Key Words: early intervention, prelinguistic milieu teaching, developmental delay, social interaction, play interventio

Citation Characteristics of Study Particpants

Girolametto, L., Verbey, M., & Tannock, R.

1994). Improving joint engagement in parent- Fourteen preschool-aged children with
child interaction: An intervention study. developmental delays and their mothers.
Journal of Early Intervention, 18(2), 155-167.

Franco, J.H., Davis, B.L, & Davis, J.L. (2013).
Increasing social interaction using prelinguistic
milieu teaching with nonverbal school-age
children with autsim. American Journal of
Speech-Language Pathology, 22, 489-502. doi:
10.1044/1058-0360(2012/10-0103)
Six children (between 5-8 years) with autism, English
as primary language, lack of communication like
vocalizations, eye gaze, or gestures, normal vision and
hearing, and expressive and receptive language
greater than 18 months

Yoder, P.J. & Warren, S.F. (1998). Maternal

responsivity predicts the prelinguistic Fifty eight children (between 17 and 36 months with
communication intervention that facilitates the production ability of 10 or fewer words, with no
generalized intentional communication. vision/hearing loss, and ability to hold object while
Journal of Speech, Language, and Hearing
rotating torso) with their parents
Research, 41, 1207-1219. doi: 1092-
4388/98/4105-1207
Kasari, C., Gulsrud, A.C., Wong, C., Kwon, S., &
Locke, J. (2010). Randomized controlled 38 caregivers and their toddlers (75% were male, 25%
caregiver mediated joint engagement female), child was under 36 months, met criteria for
intervention for toddlers with autism. Journal autism, and did not have additional syndromes
of Autism and Developmental Disorders, 40(9),
1045-1056. doi: 10.1007/s10803-010-0955-5

Schertz, H.H. & Odom, S.L. (2007). Promoting

joint attention in toddlers with autism: A
parent-mediated developmental model. 3 parents of toddlers with autism. All three
Journal of Autism and Developmental participants were mothers of boys,
Disorders, 37(8), 1562-1575. doi:
10.1007/s10803-006-0290-z

Debra Leach and Michelle LaRocque.

Increasing Social Reciprocity in Young Children
With Autism
teraction, play interventions, joint attention, joint engagement
Design of Study

12 weeks of 9 group
sessions and 3 home visits

Multiple baseline design,

3-10 sessions were
randomly selected for
each participant, 25-30
minute sessions
conducted in each
participant's home with a
parent/guardian

Randomized group
experiment (two groups),
4 times a week for 6
months
Randomized using a
random number method,
8 weeks with 30 minutes
of direct instruction in
each session (24 total
sessions, 3 days per week)

Single subject design,

focused in the families'
homes, parents requested
to spend 1 hour daily with
their child
s, joint attention, joint engagement
Intervention (IV)

Hanen Program encourages parents to increase the frequency of child's social interaction in naturally
occurring events by following the child's lead and responding contingently to the child's immediate focus.
Mothers were trained to facilitate joint engagement by using interaction-promoting strategies (signal for child
to interact, wait with anticipation) which encourage child's nonverbal or verbal participation in reciprocal
interaction, language-modeling strategies (responsive labels, expansions, extensions, and parallel talk) which
increase contingency of adult's responses to child's topic or focus, and child-oriented strategies (follow child's
lead, interpret child's cues, respond to child's focus of attention) which extend child's focus of attention and
play

Children were taught to use vocalizations, gestures and eye gaze using PMT techniques arranging the
environmnet and using play routines with the goal of creating opportunities for the child to initiate
communication, adult followed the child's attention and motivation and imitated the child's sounds. The adult
attempted to engage in turn taking with the child like joining in during interactive play by creating a game of
"catch". The adult conducted teaching episodes (about 1 per min) where child behavior was taught using a
sequence of prompts (verbal/gestural cues), model (gesture model/vocal model), and natural consequences
(compliance/imitation/recast). Adult would create a situation where child is likely to communicate.
Gestural/verbal prompts(indicating it was the child's turn) given if child did not attempt communication, wait
time used after to allow child to respond, adult modeled an appropriate response. Continuation with
interaction/routine if child still didn't engage. Avoidance of directive manner when prompting

