Increasing Social Interaction Using Prelinguistic Milieu Teaching With Nonverbal School-Age Children With Autism

Abstract

Purpose: Children with autism display marked deficits in initiating and maintaining social interaction. Intervention using play routines can create a framework for developing and maintaining social interaction between these children and their communication partners. Method: Six nonverbal 5-to 8-year-olds with autism were taught to engage in social interaction within salient play routines. Prelinguistic milieu teaching (PMT) techniques were used to teach the children to communicate intentionally during these routines. Intervention focused on the children's social interaction with an adult. The effects of intervention were evaluated using a multiple baseline design across participants. Results: At study onset, the participants demonstrated few consistent interaction with others. With intervention, all of the children improved their ability to sustain social interactions, as evidenced by an increase in the number of communicative interactions during play routines. Participants also increased their overall rate of initiated intentional communication.Conclusion: Development of intentional prelinguistic communication within salient social routines creates opportunities for an adult to teach social and communication skills to young school-age children with autism who function at a nonverbal level.

Joint Attention and Occupations for Children and Families Living with Autism Spectrum Disorder: A Scoping Review

“…In addition to positive findings on the overall effectiveness of JA teaching strategies immediately post-intervention, a large number of studies have found that significant improvements in various aspects of JA skills maintain at follow-up assessments after 4 to 6 weeks (Franco et al, 2013), 2 to 3 months (Chiang et al, 2016;Ingersoll, 2012;Rocha et al, 2007), 6 months (Lawton & Kasari, 2012a), and 1 year postintervention (Kasari et al, 2010;Lawton & Kasari, 2012a). Furthermore, findings indicate that JA skills developed through targeted teaching interventions may be generalizable to novel adults, settings, and play routines (Jones et al, 2006;Kaale et al, 2012;Kasari et al, 2006;Rocha et al, 2007;Wong et al, 2007).…”

“…Fourteen studies used structured or standardized assessments, contributing to the strength of the research findings (Chiang et al, 2016;Franco et al, 2013;Ingersoll, 2012;Kaale et al, 2012;Kasari et al, 2006Kasari et al, , 2010Kim et al, 2008;Lawton & Kasari, 2012a, 2012bRocha et al, 2007;Schertz et al, 2013;Wong, 2013;Wong et al, 2007;Yoder & Stone, 2006). Of the studies that incorporated video recording for the purpose of analyzing observational data, nearly all of them used some combination of blinded, independent assessors to code data with documentation of acceptable levels of interobserver agreement, thus contributing to the strength of the experimental design (Chiang et al, 2016;Franco et al, 2013;Gulsrud et al, 2007;Jones et al, 2006;Kaale et al, 2012;Kasari et al, 2010;Kim et al, 2009;Lawton & Kasari, 2012b;Schertz et al, 2013;Vismara & Lyons, 2007;Wong, 2013;Yoder & Stone, 2006).…”

“…One study featured a non-randomized controlled trial design, with an equivalent sample size of 34 participants (Chiang et al, 2016). Five studies featured multiple baseline single-group design, with a fewer number of participants ranging from two to six per study (Franco et al, 2013;Jones et al, 2006;Martins & Harris, 2006;Rocha et al, 2007;Vismara & Lyons, 2007). (Franco et al, 2013;Gulsrud et al, 2007;Jones et al, 2006;Kim et al, 2008Kim et al, , 2009Lawton & Kasari, 2012a, 2012bMartins & Harris, 2006;Schertz et al, 2013;Vismara & Lyons, 2007;Wong, 2013); response to JA and overall JA behaviors (Kasari et al, 2010;Kim et al, 2008;Rocha et al, 2007;Schertz et al, 2013;Wong, 2013); and initiating JA skills (Franco et al, 2013;Ingersoll, 2012;Jones et al, 2006;Kaale et & Kasari, 2012b;Rocha et al, 2007;Schertz et al, 2013;Vismara & Lyons, 2007;Yoder & Stone, 2006 (Chiang et al, 2016;Jones et al, 2006;Kasari et al, 2010;Rocha et al, 2007;Vismara & Lyons, 2007).…”

“…JA intervention (JAI) is defined as the teaching of JA skills, and this approach to intervention has been researched extensively in the past decade (Chiang et al, 2016;Franco, Davis, & Davis, 2013;Gulsrud, Kasari, Freeman, & Paparella, 2007;Ingersoll, 2012;Jones, Carr, & Feeley, 2006;Kaale, Smith, & Sponheim, 2012;Kasari, Freeman, & Paparella, 2006;Kasari et al, 2010;Kim, Wigram, & Gold, 2008, 2009Lawton & Kasari, 2012a, 2012bMartins & Harris, 2006;Rocha, Schreibman, & Stahmer, 2007;Schertz, Odom, Baggett, & Sideris, 2013;Vismara & Lyons, 2007;Wong, 2013;Wong, Kasari, Freeman, & Paparella, 2007;Yoder & Stone, 2006). JA teaching strategies tend to incorporate principles from applied behavior analysis in the context of a table-top play routine or a naturalistic play setting (Kasari et al, 2010).…”

“…JA teaching strategies tend to incorporate principles from applied behavior analysis in the context of a table-top play routine or a naturalistic play setting (Kasari et al, 2010). JAI has been used to develop skills to promote social interaction, joint engagement, expressive and receptive language skills, play, parent-child relationships, social motivation, and quality of friendships (Franco et al, 2013;Freeman, Gulsrud, & Kasari, 2015). can have an adverse effect on occupational engagement and family relationships (Case-Smith, 2015).…”