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Can Joint Attention Skills be Measured Reliably? Dutch Effect Study of Jasper-Training
Infants with autism spectrum disorders (ASD) have problems with social interaction, communication and play (Zwaigenbaum et al., 2013). Early intervention can lead to better long-term outcomes (Dawson et al., 2010). Early stimulation of joint attention (JA) skills, in particular, is associated with better language, communication and social outcomes (Warreyn et al., 2014; White et al., 2011).
The JASPER training (Kasari et al., 2006) focuses on Joint Attention Symbolic Play Engagement and Regulation in young children. During play sessions, parents learn how they can encourage JA and play skills in their child. They learn how to recognize, model, connect and expand these skills. If applicable, parents also learn how they can support their child in regulating its emotions.
Objectives:
Is the Dutch version of the JASPER training effective in infants with ASD?
Can we develop an observation standard to reliably assess JA amelioration?
Methods:
Infants with ASD, developmental delays and limited spoken language (2-4 years old, ADOS-2, BSID-II) participated in the JASPER training. There were 15 weekly sessions: 10 play sessions (30-45 minutes, with child & parent(s)) and 5 evaluation sessions (60 minutes, with parent(s) only). All JASPER play sessions were videotaped and later used during the evaluation sessions with parents.
There were two control groups: a clinical non-JASPER group (infants with ASD who did not receive the JASPER training) and a typically developing group (TD).
Pre- and post-treatment, parents filled in the ESCBQ (Early Social Communicative Behavior Questionnaire) and the PICS (Pictorial Infant Communication Scale), as measurements for JA and other early social communicative behaviors.
Results:
The data collection is ongoing (N = 20 have been collected).
Preliminary results of a small group of infants with ASD (n = 4) show that specific skills improved significantly at post-treatment, in comparison with the clinical non-JASPER group, as measured by 4 ESCBQ subscales (Mann Whitney: z(-2.081), z(-1.875), (z(-1.979), z(-1.732); p <.05; eye contact, emotion, gaze following and showing respectively) and all 3 PICS subscales (Mann Whitney: z(-1.955), z(-1.949), z(-2.453); p <.05; initiating JA, initiating behavior request, and responding to JA respectively). Though, their skills are still at a significant lower level than that of TD children (ESCBQ total score; z (-1.874), p <0.05; no data available concerning BICS).
In order to really capture the amelioration of early social communicative behaviors through parent child interactions, a qualitative coding system needed to be developed. Originally, 46 categories were formulated in MediaCoder, based on literature study and clinical experience. The statistical analyzes proved multiple categories to be unreliable, difficult to operationalize and/or poor on inter- and intra-variability. Therefore, the subsequent qualitative coding system consists of 15 child and 5 parent categories. Currently, all JASPER videotapes of another small group of infants with ASD (n=4) are being coded with this new coding system.
Conclusions:
The first results concerning the JASPER intervention study are promising and in line with former findings (Kasari et al., 2006, 2008, 2010, 2012, 2014; Stickles-Goods et al., 2013). A qualitative coding system is being developed. Further research is warranted.