This study supplements an existing NIH-funded research protocol that focuses on improving spoken language outcomes of preschoolers with minimal spoken language ability (""""""""Multisite RCT of early intervention for spoken communication in autism"""""""";1R01MH085048-01A1) at the Kennedy Krieger Institute site only. The proposed study was designed in response to NIH NOT-DC-11-001, which provides funds to expand the scope of an existing research protocol to develop preliminary investigations into treatment of nonverbal school-aged children with autism. The proposed study targets 15 participants who completed one of two evidence-based interventions through the parent grant. Despite receiving a 6-month intensive intervention involving either Discrete Trial Training (Lovaas et al., 1981) or Joint Attention-Symbolic Play (JASP;Kasari et al., 2006), these 15 children did not become functional spoken language communicators. Upon completing the parent study, these children will be enrolled in a novel intervention aimed at improving expressive communication development.
Specific aims of the new project are to preliminarily examine whether: (1) a novel intervention package is an active ingredient for improving expressive communication development and outcomes in nonverbal school-aged children with autism;and (2) parent and teacher training mediates children's generalization of expressive communication skills to the classroom and home. The exploratory aim is to examine pre-treatment variables that may be associated with degree of treatment response to inform planning for a larger-scale intervention study of this population. A nonconcurrent multiple baseline study design will be used, allowing us to examine trajectory of change and treatment response at the individual level for this heterogeneous group (Lord, 2010). After the baseline phase, all participants will receive the same intervention package at the same dosage for 5 months. At specified points in the intervention, teacher and parent training will occur in the classroom and home, respectively. Active ingredients in the novel intervention include training the children, teachers, and parents in the use of an augmentative and alternative communication (AAC) device;Pivotal Response Training;computer-based receptive and expressive lexical and relational semantics training;and strategically selected target vocabulary and use of instructional activities to maximize flexibility of expressive language behavior (natural speech or aided). Analyses will involve visual inspection and quantitative analyses. This supplement will permit, for the first time, assessment of a new treatment for known 'non-responders'to a prior evidence-based intervention. If the proposed intervention is shown to effect change on the dependent variables, the stage will be set for a randomized clinical trial powered appropriately to examine mediators and moderators of treatment response in this heterogeneous group of nonverbal children.

Public Health Relevance

Many children with autism reach school age without having acquired functional communication abilities using spoken language despite having had years of intervention. The proposed study focuses on such a group who did not develop functional speech after receiving one of two interventions through a different study. Through this new project, we will study the effects of a novel approach to intervention aimed at improving the expressive communication abilities of nonverbal school-aged children with autism.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZDC1-SRB-Q (66))
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Gilotty, Lisa
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Hugo W. Moser Research Institute Kennedy Krieger
United States
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