Hannah H. Schertz

Joint Attention and Early Intervention with Autism: A Conceptual Framework and Promising Approaches.

This article reviews research on the typical development of joint attention and challenges that infants and toddlers with autism experience in achieving this milestone. We define joint attention as coordinating attention to an event or object with another individual, sharing interest and social engagement, and showing an understanding that the partner is sharing the same focus. Conceptual frameworks for understanding joint attention are organized around three theoretical perspectives: cognitive-perceptual, language, and social-affective. Several intervention models are explored for their applicability to promoting joint attention in very young children. Finally, future research needs related to joint attention in early intervention are described.

Designing Studies to Evaluate Parent-Mediated Interventions for Toddlers With Autism Spectrum Disorder

Given recent advances in science, policy, and practice of early identification in autism spectrum disorder (ASD), questions about the effectiveness of early intervention have far-reaching service and policy implications. However, rigorous research evaluating the efficacy and effectiveness of intervention programs for toddlers with ASD faces a multitude of novel scientific challenges. The Autism Speaks Toddler Treatment Network (ASTTN) was formed in 2007 to provide an infrastructure for ongoing communication between the investigators of eight research projects evaluating parent-mediated interventions for toddlers with ASD. The present article describes and compares the research studies of the ASTTN; highlights specific challenges with regard to research design, participants, recruitment, eligibility criteria, enrollment, and intervention approach; and outlines practical considerations that may guide the next generation of parent-mediated intervention studies involving toddlers with ASD.

Interventions for Toddlers With Autism Spectrum Disorders An Evaluation of Research Evidence

Recently emerging intervention studies for toddlers with autism spectrum disorders (ASD) were reviewed through a systematic assessment of intervention outcomes, research rigor, and intervention features. The review includes published peer-reviewed experimental studies of toddlers with high risk for or diagnosis of ASD in which the majority of interventions occurred before age 36 months. Of 20 identified research studies, 6 were group comparison studies, all of which showed small to large magnitudes of effect when a uniform metric was applied. Fourteen were single-case design (SCD) studies, all of which reported effects on a variety of outcomes. When grouped by area of intervention focus (communication, general development, family well-being, imitation, joint attention, and play), commonly identified needs within focus areas were for replication, common measures, and authentic practices. A majority of studies in most focus areas showed strong to acceptable levels of research rigor, though this is an area of ongoing need.

Parent-Reported Repetitive Behavior in Toddlers on the Autism Spectrum.

Toddlers with autism spectrum disorder (ASD) were assessed on the Repetitive Behavior Scale-Revised (RBS-R), which we found to have acceptable internal consistency. Stereotypical subscale scores showed a negligible association with cognitive level, but correlated more strongly with adaptive and social indicators. Relative to earlier reported RBS-R scores for older age groups, toddlers’ scores trended toward higher stereotyped behavior and lower ritualistic/sameness behavior. Our findings on associations with developmental indicators align with those of researchers who used more resource-intensive repetitive behavior measures. The convergence of these findings with those derived from other measurement methods suggests that the RBS-R, a cost effective parent-report measure, is a viable means of assessing repetitive behavior in toddlers with autism.

Interventions for Toddlers With Autism: Building on the Parent-Child Relationship to Promote Joint Attention

Ryan was only 33 months old when our family participated in an intervention program to develop joint-attention for toddlers with early signs of autism. By that time, we were dealing with a wide variety of issues and our frustration level was quite high. Ryan is the youngest of three boys, all born prematurely at 34, 36, and 35 weeks respectively. My husband and I were familiar with early intervention services, as our oldest son had received physical therapy for low muscle tone until he turned 2 years old. Our middle son had more complications and began receiving services at 30 months. At 36 months, he transitioned into preschool special education because of

Facilitating Toddlers’ Social Communication from Within the Parent-Child Relationship: Application of Family-Centered Early Intervention and Mediated Learning Principles

Two complementary theoretical orientations, family-centered early intervention and mediated learning, provide guidance for parent-mediated intervention for toddlers on the autism spectrum. Early intervention for infants and toddlers with disabilities and their families has evolved toward a set of practices that are family-centered, relationship-based, situated in natural environments, and embedded in natural experiences. Mediated learning emphasizes competency-oriented principles that promote “learning to learn” through focusing, organizing and planning, giving meaning, encouraging, and expanding. This chapter describes the integration of early intervention principles within a mediated learning framework to cultivate developmentally important social communication competencies for toddlers with autism. The aim of this approach is to embed relationship-based learning in naturally occurring interactions and to build on prior learning and personal interests as a means of promoting learner self-efficacy, motivation, and active engagement in the social learning process. This integrated framework provides a structure to guide both parent and toddler learning by actively facilitating parents’ conceptual understanding and confidence for supporting toddler social engagement.

