Joint Attention-Based Occupational Therapy Intervention in Pre-Schoolers With Autism Spectrum Disorder
Condition: Autism Spectrum Disorder; Social Communication; Behavior Problem; Visual Perceptual Weakness
MeSH terms: Autistic Disorder; Autism Spectrum Disorder; Child Development Disorders, Pervasive; Problem Behavior
Study type: Interventional

Summary: 
      In order to support the development of preschool children, joint attention training with
      activities incorporated in their natural routines can support the achievement of occupational
      therapy goals. This study explores the adjunctive benefit of a joint attention-based
      occupational therapy program offered in addition to the usual special education program
      (USEP) compared to USEP alone.

      The present study was designed as a randomized controlled study, including pre-post testing.
      The Social Communication Questionnaire (SCQ), Autism Behaviour Checklist (ABC), and A
      Motor-Free Visual Perception Test 4 (MVPT-4) were implemented to measure the participants'
      conditions before and after the intervention.
    

Detailed description: 
      Twenty children, ten in each group, were included in the study. The study inclusion criteria
      were being between the ages of 4 and 6, diagnosed with ASD, and consenting to participate in
      the study. The study did not include children who had a co-morbid condition other than ASD
      and had no previous education or training. Between 1 April and 25 June 2020, a total of 28
      children were interviewed for this study, and 3 children were excluded because they did not
      meet the inclusion criteria. 13 children were randomly assigned to the study group and 12
      children to the control group. 3 individuals from the study group were excluded because of
      time, transportation or other reasons, and 2 children from the control group were excluded
      because they did not complete the assessments. As a result, a total of 20 children with ASD,
      10 of whom were working and 10 were control, formed the sample group of the study. Informed
      consent was obtained after the scope and purpose of the study were explained in detail to the
      participants and primary family caregivers.

      A social communication questionnaire (SCQ), autistic behavior checklist (ABC), and motor-free
      visual perception test-4 (MVPT-4) were administered to the children before and after the
      intervention, and the results were compared.

      The SCQ was developed to evaluate the social communication of individuals with autism. The
      total score can be between 0-and 39 for children who can speak. The SCQ which comprises three
      sub-dimensions: reciprocal social interaction, language and communication, and repetitive and
      stereotyped patterns has the validity and reliability in Turkish.

      The ABC is among the scales used for screening and evaluating education in autism in many
      countries. The ABC consists of five sub-dimensions: sensory, relating, body or object use,
      language, and social and self-help. The total score is between 0-159.

      MVPT-4 is an instrument that presents a fast, reliable, and valid evaluation of children and
      adults' general and visual perceptual abilities. MVPT-4 consists of 45 items that are
      organized and grouped to provide a smooth implementation process. The items consist of black
      and white drawings and patterns developed to present answer options, making the
      implementation easy in a multiple-choice form. Motor skills are not necessary to get a
      response, which makes this test useful, especially for people with motor disabilities.

      All children included in the study attend a usual special education program (USEP) 2 sessions
      per week in a rehabilitation center. The USEP studied was including gross motor skills,
      communication skills, preschool preparation skills, and self-care skills. The control group
      of the study consisted of children attending the USEP. Children in the study group received
      an occupational therapy intervention based on joint attention in addition to the USEP they
      continued. As an intervention in the study group, the sessions were conducted three days a
      week for a total of 12 weeks. The initial assessments were administered to children in both
      groups. At the end of the 12 weeks, the evaluations were repeated in both groups.

      The acquisition frame of reference, which proposes to shape the behaviors that contribute to
      skill acquisition, and the developmental frame of reference, which emphasizes the continuous
      change and emergence of skills with age, guided the occupational therapy intervention.
      Therefore, all activities were designed according to the chronological and developmental ages
      of the children. During the joint attention-based intervention sessions, holistic
      occupational therapy approaches for the child's sensory, physical, social, language and
      communication deficits were discussed.

      The steps followed are:

        1. Each parent was interviewed about the child's preferences. The toy types preferred by a
           child and the toys that a child might react negatively to were identified. The
           intervention specialist selected a total of 15 toys for paired stimulus preference
           assessments. Five of these toys were stuffed animals and figures. Five comprised
           multi-part activities, and the other five consisted of toys activated by light,
           movement, and/or sound. Each group of toys was used according to the child's interests
           and habits in three stages: creating a response to a joint attention offer, initiating
           joint attention, and reinforcing a joint attention response.

        2. During the joint attention-based occupational therapy intervention, researchers paid
           attention to maintaining eye contact and following the child's lead. Activities were
           conducted at the desk and on the floor. A game pattern was created using the selected
           toys; the pattern was planned and implemented as activities for an average of 20
           minutes.

        3. In the sessions, (a) fine motor activities such as handicrafts, finger games; (b) gross
           motor activities such as obstacle course, music, dance; (c) visual-motor activities such
           as drawing, cutting, and assembly were used. Initiating and responding to joint
           attention during these activities was the focus of the intervention. With the training,
           the aim was to generalize behavioral skills and transfer them to the context of social
           play.

        4. It is stated that compatible environmental arrangements that will provide visual cues
           are important when structuring environmental activities because children with autism
           respond to the use of visual input. For this reason, environmental arrangements were
           made with visual stimuli that could attract a child's attention.
    

Intervention name(s): Occupational Therapy
Intervention type(s): Behavioral
Intervention description(s): occupational therapy sessions are based on the joint attention
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This prospective studies that measure the effectiveness of occupational therapy intervention. Randomized controlled trials (RCT) are prospective studies that measure the effectiveness of a new intervention or treatment. Participants are recruited and randomly assigned to either the intervention or the comparator group. It is important to ensure that at the time of recruitment there is no knowledge of which group the participant will be allocated to; this is known as concealment. It is examined whether there is any difference in the results of the study intervention and also the intervention and control group are compared.
Masking: Single (Investigator)
Primary purpose: Treatment