Child-therapist interaction features impact Autism treatment response trajectories

BACKGROUND

Identifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated.

AIMS

The longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling.

METHODS AND PROCEDURES

N = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features.

OUTCOMES AND RESULTS

Baseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist's efficacy in child engagement, respecting children's timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment.

CONCLUSIONS AND IMPLICATIONS

Clinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.

Interpersonal synchrony: Interaction variables and gender differences in preschoolers with ASD

BACKGROUND

Females with ASD tend to be under-recognized as they might present a different symptom manifestation, better social abilities, and masking behaviors. Since the main limitation of current literature on gender differences is represented by focusing on broad constructs, research needs to prioritize narrower constructs related to the subdomains of social abilities. Hence, the aim of this work was to explore gender differences in Interpersonal Synchrony of children with ASD.

METHOD

N = 51 psychologist-child dyads, 25 females and 26 males participated in the study. An Observational Coding Scheme to study interaction features was applied to video-recorded sessions of the ADOS-2 administration.

RESULTS

Females presented more synchronous behaviors with shorter latencies. Their interplays were longer, more complex, more engaging and most frequently adequately concluded with respect to males. The complexity of interchanges, their total duration and the proportion of exchanges adequately terminated correlated with the Social Affect score, Personal-Social, and Language Quotients in females, but not in males. The success rate of psychologist proposals correlated with Language Quotient in both males and females. The number of exchanges positively correlated with the Performance Quotient in males. Despite females being significantly older than males, age-related differences did not emerge.

CONCLUSIONS

Our findings suggest the importance of studying gender differences with respect to interaction variables. Females may present better IS abilities which, in turn, may promote social and language development. Further, our results suggested that successful interactions seem to rely more on social abilities in females, while males appeared to rely more on performance skills.

Quantifying the Child-Therapist Interaction in ASD Intervention: An Observational Coding System

BACKGROUND

Observational research plays an important part in developmental research due to its noninvasiveness. However, it has been hardly applied to investigate efficacy of the child-therapist interaction in the context of naturalistic developmental behavioral interventions (NDBI). In particular, the characteristics of child-therapist interplay are thought to have a significant impact in NDBIs in children with autism spectrum disorder (ASD). Quantitative approaches may help to identify the key features of interaction during therapy and could be translated as instruments to monitor early interventions.

METHODS

n = 24 children with autism spectrum disorder (ASD) were monitored from the time of the diagnosis (T0) and after about one year of early intervention (T1). A novel observational coding system was applied to video recorded sessions of intervention to extract quantitative behavioral descriptors. We explored the coding scheme reliability together with its convergent and predictive validity. Further, we applied computational techniques to investigate changes and associations between interaction profiles and developmental outcomes.

RESULTS

Significant changes in interaction variables emerged with time, suggesting that a favorable outcome is associated with interactions characterized by increased synchrony, better therapist's strategies to successfully engage the child and scaffold longer, more complex and engaging interchanges. Interestingly, data models linked interaction profiles, outcome measures and response trajectories.

CONCLUSION

Current research stresses the need for process measures to understand the hows and the whys of ASD early intervention. Combining observational techniques with computational approaches may help in explaining interindividual variability. Further, it could disclose successful features of interaction associated with better response trajectories or to different ASD behavioral phenotypes that could require specific dyadic modalities.