Distinct Language Improvements of Minimally Verbal Children with ASD inside and Outside Episodes of Engagement As Response to Treatment

Background: Communication impairment is a defining feature of Autism Spectrum Disorder (ASD). Despite increased attention to early intervention, nearly 30% of children with ASD remain nonverbal at school-age (Tager-Flusberg & Kasari, 2013). In addition to language deficits, children with ASD exhibit a core deficit in joint engagement, or the ability for a child to share attention with others around an object. Research has demonstrated that joint-engagement based interventions are associated with significantly better language outcomes and joint engagement in children with ASD (Kasari, Paparella, Freeman, & Jahromi, 2008; Kasari, Gulsrud, Wong, Kwon, & Locke, 2010). Thus, the associations between joint engagement and language outcomes for children with ASD make this an important topic to investigate further.

Objectives: 1) Does language used during episodes of joint engagement change over the course of intervention for minimally verbal children with ASD? 2) Are there observable changes in language abilities over time of minimally verbal children when they are not jointly engaged with an interventionist?

Methods: Participants included 18 minimally verbal school-aged (4.5 to 8 years old, M=6.56, SD=1.16) children diagnosed with ASD. Children received 6 months of an evidence-based intervention that combined elements of Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) and Enhanced Milieu Teaching (EMT). Entry and exit intervention sessions were videotaped and ten-minute clips of the therapist-child interactions during sessions were later coded for child language abilities inside and outside episodes of joint engagement. These recorded interactions were first transcribed using SALT conventions. Joint engagement episodes were coded during a second viewing of the sessions; episodes of engagement were defined as the time the child and therapist coordinated their play around an object or activity. These two coding systems were combined to create two separate transcripts: one for language while inside episodes of joint engagement and one for language used outside. These transcripts were then analyzed using SALT Software. Language abilities involving frequency were divided by the appropriate amount of time to yield per-minute rates.

Results: Paired samples t-tests were conducted to examine changes in children’s language abilities while jointly engaged in play. Results reveal that children use significantly more different words (p<.01), social communicative utterances (p<.01), longer utterances (MLU; p<.1) at trend level, spontaneous comments (p<.05), and spontaneous requests (p<.05) at exit as compared to entry as a result of receiving JASPER+EMT. In examining language used when children are not engaged in play, children also use significantly more different words (p<.05), social communicative utterances (p<.01), and spontaneous requests (p<.05) at exit as compared to entry as a result of receiving JASPER+EMT.

Conclusions: Children increased their spoken language production in sessions with an interventionist during JASPER+EMT over six months. However, only during joint engagement did children significantly increase their commenting language with a trend towards greater MLU inside as well. This topic should be further investigated with a larger sample.