Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play
Open accessAbstract
Objective This study examines the cognitive and language outcomes of children with an autism spectrum disorder (ASD) over a five -year period after receiving targeted early interventions that focused on joint attention and play skills. Method Forty children from the original study (n = 58) had complete data at the five year follow up. Results 80% of children had achieved functional use of spoken language with baseline play level predicting spoken language at the five -year follow- up. Of children who were using spoken language at age eight years, several baseline behaviors predicted their later ability, including earlier age of entry into the study, initiating joint attention skill, play level, and assignment to either the joint attention or symbolic play intervention group. Only baseline play diversity predicted cognitive scores at age eight. Conclusions This study represents one of the only long term follow up studies of children who participated in preschool early interventions aimed at targeting core developmental difficulties. The study findings suggest that focusing on joint attention and play skills in comprehensive treatment models is important for long term spoken language outcomes.
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- Findingown data
At baseline, the 8 children who could not achieve EVT scores at the five-year point had an average play level of 3.3 (SD=1.1), while the 32 children who could had an average play level of 6.7 (SD=2.0).
“At baseline, the average play level of the 8 children who were unable to achieve scores on the EVT at the 5 -year point was 3.3 (SD=1.1) (essentially discriminate acts with objects), while the average play level of the other 32 children was 6.7 (presentation combinations) (SD=2.0) at baseline.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Eighty percent of the children had achieved functional spoken language by age 8 to 9 years.
“80% of children had achieved functional use of spoken language with baseline play level predicting spoken language at the five -year follow- up.”
- Also stated in: § Discussion · plain
“The majority of children we tested at the follow up (80%) had useful, functional spoken language by age 8-9 years consistent with other longitudinal studies of children with autism.27,35”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Also stated in: § Discussion · plain
- Findingown data
Baseline play level predicted spoken language at the five-year follow-up.
“baseline play level predicting spoken language at the five -year follow- up.”
- Also stated in: § Descriptive data at follow up · plain
“The only predictive variable was the initial play level (PLEVEL) (X2=18.15, p<.01, R2=.58).”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Also stated in: § Descriptive data at follow up · plain
- Findingown data
Only baseline play diversity predicted cognitive scores at age 8.
“Only baseline play diversity predicted cognitive scores at age eight.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Children who showed more functional play types at baseline obtained better cognitive scores.
“Children who showed more functional play types at baseline obtained better cognitive scores.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
The difference between the joint attention and symbolic play treatment groups on the language measure was non-significant (p=.61).
“The difference between the treatment groups was non-significant (p=.61).”
Quote in the paperNot a substantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
On average, children gained 1.1 (SE=.3) standard score in spoken vocabulary per month earlier entry into treatment.
“On average, the children gained a standard score of 1.1 (SE=.3) in spoken vocabulary ability per month that they enter the treatment earlier”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
For the EVT at age 8, the predictor set identified by forward hierarchical regression included age at first assessment, joint attention initiations, play level, and treatment assignment (F(5,26)=9.22, p<.01, R2=.57).
“For the EVT, the predictor set identified by the forward hierarchical regression included Age at the first assessment, joint attention initiations, play level and treatment assignment (F(5,26)=9.22, p<.01, R2=.57).”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
For the 32 children who completed both the DAS and EVT, functional play types was the only predictor selected for overall cognitive ability (F(1,30)=14.62, p<.01).
“For overall cognitive ability, measured by the DAS, the only predictor selected from the candidate set was functional play types (F(1,30)=14.62, p<.01).”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Spoken vocabulary increased by 5.8 (SD=1.3) per increase in baseline play level.
“Similarly, spoken vocabulary ability increased by 5.8 (SD=1.3) per increase in play level at baseline.”
Quote in the paperNot a substantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Chronological age at the beginning of the study predicted 14% of the variability in spoken vocabulary ability at age 8 (p=.03).
“The only demographic variable defined above, chronological age at the beginning of the study predicts by itself 14% of the variability of spoken vocabulary ability at age 8. This contribution is significant (p=.03).”
Quote in the paperNot a substantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Children gained 2.1 (SE=.9) standard score in spoken vocabulary per one frequency increase in joint attention initiations.
“and they gain a standard score of 2.1 (SE=.9) in spoken vocabulary ability per one frequency increase in joint attention initiations.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Each one-unit increase in functional play types was associated with a 2.12 (SE=.55) standard score increase on the DAS.
