Caregiver Mediated Joint Engagement Intervention for Young Children with Autism: A Case Study

Background: Children with autism spectrum disorders display marked deficits in joint attention skills (JA) and poor joint engagement (JE) (Adamson, et al., 2009). Kasari and her colleague developed the caregiver mediated JE (CMJE) intervention program (Kasari, et al., 2010) and suggested that JA intervention could facilitate or maximize JE.

Objectives: The purpose of the study was to develop a CMJE intervention program for children with autism in Taiwan. This report described the initial results of working with 2 low-to-middle functioning children with autism.

Methods: Case A was a 38-month-old boy, whose mental age (MA), verbal mental age (VMA), and nonverbal mental age (NVMA) were 30 months, 29 months, and 31 months, respectively. Case B was a 44-month-old boy, whose MA, VMA, and NVMA were 27 months, 25 months, and 26 months, respectively. Mullen Scales of Early Learning (MSEL; Mullen, 1995) was used as the measure for developmental ability. Both boys were referred by hospitals in Taipei, were diagnosed with DSM-IV-TR and ADOS by two psychologists. Caregivers who attended the CMJE were both mothers. The program was developed according to Kasari's suggestion (Kasari, et al., 2010), consisted of 20 caregiver-mediated sessions with follow-up 3 months later. Each dyad completed ten modules in the 20 sessions, 60 minutes per session, and two sessions per week for 10 weeks. The CMJE intervention program was based on both of Kasari’s lab and authors’ clinical experience and followed the Caregiver Mediated Model (CMM) Treatment Manual. Each intervention session included interventionist coaching of caregiver and child engaging in play routines. Caregivers also had to practice in home after each session, bring their videotapes in next session and discuss with their interventionists. The primary measures were free play of parent-child interaction (Kasari, et al., 2010) for JE states and the Early Social Communication Scales (Mundy, et al., 2003) for JA skills. The other measures were the Screening Tool for Autism in Toddlers (Stone, et al., 2004) and ADOS for autistic symptoms, MSEL for developmental ability, and Reynell Developmental Language Scales for language development.

Results: The results showed that there was greater improvement for case A on joint engagement outcomes, but slight improvement for case B. In JA skills, case A improved his ability from distal pointing for requesting to showing for JA in mild assistance. Case B developed his ability from reaching for requesting to showing for JA in hard assistance. The primary measures manifested some JA progress in case A but not in case B. There was improvement for case A on autistic symptoms, but worse for case B. There was no significant improvement on MA in both cases, but greater improvement on language in case A.

Conclusions: Our JE intervention for middle-to-low functioning children with autism seems promising. Further studies are needed to explore the variables might influence the efficacy of JE intervention. Experiment group design to explore the efficacy of the JE intervention in children with autism is also needed.