Comprehensive Communication Intervention for Minimally Verbal Children With Autism
| Status: | Completed |
|---|---|
| Conditions: | Neurology, Psychiatric, Psychiatric, Autism |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 7/14/2018 |
| Start Date: | September 2014 |
| End Date: | March 2018 |
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.
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)?
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)?
Inclusion Criteria:
- A diagnosis of ASD as confirmed by the ADOS
- Mental age (MA) of 18 months as measured on the Mullen Scales of Early Learning
- Expressive vocabulary of less than 10
- Age between 36 and 54 month
- English as the primary language spoken at home
- Parents who are willing to participate in parent training.
Exclusion Criteria:
- Exclusion criteria include any major medical conditions other than ASD, specifically a
genetic disorders such as Down syndrome
- Sensory disabilities such as blindness or deafness
- Motor disabilities such as cerebral palsy.
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