A Play and Joint Attention Intervention for Teachers of Young Children with Autism

Background:

Extensive research has shown that both symbolic play and joint attention are delayed or deficient in young children with autism, and predictive of their later language and social development. Recent studies have shown that these skills can be taught by trained interventionists with a few studies emerging that demonstrate the success of caregiver-mediated interventions in facilitating some of these behaviors. However, little focus has been given to teachers of young children with autism in the preschool special education classroom.

Objectives:

The aims of this study were to develop and then pilot test a classroom-based intervention focused on facilitating play and joint attention for young children with autism. Specifically, we aimed to assess changes in the child’s engagement, play, and joint attention during and following the intervention.

Methods:

Thirty-three children diagnosed with autism (confirmed with the CARS), ages three to six years (mental ages ranging from 15 to 58 months), participated in the study with their classroom teachers (n=13). The thirteen preschool special education teachers were randomly assigned to one of three groups:

1) Symbolic play intervention (4 weeks) then joint attention intervention (4 weeks)

2) Joint attention intervention (4 weeks) then symbolic play intervention (4 weeks)

3) Wait period (4 weeks) then further randomized to either group 1 or 2 (8 weeks)

In the intervention, teachers participated in eight weekly individualized 1-hour sessions with a researcher that emphasized embedding strategies targeting symbolic play and joint attention into their everyday classroom routines and activities. The main child outcome variables of interest were collected through one-hour classroom observations over three-day periods. Using a PDA, children’s engagement levels were tracked and then calculated to determine percent time spent in a joint engagement state where the child and another individual (teacher or peer) were actively involved with the same object or event. Additionally, the frequency of play (functional and symbolic) and joint attention (responses and initiations) behaviors were also recorded.

Results:

Results show that before intervention, children with autism were spending about 21 percent of the classroom observation time in a joint engagement state. An ANCOVA (with CARS scores as a covariate) indicated that in the classrooms where the teacher first received either the symbolic play or joint attention training sessions, the children increased their joint engagement time to 44 percent of the observation time as compared to the children with teachers in the wait-list control group who remained at approximately 20 percent. Finally, analyses of the target behaviors throughout the intervention of all children showed an increase of symbolic play and joint attention initiations with children having CARS scores in the mild/moderate range (<37) displaying greater increases.

Conclusions:

Findings indicate that teachers can implement an intervention to improve joint engagement, symbolic play, and joint attention of young children with autism in their classrooms, especially with children who were classified more as having mild/moderate autism. These pilot data emphasize the need for further research and implementation of classroom-based interventions targeting play and joint attention skills for young children with autism.