Exploring Predictors of Response to a Peer-mediated Communication Intervention for Minimally Verbal Preschoolers With ASD

Overview. This project will use a single group pre-post treatment design across four independent cohorts of children (n=8, 10, 11, and 11 per cohort). This design is appropriate because the purpose of this study is to examine predictors of treatment response and the intervention's efficacy has been documented in an RCT.

Research Team. Dr. Bourque (PI) was the lead investigator on a NIH funded R01, examining a peer-mediated SGD intervention for preschoolers with ASD, Co-PI of a RCT peer network intervention for elementary-age students with ASD (IES), and Co-PI of two NIH grants (R01, P01) to assess communication development of preschoolers with ASD/IDD using AAC. She has almost 20 years of established relationships with local districts recruiting participants, Dr. Boyd is PI of a NIH funded R01 grant focused on outcome measure development for children with ASD, and Co-I of an R01 focused on predictors of treatment response for children with ASD. Dr. Salley has extensive experience developing eye-tracking (ET) and bio-behavioral attention measures with infants/toddlers and is PI of a longitudinal study examining the development of early social/nonsocial attention (NIH). Dr. Fleming is Director of the Research Design and Analysis Unit in the Life Span Institute. She has participated as a quantitative methodologist on 38 NIH and USDE-supported grants. Consultants to the team bring specialized expertise: (1) Dr. Shic has contributed to the design of 50 ET paradigms and 6000 recorded eye tracking datasets, the majority at-risk for or diagnosed with ASD, and is thus well-prepared to provide guidance in ET methodology and analysis; (2) Dr. McPartland is PI of the NIH-funded Autism Biomarker Consortium for Clinical Trials, a large scale effort to evaluate the utility of ET and EEG biomarkers in ASD. He will assist in administration of ET paradigms and in data acquisition.

Sample and Recruitment. A total of N=40 children between the ages of 3-6 years will participate, with n=18 recruited in Year 1 (Cohort 1=8; Cohort 2=10) and n=22 in Year 2 (Cohort 3=11; Cohort 4=11). Participants will attend preschool with access to typically developing peers. ASD diagnosis will be confirmed by the Autism Diagnostic Observation Scale-2 and DSM-V criteria, with minimal verbal skills defined as less than 20 spontaneous words or symbols. Each child will demonstrate symbol discrimination skills by intentionally selecting preferred items in 80% of trials in two 1:1 adult sessions using a matching-to-sample procedure; children who do not meet this criteria will be excluded due to insufficient skills to benefit from SGD intervention. Recruitment will occur in local preschools and the Kansas Center for Autism Research and Training registry, which contains 3000+ families, with approximately 65% individuals with ASD. The investigators are confident they can recruit 40 children given the gradual recruitment plan in Year 1 and the teams established relationships with administrators. Two peers without disabilities from the same classroom (or school building) will be recruited for each child with ASD (n=36 peers Year 1; 44 Year 2; N=80 total). Teachers will recommend peers who meet a minimum 6 of 8 behavioral characteristics related to peer social responsiveness and fidelity in the prior RCT.

Pre-Treatment Standardized Measures. Three standardized measures will be administered at enrollment: (1) the Preschool-Language Scale-5 to describe children's expressive language and auditory comprehension skills, (2) the Early Years Battery of the Differential Ability Scales-II to assess cognitive abilities across verbal, nonverbal reasoning, and spatial clusters, and (3) the Vineland Adaptive Behavior Scales III-Parent Interview to describe communication and adaptive skills. Child language and cognitive scores will be used as indicators of global child characteristics and added as covariates to analytic models. All standardized tests and social variable measures will be administered by research staff naive to study hypotheses.

Measurement Contexts. Social attention and peer interest will be measured in three contexts at one time point, prior to the start of treatment: (1) semi-structured peer communication sample, (2) naturalistic observations, and (3) eye-tracking (ET) paradigms. The SGD will be available during contexts (1) and (2), and during breaks in context (3). The first context was used in the PIs R01 to measure communication and joint attention between children with ASD and peers; thus, the administration manual and reliability procedures already exist. In this study, codes will be modified to collect social attention and peer interest data. The PI has extensive experience developing direct observation coding systems and training staff to be reliable in collecting multifaceted communication and social behavior data for this population. Along with Dr. Salley's ET experience, our team is confident that collecting reliable data across the three planned contexts is feasible.