“For a one unit increase in functional play types, there was a 2.12 (SE=.55) standard score increase on the DAS.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Children with higher play levels at ages 3 to 4 were categorized in the functional spoken vocabulary group at the five-year follow-up.
“Children with higher play levels when they were 3-4 years of age were categorized in this group at the five year follow up.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Children who demonstrated simple combination play at ages 3 to 4 were able to use functional spoken language, unlike children who played with objects indiscriminately or with simple discriminations.
“Children who could demonstrate simple combination play at age 3-4 years were able to use functional spoken language versus children who played with objects indiscriminately, such as mouthing or banging, or with simple discriminations of pushing a pop-up toy.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Play level added a unique 21% of explained variance beyond demographics and joint attention (p=.03).
“The unique contribution of play level beyond this is another 21% (p=.03)”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Initiation of joint attention added 22% explained variance in spoken vocabulary, for a total of 36% (p<.01).
“Initiation of joint attention adds an additional 22% of explained variance, for a total of 36% of the explained variance (p<.01).”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
The model including all predictors explained about 64% of the variability in spoken vocabulary ability at the five-year follow-up.
“The model including all these predictors explains about 2/3 (64%) of the variability of spoken vocabulary ability at the 5 year follow-up point”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Findingown data
Treatment assignment added 7% of explained variance after controlling for the other variables (p=.03).
“and even after controlling for these variables treatment assignment adds another 7% (p=.03).”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Study design and conductown data
Forty of the 58 children from the original study returned for the five-year follow-up assessments.
“Forty children from the original study (n = 58) had complete data at the five year follow up.”
- Also stated in: § Participants · plain
“Of the 58 children in the original study, 40 children returned for the five -year follow-up assessments.”
Quote in the paperNot a substantial claim - Also stated in: § Participants · plain
- Study design and conductown data
The original sample was randomized to a joint attention group of 20 children, a symbolic play group of 21 children, and a control group of 17 children.
“The sample consisted of 20 children in the joint attention (JA) group, 21 children in the symbolic play (SP) group, and 17 children in the control (CO) group.”
Quote in the paperNot a substantial claim - Study design and conductown data
The distribution of returning and non-returning children across the three treatment groups did not differ significantly.
“These ratios are not different from the ratios in the returning children (15 (37%), 14 (35%) and 11 (27%) respectively, X2(2)=0.55, p=.76).”
Quote in the paperNot a substantial claim - Premisecitation
Two parent education studies found neither had significant main effects on language outcomes for the experimental intervention compared to a no-treatment control group.
“but neither study found significant main effects on language outcomes for the experimental intervention compared to a no-treatment control group.22,23”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [22] Green, 2010, Parent-mediated Communication-focused Treatment in Children with Autism (PACT): a randomized controlled trial, Lancet source
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- cites [23] Carter, 2011, A randomized controlled trial of Hanen's ‘More Than Words’ in toddlers with early autism symptoms, J Child Psychol Psychiatry source
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- Premisecitation
In a randomized controlled study, focused joint attention content delivered by skilled interventionists for 30 minutes daily over an average of 6 weeks and layered into an intensive early intervention program of 30 hours per week produced significant effects on joint attention skills.
“For example, significant effects on joint attention skills were found in a study in which focused content on joint attention was delivered by skilled interventionists for 30 minutes daily over an average of 6 weeks and layered into an intensive early intervention program of 30 hours per week.25”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] Kasari, 2006, Joint attention and symbolic play in young children with autism: a randomized controlled intervention study, J Child Psychol Psychiatry source
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- Interpretationown data
Focusing on joint attention and play skills in comprehensive treatment models is important for long-term spoken language outcomes.
“The study findings suggest that focusing on joint attention and play skills in comprehensive treatment models is important for long term spoken language outcomes.”
Quote in the paperSubstantial claim- Rests on an assumption: Early skills in joint attention and play are rarely assessed before and after intervention, so little is known about how they change with specific interventions and whether changes in these skills account for improvements in developmental outcomes.
- The authors state this as an assumption: Joint engagement between parent and child serves as a platform for the continued development of social, communication, and language skills over time.
- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Premisecitation
Longitudinal studies document that these early skills are important to later developmental outcomes, particularly spoken language.
“Longitudinal studies document the importance of these early skills to later developmental outcomes and particularly spoken language, a core developmental problem of autism.1,3”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Charman, 2003, Predicting language outcome in infants with autism and pervasive developmental disorder, Int J Lang Commun Disord source
Not checked in the free run.
