2016 Gatlinburg Conference Poster
PS-88
Title: Toddlers and Families Together: Promoting Joint Engagement for Young Children with or at Risk for Autism Spectrum
Disorder
Authors: Connie Wong, Kathleen C. Gallagher, Kira Wong, Leonard Nieto, Shani Arbiv, Jessica Page
Introduction: Research on early intervention programs targeting toddlers with or at risk for autism spectrum disorder (ASD)
primarily involve individual sessions with the caregiver and child in the home which may be isolating or impractical for some
families. Given the importance of joint engagement to later development, in Toddlers and Families Together (Together), toddlers
and their families participate in eight weekly group sessions that take place during the weekend and focus on increasing joint
engagement with their child. Specifically, families have an opportunity to practice strategies and receive feedback within a
context of everyday routines and activities within 3-hour long group sessions that also include a family education/support
segment to learn and discuss strategies with a facilitator and other caregivers while the toddlers are engaged in various learning
activities. With an overarching goal of promoting joint engagement for children with ASD through the Together program, the
specific questions of this study include:
1.
2.
Does participation in the program result in changes in joint engagement during play interactions between the toddler
and his/her caregiver?
After participating, what are caregiver perceptions of the strategies and the program?
Methods: This study utilized a single case multiple baseline design across four toddlers (24-31 months) with or at risk for ASD
and their families that included an initial baseline period (of 4, 6, 8, or 10 weeks) followed by participation in the 8-week
Together program. The weekly sessions included a 10-minute video-recorded interaction between the child and the primary
caregiver that was coded for length of time the child was in a supported or coordinated joint engagement state. Caregivers were
also rated on eight items that were scored on a three-point Likert scale for implementation of strategies to promote joint
engagement. In addition, families participated in a semi-structured interview to provide their opinions about the intervention.
Results: Results show increases in the amount of time children spent in a joint engagement state as well as an increase in
caregiver implementation of strategies during intervention. Visual analysis indicates a functional relationship between the
intervention and duration of children's joint engagement with increased level changes observed during the intervention phases
for all children. Similar trends were found for caregiver's implementation of the strategies. Furthermore, most family members
felt comfortable and confident with the strategies but did note that it did take a little effort and time to implement the
strategies. They also reported that the family support/education sessions were the most helpful aspect of the intervention.
Discussion: The results from this study provide preliminary efficacy and social validity data supporting the Together program.
However, findings from our ongoing randomized controlled trial is needed to test the program with a larger sample of children
and families. Furthermore, additional analysis is required to examine caregiver outcomes of stress and coping as well as child
outcomes of joint attention and play. Overall, it may be beneficial to both toddlers and families to use a group-based model of
intervention for families of young children with or at risk for ASD.
References/Citations:
• Bakeman, R., & Adamson, L.B. (1984). Coordinating attention to people and objects in mother-infant and peer-infant
interaction. Child Development, 55, 1278-1289.