Autism, Autism Spectrum Disorder, Autism, Susceptibility to, 6
Conditions
Keywords
Communication, Language, Autism, Infancy, Preemptive
Brief summary
This project will look at Milieu Teaching (i.e., a language intervention) that encourages looking to audiovisual speech cues (Milieu Teaching-AV) for infants with autistic older siblings (Baby Sibs), who are highly likely be diagnosed with autism or developmental language disorder (DLD), compared to Milieu Teaching alone (Milieu Teaching-NoAV). This study will specifically look at whether Milieu Teaching-AV (compared to Milieu Teaching-NoAV) results in (a) increased looking towards caregivers' faces, (b) increased communicative behaviors and language skill, and (c) increased engagement with the caregiver during play. We will also look at caregiver factors, such as their use of strategies and their attitudes toward the intervention they received.
Detailed description
Language outcomes are highly heterogenous in autism and can impact long-term psychosocial, educational, and vocational outcomes for children on the autism spectrum. Thus, there is a pressing need to identify novel approaches to language intervention, ideally those that can be implemented in early stages of development, when brain and behavior are most plastic. Many have begun to consider "pre-emptive" interventions for infants with autistic older siblings (Baby Sibs), who are highly likely be diagnosed with autism or developmental language disorder (DLD) themselves. I hypothesize that a targeted pre-emptive intervention that encourages Sibs-autism to look to the mouth of a speaker (i.e., by moving a referent, or the item about which an adult is talking, near the mouth) during an evidence-based intervention for language may yield more optimal language outcomes than traditional therapy alone. This strategy has already been shown to boost word learning in autistic preschoolers, at least for proximal targets (i.e., for words that were specifically taught using the strategy in a short-term training context). This study represents a preliminary systematic test of this strategy in Sibs-autism. I will evaluate the effects of an intervention that encourages looking to audiovisual speech by moving the referent of interventionist talk near the mouth (Milieu Teaching-AV) compared to Milieu Teaching-NoAV in a total of 60 Baby Sibs within the context of a pilot randomized controlled trial (RCT). This pilot RCT will allow me to estimate effect sizes for (a) direct effects on word learning, both for trained words and broader language, (b) moderated effects (i.e., determining for whom the intervention yields optimal outcomes), and (c) mediated effects (i.e., determining the mechanisms by which the intervention works).
Interventions
BEHAVIORALMilieu Teaching-AV
Milieu Teaching is a previously developed and well established Naturalistic Developmental Behavioral Intervention. Key principles of Milieu Teaching include: (a) individualized treatment goals based on the child's entry-level communication abilities, (b) use of environmental arrangement, reciprocal social interactions and/or play routines with balanced turns to maximize engagement and opportunities for child attention or communication leads, (c) child-initiated teaching episodes, (d) adult modeling of communication targets and language, and (e) expansion of child communication with more complex strategies. Coaches will teach caregivers to engage their infant in play or routines around a standardized set of toys, follow their infant's attention or communication lead around these toys, and respond to their infant's communication acts by modeling and expanding those communication acts into more sophisticated strategies.
BEHAVIORALMilieu Teaching-NoAV
Milieu Teaching is a previously developed and well established Naturalistic Developmental Behavioral Intervention. Key principles of Milieu Teaching include: (a) individualized treatment goals based on the child's entry-level communication abilities, (b) use of environmental arrangement, reciprocal social interactions and/or play routines with balanced turns to maximize engagement and opportunities for child attention or communication leads, (c) child-initiated teaching episodes, (d) adult modeling of communication targets and language, and (e) expansion of child communication with more complex strategies. Coaches will teach caregivers to engage their infant in play or routines around a standardized set of toys, follow their infant's attention or communication lead around these toys, and respond to their infant's communication acts by modeling and expanding those communication acts into more sophisticated strategies.
Sponsors
Father Flanagan's Boys' Home
National Institute on Deafness and Other Communication Disorders (NIDCD)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Due to the nature of the behavioral intervention, we can only mask the outcomes assessor for non-caregiver report outcomes
Intervention model description
We will conduct a randomized controlled trial with 2 arms
Eligibility
Sex/Gender
ALL
Age
5 Months to 13 Months
Healthy volunteers
Yes
Inclusion criteria
1. chronological age of 6-12 months at study entry (±30 days); 2. an older sibling with an autism diagnosis, confirmed by a detailed developmental interview and administration of the Autism Diagnostic Observation Schedule (ADOS-2); and 3. monolingual English-speaking household.
Exclusion criteria
1. adverse neurological history; 2. known genetic condition; 3. pre-term birth (gestation \< 37 weeks); and 4. caregiver report of a diagnosed vision impairment or hearing loss
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Looking to the mouth of their caregiver | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | The total number of looks to infants' caregivers' mouths during caregiver-child free play |
| Looking to the mouth of a speaker | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | Proportion of total looking time to mouth for native, infant-directed audiovisual speech during an eye tracking task |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Prelinguistic vocal complexity | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | Consonant inventory and canonical syllabic communication, as derived from (a) a caregiver-child free-play task and (b) the Communication and Symbolic Behavior Scales |
| Caregiver-child engagement | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | Proportion of intervals in higher- and lower-order supported joint engagement during a caregiver-child engagement task |
| Expressive and receptive communication | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | Receptive and expressive communication age equivalency scores from the Vineland Adaptive Behavior Scales |
| Expressive and receptive language | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | Receptive and expressive language age equivalency scores from the Mullen Scales of Early Learning |
| Expressive and receptive vocabulary | 6-month follow-up | (a) Caregiver-reported words understood and said on the MacArthur-Bates Communicative Development Inventories: Words and Gestures checklist and (b) Number of different words used during the Communication and Symbolic Behavior Scales |
| Caregiver strategy use | Baseline, following 3 months of intervention (i.e., post-test), and 6-month follow-up | Proportion of milieu teaching trials during the caregiver-child free play wherein the caregiver moves the referent of the child's lead towards the mouth |
Countries
United States
Contacts
CONTACTJacob I Feldman, PhD, CCC-SLP
Outcome results
None listed