- cites [3] Mundy, 1990, A longitudinal study of joint attention and language development in autistic children, J Autism Dev Disord source
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- Premisecitation
In that study, children receiving the play intervention also demonstrated significantly improved language scores one year later.
“In this study, children receiving the play intervention also demonstrated significantly improved language scores one year later”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] Kasari, 2008, Language outcome in autism: randomized comparison of joint attention and play interventions, J Consult Clin Psychol source
Not checked in the free run.
- Interpretationown data
These data lend further support to focusing on early developmental skills as a means of improving language outcomes.
“These data lend further support to focusing on these early developmental skills as a means of improving language outcomes.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Interpretationreasoning
The difference in findings between the current study and other studies targeting social communication could be attributed to differences in the density of the experimental treatments and the additional background hours of early intervention.
“Thus, the difference in findings between the current study and other studies targeting social communication skills could be attributed to differences in the density of the experimental treatments and the additional background of significant hours of early intervention.”
Quote in the paperNot a substantial claim- Rests on an assumption: Additional community interventions received after the experimental phase did not differ systematically between treatment groups in ways that affect long-term language outcomes.
- Premisecitation
That seven-year follow-up study did not examine early core social communication skills as predictors of later language and cognition.
“This study did not examine early core social communication skills as predictors of later language and cognition.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] Magiati, 2011, Patterns of change in children with Autism Spectrum Disorders who received community based comprehensive interventions in their pre-school years: A seven year follow-up study, Res Autism Spectr Disord source
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- Premisecitation
Early difficulties in ASD center primarily on social and communication skills such as joint attention, imitation, affective sharing, and object play.
“These early difficulties center primarily on social and communication skills, such as joint attention, imitation, affective sharing, and object play skills.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Charman, 2003, Predicting language outcome in infants with autism and pervasive developmental disorder, Int J Lang Commun Disord source
Not checked in the free run.
- cites [2] Mundy, 1986, Defining the social deficits of autism: the contribution of non-verbal communication measures, J Child Psychol Psychiatry source
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- Premisecitation
Initiating joint attention at age two was associated with better language outcomes at age five.
“initiating joint attention at age two was associated with better language outcomes at age five,5”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Thurm, 2007, Predictors of language acquisition in preschool children with autism spectrum disorders, J Autism Dev Disord source
Not checked in the free run.
- Interpretationreasoning
Dose is likely important.
“Dose is also likely important.”
Quote in the paperNot a substantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Interpretationown data
Targeted interventions on core deficits are important to later developmental outcomes.
“In summary, this study provides evidence that targeted interventions on core deficits are important to later developmental outcomes.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Rests on an assumption: Additional community interventions received after the experimental phase did not differ systematically between treatment groups in ways that affect long-term language outcomes.
- Interpretationown data
The current study's data are inconsistent with a prior non-experimental follow-up that found no younger age advantage on later cognitive and language outcomes.
“Thus, our data are inconsistent with the foregoing study but may be explained by several factors including fewer hours of intervention per week in the non-experimental study, and the recruitment of all children from the same early intervention program in the current study.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] Magiati, 2011, Patterns of change in children with Autism Spectrum Disorders who received community based comprehensive interventions in their pre-school years: A seven year follow-up study, Res Autism Spectr Disord source
Not checked in the free run.
- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Interpretationown data
Timing and content (joint attention, play) of early interventions are implicated as potentially important active ingredients.
“Implicated are the timing and the content (joint attention, play) of early interventions.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Interpretationown data
Treatment effects were long lasting in this study.
“Importantly treatment effects were long lasting in this study”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Rests on an assumption: Additional community interventions received after the experimental phase did not differ systematically between treatment groups in ways that affect long-term language outcomes.
- Premisecitation
Early skills may affect language outcome because they require a shared focus of attention that enables the child to acquire socially learned skills such as language.
“Theoretically, these early skills may affect language outcome because they require a shared focus of attention that enables the child to acquire the types of skills that are socially learned, such as language.7,8”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [7] Adamson, 2004, The development of symbol-infused joint engagement, Child Dev source
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- cites [8] Tomasello, 1995, Joint attention as social cognition
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- Interpretationown data
These data represent some of the first to demonstrate long-term effectiveness of an intervention focused on early core deficits in autism.
“Thus these data represent some of the first to demonstrate the long term effectiveness of an intervention focused on early core deficits in autism.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Rests on an assumption: Additional community interventions received after the experimental phase did not differ systematically between treatment groups in ways that affect long-term language outcomes.
