Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder

Landa, R. J., Holman, K. C., O’Neill, A. H., & Stuart, E. A. (2011). Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial.

Reviewed by: ToniAnne Giunta, Caldwell College

Why review this topic?

Autism Spectrum Disorders (ASDs) are characterized by deficits in social skills and communication in areas including recognition and use of facial expression, imitation, reciprocity in interaction, social/affective signaling, joint attention, symbolic behavior, language understanding, and conventional use of gestures. These deficits can greatly limit opportunities for language and social learning. However, little research is available on interventions intended to alleviate such deficits. To address this gap, the present study tested interventions for improving socially engaged imitation (SEI), imitation of joint attention (IJA), and shared positive affect (SPA) in two-year-old children with autism. The primary questions were (a) are there differences in outcome measures of SEI, IJA, and SPA with learners receiving a supplemental social curriculum in their intervention?; (b) are there differences in expressive language growth and nonverbal cognitive functioning with learners receiving a supplemental social curriculum?; and (c) will gains established during interventions maintain throughout a six-month follow-up?

What did the researchers do?

Forty-eight learners with ASD, ages 21-33 months, were randomly assigned to one of two groups: Interpersonal Synchrony (IS) and Non-Interpersonal Synchrony (Non-IS). Both groups received 2.5 hours of classroom-based intervention per day for four days a week over a six-month period. Instruction included discrete-trial teaching and pivotal-response treatment, with an emphasis on the use of highly motivating tasks, materials, and natural consequences. Target skills were selected from the Assessment, Evaluation, and Programming System for Infants and Children developmental curriculum. Parent education classes supplemented classroom instruction. The IS group received more opportunities to (a) respond to and initiate joint attention to objects, people, and events (e.g., by placing interesting pictures on the walls to increase the likelihood of using these skills); (b) imitate others during social interactions (e.g., modeling social targets and providing prompts when necessary); and (c) share positive affect (e.g., introducing activities that involved imitation of peers and adults performing silly actions with objects). Learners were assessed using the Communication and Symbolic Behavior Scales Developmental Profile (for IJA and SPA), an imitation assessment (for SEI), and the MSEL developmental tests (for expressive language and nonverbal cognition).

What did the researchers find?

The researchers found significant differences in outcomes between groups for SEI, but not for IJA and SPA (i.e., more SEI performed by the IS than Non-IS group). They also found significantly higher levels of nonverbal cognition for the IS group at the follow-up, but minimal differences in expressive language between the groups. In regard to growth over time (i.e., timing, rate, and direction of change that provides insight to whether intervention gains remain after termination of the intervention), the IS group showed significantly more growth over time and more rapid growth on every outcome measure when compared to the Non-IS group

What are the strengths and limitations of the study? What do the results mean?

This was the first study conducted that assessed the effects of a classroom-based intervention on social development for two-year-olds. The findings show that gains in social development can be made in relatively brief periods of time. Future research, however, is warranted in many areas, including in (a) determining whether toddlers with ASD who develop SEI learn more efficiently within other domains of development and (b) separating the components of the intervention to determine which ones are most effective in increasing social development. Furthermore, a control group was not included, making it difficult to infer that gains in secondary outcomes were affected by the interventions alone.


Giunta, T. (2012). Research review: Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Science in Autism Treatment, 9(2), pp. 24