, C. A. (2014). Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behavior and Development, 37(4), 711–721. https://doi.org/10.1016/j.infbeh.2014.08.007.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim, S. H., Paul, R., Rogers, S., & Lord, C. (2014). Language and communication in autism, Vol. 1. In F. Volkmar, R. Paul, H. Tager-Flusberg & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders (pp. 230–262). Hoboken, NJ: Wiley.

    Google Scholar 

  • Klein, P. S. (2003). A mediational approach to early intervention: Israel. In S. L. Odom, M. J. Hanson, J. A. Blackman & S. Kaul (Eds.), Early intervention practices around the world (pp. 69–80). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Klin, A., & Jones, W. (2017). Developmental endophenotypes to quantify the emergence of autism in infancy International Meeting for Autism Research Conference Archives (p. 625). San Francisco, CA: International Society for Autism Research.

    Google Scholar 

  • Klin, A., Lin, D. J., Gorrindo, P., Ramsay, G., & Jones, W. (2009). Two-year-olds with autism orient to non-social contingencies rather than biological motion. Nature, 459(7244), 257–261. https://doi.org/10.1038/nature07868.

    Article  PubMed  PubMed Central  Google Scholar 

  • Landa, R. J., Holman, K. C., O’Neill, A. H., & Stuart, E. A. (2011). Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology & Psychiatry, 52(1), 13–21. https://doi.org/10.1111/j.1469-7610.2010.02288.x.

    Article  Google Scholar 

  • Lord, C., Luyster, R., Gotham, K., & Guthrie, W. (2012). Autism diagnostic observation schedule—toddler module manual. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Lord, C., & McGee, J. P. (Eds.). (2001). Educating children with autism. Washington, D.C.: National Academy Press.

    Google Scholar 

  • Mahoney, G., Boyce, G., Fewell, R. R., Spiker, D., & Wheeden, C. A. (1998). The relationship of parent-child interaction to the effectiveness of early intervention services for at-risk children and children with disabilities. Topics in Early Childhood Special Education, 18(1), 5–17.

    Article  Google Scholar 

  • Moriuchi, J. M., Klin, A., & Jones, W. (2017). Mechanisms of diminished attention to eyes in autism. American Journal of Psychiatry, 174(1), 26–35. https://doi.org/10.1176/appi.ajp.2016.15091222.

    Article  PubMed  Google Scholar 

  • Mullen, E. M. (1995). Mullen scales of early learning (AGS edition). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Mundy, P. (1995). Joint attention and social-emotional approach behavior in children wih autism. Development and Psychopathology, 7, 63–82.

    Article  Google Scholar 

  • Mundy, P. (2016). Autism and joint attention: Developmental, neuroscience, and clinical fundamentals. New York: Guilford Pub. Inc.

    Google Scholar 

  • Mundy, P., Block, J., Delgado, C., Pomares, Y., Van Hecke, A. V., & Parlade, M. V. (2007). Individual differences and the development of joint attention in infancy. Child Development, 78(3), 938–954.

    Article  PubMed  PubMed Central  Google Scholar 

  • Odom, S. L. (2016). The role of theory in early childhood special education and early intervention. Handbook of early childhood special education, (pp. 21–36) Cham: Springer.

    Chapter  Google Scholar 

  • Odom, S. L., Schertz, H. H., & Baggett, K. B. (2011). Single case design and growth curve analysis of an intervention to promote joint attention for toddlers with autism spectrum disorders. Paper presented at the International Meeting of Autism Research. San Diego, CA. http://imfar.confex.com/imfar/2011/webprogram/start.html#srch=words.

  • Oosterling, I., Visser, J., Swinkels, S., Rommelse, N., Donders, R., Woudenberg, T., ..., & Buitelaar, J. (2010). Randomized controlled trial of the focus parent training for toddlers with autism: 1-year outcome. Journal of Autism & Developmental Disorders, 40(12), 1447–1458. https://doi.org/10.1007/s10803-010-1004-0.

    Article  Google Scholar 

  • Robins, D., Fein, D., & Barton, M. (2012). Modified checklist for autism in toddlers. Retrieved November 10, 2017, from https://m-chat.org/.

  • Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., ..., & Dawson, G. (2012). Effects of a brief early start Denver model (ESDM): Evidence-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1052–1065.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogoff, B. (1990). Apprenticeship in thinking: Cognitive development in social context. New York: Oxford University Press.

    Google Scholar 

  • SAS Institute. (2014). Base SAS 9.4 procedures guide: Statistical procedures. SAS Institute.

  • Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177.

    Article  PubMed  Google Scholar 

  • Schertz, H. H. (2013). Precursors of joint attention measure (2nd edn.). Bloomington: Indiana University. (Unpublished work)

    Google Scholar 

  • Schertz, H. H., & Horn, K. (2017). Facilitating toddlers’ social communication from within the parent-child relationship: Application of family-centered early intervention and mediated learning principles. In M. Siller & L. Morgan (Eds.), Handbook of family-centered practice for very young children with autism. Cham, Switzerland: Springer.

