PMID 16712638
Connie Kasari, Stephanny Freeman, and Tanya Paparella, June 2006
UCLA, USA
Background
Children with ASD show a characteristic deficit in two categories, which are joint attention and symbolic play. Joint attention is the ability to switch one’s attention between another individual and an object. Symbolic play involves pretending that an object represents another object. Previous studies have shown that improvements in joint attention would increase language abilities, and that improvements in symbolic play would develop the ability to maintain social relationships.
Introduction
Goal: Analyze effectiveness of interventions for symbolic play and joint attention with randomized treatment and control groups.
Methods
Participants: 58 children aged between 3 and 4 years.The participants were randomly chosen from an early intervention program. All were boys. Participants underwent three experimental procedures in a controlled environment. The first, early social-communication scales, involved showing children a variety of different toys which were out of reach, testing for joint attention behaviors. The second, structured play assessment, involved presenting the participant with various toys and observing the level of interaction and how many different toys the participant played with in a 15 to 20 minute session. Structured play assessments were used to measure levels of symbolic play. The third, caregiver-child interaction, combined joint attention with symbolic play by having a 15 minute caregiver-child interaction session with toys. Treatment was 3 times a week with each session lasting about 5 to 8 minutes. Treatment lasted on average for 5 to 6 weeks. The treatment involved applied behavior analysis and responsive/facilitative interactive methods. The treatment was led by the child, with the experimenter following the child’s cues and using opportunities to gain a desired response from the child. Mastery was determined if the child had initiated and achieved a specific goal in three different ways, three times on both a table and the floor.
Results
The joint attention and symbolic play groups both showed significant improvements in joint attention compared to the control group for time (F(1, 55) = 4.13, p < .05) and group and time (F(2, 55) = 3.89, p < .05). The joint attention group showed no significant improvement compared to the symbolic play group in regards to initiating joint attention cues, but the joint attention group showed an improvement in responding to joint attention cues over time compared to the symbolic play and control groups (F(1,55) = 7.02, p=.01). Overall, though, the joint attention group showed no significant difference compared to the symbolic play group for joint attention. Findings for symbolic play showed significant improvements in the symbolic play group compared to the control group and the joint attention group. A significant main effect of group (F(1, 55) = 3.66, p < .05) and group and time (F(2, 55) = 9.46, p < .001) was found for child-initiated joint engagement. The joint attention group and the control group had no significant improvements in symbolic play when compared to each other.
Conclusion
Both joint attention and symbolic play were shown to improve over baseline in this study, and both showed that children could generalize these newly learned skills to other contexts outside of the controlled environment.
Discussion
A future direction of this study is to analyze the long-term effects this treatment has on children with ASD.
