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.

ACKNOWLEDGMENTS

Clinical Trials Number: NCT01013545. We thank the families and children who participated in this study. We thank the team of interventionists, coders, transcribers, and data analysts at our three sites: UCLA—Kathryne Krueger, Dalia Kabab, Caitlin McCracken, Julia Kim, Alison Holbrook, Abbey Hye, Kelsey Johnson; Vanderbilt University—Stephanie Jordan, Courtney Wright, Blair Burnette, Jennifer Nietfeld; Kennedy Krieger Institute—Philip Menard, Emily Watkins, Kerry Buechler, Christine Hess, Sarah Gardner.

Funding

This study was funded by Autism Speaks grant #5666, Characterizing Cognition in Nonverbal Individuals with Autism, awarded to the last author. We also acknowledge funding from the National Institutes of Health: R01DA039901 (Almirall, Nahum-Shani), R03MH097954 (Almirall), P50DA039838 (Almirall), and R01HD073975 (Kasari, Kaiser, Almirall, Shire, Lu, Nahum-Shani), and the Autism Speaks Mexiner Postdoctoral Fellowship in Translational Research (DiStefano).

Additional information

Funding

This study was funded by Autism Speaks grant #5666, Characterizing Cognition in Nonverbal Individuals with Autism, awarded to the last author. We also acknowledge funding from the National Institutes of Health: R01DA039901 (Almirall, Nahum-Shani), R03MH097954 (Almirall), P50DA039838 (Almirall), and R01HD073975 (Kasari, Kaiser, Almirall, Shire, Lu, Nahum-Shani), and the Autism Speaks Mexiner Postdoctoral Fellowship in Translational Research (DiStefano).