Autism Spectrum Disorder Clinical Trial
Official title:
Comprehensive Communication Intervention for Minimally Verbal Children With Autism
Overview The goal of Comprehensive Communication Intervention for Minimally Verbal Children with Autism is to conduct an efficacy study of a promising intervention to increase spoken language in preschool children who are minimally verbal. The proposed study compares a comprehensive communication intervention (JASP- EMT Plus; JEP) to a business as usual (BAU) control group in a randomized controlled trial (RCT) across 4 time points. The study replicates and extends procedures used by Kasari, Kaiser et al (2014) to successfully promote social communication in older minimally verbal children. Intervention components include: (1) Joint Attention, Structured Play, Engagement and Regulation and Enhanced Milieu Teaching (JASP- EMT), (2) applied with systematic parent training, (3) use of speech generating device (SGD) and (4) supplementary direct teaching of foundational skills for language learning as indicated by child entry skills (CORE-DTT; Smith, 2009). Children who remain minimally verbal beyond age 5 are at high risk for persistent, severe communication deficits that impact social development, educational achievement and quality of life (Tager-Flusberg & Kasari, 2013). Thus, there is an urgent need for effective strategies to promote communication development during the preschool years to ameliorate early communication deficits and prevent persistent minimally verbal status. This study aims to change social communication in minimally verbal preschool children with ASD by applying a naturalistic social communication intervention which teaches the social foundations of communication and functional use of verbal language in play and interaction. In addition, the intervention addresses three factors that may contribute to remaining minimally verbal: lack of an effective mode of speech production, lack of foundational skills for learning language (receptive language, imitation, joint attention), and lack of communication partners to support continued language learning in natural environments.
The proposed project is a randomized control design study testing the effectiveness of a
comprehensive communication intervention to improve spoken language and social communication,
and to reduce the portion of children with autism who are minimally verbal at age 5. The
intervention (JASP-EMT-Plus; JEP) includes four components which have been shown to be
effective in improving outcomes for older children with ASD who are minimally verbal. These
components are (a) direct teaching for foundational language skills, (b) systematic
introduction of an SGD paired with spoken language; (c) A naturalistic communication
intervention: Joint Attention, Structured Play, Engagement and Regulation and Enhanced Milieu
Teaching (JASP-EMT); and (d) parent training to support and generalize newly learned
communication skills.
Following comprehensive assessment linking children's extant communication skills to the
skills taught in each intervention component, an adapted treatment protocol will be developed
for each child within the framework of the comprehensive treatment model. A total of 97
children ages 36 to 54 months will be randomly assigned to the treatment or a BAU control
group. Progress in treatment will be monitored throughout the 3-month (42 session)
intervention. Children will be assessed at 4 time points: pre intervention, post-
intervention, 2 months, and 4 months after intervention. The data collected in this
randomized trial will provide: (1) evidence of effectiveness for a comprehensive
communicative intervention for improving communication in minimally verbal children with
autism; and (2) new information about the correlates of minimal verbal status in children
with autism.
Aim. To examine the effects of JEP on social communication (primary outcome) RQ1: Do young
children with ASD who receive JEP produce significantly more social communicative utterances
(proximal) in language samples, social communication on standardized assessment (distal), and
expressive language on standardized assessment (distal) than children in the BAU group at T2
(immediately following intervention)?
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