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School-Age Children with Autism with Limited Expressive Language Skills: An Intervention Study

Principal Investigator:
Rebecca
Landa

This project will address a major challenge to the field of autism research: improving expressive communication in children with autism who have reached school age but have not acquired functional spoken language (non-verbal school aged children with autism; NVSACA).

This project will provide an innovative intervention to improve expressive communication in NVSACA that addresses all of these developmental systems based on the (a) literatures on autism intervention and information processing, developmental cognitive sciences, applied behavior analysis, and augmentative and alternative communication (AAC); (b) investigative team’s years of clinical experience with the target population; and (c) research experience with NVSACA obtained through the CCNIA study (Autism Speaks High Risk, High Impact study; PI’s Kasari, Kaiser, Landa; Co-investigator Mathy ) and the RO1 for which the proposed study is a supplement.

Participants in the supplemental study will be school-aged children who completed one of two intensive (5 hours per week at school) interventions through a multi-site intervention study currently being conducted at the Center for Autism and Related Disorders (CARD): Multisite RCT of Early Intervention for Spoken Communication in Autism (NA_0028617- ICAN). Of the six children who have completed this intervention thus far, only one has shown robust expressive language improvement. This indicates that this intervention may lack ingredients that uniquely enhance expressive language development for children with autism. Thus, although joint attention is a known predictor of language gain, Kasari et al.’s (2008) report reveals that highly focused interventions targeting joint attention may be insufficient to advance expressive language development in low verbal children with autism. More explicit language instruction may be needed to activate expressive language gains. This study will be located at Kennedy Krieger. Neither UCLA nor University of Rochester will be involved in this study nor will there be data sharing.

The aims of this research are as follows:

o Aim 1. The proposed intervention will specifically target receptive vocabulary because it contributes to proficiency in expressive communication.
o Aim 2. Social impairment will be targeted as it relates to communicative engagement including:

  1. ability to use others’ cues (e.g., directional gaze cues, gestures) to attend to relevant salience pertinent for language learning;
  2. initiation of social communication; and
  3. expression of contextually appropriate language content.

o Aim 3. Motor impairments as they relate to communication via speech and gesture will be addressed through direct and semi-structured instruction in use of Augmentative and Alternative Communication (AAC). Integration of AAC into intervention will not interfere with, and is likely to promote, acquisition of spoken language.

Fifteen children who completed the RO1 ICAN intervention and follow-up testing but continue to have minimal functional spoken language will be participants in this study. After eligibility is established, participants will be randomly assigned to a baseline duration of one week, two weeks or three weeks before the start of active treatment. Once the baseline duration is completed, participants begin active treatment one hour of intervention three days per week in the participants' school setting. In month 2, weekly teacher trainings begin. In month 5, weekly parent trainings begin to improve the child’s generalization of skills and teach parents the strategies implemented in their child’s treatment. Post-baseline and post-treatment assessments will be completed in the lab at a time that is convenient for the participants' families.
 

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