Developmental and Augmented Intervention for FacilitatingExpressive Language
This project addresses the development of novel treatment methods for children who are nonverbal (not using spoken language) by 5 years of age despite involvement in traditional intervention programs. In previous work, this team of investigators has developed novel treatments with significant improvements in expressive language development for children who were nonverbal at the beginning of treatment. Because there currently are no data suggesting a superior intervention for children with ASD who are nonverbal, we propose to test our novel interventions in two phases. First, we will integrate common elements of the interventions and maintain unique elements (choice of verbal or AAC mode) to create two contrasting interven- tions. Both interventions develop the child's joint attention and engagement with others with one focusing primarily on spoken communication, and the other on communication using an alternative and augmentative communication system. The two interventions will be piloted on 2 children at each site in order to further develop and manualized the interventions. Next, we propose to test the interventions by employing a sequential multiple assignment randomized trial (SMART) design in order to develop evidence based adaptive intervention strategies that can then be evaluated in a subsequent RCT. Consistent with the SMART design, delivery of the intervention will occur in two stages. At stage 1, ninety children between 5 and 8 years of age with fewer than 5 spoken words (30 children at each site) will be randomized to one of the initial treatments (JA-EMT or JA-AAC) for 12 weeks of intervention. In Stage 2, we will continue the same treatments for responders of both treatments and differential treatment sequences will be implemented for nonresponders. For non-responders to JAE-AAC, we will increase the intensity of treatment. For non-responder of JAE-EMT, we will randomize children to two Stage II treatments: JAE-AAC or more intense JAE-EMT. This design will allow us to test the initial effects of the two novel treatments, and the effect of alternative treatments for children who are nonresponders to these treatments. Information gained from this study will yield important information on children's response to treatment and how to adapt treatment to a child's changing course of improvement.