Tempt-Trigger Intervention to Promote Intentional Communication in Three Young Children with ASD

Transcription

1 Tempt-Trigger Intervention to Promote Intentional Communication in Three Young Children with ASD Susan Lien, Cynthia J. Cress, Heather Kampschnieder, HopeEllen Petro, Laura Thayer, Peggy Merrill, Josie Wittwer Abstract: Intervention strategies are relatively limited for pre-intentional communicators that do not yet direct communication toward objects or toward others, particularly children who are early communicators with complex communication needs (CCN). Children who continue to rely on preintentional communication behaviors after infancy are at high risk for CCN regardless of their specific diagnosis. In particular, children with autism who do not develop effective and consistent intentional communication run a lifelong risk for situation-specific communication, including poor generalization of communication and prompt-dependency on partner cueing. The Tempt-Trigger intervention is a strategy that embeds partner assistance for children to produce communication skills into situations in which the child initiates individual signals of their intent. One of the benefits of the Tempt-Trigger intervention model is promoting child spontaneous initiation of meaningful communication behaviors, a skill particularly at risk for children with autism. Components of the strategy include: temptation (through situation and activity), trigger (the child s own natural behavior spontaneously produced at the temptation), transfer (helping the child produce a more effective communication behavior at the time they express the communicative intent), and touch (providing the child meaningful feedback of the means and results of this communication act). This poster demonstrates the effectiveness of the Tempt/Trigger intervention strategy at increasing object-directed and person-directed communication behaviors in three young children with autism spectrum disorders. At time of submission, two of the three children both developed and maintained person-directed communication due to the treatment, and complete results will be available on the third child by ISAAC. Background: Intentional communication acts are defined as gestures, vocalizations, or verbalizations that are directed toward another person to convey a communicative function, such as requests/refusals, joint attention, or social interaction (Wetherby & Prizant, 1995). Multiple studies demonstrate the effectiveness of a wide variety of interventions at promoting communication toddlers with ASD who have emerging symbolic skills; effects for communication in prelinguistic children were mixed with only some outcomes achieved and/or small effect sizes (Morgan, et al., 2014). Many intervention studies targeting prelinguistic children with autism target joint attention and/or social reciprocity skills that are key foundations for effective interpersonal communication, such as Joint Attention Mediated Learning (Schertz, Odom, Baggett, & Sideris, 2013) or the Brief Early Start Denver Model (Rogers, et al., 2012).

2 A few studies have tested the efficacy of interventions for infants and toddlers at high risk for autism at ages of 4-12 months in which typically developing children are not necessarily expected to be intentional communicators. These interventions derived from Intervention in BASIS (Green, et al., 2013) or Pivotal Response Therapy (Koegel, et al., 2013) addressed goals such as increasing parent-infant synchrony, eye contact, and social engagement for infants under 12 months, and began to address verbal and nonverbal communication behaviors for children 12 months and over. Effective programs such as Hanen More Than Words (Carter, et al., 2011) demonstrate increases in social communication for prelinguistic children with ASD, with greater gains for children who demonstrated poorer object interest prior to intervention. This program is a parent-training program that combines responsivity with modeling of effective nonverbal or verbal behaviors that follow the child s attention. There is a need for additional intervention approaches for preintentional communicators who do not yet respond consistently to adult modeled behaviors, to help bridge the potential gap between responsivity and modeling approaches to communication intervention. The Tempt/Trigger model was developed to provide intermediate support for children to supplement the benefits of responsivity and modeling approaches. Methods The participants were three children ranging in age from 18 months to 6 years, all of whom were pre-intentional communicators, indicated by fewer than 3 intentional communication acts produced on the Communication and Symbolic Behavior Scales- DP (CSBS-DP; Wetherby & Prizant, 1995). Two of the participants were 18-month old female twins, one recently diagnosed with autism by a multi-disciplinary team and one diagnosed with developmental disabilities with suspected autism by the same team. The third participant was a 6-year-old male with medical and educational diagnosis of autism who did not consistently demonstrate person-directed communication acts without prompting. All of the children scored at least moderate risk for autism on the ADOS-2 assessment. Other developmental assessments administered included the Mullen Developmental Scales, Vineland Parent Questionnaire, and initial assessment with the CSBS-DP. The children were also administered initial assessments with the Infant Social and Communication Behavior Scales (Cress, et al., 2014), to allow independent tracking of 12 domains of pre-intentional skills associated with the development of intentional communication before as well as after treatment. Procedures

