Featured Article: Adaptive Intervention to Improve Language Skills in Children With Autism

January 27, 2015:
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Adaptive interventions help guide clinicians in their decisions concerning when and how treatments should be altered, but developing empirically based adaptations requires gathering the right kind of data. The sequential, multiple assignment, randomized trial is a recent innovation that can provide high-quality, experimental data for developing adaptive interventions. Recently, a group of autism researchers published the results of their SMART study in the article “Communication interventions for minimally verbal children with autism: A sequential, multiple assignment, randomized trial,” which appears in the Journal of the American Academy of Child and Adolescent Psychiatry, a top journal in child and adolescent mental health. The authors, led by Connie Kasari of UCLA, designed a project to improve spoken communication for children with autism who are minimally verbal. The study’s results show the benefit of integrating speech-generating devices (SGD) as a part of language development interventions and the potential of SMART designs for developing adaptive interventions.

One in four children with autism are minimally verbal, even when they are receiving interventions. While evidence shows that children can develop spoken language after the age of five, they often cannot without intensive, targeted interventions (Wodka, Mathey & Kalb, 2013). This SMART study followed 61 minimally verbal children with autism who were provided a blended developmental and behavioral intervention known as JASPER + EMT (joint attention, symbolic play, engagement and regulation plus enhanced milieu training; Kasari, Gulsrud, Wong, Kwon & Locke, 2010; Hancock & Kaiser, 2002). Some children also received a SGD (such as an iPad or Dynavox). After three months, treatment was altered for children whose spoken language skills were not sufficiently improved. Among children who received JASPER + EMT alone initially and were slow responders, some received an SGD, others received intensified treatment. The authors found that incorporating SGDs early in the intervention (as opposed to later for slow responders, or not at all) significantly improved a number of key spoken communication outcomes. As a follow-up to this study, Dr. Kasari and her collaborators, who include Methodology Center investigators Susan Murphy and Daniel Almirall, have developed another, larger SMART to study adaptive language interventions for minimally verbal children with autism.


See the design of this trial.


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Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., Murphy, S. A., & Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(6), 635-46.

Wodka, E., Mathey, P. & Kalb, L. (2013). Predictors of phrase and fluent speech in children with autism and severe language delay. Pediatrics, 131, 1-7.

Kasari, C., Gulsrud, A. C., Wong, C., Kwon S. & Locke, J. (2010) Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorder, 40(9), 1045-1056.

Hancock T. B. & Kaiser, A. P. (2002). The effects of trainer-implemented enhanced milieu teaching on the social communication of children who have autism. Topics in Early Childhood Special Education, 22(1), 39–54.

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