- Premisecitation
Evidence shows that comprehensive early interventions are effective on developmental outcomes when delivered with intensity, at least twenty hours per week for several years.
“We also have amassed a great deal of evidence of the effectiveness of comprehensive early interventions on the developmental outcomes of children with ASD when interventions are delivered with intensity, at least twenty hours per week for several years.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Virues-Ortega, 2010, Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes, Clin Psychol Rev source
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- Premisecitation
In that study, children also demonstrated significantly greater spoken language scores one year after the end of intervention.
“Not only did joint attention skills improve relative to the control group but children also demonstrated significantly greater spoken language scores one year after the end of intervention.26”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] Kasari, 2008, Language outcome in autism: randomized comparison of joint attention and play interventions, J Consult Clin Psychol source
Not checked in the free run.
- Premisecitation
Responding to joint attention at ages three to five predicted better language outcomes one year later and eight years later.
“responding to joint attention at age three to five years predicted better language outcomes a year later3 and eight years later.6”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [3] Mundy, 1990, A longitudinal study of joint attention and language development in autistic children, J Autism Dev Disord source
Not checked in the free run.
- cites [6] Sigman, 1999, Social Competence in Children with Autism, Down Syndrome and Developmental Delay: a Longitudinal Study, Monogr Soc Res Child Dev
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- May combine two claims. 16
- Classified as probably not a substantial claim. 8
May combine two claims.
Findingown dataAmong children who were using spoken language at age 8, earlier age of entry into the study, initiating joint attention skill, play level, and assignment to the joint attention or symbolic play intervention group predicted later ability.
“Of children who were using spoken language at age eight years, several baseline behaviors predicted their later ability, including earlier age of entry into the study, initiating joint attention skill, play level, and assignment to either the joint attention or symbolic play intervention group.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
May combine two claims.
Findingown dataThe joint attention treatment group scored on average 12.5 (SE=5.8) points higher than controls on the language measure, and the symbolic play group scored 10.6 (SE=6.2) points higher than controls.
“The JA treatment group scores on average 12.5 (SE=5.8) points higher than controls on the language measure, and the SP treatment group scores an average 10.6 (SE=6.2) points higher on the language measure than the control group.”
- Also stated in: § Discussion · boosted
“Importantly treatment effects were long lasting in this study with the joint attention intervention group gaining 12.5 expressive language standard score points and the play group 10.6 points above the control group.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
- Rests on an assumption: Additional community interventions received after the experimental phase did not differ systematically between treatment groups in ways that affect long-term language outcomes.
- Also stated in: § Discussion · boosted
May combine two claims.
Findingown dataSpoken vocabulary at the five-year follow-up was predicted by beginning intervention at an earlier age, initiating more joint attention, demonstrating higher play levels, and receiving the experimental interventions.
“Thus, beginning intervention at an earlier age, initiating more joint attention, demonstrating higher play levels and receiving the experimental interventions yielded greater spoken vocabulary scores at the five year follow up.”
Quote in the paperSubstantial claim- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenAll assessments were administered by testers who were blind to group status and were not part of the original RCT.
“Testers who were blind to group status and who were not part of the original RCT study administered all assessments.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataAt follow-up, 32 of the 40 children met the basal criteria for functional language on the EVT and were tested with the EVT and DAS.
“Of the 40 children, 32 met the basal criteria of functional usage of language on the Expressive Vocabulary Test,30 and were tested with this measure and the Differential Abilities Scale (DAS).31”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [30] Williams, 1997
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- cites [31] Elliott, 1993, Differential Abilities Scale (DAS), Child Assessment News
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May combine two claims.
Study design and conductown dataInter-rater reliability for the SPA was high, with ICC values of .97 for functional play types, .99 for symbolic play types, and 1.0 for play level.
“Inter rater reliability of blinded coders (ICC) was .97 for functional play types, .99 for symbolic play types and 1.0 for play level.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataInter-rater reliability for the ESCS was high, with ICC values of .79 for joint attention initiations and .82 for responses.
“Inter-rater reliability was high between blinded coders, ICC=.79 for initiations and .82 for responses.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataBlinded coders rated the PCX tapes with ICC values ranging from .78 to 1.0.
“Blinded coders rated tapes with ICC values ranging from.78 to 1.0.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe original randomized controlled trial enrolled 58 children with ASD who were under 5 years old, had no seizures or medical co-occurring conditions, and met diagnostic criteria on the ADI-R and ADOS.
