BACKGROUND

Research on early intervention programs targeting toddlers with or at risk for autism spectrum disorder (ASD) primarily involve individual sessions with the caregiver and child in the home which may be isolating or impractical for some families.

In Toddlers and Families Together (Together), toddlers and their families participate in sessions that focus on increasing joint engagement with their child. Young children with autism have significant

delays in the development of attention states that involve sustaining joint engagement with others (Adamson, et al., 2009).

Specifically, families have an opportunity to practice strategies and receive feedback within a context of everyday routines and activities for toddlers within 3-hour long group sessions that also include a family education/support segment to learn and discuss strategies with a facilitator and other caregivers while the toddlers are engaged in various learning activities.

OBJECTIVESWith an overarching goal of promoting social-communication development for children with ASD through the Together program, the specific questions of this study include: Does participation in the program result in changes

in changes in joint engagement during play interactions between the toddler and his/her caregiver?

After participating, what are caregiver perceptions of the strategies and the program?

METHOD

Design Multiple probe baseline design across four toddlers

with or at risk for ASD and their families that included an initial baseline period of 4, 6, 8, and 10 weeks then participation in the 8-week Togetherintervention program, and followed by post-intervention assessments.

Toddlers and Families TogetherPromoting Joint Engagement for Young Children with or At Risk for Autism Spectrum Disorder

Connie WongFrank Porter Graham Child Development Institute

University of North Carolina at Chapel Hill

RESULTS

Funded by HRSA MCHB grant #R40MC26197

METHOD

Participants Four families and their toddlers with or at-risk for ASD

Identified as children who would benefit from a more developmental and autism evaluation on the Modified Checklist for Autism in Toddlers (M-CHAT)

Measures Caregiver-child interaction: 10-minute video-recorded

interactions between the child and the primary caregiver were coded for duration of joint engagement states (adapted from Adamson, et al., 2004), which was then used to calculate the percentage of time spent in a joint engagement state during the interaction. Joint engagement occurs when the child and another

person are actively involved in the same object or toy. Joint engagement includes both supported and coordinated joint engagement.

Caregiver Diary: At the end of treatment, caregivers completed a brief questionnaire reporting on a five-point Likert scale (higher ratings indicate stronger agreement) their ability (finding time, ease of implementation, confidence, comfort) to implement the treatment strategies.

Interview: Families also participated in a semi-structured interview to provide their opinion about the intervention.

InterventionToddlers & Families Together Program Eight weekly group sessions held on Saturday

mornings

CONCLUSION

The results from this SCD provide preliminary efficacy and social validity data supporting the Together program.

However, further study needs to test the program with a larger sample of children and families in randomized controlled trial.

Furthermore, additional analysis is required to examine caregiver outcomes of stress and coping as well as child outcomes of joint attention and play.

Overall, it may be beneficial to both toddlers and families to use a group-based model of intervention for families of young children with or at risk for ASD.

Results show increased caregiver implementation of strategies during intervention and demonstrated family acceptability of the intervention.

Joint EngagementCaregiver-Child Interaction Visual analysis indicates a functional relationship

between the intervention and percentage of time spent in a joint engagement state; specifically, increased level changes were observed during the intervention phases for all caregivers and their children.

Joint Engagement

RESULTS

Caregiver PerceptionsFurthermore caregiver responses to the questionnaire and interview indicated overall acceptability of the strategies and program.

Family DiaryMost family members felt comfortable and confident with the strategies but did note that it did take a little time to implement the strategies.

Family InterviewFamilies also reported that the family support/education sessions were the most helpful aspect of the intervention.

together@unc.edu

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number R40MC26197 and title Toddlers and Families together for grant amount $582,436 with 0% financed with nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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Garrett Nate Annie BenjaminGender Male Male Female MaleAge (months) 30 27 23 29

Race White

Bi-Racial: White,African

American

Bi-Racial: White,African

American

White

ADOS-2 Range of Concern Little-No Little-No Moderate-Severe Moderate-Severe

MSEL Early Learning Composite

97 71 77 86

Mothers Age (years) 31 27 42 ---Mothers Highest Level of Education

College College Graduate School ---

Employment Status Part Time Full Time Full Time Full Time

Intervention Schedule9:00 Check in: Free play9:15 Together Time: Welcome

9:30Learning session Toddler skills session Family support session

10:15 Snack & bathroom

10:45

Stations Toy Play Art Music & Games Together Play (CCX)

11:45 Together Time: Closing

TopicsJoint engagement

Practicing positive behaviors

Managing difficult behaviorsLookingPointingShowingPlaying

Pretending

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Finding Time Easy to Implement Feel Confident Feel Comfortable

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Implementation of Intervention Strategies

Garrett Nate Annie Benjamin

Opened my eyes and made me

more aware about the importance of attention and (object) play

Good to share with other parents

and know that [others] are dealing with

similar things