Social and Instrumental Interaction Between Parents and Their Toddlers With Autism: A Qualitative Analysis:

A qualitative study of three parents and their toddlers with autism was conducted to investigate the communicative functions underlying parent–toddler interactions and how the instrumental or social nature of one partner’s actions influenced the other’s engagement. Parent–child interaction videos collected from a separate intervention study were transcribed with thick description, coded for literal and inferential meaning by independent coders, and analyzed for emergent themes following an iterative process of code categorization. Themes converged around the partner as instrument, attempted but missed social connections, and congruent social engagement. A complementary interactional sequential analysis revealed that communicative functions of initiating partners were largely mirrored in their partners’ responding actions, suggesting that actively supporting parents to interact with their toddlers socially, rather than prescriptively or instrumentally, may be a potent intervention strategy to address the core social communication challenge in autism during the formative early developmental period.

Book Review: Sandall, S. R., & Schwartz, I. S. (2008). Building Blocks for Teaching Preschoolers with Special Needs (2nd ed.). Baltimore: Paul H. Brookes. 236 pages. US

unsupported claims in all of these areas provides readers with both sides of the picture regarding the controversies. For example, one of the major controversies surrounding the etiology of autism involves the belief that the measles, mumps, and rubella (MMR) vaccine causes autism. Schreibman does a nice job citing the Wakefield report, which initiated this belief, and the flaws associated with that research, including the fact that 10 of the 13 authors of the report later retracted their beliefs that the MMR vaccine is associated with causing autism (p. 104). She then cites the findings of a large research study involving 140,000 children, conducted by the Centers for Disease Control and Prevention, which concluded that there was little evidence of a link between vaccines and developmental problems (p. 104). The heart of the book is dedicated to reviewing treatment options, including interventions that are proven effective, interventions that are likely effective, interventions that are less likely effective, and interventions that are completely unsupported. Schreibman explains that interventions based on the behavioral model have been the most successful and have the strongest empirical validation. Therefore, interventions that are classified as being proven effective include discrete trial training (DTT) and naturalistic behavioral interventions including pivotal response training (PRT). Interventions that are likely effective include Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) and Floortime. Interventions that are likely less effective include sensory integration therapy as well as pharmacological and nutritional treatments. Interventions that are completely unsupported include facilitated communication (FC), the Rapid Prompting Method (RPM), psychotherapies, holding therapies, options therapy, and animal therapies. In her evaluation of interventions, Schreibman indicates that the interventions based on the behavioral model are the only interventions that are empirically validated. She indicates that the strengths of the behavioral model include the rigorous research conducted in the area, the fact that the behavioral approach is self-analytical, and the ease of replication. The controversies surrounding the behavioral approach include the beliefs that behavioral treatments are overly structured, the skills taught are simplistic, and children fail to generalize new skills to untrained situations. Within the section outlining the controversies of the behavioral approach, Schreibman describes DTT; unfortunately, she does not clearly delineate between the discussion of controversies regarding the behavioral model in general and DTT specifically. She does mention specific weaknesses associated with DTT, such as robotic responding, lack of spontaneity, prompt dependency, the overly structured format of the intervention, and the use of aversives; however, these weaknesses are presented in the same section of the chapter as the overall weaknesses of the behavioral model approach. Schreibman states that the weaknesses associated with DTT can be addressed through naturalistic approaches referred to as “DTT-Lite” (p. 157), which include naturalist behavioral approaches such as PRT. Because the naturalistic approaches are also based on a behavioral model, the structure of this particular chapter may prove confusing to readers who are unfamiliar with the behavioral model, as the description of the strengths and weaknesses of DTT appears to be overgeneralized to all behavioral approaches. Readers may erroneously conclude that DTT is synonymous with “behavioral interventions” and may not realize that there are a variety of interventions based on the behavioral model that have proven effective for teaching new skills to children with ASD. Although not mentioned in the book, behavioral strategies including time delay, system of least prompts, and incidental teaching (Alberto & Troutman, 2009) have been empirically validated as effective for many individuals, including those with ASD. Although new controversies arise every day related to autism, Schreibman covers the most current controversies (e.g., the role of the MMR vaccine in the cause of autism, interventions based on the behavioral model vs. sensory integration therapy, placement in self-contained special education classes vs. full inclusion in general education classes for students with autism) as well as the controversies that have persisted over the past several decades (e.g., the influence of parental behavior causing autism, the use of psychotherapies to treat individuals with autism, the possibility of recovery from autism as described by Lovaas). Through this book, Schreibman achieves her goal of educating readers about the controversies in the field of autism and provides information needed to make informed decisions about what to believe and which interventions are worth the investment of time and money. The book is well organized and written, making it enjoyable to read as well as educational. The information provided by Schreibman is valuable to parents, teachers, caregivers, and professionals alike, and the book is an excellent resource for basic information surrounding the numerous controversies in the field of autism.