Treatment Effects of the Joint Attention, Symbolic Play, Engagement and Regulation (JASPER) Intervention for Toddlers with ASD

Background: Behavioral interventions have well-established efficacy for children with autism spectrum disorders (ASD). Targeted approaches that focus on early core deficits in joint attention and play have led to lasting expressive language gains in preschoolers (Kasari et al., 2008, 2012). Far less is known about the efficacy of this targeted intervention for the youngest children with ASD and whether other-than highly trained interventionist can be effective in deploying the intervention.    

Objectives: This study was developed to test a parent-mediated adaptation of the JASPER intervention for toddlers with ASD. JASPER is already an empirically supported treatment for preschoolers with autism (Kasari et al., 2006, 2008, 2012). 

Methods: Participants were randomized to either a parent-mediated JASPER condition or an individualized psychoeducational intervention (PEI) targeting parental stress-reduction (Brereton and Tongue, 2006).  Families met one-on-one weekly with a trained therapist for 10 weeks. 86 parent- child dyads were enrolled in the study. Children had an average chronological age of 31.5 months and mothers were on average 35.9 years old. The sample of toddlers consisted of mostly Caucasian males with an average IQ of 68.

Results: The main effect of interest was the interaction between time and treatment, testing if there are differences in the degree of change over time that is associated with the treatment condition. We chose either a poisson GLMM or a linear GLMM depending on which model fit the data better based on the BIC. Joint Engagement: The distribution of this variable was sufficiently close to normal to allow the use of a standard GLMM (AIC of the linear glmm=1964, AIC of the poisson glmm=4599). There was a significant group x time interaction (F(1,84)=43.52, p<.01), showing that there was a significant increase in the length of time spent in joint engagement for the JASPER treatment compared to the PEI condition. Number of Functional Play Types: Function play did not show zero inflation (F(1,84)=0.25, p=.61), but due to its skew it was modeled using a Poisson GLMM (AIC=694) over a Linear GLMM (AIC=789). There was a significant group by treatment interaction showing that the JASPER group increased more in their number of different types of functional play acts than the PEI group (F(1,84)=6.56, p=.01). Highest Play Level Achieved: This variable did not show significant zero inflation (F(1,84)=0.39,p=.53), but the skew of the data meant it was modeled more accurately using a Poisson distribution (AIC=833) than a normal distribution (AIC=839). Using the Poisson model, there was a significant treatment by time interaction for the highest play level achieved (F(1,84)=9.13, p<.01), such that the JASPER group increased more than the PEI group.

Conclusions: This study highlights the efficacy of employing a parent-mediated approach to JASPER for toddlers with ASD.  Increases in child outcomes were noted for the JASPER condition in the areas of joint engagement, diversity of functional play and the highest play level achieved compared to a psychoeducation intervention focused on parental stress reduction.