Developmental and Augmented Intervention for Facilitating Expressive Language
Condition: Joint Engagement + Enhanced Milieu Training; Joint Engagement + Enhanced Milieu Training+Augmentative Communication (AAC)
Study type: Interventional

Summary: 
      This study will contrast two experimental treatment conditions by testing whether joint
      attention/joint engagement intervention using spoken communication (JAE-EMT) results in
      better outcomes than joint attention/joint engagement intervention that is instead
      supplemented with an individualized AAC system (JAE-AAC). Thus, the skills of joint
      attention/joint engagement (JAE) remain foundational to developing expressive language but
      the difference in the two treatments will be between whether the JAE is administered through
      the more traditional spoken means (EMT) or through an augmentative and alternative
      communication device (AAC).
    

Detailed description: 
      Both treatments will be manualized and a novel research design method called Sequential
      Multiple Assignment Randomized Trial (SMART) will be applied. SMART design will allow the
      interventionists to adjust the course of treatment based on whether the children respond to
      the treatment. More specifically, there will be two stages of intervention and during Stage
      1, 90 nonverbal (e.g. those who have less than 5 spoken words) children with ASD between 5
      and 8 years of age will be randomly assigned to either the JAE-EMT or JAE-AAC group. After
      receiving the assigned Stage 1 treatment for 12 weeks, all participants will be assessed to
      see if they responded to the Stage 1 treatment. If the children do respond to Stage 1
      treatment, they will continue with that same treatment for another 12 weeks in Stage 2. A
      different treatment sequence will be used for those who do not respond to Stage 1 treatment
      where these non-responders will be re-assigned to 1 of 3 alternative intervention conditions.
      For example, those who do not respond to JAE-AAC will have the intensity of that same JAE-AAC
      treatment increased. Those who do not respond to the other, JAE-EMT treatment will be
      randomly assigned to either a more intense JAE-EMT condition, or the original JAE-AAC
      implemented in Stage 1. At the end of Stage 2, another follow-up assessment of cognitive,
      language, and social communication skills will be administered. Furthermore, several children
      who enter the study in the early stages will be tested again, 3 months after the Stage 2
      follow up (not all children will be able to be tested at 9 months within the 3 year grant
      period).
    

Intervention name(s): JAE Intervention
Intervention type(s): Behavioral
Intervention description(s): The overall goal in each session will be for the caregiver-child dyad to be in a state of supported or coordinated joint engagement. In this state the child is aware of the other's activity, and may actively coordinate their attention between an object/toy and the caregiver. The interventionist will coach the caregiver and child while they engage in play routines established through collaboration between caregiver and interventionist.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: joint engagement; augmentative communication (AAC); enhanced milieu training; autism spectrum disorder; language