Interventions for Communication in Autism Network
Condition: Autism
MeSH terms: Autistic Disorder
Study type: Interventional

Summary: 
      The goal of this project is to compare the efficacy of two interventions for improving spoken
      language and reducing symptoms of autism.
    

Detailed description: 
      While significant progress has been made toward identifying effective interventions for
      preschool-age children with autism (National Research Council, 2001), few scientifically
      rigorous studies have compared active ingredients of these interventions or examined outcomes
      focused on core deficits. To address these areas of need, this collaborative, multi-site
      project combines the expertise of investigators experienced in randomized controlled clinical
      trials (RCTs), in the study of core deficits in young children with autism, and in data
      management and analysis of multi-site clinical trials.

      The goal of this project is to compare the efficacy of two interventions for improving spoken
      language and reducing symptoms of autism: (1) Discrete trial training (DTT)--an applied
      behavior analysis approach emphasizing highly structured teaching of school readiness skills
      (match-to-sample, imitation, functional play, and receptive and expressive language) and (2)
      Interpersonal developmental approach (IDA): a visually supported, child-focused, flexible
      engagement, social communicative engagement approach on joint attention, symbolic play, and
      the use of conventional symbols within socially valid communicative contexts.

      Children will be randomly assigned to DTT or IDA. In each condition, children's ongoing early
      intervention programs will be augmented with two 30-minute sessions daily of the study
      intervention (DTT or IDA) conducted by supervised therapists for 4 months, with transition to
      home therapy for 2 months.

      Potential moderators (e.g., initial mental age and language age) and mediators (e.g. parent
      synchronization of joint attention and changes in parental expectancies) on treatment outcome
      will also be examined.

      The assessment measures will include diagnostic and developmental measures. There are three
      sets of assessments. The first set of assessments is to determine whether the child is
      eligible for the study. If the child is eligible, we will complete the next set of
      assessments, which are completed at three points: (1) prior to entry into the treatment (this
      is a baseline measurement conducted just before the start of the treatment phase); (2) at
      exit; and (3) at a 6 month follow-up. Several assessments will also be completed after 2
      months, 4 months, and 6 months.
    

Intervention name(s): Discrete Trial Training; Interpersonal Developmental Approach
Intervention type(s): Behavioral; Behavioral
Intervention description(s): UCLA model, developed by Lovaas and colleagues (Smith, Groen & Wynn, 2000). Two 30-minute sessions daily (5 hours/week) of 1:1 intervention focusing on imitation, match-to-sample, receptive and expressive language. Using operant conditioning, the therapist works individually with a child in a distraction-free setting and administers approximately 10 trials in a sitting, with breaks between sittings.
During months 5 and 6, we will provide parents with training in an apprenticeship format one day per week for an hour per day. The clinician will demonstrate a DTT instructional program, then the parent will take a turn implementing it. The clinician and parent will give each other feedback on their implementation of the program.; Focus on teaching joint attention and symbolic play developmentally via floor play milieu teaching approach. Principles applied include following the child's lead and interest in activities, talking about what the child is doing, repeating back what the child says, expanding on what child says, giving corrective feedback, sitting close to the child and making eye-contact, and making environmental adjustments to engage the child (Kasari et al., 2006).
Parents will be incorporated into the treatment to encourage joint engagement with their child and to focus specifically on joint attention and play skills in their interactions. Each home session will last one hour (once a week) during month 5 and 6 and will involve therapist modeling, and coaching of parent in child-directed activities.
Other intervention name(s): DTT; IDA
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment