Generalization of Joint Engagement to the Classroom for Toddlers with ASD Following a Parent-Mediated Intervention

Background: Children with autism exhibit significant impairment in their ability to engage with their play partner and with toys, including sharing attention between the two (joint engagement). Studies have found children with autism to be primarily unengaged during playtime or solely focused on objects. Several early intervention studies have successfully targeted and reliably measured changes in engagement states, finding significant improvements in engagement type and duration. Previous research has shown that dyads receiving a parent-mediated (JASPER) intervention significantly increased the number of child-initiated play routines and increased the duration of play spent jointly engaged following treatment. However, the extent to which children can generalize these improvements to other play partners and new environments is unknown.

 Objectives: The goal of this study was to determine if children’s improvements in engagement during play following a brief parent-focused early intervention program were generalized cross-contexts. . This is the first early intervention study to observe the child with an adult unfamiliar with the intervention (JASPER) and in a separate environment (the classroom), which allows an exploration of the degree to which true generalization of engagement changes occurred.

 Methods: Eighty-six parent-child dyads were recruited from an intensive early intervention program that provides 30 hours per week of treatment in a classroom setting. Children were between 18 and 33 months old (M=31.5) with an autism diagnosis and mean IQ of 68. Parent-child dyads were randomized to receive either a parent-mediated intervention (JASPER) or a parent-education condition (focused on reducing stress and informing parents on development, behavior, etc.) (Brereton & Tongue, 2006) in addition to their 30 hour per week classroom treatment. All participants met one-on-one with a trained interventionist weekly for 10 weeks. Live classroom observations were collected pre and post treatment while the child played with their teacher who was not trained in the intervention techniques and blind to child condition.

 Results: Results indicate that children randomized to the parent-mediated (JASPER) intervention showed a significant interaction effect of time and treatment for joint engagement (F (1, 79)= 5.46, p=0.02). There was also significant effect of time on decreasing disengagement (F (1,79)= 14.78; p= 0.0002), yet there was no significant interaction effect (F (1,79)= 1; p= 0.3195).

 Conclusions: This study is the first to directly observe child behaviors both within a novel environment and with a novel (untrained) play partner as generalization from a parent-mediated intervention. Other studies have gathered reports from teachers on child engagement with less robust effects of intervention (e.g, Green et al, 2010).  In addition, participants were recruited from the same comprehensive and intensive early intervention program, which provides a unique ability to observe children in their classroom and allows valid examination of child behaviors as related to their treatment assignment. These data suggest that while a parent-mediated intervention can directly improve child outcomes (Kasari et al., 2006, 2008, 2010, 2012) it may also produce effects robust enough to transcend the context in which they were taught and generalize to other play interactions, thus changing social interactions with new play partners.