To target proto-imperatives (requests for objects or actions)they first attempted to increase the probability of
establishing one or more play routines... Once a child engaged in 3 or more turns, the adult withheld their
turn... if child didn't respond to withheld turn or if they requested a continuation using a less mature behavior,
the trainer used prompting like "look at me". The prompting was later faded... If the child gave the targeted
behavior, the routine was continued and trainer gave specific feedback of the behavior "you looked at me!" If
child still did not ask that the routine continue, the trainer continued the routine anyway to maintain positive
affective milieu for teaching
Each intervention session included interventionist coaching of caregiver and child engaging in play routines
that were established through collaboration between parent and interventionist. Principles applied included
following the childs lead and interest in activities, imitating child actions, talking about what the child was
doing, repeating back what the child said, expanding on what the child said, giving corrective feedback, sitting
close to the child and making eye-contact, and making environmental adjustments to engage the child. Each
caregiverchild dyad received approximately 30 minutes of direct instruction, modeling, guided practice, and
feedback from the interventionist in each session.

To promote interaction, parents played face-to-face games using toys that were present in the home. Two
levels comprised each phase, the first relying on parent initiative and the second seeking more initiative from
the child. Rather than rigid prescriptions, suggested activities were intended to help parents envision ideas of
their own to encourage their childs best response. Focusing on faces strategies were aimed at increasing child
tolerance for looking at faces, the single greatest difference found between 12-month-olds later identified
with and without autism. Examples included using interactive face-oriented vocal games with strong rhythms,
pairing looks to the face with expressions of affection, making the parents face hard to avoid, imitating facial
gestures, and mirror play. Turn-taking activities aimed to promote reciprocity, a component of joint attention,
and included imitation of child-initiated gestures, responding to child actions as if they were intended as
interactions, embedding parents actions into the childs isolated repetitive play, following the childs lead,
pausing for the childs response after the parents turn, and playing teasing games. Responding to joint
attention strategies targeted shared attention to objects through supportive parent initiations. For example,
parents were encouraged to introduce a toy after establishing eye contact, hold the toy close to their faces
when offering it to the child, and use excitement or suspense to encourage the child to look between a toy
and the parents face. Finally, initiating joint attention activities encouraged the child to engage the parents
attention in relation to an object by expressing excitement about the childs play with a toy or introducing
surprise bags or wrapped packages.
Dependent Variable

Interactive engagement (elicited joint engagement, supported joint engagement, and

coordinated joint engagement)- significant effects found, 42 second increase in total duration
time of joint engagement, more frequency episodes of joint engagement
Unitary engagement (the child visually monitors the partner's action or is exclusively engaged
with an object ora person, but not both at the same time)- decrease in unitary engagement was 1
minute

Child: All participants demonstrated an increase in the maximum number of communication acts
in a routine per session, follow up data determined that most participants were able to maintain
their increased ability to sustain interaction during a routine. All participants increased in rates of
initiation of intentional communication compared to baseline.

Parent: PMT mothers interpreted their child's nonverbal behavior as communicative more often
and more confidently, they used more prompts for communication and more instances of vocal
imitation. The PMT trainers used more specific acknowledgment.
Chidren: PMT children used more communication acts when the parents
were more responsive.
Child: Children in the immediate treatment group engaged in less object-focused play and more
joint engagement compared to children in the waitlist group. No significant differences between
groups for unengagement. IT children showed greater responsiveness to joint attention than the
WL group. IT children displayed more types of functional play acts compared to WL group. IT
children didn't show greater initiations of joint attention or increased diversity of symbolic play.
1 year follow up: Maintenance occurred for
the states of object engagement and responsiveness to join attention. Improved skills in regards
to types of functional play acts for IT children
Parent: Caregiver involvement was not related to the duration of object
engagement or the unengaged/other category in the caregiverchild dyad at posttreatment, nor
did it predict increases in play or joint attention skills

Child: They looked at their parent's face more and had an increase in turn taking skills
Parent: They showed an interest in learning about autism and progressed from focusing primarily
on their childrens limitations toward increasing acceptance and recognition of child potential,
one parent invested in their own personal development
Personal Evaluation

Each child varied in interests,

but overall the findings were
effective