Comprehensive Communication Intervention for Minimally Verbal Children With Autism
Condition: Autism Spectrum Disorder
MeSH terms: Autistic Disorder; Autism Spectrum Disorder
Study type: Interventional

Summary: 
      Overview The goal of Comprehensive Communication Intervention for Minimally Verbal Children
      with Autism is to conduct an efficacy study of a promising intervention to increase spoken
      language in preschool children who are minimally verbal. The proposed study compares a
      comprehensive communication intervention (JASP- EMT Plus; JEP) to a business as usual (BAU)
      control group in a randomized controlled trial (RCT) across 4 time points. The study
      replicates and extends procedures used by Kasari, Kaiser et al (2014) to successfully promote
      social communication in older minimally verbal children. Intervention components include: (1)
      Joint Attention, Structured Play, Engagement and Regulation and Enhanced Milieu Teaching
      (JASP- EMT), (2) applied with systematic parent training, (3) use of speech generating device
      (SGD) and (4) supplementary direct teaching of foundational skills for language learning as
      indicated by child entry skills (CORE-DTT; Smith, 2009). Children who remain minimally verbal
      beyond age 5 are at high risk for persistent, severe communication deficits that impact
      social development, educational achievement and quality of life (Tager-Flusberg & Kasari,
      2013). Thus, there is an urgent need for effective strategies to promote communication
      development during the preschool years to ameliorate early communication deficits and prevent
      persistent minimally verbal status. This study aims to change social communication in
      minimally verbal preschool children with ASD by applying a naturalistic social communication
      intervention which teaches the social foundations of communication and functional use of
      verbal language in play and interaction. In addition, the intervention addresses three
      factors that may contribute to remaining minimally verbal: lack of an effective mode of
      speech production, lack of foundational skills for learning language (receptive language,
      imitation, joint attention), and lack of communication partners to support continued language
      learning in natural environments.
    

Detailed description: 
      The proposed project is a randomized control design study testing the effectiveness of a
      comprehensive communication intervention to improve spoken language and social communication,
      and to reduce the portion of children with autism who are minimally verbal at age 5. The
      intervention (JASP-EMT-Plus; JEP) includes four components which have been shown to be
      effective in improving outcomes for older children with ASD who are minimally verbal. These
      components are (a) direct teaching for foundational language skills, (b) systematic
      introduction of an SGD paired with spoken language; (c) A naturalistic communication
      intervention: Joint Attention, Structured Play, Engagement and Regulation and Enhanced Milieu
      Teaching (JASP-EMT); and (d) parent training to support and generalize newly learned
      communication skills.

      Following comprehensive assessment linking children's extant communication skills to the
      skills taught in each intervention component, an adapted treatment protocol will be developed
      for each child within the framework of the comprehensive treatment model. A total of 97
      children ages 36 to 54 months will be randomly assigned to the treatment or a BAU control
      group. Progress in treatment will be monitored throughout the 3-month (42 session)
      intervention. Children will be assessed at 4 time points: pre intervention, post-
      intervention, 2 months, and 4 months after intervention. The data collected in this
      randomized trial will provide: (1) evidence of effectiveness for a comprehensive
      communicative intervention for improving communication in minimally verbal children with
      autism; and (2) new information about the correlates of minimal verbal status in children
      with autism.

      Aim. To examine the effects of JEP on social communication (primary outcome) RQ1: Do young
      children with ASD who receive JEP produce significantly more social communicative utterances
      (proximal) in language samples, social communication on standardized assessment (distal), and
      expressive language on standardized assessment (distal) than children in the BAU group at T2
      (immediately following intervention)?
    

Intervention name(s): Intervention JEP
Intervention type(s): Behavioral
Intervention description(s): A blend of JASP-EMT using SGDs with parent training intervention with the addition of individualized DTT to teach receptive language, imitation, and joint attention when children lack these skills at entry.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment