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Study Summary:
The goal of this study is to construct and test an adaptive intervention for children with ASD who are minimally verbal. In this study, participants are first randomized to one of two study groups:

1.  Joint Attention, Symbolic Play, Engagement, and Regulation with Enhanced Milieu Teaching (JASP-EMT)
  2. Discrete Trial Training for Core Features of ASD (CORE-DTT).

Both interventions target spontaneous communication using different styles of treatment:

1.  JASP-EMT embeds naturalistic teaching into play routines and daily activities
  2. DTT is structured, adult-lead, and taught with direct-instruction.
Participants are then assigned to a different treatment group based on their response to the intervention.

Research Design:

The target population for this study is school-aged children (4 years 6 months to 8 years 3 months) with ASD who are minimally verbal (i.e. fewer than 20 functional words used spontaneously) and have a minimum developmental age of at least 18 months on non-verbal assessments. From beginning to end, this study takes approximately 36 weeks (about 9 months) to complete. Interventions are performed at the child’s school and, in some cases, home. The study is broken up into several phases, with assessments, two rounds of treatment, randomization points, and follow-up assessments. The study compares two different treatment styles: JASP-EMT and CORE-DTT.

JASP-EMT (Kasari et al., 2014) is a behavioral intervention built on the belief that communication develops during interactions with a social partner. The intervention combines strategies from two different interventions: Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER: Kasari et al., 2006, 2008; 2010; 2014) and Enhanced Milieu Teaching (EMT: Kaiser & Roberts, 2011). The interventionist uses these strategies during child-led play activities to help facilitate a shared state of engagement between the adult and child, meaning the child notices both the shared activity as well as their play partner. During these shared activities, the adult focuses on targeting early social communication skills.

  CORE-DTT (Smith et al., 2001; Whalen & Schreibman, 2003) is a behavioral intervention that emphasizes adult-led instruction. The interventionist uses Discrete Trial Teaching (DTT) methods to target core communication skills. The goal of CORE-DTT is to help children be successful in learning communication skills by breaking these skills down into small steps, providing direct instruction on each step, and reinforcing (e.g., with praise or access to preferred items) children for demonstrating skills.

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