01-09-2010 | Original paper | Uitgave 9/2010 Open Access

Randomized Controlled Caregiver Mediated Joint Engagement Intervention for Toddlers with Autism
- Tijdschrift:
- Journal of Autism and Developmental Disorders > Uitgave 9/2010
Introduction
Why Develop Joint Attention in Autism?
Joint Attention Interventions for Children with Autism
Joint Attention Interventions for Toddlers with Autism
Factors Affecting Intervention Outcomes
The Current Study
Methods
Participants
M (SD)/frequency (%) | X2/F | ||
---|---|---|---|
IT (N = 19) | WL (N = 19) | ||
Gender | |||
Male | 15 (79%) | 14 (74%) | X2 (1) = 0.146, p = 0.70 |
Female | 4 (21%) | 5 (26%) | |
Ethnicity | |||
Caucasian | 10 (53%) | 12 (63%) | X2 (5) = 3.52, p = 0.62 |
Minority | 9 (47%) | 7 (37%) | |
Birth order | |||
Only child | 10 (53%) | 7 (36%) | X2 (3) = 2.63, p = 0.45 |
First born | 7 (36%) | 5 (26%) | |
Second born | 2 (11%) | 2 (11%) | |
Twin | 0 | 2 (11%) | |
Missing data | 0 | 3 (16%) | |
Child chronological age (months) | 30.35 (0.93) | 31.31 (0.90) | F(1,35) = 0.53, p = 0.47 |
Mullen scales of early learning | |||
Mental age (months) | 19.83 (1.80) | 18.57 (1.09) | F(1,35) = 0.36, p = 0.55 |
Developmental quotient | 64.80 (5.35) | 59.81 (3.14) | F(1,34) = 0.61, p = 0.44 |
M (SD)/frequency (%) | X2/F | ||
---|---|---|---|
IT (N = 19) | WL (N = 19) | ||
Caregiver’s age (years) | 34.82 (0.99) | 34.23 (1.11) | F(1,33) = 0.15, p = 0.71 |
Caregiver’s highest level of education | |||
Some college/vocational training | 3 (16%) | 2 (11%) | X2 (2) = 1.58, p = 0.45 |
College | 12 (63%) | 11 (58%) | |
Professional/graduate | 4 (21%) | 6 (31%) | |
Caregiver’s employment status | |||
Not employed | 14 (74%) | 12 (63%) | X2 (1) = 0.504, p = 0.48 |
Employed part or full-time | 5 (26%) | 7 (37%) |
Design Overview
Primary Outcome Measures
Engagement state | Definition |
---|---|
Unengaged/other engagement | Includes unengaged, onlooking and person only engaged. Child may be uninvolved with objects, or unengaged as when scanning the environment. Child may be onlooking by showing one-way awareness of another person in the room. Child may be person engaged by engaging in a song or game without the use of objects |
Object engagement | Child is actively involved in playing with objects alone, and oblivious to people. The child may be producing language or symbolic gestures, and symbols do not have a clear external referent |
Joint engagement | Child and partner are actively involved with the same object or event. The child may not overtly acknowledge the partner’s presence, but there is evidence of awareness of partner. Partner must be involved with same object and/or event (supported joint engagement). Or, the child and partner are actively involved with the same object or event, and the child is actively and repeatedly acknowledging the partner’s participation by coordinating his or her attention to both another person and an object or event0 they are sharing (coordinated joint engagement). Symbols or the production or understanding of language may be present in both supported and coordinated joint states |
Secondary Measures
Caregiver Quality of Involvement
Parent Adherence to Treatment and Competence
Service Utilization Measure
Joint Attention Intervention
Fidelity
Statistical Analyses
Results
Primary Analyses: Engagement States, Joint Attention and Play
M (SD) | Cohen’s d
| |||||
---|---|---|---|---|---|---|
IT pre (N = 19) | IT post (N = 19) | WL pre (N = 19) | WL post (N = 19) | IT F-UP (N = 19) | ||
Unengaged/other engagement | 20.80 (19.03) | 22.01 (18.24) | 19.52 (14.95) | 17.31 (10.17) | 15.87 (13.55) | NS |
Object engagement | 48.58 (21.87) | 34.75 (18.39) | 54.97 (17.43) | 54.69 (18.15) | 28.35 (15.87) | 1.09 |
Joint engagement | 30.26 (14.91) | 42.85 (19.96) | 24.98 (10.74) | 27.87 (14.01) | 52.27 (20.56) | 0.87 |
Frequency of joint attention initiations | 3.0 (2.77) | 3.11 (3.41) | 3.62 (5.92) | 3.77 (3.76) | 4.44 (5.61) | NS |
Frequency of joint attention responses | 0.42 (0.69) | 0.79 (0.23) | 0.63 (0.23) | 0.05 (0.23) | 0.61 (0.70) | 0.74 |
Type of functional play acts | 3.00 (2.38) | 5.29 (2.37) | 4.42 (3.17) | 3.29 (2.30) | 8.44 (4.77) | 0.88 |
Type of symbolic play acts | 0.11 (0.46) | 0.26 (0.65) | 0.42 (0.84) | 0.53 (1.43) | 1.11 (2.37) | NS |
Secondary Analyses: Factors Related to Outcome
IT | ||||
---|---|---|---|---|
Min | Max | Mean (SD) | ||
Caregiver quality of involvement | Experimenter rating of 4 items: confidence, enthusiasm, comfort, quality | 3.60 | 5.0 | 4.51 (0.41) |
Parental adherence to treatment | Parent report of 4 items: time, complexity, natural, effort | 2.72 | 5.0 | 3.97 (0.65) |
Parental competence | Parent report of 2 items: confidence and comfort | 3.27 | 5.0 | 4.35 (0.53) |
Service Utilization
WL | IT | p Value | |||||||
---|---|---|---|---|---|---|---|---|---|
N
| Min | Max | Mean (SD) |
N
| Min | Max | Mean (SD) | ||
ABA hours per week | 6 | 2 | 20 | 11.5 (7.45) | 6 | 2 | 30 | 14.17 (11.04) | 0.63 |
School hours per week | 13 | 15 | 30 | 21.15 (4.16) | 19 | 4 | 30 | 19.37 (7.59) | 0.45 |
Speech hours per week | 11 | 1 | 7 | 2.18 (1.66) | 12 | 1.5 | 4 | 2.37 (0.71) | 0.71 |
OT hours per week | 6 | 1 | 4 | 2.0 (1.10) | 10 | 1 | 6 | 2.20 (1.40) | 0.77 |
Misc hours per week | 4 | 1 | 12 | 6.5 (5.32) | 8 | 0.5 | 14 | 4.94 (4.81) | 0.62 |