Bidirectional influences of caregiver utterances and supported joint engagement in children with and without autism spectrum disorder.
Kristen Bottema-Beutel, Blair Lloyd, Linda Watson and 1 others
PMID 29356414WHAT IT FOUND
In play, caregiver talk about what the child was doing, especially suggestions for how to play, was more likely to be followed by higher-level joint engagement than caregiver-focused talk.
This held for children with and without autism, but cannot prove intervention effects.
Key findings
01Caregiver utterances that followed the child's focus were more likely to be followed by supported joint engagement than intervals without such utterances, in both groups.
02Caregiver utterances that followed the child's focus were more likely to be followed by higher-order supported joint engagement than caregiver-focused utterances, with no group difference.
03Follow-in directives were more likely to be followed by higher-order supported joint engagement than follow-in comments, with no group difference.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was observational and correlational, so it can show temporal links but cannot prove that caregiver utterances caused engagement or that coaching would improve outcomes. The advantage of follow-in directives over comments could be due to unmeasured cues such as pointing, giving or handling toys, not the words alone. The analysis used 5-second intervals and did not identify where within an interval an utterance or engagement state began, nor whether utterances started or maintained engagement. The ASD and TD groups differed in chronological age (39.6 months vs 14.22 months), although mental age was matched and chronological age was included in the models. The ASD Mullen scores were taken four months before the play session, and an adjusted mental age was needed, which may complicate group matching. The sample was mostly White/Caucasian (73%) and English-speaking, so the findings may not generalize across cultural or language contexts. Caregivers may have had prior early intervention training, but this was not measured.
Declared interests
The authors report no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that caregiver talk caused joint engagement or that coaching caregivers improves language. This was an observational free-play study, not an intervention, and unmeasured cues such as pointing may explain the directive finding.