Outcome of Early Start Denver Model “Play Date” for Young Children with Autism and their Peers

The Early Start Denver Model (ESDM) is a routines-based naturalistic developmental behavioural intervention for children with, or at risk for ASD under the age of 5. See Rogers and Dawson's (2010) manual: Early Start Denver Model for young children with autism for more information. This intervention will involve two 1-hour sessions per week for 12 weeks of ESDM play date intervention delivered to children with ASD and typically developing peers by a therapist who is trained in the ESDM. All sessions will take place in the children with ASD's homes. The materials used during the intervention will be those that are typically available in each family's home, in addition to a range of age appropriate toys (listed in the ESDM manual). During the initial hour-long ESDM therapy session the therapist will play in a naturalistic way with the child with ASD and a second therapist will note on the ESDM Curriculum Checklist whether or not the child displayed a range of developmental skills. Based on this assessment two to three goals will be selected for each of the nine developmental domains targeted in the ESDM. During each subsequent play date session the child with ASD's goals will be embedded into the therapist’s play with the children and will be taught by applying the following behaviour analytic teaching principles: (a) the delivery of learning opportunities at least every 30s, (b) delivery of clear antecedents, (c) the use of reinforcement, and (d) the use of instructional strategies such as prompting, shaping, chaining, and fading. At the beginning of each session, the therapist will greet the children and then allow them to verbally or non-verbally (e.g. leading the adult to the activity or object, pointing) choose the first activity, either by presenting a limited choice of two options or allowing the child to choose any toy or activity. Teaching will occur through the use of two types of routines: sensory social routines, in which the therapist will play with the child without an object (e.g. songs, chase, tickles), or using special sensory objects that the child did not operate (e.g. balloons, bubbles, shaving foam); and joint activity routines, in which the therapist and the child will play together with an object (e.g. blocks, books, balls). Throughout these routines, the therapist will maintain a positive affect, employ strategies to maximise the child’s motivation (e.g., offering choices, following the child’s lead, and being sensitive and responsive to all attempts at communication), and make conscious attempts to attract and maintain the child’s attention to her face, voice, and actions. When the therapist determines that there are no more learning opportunities during the chosen activity, the child seems bored, or the child initiates finishing an activity, the therapist will instruct the child to tidy up and, once the child had done so, he or she will select a new activity. Furthermore, the therapist will use specific strategies to encourage interaction between the child with ASD and typically developing peer as well as teach the typically developing peer to interact with and teach social communication and play skills to the child with ASD. This will involve setting up play spaces with toys and materials that elicit cooperative play, and providing duplicates of toys and materials to encourage parallel play (e.g. two sets of farm animal toys, or sufficient Duplo blocks for both children to play with). By choosing toys and activities that are interesting to both children, spontaneous motivation and interest in the other play partners will be more likely to develop. The therapist will also provide active guidance (using appropriate prompting and reinforcement) to the typically developing peers to help them interact with the children with ASD in a way that promotes learning. If the children are engaging at a level where all of the target social behaviours are naturally occurring, the therapist will adopt an ‘invisible helper’ role, where the therapist joins in activities as a play partner and facilitator rather than a director. Sessions will be terminated after one hour or when the therapist determines from the children’s behaviour that they no longer want to continue. Fidelity of therapist implementation of the intervention using the ESDM Teaching Fidelity Rating System (Rogers & Dawson, 2010) will be evaluated. The questionnaire has 13 fidelity categories: management of attention, ABC format, instructional techniques, affect and arousal, management of unwanted behaviours, dyadic engagement, motivation, positive affect, sensitivity and responsivity, multiple and varied communication, appropriateness of adult language, joint activity structure and elaboration, and transition between activities. Furthermore, a checklist that corresponds to each phase of the study will also be used to monitor adherence to the intervention. The checklist describes each step of the procedures for each phase of the study. For example, “the session lasted ten minutes from the child taking a toy”, and “researcher responded appropriately to any child attempts to initiate play or interaction”.