Abstract
JASP-EMT, the combined Enhanced Milieu Teaching (EMT) and Joint Attention, Structured Play, and Emotion Regulation (JASPER) interventions, has been found to be effective for promoting social communication in young children with autism (Kasari et al. in J Am Acad Child Adolesc Psychiatry 53(6):635–646, https://doi.org/10.1016/j.jaac.2014.01.019, 2014). The current study examined the effects of this naturalistic intervention on social language use in three children with autism who were in the early stages of language acquisition. Generalization to communication partners who did not utilize the intervention strategies was systematically examined using a multiple-baseline design. The results from this study indicate that this blended intervention is effective in increasing target social language for young children with autism, however, generalization to communication partners does not readily occur. Implications for practice and future research are discussed.
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References
Adamson, L. B., Bakeman, R., Deckner, D. F., & Romski, M. (2009). Joint engagement and the emergence of language in children with autism and Down syndrome. Journal of Autism and Developmental Disorders, 39(1), 84–96. https://doi.org/10.1007/s10803-008-0601-7.
Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., et al. (2007). Patterns of growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75(4), 594–604. https://doi.org/10.1037/0022-006X.75.4.594.
Bono, M. A., Daley, T., & Sigman, M. (2004). Relations among joint attention, amount of intervention and language gain in autism. Journal of Autism and Developmental Disorders, 34(5), 495–505. https://doi.org/10.1007/s10803-004-2545-x.
Brignell, A., Morgan, A. T., Woolfenden, S., Klopper, F., May, T., Sarkozy, V., et al. (2018). A systematic review and meta-analysis of the prognosis of language outcomes for individuals with autism spectrum disorder. Autism & Developmental Language Impairments, 3, 2396941518767610.
Chow, J. C., & Hampton, L. H. (2019). Sequential Multiple-Assignment Randomized Trials: Developing and evaluating adaptive interventions in special education. Remedial and Special Education, 40(5), 267–276. https://doi.org/10.1177/0741932518759422.
Dunn, L. M., Dunn, L. M., Bulheller, S., & Häcker, H. (1965). Peabody picture vocabulary test. Circle Pines, MN: American Guidance Service.
Dunn, P. L. M., & Dunn, P. D. M. (2007). Peabody picture vocabulary test, Fourth Edition (PPVT4)—FORM B (Fourth Edition). Pearson Assessments.
Fuller, E. A., & Kaiser, A. P. (2019). The effects of early intervention on social communication outcomes for children with autism spectrum disorder: A meta-analysis. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-019-03927-z.
Gast, D. L., & Ledford, J. R. (2014). Single case research methodology: Applications in special education and behavioral sciences. London: Routledge.
Goods, K. S., Ishijima, E., Chang, Y.-C., & Kasari, C. (2012). Preschool based JASPER intervention in minimally verbal children with autism: Pilot RCT. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-012-1644-3.
Gulsrud, A. C., Hellemann, G. S., Freeman, S. F., & Kasari, C. (2014). Two to ten years: Developmental trajectories of joint attention in children with ASD who received targeted social communication interventions. Autism Research, 7(2), 207–215.
Hampton, L. H., Harty, M., Fuller, E. A., & Kaiser, A. P. (2019). Enhanced milieu teaching for children with autism spectrum disorder in South Africa. International Journal of Speech-Language Pathology, 21(6), 635–645.
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.
Hampton, L. H., Kaiser, A. P., & Roberts, M. Y. (2017). One-year language outcomes in toddlers with language delays: An RCT follow-up. Pediatrics, 140(5), e20163646.
Kaiser, A. P., & Hampton, L. H. (2017). Enhanced Milieu teaching. In R. McCauley, M. Fey, & R. Gilliam (Eds.), Treatment of language disorders in children (pp. 87–119). Baltimore: Brooks Publishing Co.
Kaiser, A. P., & Hester, P. P. (1994). Generalized effects of enhanced milieu teaching. Journal of Speech, Language, and Hearing Research, 37, 1320–1340.
Kaiser, A. P., & Roberts, M. Y. (2013). Parent-implemented Enhanced Milieu Teaching with preschool children who have intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56(1), 295.
Kaiser, A. P., Scherer, N., Frey, J., & Roberts, M. Y. (2017). The effects of enhanced milieu teaching with phonological emphasis on the speech and language skills of young children with Cleft Palate: A pilot study. American Journal of Speech-Language Pathology, 26(3), 806–818.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620. https://doi.org/10.1111/j.1469-7610.2005.01567.x.
Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2012). Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 487–495. https://doi.org/10.1016/j.jaac.2012.02.019.
Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056. https://doi.org/10.1007/s10803-010-0955-5.
Kasari, C., Kaiser, A. P., Goods, K., Nietfeld, J., Mathy, P., Landa, R., et al. (2014a). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(6), 635–646. https://doi.org/10.1016/j.jaac.2014.01.019.
Kasari, C., Lawton, K., Shih, W., Barker, T. V., Landa, R., Lord, C., et al. (2014b). Caregiver-mediated intervention for low-resourced preschoolers with autism: An RCT. Pediatrics, 134(1), e72–e79.
Kasari, C., Siller, M., Huynh, L. N., Shih, W., Swanson, M., Hellemann, G. S., et al. (2014c). Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behavior and Development, 37(4), 711–721.
Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008). Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125–137. https://doi.org/10.1037/0022-006X.76.1.125.
Kaufman, N. R. (1995). Kaufman speech praxis treatment kit for children: Basic level. Detroit: Wayne State University Press.
Lord, C., Rutter, M., DiLavore, P., & Risi, S. (2002). Autism diagnostic observation schedule: ADOS: Manual. Los Angeles, CA: Western Psychological Services.
Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T., et al. (2005). Challenges in evaluating psychosocial interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 35(6), 695–708.
Miller, J. F. (1981). Assessing language production in children: Experimental procedures (Vol. 1). Univ Park Press.
Miller, J., & Chapman, R. (2008). Systematic analysis of language transcripts. Baltimore: University Park Press.
Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A., & Seibert, J. (2003). Early social communication scales (ESCS). Coral Gables: University of Miami.
National Research Council. (2001). Educating children with autism. Washington, DC: National Research Council.
Paul, R. (2008). Interventions to improve communication in autism. Child and Adolescent Psychiatric Clinics of North America, 17(4), 835–856.
Rogers, S. J., Hepburn, S. L., Stackhouse, T., & Wehner, E. (2003). Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44(5), 763–781.
Roid, G. H., & Miller, L. J. (1997). Leiter international performance scale-revised (Leiter-R). Wood Dale, IL: Western Psychological Services.
Rutter, M. (1978). Diagnosis and definition. In Autism (pp. 1–25). Springer. https://doi.org/10.1007/978-1-4684-0787-7_1.
Schreibman, L., & Stahmer, A. C. (2014). A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism. Journal of Autism and Developmental Disorders, 44(5), 1244–1251. https://doi.org/10.1007/s10803-013-1972-y.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research, 6, 468–478. https://doi.org/10.1002/aur.1329.
Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R., et al. (2009). Defining spoken language benchmarks and selecting measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research, 52(3), 643–652.
Tasker, S. L., & Schmidt, L. A. (2008). The “dual usage problem” in the explanations of “joint attention” and children’s socioemotional development: A reconceptualization. Developmental Review, 28, 263–288. https://doi.org/10.1016/j.dr.2007.07.001.
Toth, K., Munson, J., Meltzoff, A. N., & Dawson, G. (2006). Early predictors of communication development in young children with autism spectrum disorder: Joint attention, imitation, and toy play. Journal of Autism and Developmental Disorders, 36(8), 993–1005. https://doi.org/10.1007/s10803-006-0137-7.
Ungerer, J. A., & Sigman, M. (1984). The relation of play and sensorimotor behavior to language in the second year. Child Development, 55, 1448–1455.
Wolery, M. (2013). A commentary: Single-case design technical document of the What Works Clearinghouse. Remedial and Special Education, 34(1), 39–43.
Wright, C. A., Kaiser, A. P., Reikowsky, D. I., & Roberts, M. Y. (2012). Effects of a naturalistic sign intervention on expressive language of toddlers with down syndrome. Journal of Speech, Language, and Hearing Research: JSLHR., 56(3), 994–1008.
Yoder, P. J. (2006). Predicting lexical density growth rate in young children with autism spectrum disorders. American Journal of Speech-Language Pathology, 15(4), 378–388.
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Thank you Dr. Mark Woolery for his guidance of the study design.
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All of the authors contributed to the design and analysis of the study. LHH and AK contributed to the execution of the study, and JPN and APK provided intervention and fidelity training and supervision. LHH and APK prepared the manuscript. The final manuscript has been edited and approved by all the authors.
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Hampton, L.H., Kaiser, A.P., Nietfeld, J.P. et al. Generalized Effects of Naturalistic Social Communication Intervention for Minimally Verbal Children with Autism. J Autism Dev Disord 51, 75–87 (2021). https://doi.org/10.1007/s10803-020-04521-4
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DOI: https://doi.org/10.1007/s10803-020-04521-4