Joint Attention Intervention for Young Children with Autism and Their Parents: A Case-Control Study

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. No 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 for children with autism and their parents. The current report was to describe initial findings for case-control study.

Methods: Participants were 15 children with autism (CA = 28-56 months, MA = 14-50 months) in intervention group and 15 CA, MA, gender and SES matched children with autism in control group. All of the children were 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, and the other for their parents. The child JA intervention program was referred from Kasari’s suggestion (Kasari, et al., 2006, 2010). 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 both of Kasari’s lab and authors’ clinical experience and followed the Parent JA Intervention Manual (PJAIM). The first half of the parent training was from session 1 to 8, 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 9 to 24, the parent was invited to interact with his/er child guided by interventionist for 15 minutes after child’s training session. The interventionist assisted the parent to practice the strategies to improve the child’s JA skills and joint engagement. The pre- and post- tests were: ESCS (Mundy, et al., 2003), and free play of parent-child interaction.

Results: The initial results showed significant difference in joint engagement but not in joint attention skills between intervention group and control group, with intervention group yielding more supported joint engagement in parent child interaction.

Conclusions: The initial findings revealed that the JA intervention program for young children with autism and their parents seems positive. The parents changed their teaching strategies from adult-directed approach to child-directed approach in the sessions and maintained the child-directed teaching strategies. Further studies are needed to analyze the joint attention skills in other conditions and its collateral abilities and follow the long term effects.