Joint Attention Intervention Combined the Training of Children with Autism and Their Parents: The Preliminary Findings

Background: Joint attention (JA) deficit is one of core symptoms in children with autism. Recent literature demonstrated that the JA intervention could improve their JA, play and language abilities. Few studies explore the efficacy of JA intervention systematically and never include parent training in the program in Taiwan.

Objectives: The purpose of the study was to develop JA intervention program combined child and parent training for children with autism in Taiwan. The current report was to describe initial findings for six children with autism in JA intervention group and 3 children in the controlled group.

Methods: Participants were 9 children with autism (CA = 28-52 months, MA = 17-30 months), diagnosed with DSM-IV-TR and ADOS by a research team including psychiatrists and psychologists. The JA intervention program consisted of two parts, one for children, the other for their parents. The child JA intervention program was referred from Kasari’s suggestion (Kasari, et al., 2006). For the child training, each session was 30 minutes, 3 times per week, and the total was 24 sessions. The discrete trial training and milieu teaching approaches were used on the table time and floor time separately. The JA intervention program for the parents was based on the authors’ clinical experience and followed the Parent JA Intervention Manual (PJAIM). The first half of the parent training was from session 1 to 12, the interventionist used the PJAIM as a reference to teach the parent what is going on from one way mirror while they are observing his/er child’s training session in the play room. From session 13 to 24, the parent was invited to interact with his/er child guided by interventionist for 20 minutes after child’s training session. The interventionist assisted the parent to practice the strategies to improve the child’s JA skills. The pre-, post-, and 4-month follow-up tests were: ESCS (Mundy, et al., 2003), the structured play (Kasari, et al., 2006), and Reynell Developmental Language Scales (Reynell & Gruber, 1991) and MacArthur-Bates Communicative Development Inventory-Chinese version (Tsao, et al., in press)

Results: The results show that all of the six children improve their JA, play and language abilities after the JA intervention program. For JA, children improve from pointing for requesting an object to showing/giving an object to a person for sharing, and their play skills also improve from child as an agent to multi-schemes for symbolic play in the post-intervention test. The improvements are also shown in the 4 months follow-up test. The parents also changed their teaching strategies from adult-directed approach to child-directed approach in the sessions and maintained the child-directed teaching strategies after 4 month. However, the three children with autism in the control groups seems to develop slow on the three social communicative abilities at post and 4 months follow-up tests.

Conclusions: The initial data revealed that the JA intervention program combining the training of children and their parents is promising. Further studies are needed to recruit more subjects into the two groups to learn the long term effect.