Evaluation of a Novel Curriculum Targeting Early Social Communication Skills in Minimally Verbal, Preschool Aged Children with Autism Spectrum Disorder (ASD): A Pilot Study

Background: Some of the most enduring impairments in children with autism spectrum disorder (ASD) fall within the domain of social communication. Distinguishing characteristics of delays include difficulties with social orienting and joint attention (Dawson et al., 2004). Preverbal social communication skills have been linked to improved developmental trajectories including spoken language and adaptive functioning that may be maintained throughout adolescence (Kasari et al., 2008; McGovern & Sigman, 2005). However, only a small amount of research has been devoted to the treatment of preverbal social communication skills in minimally verbal children with ASD. With such potentially promising outcomes, there is a clear need for empirically-based early interventions targeting this core deficit domain. As a good portion of time for young preschool-aged children takes place in a classroom environment, these interventions need also be easily implemented and generalized by classroom personnel.

Objectives: To carry out a pilot study evaluating the efficacy of The Preverbal Communication and Social Expressive Skills (PCSES) curriculum, a newly manualized intervention targeting behavior regulation, joint attention, and interaction skills in minimally verbal preschool children with ASD.  Each target skill required 5 consecutive days of lessons that included behavioral modeling, rehearsal and feedback.  

Methods: Three children with ASD ages 4-5 years were recruited from an early intervention preschool program to participate in the PCSES curriculum and subsequent evaluation.  Each day, PCSES was carried out using two non-consecutive didactic sessions. These small group sessions were composed of naturalistic lessons based on the principles of ABA and Milieu based treatment. Pilot data were collected on all three participants.  Pre-treatment assessments included the Early Social Communication Scales (ESCS) and a semi-structured play assessment (SSPA).  The SSPA was designed to provide opportunities for the children to exhibit each targeted PCSES skill (attending to adults face, smiling responsively, regarding self in mirror, orienting to adults, following points, reaching and giving to request).  All children were then given the SSPA following the five days of treatment to monitor the acquisition and maintenance of the skill.  The ESCS was then re-administered post-maintenance.  

Results: A non-concurrent multi-baseline design was used to analyze pre- and post-treatment SSPA data.  Pre-treatment skills varied per child but overall, all children performed better following the implementation of the PCSES curriculum, with the frequency of target skills trending in a therapeutic direction (see Figure 1). These conclusions were further supported by an analysis of effect size using percentage of data exceeding the median (PEM) (Lenz, 2013).  For two children, intervention was shown to be moderately to very effective (effect sizes .66-1) on 5/5 needed skills. For the other child, intervention was very effective (.83-.92) for 4/5 skills, with one showing debatable effectiveness (.5).  Preliminary analysis of the ESCS demonstrates a positive change in early social gestures.  

Conclusions: The current findings show that the PCSES curriculum may result in positive trends of growth in certain behavior regulation and joint attention skill that have been shown to impact developmental trajectory. A RCT with additional standardized measures is needed to explore these results further.

See more of: Interventions Non-Pharmacologic - Preschool
See more of: Interventions - Non-pharmacologic - Preschool