NCSER-EIEL Goal 3: An Efficacy trial of J-EMT: Enhanced Milieu Teaching Language Intervention plus Joint Attention, Engagement and Regulation Intervention for Toddlers with Autism

The goal of the proposed project is to conduct an efficacy trial (Goal 3) to determine whether a combined intervention, J-EMT, based on blending two empirically based and manualized interventions [Enhanced Milieu Teaching (EMT, Kaiser, 1993) and Joint Attention, Symbolic Play and Regulation (JASPER, Kasari, Paparella, Freeman, & Jahromi, 2008)], improves social communication outcomes for young children with autism spectrum disorders (ASD). The target population is children ages 24 –36 months diagnosed with autism and their parents. The anticipated ethnic composition of the sample will be 31% African American, 55% Caucasian, 5% Asian, 3% Multiple and 8% Other, based on community demographics. The child sample is expected to be 80% male, and 90% of participating parents are expected to be lower to upper middle class mothers, based on our previous parent training studies. The study will be conducted in Nashville TN and Chicago, IL, primarily in families’ homes; this setting is typical for provision of language interventions for children under 36 months. The innovative J-EMT intervention, implemented by therapists and parents, will be compared to business as usual community treatment (BAU) for young children with autism in a randomized controlled trial enrolling 120 children and their parents. Children assigned to the J-EMT group will receive 48, 1-hour sessions (6 mos) of direct intervention at home that will include teaching their parents to implement J-EMT procedures across daily activities at home. Parents of children in both groups will receive reports of their children’s communication progress based on assessments and staff assistance in advocating for community services. Children in both groups may participate in community services as usual throughout the study and data will be collected on use of community services. The study design is a randomized controlled trial (J-EMT vs. BAU) using standardized and observational assessments of child communication and parent behavior. Children will be assessed at 3 primary time points (T1-before, T2-after intervention, and T3-at 6 months post-intervention) to compare outcomes on primary and secondary measures of communication development. Monthly assessments of child social communication in the clinic during and after the intervention will provide data for the description and comparison of individual language growth trajectories over a period of 12 months. For the majority of measures which are collected at T1, T2 and T3 linear ordinary least squares regression, with experimental condition, age and pre-test raw scores as covariates and experimental condition as the independent variable, will be used. For social communication, which is measured repeatedly over time for a total of 12 time points, multi-level growth modeling (MLM) with assessment points (time) nested within child will be used. Results from this study will indicate the efficacy of this variation of parent-plus-therapist implemented EMT (i.e., J-EMT) specifically tailored to the characteristics of young children with ASD. Thus, this project: (a) extends research on EMT to a new population of children, (b) provides evidence about the potential for reducing developmental delays in social communication by addressing related language, joint attention, and play behaviors, and (c) expands the developmental theory linking social communication development to joint attention, symbolic play and regulation. The results of this study will have important implications related to early intervention for young children with ASD and their f