  • Schertz, H. H., & Odom, S. L. (2007). Promoting joint attention in toddlers with autism: A parent-mediated developmental model. Journal of Autism & Developmental Disorders, 37(8), 1562–1575. https://doi.org/10.1007/s10803-006-0290-z.

  • Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of joint attention mediated learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28(2), 249–258. https://doi.org/10.1016/j.ecresq.2012.06.006.

    Article  Google Scholar 

  • Schertz, H. H., Reichow, B., Tan, P., Vaiouli, P., & Yildirim, E. (2012). Interventions for toddlers with autism spectrum disorders: An evaluation of research evidence. Journal of Early Intervention, 34(3), 166–189. https://doi.org/10.1177/1053815112470721.

    Article  Google Scholar 

  • Siller, M., Hutman, T., & Sigman, M. (2013). A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: A randomized clinical trial. Journal of Autism and Developmental Disorders, 43(3), 540–555. https://doi.org/10.1007/s10803-012-1584-y.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd edn.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Stone, W. L., Ousley, O. Y., Yoder, P. J., Hogan, K. L., & Hepburn, S. L. (1997). Nonverbal communication in two- and three-year-old children with autism. Journal of Austism and Developmental Disorders, 27(6), 677–696.

    Article  Google Scholar 

  • Vygotsky, L. S. (1934/1986). In A. Kozulin (Transl.). Thought and language Cambridge, MA: MIT Press.

  • Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-Implemented social intervention for toddlers with autism: An RCT. Pediatrics, 134(6), 1084–1093. https://doi.org/10.1542/peds.2014-0757.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wetherby, A. M., & Prizant, B. M. (2002). Communication and symbolic behavior scales developmental profile—first normed edition. Baltimore: Paul H Brookers Publishing.

    Google Scholar 

  • Wiggins, L. D., Piazza, V., & Robins, D. L. (2010). Comparison of a broad-based screen versus disorder-specific screen in detecting young children with an autism spectrum disorder. Paper presented at the International Meeting for Autism Research, Philadelphia, PA, USA

  • Wolf, M. M. (1978). Social validity: The case for subjective measurement or How applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11(4), 203–214. https://doi.org/10.1901/jaba.1978.11-203.

    Article  PubMed  PubMed Central  Google Scholar 

  • Workgroup on Principles and Practices in Natural Environments: Part C Settings. (2008). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved November 10, 2017, from http://ectacenter.org/~pdfs/topics/families/Finalmissionandprinciples3_11_08.pdf.

  • Yoder, P., & Symons, F. J. (2010). Observational measurement of behavior. New York: Springer.

Download references

Acknowledgments

This study is part of the Joint Attention Mediated Learning project with funding support from the Institute for Education Sciences, U.S. Department of Education, #R324A120291. This project was supported by a grant from the Institute for Education Sciences, U.S. Department of Education R324A120291.

Author Contributions

HS, SO, and KB participated in conceiving, designing, and implementing the study. HS coordinated development of the manuscript. KB substantially contributed to the methods description, SO oversaw the data reporting, and JS conducted the statistical analyses. HS, SO, and KB, who served as PI, Co-PI, and Co-PI, respectively, implemented site-based activities in coordination with the central site. HS provided direction for intervention activities and for the project as a whole, SO coordinated research design and analysis activities, and KB coordinated assessment processes. All authors read and approved the final manuscript.

Author information

Author notes

  1. Kathleen M. Baggett

    Present address: Mark Chaffin Center for Healthy Development, School of Public Health Georgia State University, 14 Marietta, Room 135, Atlanta, GA, 30303, USA

Authors and Affiliations

  1. Department of Curriculum & Instruction, Indiana University, 201 N Rose Ave., Bloomington, IN, 47405, USA

    Hannah H. Schertz

  2. Frank Porter Graham Child Development Institute, University of North Carolina, 105 Smith Level Road, Chapel Hill, NC, 27599, USA

    Samuel L. Odom & John H. Sideris

  3. Juniper Gardens Children’s Project, University of Kansas, 444 Minnesota Ave., Kansas, KS, USA

    Kathleen M. Baggett

Authors
  1. Hannah H. Schertz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuel L. Odom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathleen M. Baggett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John H. Sideris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hannah H. Schertz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schertz, H.H., Odom, S.L., Baggett, K.M. et al. Mediating Parent Learning to Promote Social Communication for Toddlers with Autism: Effects from a Randomized Controlled Trial. J Autism Dev Disord 48, 853–867 (2018). https://doi.org/10.1007/s10803-017-3386-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3386-8

Keywords

Search

Navigation