Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

Abstract

Background: Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. Methodology: We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. Discussion: Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. Trial registration: ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019.

Overcoming hurdles to intervention studies with autistic children with profound communication difficulties and their families

“…As part of the feasibility assessment, we are analysing the suitability and acceptability of candidate measures to produce predictive information at baseline and to assess sensitivity to change over time, including the Autism Impact Measure (AIM; Kanne et al, 2014 ) – a new measure developed for autism treatment studies which has not been tested on this population before. For more information on the rationale behind the selection of each measure, see our protocol ( McKinney et al, 2020 ).…”

“…Our parent-delivered, iPad-assisted intervention Point OutWords aims to train prerequisite or ‘back door’ skills for communication development ( Karanth et al, 2010 ), that is, fine and oral motor skills and understanding of symbolic representation. Within our heterogeneous sample, we also aim to evaluate for whom the intervention might be most effective, in terms of baseline measures and characteristics ( McKinney et al, 2020 ). Such moderating characteristics should be evaluated in intervention studies as no single intervention will be suitable for all children with profound autism.…”

“…We report on the lessons from recruiting and testing 30 non-verbal or minimally verbal children with autism for our Point OutWords intervention feasibility RCT (trial registration; ISRCTN12808402, protocol: McKinney et al, 2020 , website: http://PointOutWords.online/ ). This article is separate from our main feasibility results paper, forthcoming.…”

Application of intervention strategies for behavior management in autism spectrum disorder in childhood and adolescence. a systematic review

“…According to the aforementioned information, it was found that six studies compared the effectiveness of virtual reality with different strategies to improve communication, interaction among children, facial expression, visual and motor skills in sensory processing, as well as behavioral work for anxiety in children with autism spectrum disorder. (McKinney, et al, 2020;de Moraes, et al, 2020;Wieckowski, et al, 2019;Parsons, et al, 2019;Sotoodeh, et al, 2017;Conaughton, et al, 2017).…”

The Implementation of Application Software to Improve Verbal Communication in Children with Autism Spectrum Disorder: A Review

“…Unfortunately, finding an app that 'speaks' their mother-tongue language is often challenging [44]. In addition, the apps could be further enhanced by integrating the speech processing techniques for detecting correct verbal responses to encourage verbal communication [45].…”