University of California-Los Angeles, Los Angeles, CA, USA.
University of Oregon, Eugene, OR, USA.
J Child Psychol Psychiatry. 2021 Oct;62(10):1228-1235. doi: 10.1111/jcpp.13405. Epub 2021 Mar 25.
Social communication interventions benefit children with ASD in early childhood. However, the mechanisms behind such interventions have not been rigorously explored. This study examines the mechanism underlying a naturalistic developmental behavioral intervention, JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation), delivered by educators in the community. Specifically, the analyses focus on the mediating effect of joint engagement on children's initiations of joint attention (IJA) skills and whether IJA postintervention are associated with later gains in children's receptive and expressive language.
One hundred seventy-nine children, age 2-5 years, were randomized to immediate JASPER treatment or waitlist (treatment as usual) control. Independent assessors blinded to time and treatment coded children's time jointly engaged and IJA during a 10-min teacher-child interaction at baseline, exit, and follow-up. Age-equivalent receptive and expressive language scores from the Mullen Scales of Early Learning were collected at baseline and follow-up. Mediation analyses with linear mixed models were used to explore the potential mediating effect of joint engagement on IJA.
Joint engagement significantly mediated 69% of the intervention effect on young children's IJA and IJA predicted improvements in standardized language scores.
Small but sustained changes in child-initiated joint engagement improved IJA, a core challenge in children with ASD, which in turn led to improvements in language.
社交沟通干预有益于幼儿自闭症谱系障碍儿童。然而，此类干预措施背后的机制尚未得到严格探索。本研究考察了在社区中由教育工作者实施的自然发展行为干预 JASPER（共同关注、象征性游戏、参与和调节）的作用机制。具体来说，分析重点是共同参与对儿童共同关注技能发起的中介效应，以及干预后共同关注是否与儿童接受性和表达性语言的后续增益相关。
179 名 2-5 岁的儿童被随机分配到立即接受 JASPER 治疗或候补（常规治疗）对照组。独立评估员在基线、退出和随访时对儿童的共同参与和共同关注技能发起进行了盲法评估，时间和治疗均不知情。在基线和随访时，从 Mullen 早期学习量表中收集了年龄等效的接受性和表达性语言分数。使用线性混合模型的中介分析来探讨共同参与对共同关注技能发起的潜在中介效应。
共同参与显著中介了干预对幼儿共同关注技能发起的 69%的影响，并且共同关注技能发起预测了标准化语言分数的提高。
儿童发起的共同参与的微小但持续的变化改善了共同关注技能发起，这是自闭症谱系障碍儿童的核心挑战，进而导致语言能力的提高。
