A Pilot Study on the Implementation of a Joint Attention, Parent Training Package, for Parents of Preschool Age Children with Autism

Background:

By  the end of the first year of life typically developing infants are not yet able to speak clear words, yet they have mastered the building blocks of social communication, they can coordinate attention between people and objects, and communicate with caregivers in intentional ways, using vocalizations and gestures that have shared meanings. They have developed joint attention. One of the earliest emerging deficits in children with autism is their lack of these joint attention skills. This has been shown not to improve over time without intervention. Several studies have successfully taught joint attention skills to young children with autism, using behavioural techniques, play based approaches, and combined approaches. Both children and their parents have been targeted in these studies, as teaching parents helps to generalize the skills into the child’s everyday life. More studies are now needed to translate the findings of this research into practice.

Objectives:

This purpose of this pilot study is to examine the efficacy of a joint attention training package using both behavioural and transactional approaches. Several parent teaching techniques are being used, psycho-educational, live modeling and coaching, and video coaching. Parents will be asked to evaluate the usefulness of these approaches.

Methods:

This pilot involved one child, diagnosed with autism, who was 4years and 3 months, and their family in a single subject design.  The continuous measure was a semi structured, play based, videoed observation which was coded for a range of joint attentional behaviors. 35 sessions were run, over a 3 month period,  both in a university laboratory, and in the home. Sessions involved both  adult led table based activities, and child led floor based activities. Pre and post assessment measures included the Autism Diagnostic Observation Schedule, (ADOS), module 2, the Early Social Communication Scales, (ESCS), Performance and General Language subtests from the Wechsler Preschool and Primary Scale of Intelligence III, (WPPSI III), The Adaptive Behavior Assessment System II, (ABAS II), the Clinical Evaluation of Language Fundamentals  Preschool -II (CELF P II),  and the Parenting Stress Index, (PSI). A parent satisfaction and feedback questionnaire was administered at the end of the intervention.

Results:

Coding of the continuous measure videos is currently underway, and post intervention assessment currently being undertaken. Preliminary results indicate significant changes in child joint attention behaviours and a high degree of parent satisfaction with the intervention. Data and analyses will be available for presentation at the conference.

Conclusions:

This pilot has provided good support for the main study to be conducted in 2009 with 6 families. The findings of the pilot study will inform the final design of the parent teaching package. The research design of the main study will also be single subject, but will use a multiple baseline across subjects replication. More detailed conclusions will also be available, for presentation at the conference, when  the data for this pilot is analysed.