title: Longitudinal Effects of Adaptive Interventions With a Speech-Generating Device in Minimally Verbal Children With ASD.
abstract: There are limited data on the effects of adaptive social communication interventions with a speech-generating device in autism. This study is the first to compare growth in communications outcomes among three adaptive interventions in school-age children with autism spectrum disorder (ASD) who are minimally verbal. Sixty-one children, ages 5-8 years, participated in a sequential, multiple-assignment randomized trial (SMART). All children received a developmental behavioral communication intervention: joint attention, symbolic play, engagement and regulation (JASP) with enhanced milieu teaching (EMT). The SMART included three 2-stage, 24-week adaptive interventions with different provisions of a speech-generating device (SGD) in the context of JASP+EMT. The first adaptive intervention, with no SGD, initially assigned JASP+EMT alone, then intensified JASP+EMT for slow responders. In the second adaptive intervention, slow responders to JASP+EMT were assigned JASP+EMT+SGD. The third adaptive intervention initially assigned JASP+EMT+SGD; then intensified JASP+EMT+SGD for slow responders. Analyses examined between-group differences in change in outcomes from baseline to Week 36. Verbal outcomes included spontaneous communicative utterances and novel words. Nonlinguistic communication outcomes included initiating joint attention and behavior regulation, and play. The adaptive intervention beginning with JASP+EMT+SGD was estimated as superior. There were significant (p < .05) between-group differences in change in spontaneous communicative utterances and initiating joint attention. School-age children with ASD who are minimally verbal make significant gains in communication outcomes with an adaptive intervention beginning with JASP+EMT+SGD. Future research should explore mediators and moderators of the adaptive intervention effects and second-stage intervention options that further capitalize on early gains in treatment.
authors.affiliation: a Survey Research Center, Institute for Social Research , University of Michigan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
authors.affiliation: b Semel Institute for Neuroscience and Human Behavior , University of California.
authors.forename: Charlotte
authors.initials: C
authors.lastname: DiStefano
authors.affiliation: b Semel Institute for Neuroscience and Human Behavior , University of California.
authors.forename: Ya-Chih
authors.initials: YC
authors.lastname: Chang
authors.affiliation: b Semel Institute for Neuroscience and Human Behavior , University of California.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shire
authors.affiliation: c Peabody College , Vanderbilt University.
authors.forename: Ann
authors.initials: A
authors.lastname: Kaiser
authors.affiliation: d Department of Statistics , University of Michigan.
authors.forename: Xi
authors.initials: X
authors.lastname: Lu
authors.affiliation: a Survey Research Center, Institute for Social Research , University of Michigan.
authors.forename: Inbal
authors.initials: I
authors.lastname: Nahum-Shani
authors.affiliation: e Center for Autism and Related Disorders, Kennedy Krieger Institute.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Landa
authors.affiliation: f Communication Sciences and Disorders , University of Utah.
authors.forename: Pamela
authors.initials: P
authors.lastname: Mathy
authors.affiliation: b Semel Institute for Neuroscience and Human Behavior , University of California.
authors.forename: Connie
authors.initials: C
authors.lastname: Kasari
mesh_terms: D001288:Attention / Q000502:physiology; D000067877:Autism Spectrum Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D002675:Child, Preschool; D003142:Communication; D003143:Communication Devices for People with Disabilities / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D013060:Speech / Q000502:physiology; D016896:Treatment Outcome; D014705:Verbal Behavior / Q000502:physiology*