In a new study, researchers showed that preschoolers with autism spectrum disorder gain more language and initiate more communication when teachers use a simplified version of a behavioral therapy that emphasizes shared attention and child-directed play.
The study is among the first to show that an early intervention for autism — proven effective for one-on-one behavioral therapy with an autism specialist — can be successfully adapted for real-world classroom use.
“These results are exciting since few studies have demonstrated such benefits when moving an intervention into the community,” said the study’s senior author, psychologist Dr. Connie Kasari, of the University of California, Los Angeles.
Results of the study, funded by the advocacy group Autism Speaks, appear in the Journal of Autism and Developmental Disabilities.
Kasari developed the autism intervention — dubbed JASPER for “Joint Attention, Symbolic Play, Engagement, and Regulation” — over the last 15 years. JASPER emphasizes joint attention, or shared focus, by engaging children in play routines rich in both verbal and nonverbal communication.
JASPER differs from many autism interventions in that the facilitator follows the child’s lead rather than directing his or her attention. The facilitator also encourages the child to initiate interactions rather than simply respond to questions and other prompts.
Earlier studies showed that JASPER significantly improves sociability and communication in children with autism when delivered one-on-one by highly trained behavioral therapists.
“This study moves JASPER from a one-on-one therapy model to classroom settings using small groups of children and focusing on engagement between children, adults, and peers,” Kasari said. “This highlights the promise of interventions such as JASPER that can easily be modified to fit the existing classroom structure.”
Most preschoolers with autism receive the majority of their intervention services in just such a group setting. In a typical special education preschool, a teacher and aide must divide their attention among at least eight to 12 students.
In preparation for their study, Kasari and her team worked with special education preschool teachers to simplify and adapt the JASPER method for use in classrooms.
They then enrolled 12 half-day preschool classes, each with eight children, a special education teacher, and a teaching assistant in their study. The classes were part of a diverse Los Angeles school district. Just over 20 percent of the participating children were Hispanic, 16 percent were Asian, and 13 percent were African-American.
In order to determine the intervention’s effectiveness, the researchers created a “control group” by putting six of the 12 classes on a wait list while the other six classes completed the eight-week intervention.
The researchers then provided each teacher and teaching assistant in the “intervention group” with two half-hour introductions to the JASPER method. The teachers and assistants used the JASPER techniques during a daily 15-minute play time with their students.
For the first four weeks, the researchers joined the play time to provide coaching. During the second four weeks, they reduced the coaching sessions to three or four times a week.
At the end of the eight weeks, the researchers used standardized checklists to evaluate how often children initiated social interactions and engaged in shared imaginative play. They also assessed language — in particular the length of each child’s verbal communications (one word, two words, three words, etc.)
Compared with the wait-listed students, the preschoolers who received the intervention showed significantly more shared attention with others and also initiated communication more often — using gestures, language or both. These children also used longer strings of words, on average, when communicating with their teachers.
The researchers emphasized that these improvements persisted when they returned to the classrooms three months after the eight-week intervention to reassess the students’ social communication skills.
“While individual treatment is extremely valuable, children with autism need to be supported in applying the skills they learn in everyday settings such as at school,” said Lucia Murillo, Autism Speaks’ assistant director of education research. “It’s important that evidence-based treatments be made practical for classroom use so teachers can more easily integrate them into a child’s school day.”