Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders

Yoder P, Stone WL

Journal of Consulting and Clinical Psychology 2006; 74(3): 426-435

Question: Is it possible for certain communication interventions to improve joint attention, turn taking, and initiating requests for help in nonverbal preschool children with ASD?

Background: Children with ASD have problems with joint attention, taking turns when interacting with others, and requesting objects or getting help with an activity. Some researchers think that, by improving these skills, the severity of the child’s ASD symptoms can be reduced. Getting nonverbal children with ASD to make requests and to express their interests and thoughts is very difficult as they seem to have little or no interest in communicating with other people. Programs that can be shown to improve these areas of deficit would enhance their life quality.

Design: A randomized two-group comparison study.

Setting: A university clinic in the U.S.

Participants: 36 children between 18 and 60 months of age, who were nonverbal and had no hearing or other sensory problems, took part in the study.

Intervention: The children were assigned to receive weekly 20 minute sessions of either the Picture Exchange Communication System (PECS) or Responsive Education and Prelinguistic Milieu Teaching (RPMT) for a period of six months. Each of the interventions had both a parent and a child component.

Main Outcome Measures: The children were assessed at the beginning of the study using the Early Social Communication Scales (ESCS), during an unstructured play session with an examiner, and during a free play session with a parent or other primary caregiver.

Main Results: Positive changes were associated with both interventions but the two interventions had different results. RPMT helped the children learn how to take turns and got them to initiate joint attention with an adult even outside of the research laboratory more often than did PECS. The children who were treated with PECS learned to make requests more often than the children in RPMT, including those who showed little evidence of this skill prior to treatment.

Conclusions: Both of these interventions had a positive effect on the communication skills of children with ASD. However, each showed effectiveness in improving different types of skills. PECS influenced requests made to adults and peers more than RPMT. The effect was shown even in children who did not know how to do so prior to the intervention. Children in the RPMT group learned how to take turns and to initiate joint attention with an adult. It may be that a combination of elements from both programs will best benefit the child.