“The original randomized controlled trial (RCT) consisted of 58 participants who met the following inclusion criteria: a diagnosis of ASD on the Autism Diagnostic Interview- Revised28 and the Autism Diagnostic Observation Schedule,29 no seizures or medical co-occurring conditions and under 5 years of age.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [28] Lord, 1994, Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders, Journal of Autism and Developmental Disorders source
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- cites [29] Lord, 2001
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May combine two claims.
PremisecitationThere is ample evidence that early skills are important to later spoken language outcomes in children with autism and that they should be teaching targets for early intervention programs.
“There is ample evidence that these early skills are important to later spoken language outcomes in children with autism and that they should be teaching targets for early intervention programs.1,15”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Charman, 2003, Predicting language outcome in infants with autism and pervasive developmental disorder, Int J Lang Commun Disord source
Not checked in the free run.
- cites [15] Kasari, 2002, Assessing change in early intervention programs for children with autism, J Autism Dev Disord source
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May combine two claims.
PremisecitationGreater change is identified in cognitive developmental domains compared to spoken language, with language outcomes requiring longer durations of intervention.
“In general, greater change is identified in cognitive developmental domains compared to spoken language, with language outcomes requiring longer durations of intervention.18”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18] Virues-Ortega, 2010, Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes, Clin Psychol Rev source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe EVT used in the current study does not capture more complex language use, including pragmatics of language.
“The EVT used in the current study does not capture more complex language use including pragmatics of language.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationAcquiring spoken language before age five has been heralded as the single most important achievement leading to the best social outcomes for children with autism.
“Indeed, acquiring spoken language before age five has been heralded as the single most important achievement leading to the best social outcomes of children with autism.9,10,11,12”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [9] Billstedt, 2005, Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood, J Autism Dev Disord source
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- cites [10] DeMyer, 1973, Prognosis in autism: a follow-up study, J Autism and Childhood Schizophr source
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- cites [11] Rutter, 1967, A five to fifteen year follow up of infantile psychosis: II. Social and behavioral outcomes, Br J Psychiatry source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMotor imitation skills at age two led to greater language at age four.
“motor imitation skills at age two led to greater language at age four,4”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] Stone, 2001, Predicting spoken language level in children with autism spectrum disorders, Autism source
Not checked in the free run.
May combine two claims.
PremisecitationIn two randomized controlled experiments of comprehensive intervention, spoken language standard scores significantly improved only after two years of intensive treatment in one study and were non-significant in the other.
“For example, in two randomized controlled experiments examining outcomes of comprehensive intervention, spoken language standard scores significantly improved only after two years of intensive treatment in one study19 and were non-significant in the other.20”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19] Dawson, 2009, Randomized, controlled trial of an intervention for toddlers with autism: the early start denver model, Pediatrics source
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- cites [20] Smith, 2000, Randomized trial of intensive early intervention for children with pervasive developmental disorder, Am J Ment Retard source
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May combine two claims.
Study design and conductnone givenThe original study was a randomized controlled trial that systematically tested whether the content of early interventions led to improved outcomes.
“One is that the original study was a randomized controlled trial that systematically tested whether the content of early interventions led to improved outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
Premiseown dataIn a toddler classroom study, children in the experimental classroom showed significantly better imitation skills at the end of treatment compared to controls, but no other group main effects were noted at the end of treatment or in cognitive and language outcomes six months later.
“Compared to children in the control classroom, the children in the experimental classroom showed significantly better imitation skills at the end of treatment. No other group main effects were noted at the end of treatment or in cognitive and language outcomes six months later.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] Landa, 2011, Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial, J Child Psychol Psychiatry source
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May combine two claims.
Study design and conductown dataThe sample is relatively small, and follow-up assessments were obtained on approximately 70% of the original participants five years later.
“The sample is relatively small, and follow up assessments were obtained on approximately 70% of the original participants five years later.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOver the past ten years, comprehensive early intervention programs have focused greater effort on improving joint attention, imitation, and play skills in young children.
“Over the past ten years, comprehensive early intervention programs have focused greater effort on improving joint attention, imitation and play skills in young children.16,17”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [16] Greenspan, 1998
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- cites [17] Rogers, 2010
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May combine two claims.
Study design and conductnone givenAssessments were extensive during baseline, post-intervention, and follow-up, and were conducted by assessors who were blind to child assignment and independent of the interventionists.
