Theorists of typical development have empirically documented a developmental trajectory of dyadic behaviours supporting the acquisition of joint attention and referential communication. In autism, early-onset difficulties in dyadic engagement, particularly the ability to process information from faces, may deprive children with an ASD of social learning opportunities critical to joint attention. Given that joint attention delays are typical of autism, it is vital to understand the nature of these difficulties and their amenability to change.
To determine whether behavioural changes occur in children’s gaze perception skills following the More than Words (MTW; Sussman, 1999) parent-training program using a novel, computerized task as an outcome measure of treatment effectiveness. MTW is a 12-week program that teaches parents how to use natural opportunities to socially engage their child in a manner that adheres to their child’s interest or activity by fostering the dyadic coordination of shared attention.
Fourteen children (mean CA= 34.07 months; SD = 6.16 months) newly diagnosed with either Autistic Disorder (n=12) or Pervasive Development Disorder not otherwise specified (n=2; diagnosis based on ADOS/ADI) were assigned to either a parent training (PT, n = 7) or waiting-list control (CT; n = 7) group based on a matched-pair, random assignment procedure. At the pre-intervention assessment there were no significant group differences in either developmental or social functioning. Groups were similar in terms of age, gender, ethnic distribution, languages spoken in the home, and the number of children attending daycare or receiving behaviour intervention services. Children’s perception of different gaze directions was measured using the Eye Gaze Preference Task (EGPT). During the EGPT, a central probe engages the child’s attention before each experimental slide. The display then changes to 1 of 4 conditions: eyes closed, direct gaze, or gaze averted to the left or right. Participants passively view 2 blocks of 16 randomly presented faces. Separate videos of the participant’s face and computer screen were recorded and viewed simultaneously to code children’s fixation patterns. Inter-rater reliability was established.
A pattern emerged across the course of treatment among children whose parents participated in MTW, which fell short of significance but was in the expected direction. Children whose parents received the training demonstrated greater mean increases according to specific gaze directions in their orienting responses (direct: M = 8.43, SD = 11.85; averted: M = 7.28, SD = 10.73) and percentage of total fixation time (direct: M = 9.04, SD = 15.6; averted: M = 7.73, SD = 8.88). There were no observed post-treatment gains among children in the control group across performance variables (orienting responses direct: M = .43, SD = 9.69, averted: M = -.43, SD = 9.91; percentage of total fixation time direct: M = -1.05, SD = 10.88, averted: M = 1.64, SD = 12.11).
Data reported lead to tentative suggestions that the MTW program may support developmental gains in children’s dyadic social responses. The exploratory data warrants replication among a larger sample of children with comparisons to alternative treatment approaches.