A Community-Partnered Intervention in South Los Angeles for Young Children at-Risk for ASD

Background: As more effective interventions are developed for children with Autism Spectrum Disorders (ASD), there is an increasing demand for early detection and dissemination of empirically supported treatments, especially in under-resourced communities where African American and Latino families face disproportionate access barriers. There is a critical need to identify these children at younger ages and partner with community providers to promote positive outcomes.

Objectives: The goal of this study was to use Community Partnered Participatory Research (CPPR) practices to collaborate with childcare centers to increase access to ASD-related services in South Los Angeles by 1) identifying children at-risk for ASD, and 2) adapting and implementing an intervention teaching social communication and play.

Methods: Children between the ages of 16-60 months of age were recruited from the Children’s Collective, Inc (TCCI), a childcare consortium serving children and families living in South Los Angeles.

Screening. Two parent questionnaires, the Parent’s Evaluation of Developmental Status (PEDS) and the Modified Checklist for Autism in Toddlers were used to assess for early indicators of ASD. Children who screened positive were invited to participate in the classroom intervention.

Intervention. The experimental intervention is based on JASPER, an evidence based model for teaching social communication and play to young children with ASD. Childcare sites were randomized to either an immediate 4-week treatment or a waitlist. Intervention was comprised of teacher-mediated 30-minute sessions three days per week in the classroom. Children were assessed at the beginning and end of treatment.

Teacher-child play interactions were coded in one-minute intervals for engagement states, play level, affect, and teacher directiveness. In addition, the frequency of child joint attention gestures and language were continuously coded. This coding system has been reliably used in other classroom-based studies of preschoolers with ASD (Chang et al., 2016).

Results:  124 children across four child care centers participated in developmental screening. Of those 124, twenty children screened positive on either the PEDS or the MCHAT and were invited to participate in the intervention phase of the study. A mixed model analysis showed a significant treatment by time interaction such that children in the immediate treatment group showed greater improvement in play level across the intervention period compared to the waitlist control children (F(1,31)=40.97, p<0.001). There was also a trend showing that children in the treatment showed greater improvement in joint attention language compared to the waitlist ( F(1,15)=3.49, p=0.08). Teachers in the treatment also showed less directive and more responsive interaction styles across the treatment period compared to the control (F(1,18)=6.93, p<0.05).

Conclusions: This study showed the effectiveness of JASPER when adapted and implemented in community with childcare providers and children who screened at elevated risk for ASD. Both universal screening and intervention were successfully employed using community-partnered practices, including shared decision making, and co-development of the intervention for the community setting. By partnering with the community in which the child resides to develop appropriate intervention models, one may begin to breakdown barriers to accessing early intervention.