Understanding Mediators and Moderators of an Adaptive Communication Intervention for Young Children with Autism Spectrum Disorders

Abstract

This study examines mediators and moderators of the communication outcomes for young preverbal children with autism spectrum disorder (ASD) who participated in a randomized control trial of an adaptive communication intervention. Sixty-eight children (mean age 43.06 months) with ASD were randomly assigned to either a 36-session blended intervention combining a naturalistic communication intervention with a discrete trial intervention or a business as usual control group. Object interest and the frequency of escape behaviors moderated the effects of intervention on initiating joint attention, such that children with lower frequency play behaviors and higher frequency escape behaviors who were randomly assigned to the intervention group demonstrated significantly more initiations of joint attention at posttest. Repetitive behaviors and aggressive behaviors did not moderate outcomes. Receptive language, joint attention, and verbal imitation at posttest were tested as mediators of communication outcomes; only joint attention at posttest mediated joint attention at follow-up. All other mediators did not significantly mediate the relationship between group assignment and communication outcomes at follow-up. The findings of this study suggest that children with ASD who exhibit low rates of object interest or high rates of escape behaviors benefit from a multi-component, blended intervention.