“Assessments were extensive during baseline, post intervention and follow up and conducted by assessors who were blind to child assignment, and independent of the interventionists.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataIt is unknown whether there was selective failure to return among the children who did not come back for assessments.
“Although the children who did not come back for assessments were distributed across all three groups, we do not know if there was selective failure to return.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationInitiating joint attention and play level are both associated with better language outcomes, consistent with longitudinal data.
“The finding that initiating joint attention and play level are both associated with better language outcomes is consistent with longitudinal data.3”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [3] Mundy, 1990, A longitudinal study of joint attention and language development in autistic children, J Autism Dev Disord source
Not checked in the free run.
- Rests on an assumption: Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
The paper relies on this without support.
Early skills in joint attention and play are rarely assessed before and after intervention, so little is known about how they change with specific interventions and whether changes in these skills account for improvements in developmental outcomes.
“However, because early skills in joint attention and play are rarely assessed before and after intervention, we have little information on how they might change with specific interventions, and whether changes in these skills account for improvements in developmental outcomes.”
The authors state this as an assumption.
Joint engagement between parent and child serves as a platform for the continued development of social, communication, and language skills over time.
“Theoretically, joint engagement serves as a platform for the continued development of social, communication and language skills over time.”
The paper relies on this without support.
Children who did not return for follow-up did not differ systematically from those who did in ways that affect the outcomes.
“Although the children who did not come back for assessments were distributed across all three groups, we do not know if there was selective failure to return.”
The paper relies on this without support.
Additional community interventions received after the experimental phase did not differ systematically between treatment groups in ways that affect long-term language outcomes.
“Following the experimental intervention program, children continued to receive a minimum of twenty hours per week of community interventions.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
These results may inform clinical therapies by providing further physiological foundation for JA-based behavior interventions that have been shown to significantly improve outcome in children with ASD.
“These results may inform clinical therapies by providing further physiological foundation for JA-based behavior interventions that have been shown to significantly improve outcome in children with ASD (Kasari et al. 2012; Chahrour et al. 2016).”
From Joint attention and brain functional connectivity in infants and toddlers (2017) · cites this paper as Kasari et al. 2012
Teaching joint attention or play skills within an ABA program increased their spontaneous occurrence in generalized contexts and predicted greater language outcomes compared with children in an ABA program without a focus on play and joint attention.
“Teaching these skills increased their spontaneous occurrence in generalized contexts and further predicted greater language outcomes compared with the children in the ABA program without a focus on play and joint attention. 33 , 59”
From Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research (2015) · cites this paper as [59]
Object exploration can reflect a child's flexibility in play and play level, both of which may influence later cognitive and language outcomes.
“Object exploration can reflect a child’s flexibility in play and play level, both of which may influence later cognitive and language outcomes. 59”
From Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research (2015) · cites this paper as [59]
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentχ²(2) = 0.55reported p = .76 · recomputed p = .760
“X2(2)=0.55, p = .76”
- Consistentχ²(4) = 6.87reported p = .14 · recomputed p = .143
“X2(4)=6.87, p = .14”
- ConsistentF(1, 30) = 14.62reported p < .01 · recomputed p < .001
“F(1,30)=14.62, p < .01”
- ConsistentF(5, 26) = 9.22reported p < .01 · recomputed p < .001
“F(5,26)=9.22, p < .01”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Self-check results appear here once an independent check has confirmed them.
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- Authors
- Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Kasari, Connie
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2012-05
- Volume
- 51
- Issue
- 5
- Pages
- 487-495
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3338205
- OpenAlex
- W2003733876
- Semantic Scholar
- 240a85c711c5ea04711b85dfdc48d37a33dc5cbb
- Cited by
- 305
- References
- 36
- Citations by year
- 2026: 15 · 2025: 15 · 2024: 16 · 2023: 10 · 2022: 26 · 2021: 30 · 2020: 21 · 2019: 27 · 2018: 23 · 2017: 18 · 2016: 32 · 2015: 19 · 2014: 29 · 2013: 18 · 2012: 6
- FWCI
- 11.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (UA3MC11055, P01-35470)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50 HD55784, P01HD035470, P50HD055784)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- autism spectrum disorder, joint attention, pretend play, early intervention, preschool intervention, cognitive outcomes, longitudinal follow-up
- MeSH terms
- Attention, Child, Child Development Disorders, Pervasive, Child, Preschool, Education, Special, Female, Humans, Language Development Disorders, Longitudinal Studies, Male, Play and Playthings, Symbolism, Vocabulary, Early Intervention, Educational
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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