Enhancing Positive Emotion Sharing in Toddlers at High Risk for ASD

Background: With the increased activity of longitudinal studies examining earliest signs of ASD in high-risk infants/toddlers, the age of detection continues to decrease, begging the question of what role earliest intervention might play (and what form it should take) in enhancing the development of these toddlers. We have been examining this question through a parent-mediated intervention program using adapted principles of evidence-based Pivotal Response Treatment (PRT; Koegel & Koegel, 2006), together with effective parent training techniques used with other high-risk infants (e.g., Landry et al., 2001). The targets of our intervention focus on two core domains of development: positive emotion sharing and early social communication. Following the original claim of Kanner (1943), who viewed autism as a disorder of “affective contact”, the literature is increasingly recognizing the fundamental role of emotion in the psychopathology of autism. Positive facial affect is thought to motivate earliest developing communicative skills, notably eye-to-eye gaze and reciprocal social smiling (Berger, 2006; Farroni et al., 2002; Messinger et al., 2001), both of which are fundamental to connecting with others emotionally (Hobson, 2004; Mundy & Acra, 2006). The putative significance of shared positive emotion to subsequent social development, also reflected in our preliminary infant sibling findings (Bryson et al., 2007), argues for interventions that target these core domains as well as later developing communicative skills. 

Objectives: To provide preliminary data on the expression of positive emotion in the child, the parent, as well as ‘shared’ positive emotion, in our first 9 cases, comparing pre- versus post-intervention rates.   Methods: Participants include 9 families of toddlers (aged 14-24 months) with suspected ASD, as indexed by high total scores on the Autism Observation Scale for Infants (Bryson et al., 2008). Parents received our 12-week Social ABC’s parent training program consisting of 14, 1.5-hour home visits with manualized instruction and in-vivo coaching and support. Using a pre-established coding scheme, incidents of child-, parent-, and shared positive affect (i.e., mutual smiling) were coded and averaged across three 10-minute video segments at each of two time points: baseline and post-training.

Results: Our preliminary (pilot) data on positive emotion sharing revealed limited changes from baseline to post-intervention, in contrast to strong gains in expressive language on standardized measures (gains of up to 22 T-score points on the Mullen) and analyses of video recordings (gains in responsivity of up to 24%). We attributed this to two possible factors: (1) low rates of positive affect in both the children and parents, and (2) the fact that our focus to that point had been on child expressive language communication skills. Pilot data underscored the need to revise our training module on positive emotion sharing and refine coaching goals and strategies to increase the emphasis on positive emotion, with a focus on both partners. This poster will provide data on the first 9 cases followed since our increased focus on positive emotion sharing. 

Conclusions: Discussion will centre on the importance of enhancing positive emotion in both partners in an effort to increase positive emotion sharing in high-risk-toddler-parent dyads.