Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial

Abstract

Background Social and communication impairments are core deficits and prognostic indicators of autism. We evaluated the impact of supplementing a comprehensive intervention with a curriculum targeting socially synchronous behavior on social outcomes of toddlers with autism spectrum disorders (ASD). Methods Fifty toddlers with ASD, ages 21 to 33 months, were randomized to one of two 6-month interventions: Interpersonal Synchrony or Non-Interpersonal Synchrony. The interventions provided identical intensity (10 hours per week in classroom), student-to-teacher ratio, schedule, home-based parent training (1.5 hours per month), parent education (38 hours), and instructional strategies, except the Interpersonal Synchrony condition provided a supplementary curriculum targeting socially engaged imitation, joint attention, and affect sharing; measures of these were primary outcomes. Assessments were conducted pre-intervention, immediately post-intervention, and, to assess maintenance, at six-month follow-up. Random effects models were used to examine differences between groups over time. Secondary analyses examined gains in expressive language and nonverbal cognition, and time effects during the intervention and follow-up periods. Results A significant treatment effect was found for socially engaged imitation (p=0.02), with more than doubling (17% to 42%) of imitated acts paired with eye contact in the Interpersonal Synchrony group after the intervention. This skill was generalized to unfamiliar contexts and maintained through follow-up. Similar gains were observed for initiation of joint attention and shared positive affect, but between-group differences did not reach statistical significance. A significant time effect was found for all outcomes (p<0.001); greatest change occurred during the intervention period, particularly in the Interpersonal Synchrony group. Conclusions This is the first ASD randomized trial involving toddlers to identify an active ingredient for enhancing socially engaged imitation. Adding social engagement targets to intervention improves short-term outcome at no additional cost to the intervention. The social, language, and cognitive gains in our participants provide evidence for plasticity of these developmental systems in toddlers with ASD. http://www.clinicaltrials.gov/ct2/show/NCT00106210?term=landa&rank=3

Inhaled oxytocin increases positive social behaviors in newborn macaques

“…Synchronous communicative exchanges between infants and caregivers, such as these, are important for healthy development (for a review, see ref. 47), so increasing such exchanges could be beneficial to infants (48). This finding has several implications for possible early interventions promoting social behaviors in children whose social skills could be compromised, such as in autism (49).…”

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

“…Because few studies focused exclusively on this age group, studies in which participants included some children aged .3 years were assessed as long as there was sufficient information to draw inferences about younger children. The group reviewed additional reports, which have not been listed in Table 1, including single-subject studies, [39][40][41][42][43][44] other relevant studies, 16,[45][46][47][48][49][50] metaanalyses, 51,52 and reviews. [53][54][55][56] Compared with early intervention models evaluated for preschool-aged children (aged 3-5 years), programs for children aged ,3 years were more likely to use developmental approaches, more intensively involve parents, and target social communication.…”

“…Specifically, there were studies rated as having a strong quality of evidence but equivocal findings. 16 For example, a recent trial evaluated the ESDM in a brief format: 1 hour per week of parent training for 12 weeks, as opposed to the original ESDM, which involved 20 hours per week of therapist involvement plus additional parentmediated intervention for 2 years. 14 The study failed to detect improvements in parental intervention skill acquisition and child-related outcomes relative to community intervention controls.…”

Parent-Implemented Social Intervention for Toddlers With Autism: An RCT

“…In a cliniciandelivered 2-year RCT of the Early Start Denver Model, 20 significant effects were reported on child outcomes of developmental level and adaptive behavior but not on autism symptoms. In another 6-month RCT of an interpersonal synchrony supplement to classroom-based comprehensive intervention, 24,25 shortand long-term effects were reported on social communication, developmental level, and adaptive functioning. Autism symptoms improved during treatment, but improvements were not sustained.…”