3 Research design was a multiple baseline study across subjects, addressing two target outcomes: object-directed communication behaviors (intentional behaviors) and persondirected communication behaviors (intentional communication). A communication signal inventory (CSI) was completed for all three children by familiar professionals and parents in collaboration. This CSI all spontaneous and prompted behaviors for which meaningful interpretations were judged by familiar partners, based on the type of behavior and context in which the behavior was produced. Most behaviors were not intentional communication acts and were associated with several possible interpretations; for instance, biting of a particular child s own hand was associated with interpretations of frustration, overstimulation, confusion, or dislike of a particular activity. Six temptation activities were devised for each of the children: three involved physical play on an object (such as bouncing on an exercise ball), and three involved tactile and sensory play objects (such as a vibrating pillow). Each activity was associated with a spoken word during the temptation (e.g. bounce ) to facilitate spoken communication acts. Children were familiarized with the objects and play environments in pilot sessions before beginning baseline/intervention sessions, and play temptations were not accessible to the children at any times other than experimental interventions. Each child had a customized inventory of all plausible behaviors produced under these temptation conditions, utilizing information from play interactions and the CSI, categorized into three groups: spontaneous behaviors, object-directed behaviors, or person-directed behaviors. A particular action such as vocalizing could vary, depending on the orientation of the child s behavior; vocalizing while swinging the head was judged as a spontaneous behavior, while vocalizing while gazing at or touching an object was judged an object-directed behavior. Behaviors during pilot interactions that were not anticipated ahead of time by familiar professionals and family were added to the child s customized inventory. Behaviors were grouped into request/comment behaviors and protest/escape behaviors to allow for appropriate contingent responses. The nonparticipating experimenter recorded target behaviors to estimate readiness to transition to the next phase; all experimental coding of sessions was conducted by trained observers blind to treatment condition who did not interact with any of the children, coding randomly ordered sessions. Children received four trials of each temptation in randomized order with random alternation of two familiar experimenters during twice-weekly sessions. All children received baselines in which the temptations were presented without intervention, and the first child receiving treatment continued for at least 3 sessions until stable baseline. Children then received tempt/trigger responses that were explicitly planned for the child s customized inventory, where at the communication temptation, a spontaneous behavior trigger received a transfer of an object-oriented behavior (helping the child tap the object) while an object-oriented trigger received a transfer of a person-oriented behavior, both with a touch or reinforcement of the target behavior.

4 Both of the first two participants showed clear development and maintenance of person-directed communication and reduction of spontaneous behaviors to communicate from the Tempt-Trigger intervention, and intervention had begun at time of submission with the third child. Results will be reported in full by ISAAC. References: Carter, A.S., Messinger, D.S., Stone, W.L., Celimli, S., Nahmias, A.S., & Yoder, P. (2011). A randomized controlled trial of Hanen s More Than Words in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52, Cress, C.J., Dinneen, B., Focht, K., Mosier, K., Watermeier, R., Lantis, A., Uglow, S., Gaines-Nelson, S., Johnson, K., Kind, E., Olson, A. (November, 2014). Prediction of communication risk before 12 months with the ISCBS: Group outcomes at 3 years. Poster presentation at the 89 th annual American Speech-Language-Hearing conference, Orlando, FL. Green, J., Wan, M.W., Guiraud, J., Holsgrove, S., McNally, J., Slonims, V., et al. (2013). Intervention for infants at risk of developing autism: A case series. Journal of Autism and Developmental Disorders, 43, Koegel, L.K., Singh, A.K., Koegel, R.L., Hollingsworth, J.R., & Bradshaw, J. (2013). Assessing and improving early social engagement in infants. Journal of Positive Behavior Interventions, 16, Morgan, L.J., Rubin, E., Coleman, J.J., Frymark, T., Wang, B.P., & Cannon, L.J. (2014). Impact of social communication interventions on infants and toddlers with or at-risk for autism: A systematic review. Focus on Autism and Other Developmental Disabilities, 29, Rogers, S.J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., & Dawson, G. (2012). Effects of a Brief Early Start Denver Model (ESDM) Based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51, Schertz, H.H., Odom, S.L., Baggett, K.M., Sideris, J.H. (2013). Effects of Joint Attention Mediated Learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28, Wetherby, A.R. & Prizant, B. (1995). Communication and Symbolic Behavior Scales Developmental Profile. Baltimore: Brookes Publishing. Disclosure statement: None of the authors have any conflict of interest or financial or nonfinancial disclosure related to the contents of this poster.

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