Publications by authors named "Stephanny Freeman"

12 Publications

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Methods to improve joint attention in young children with autism: a review.

Pediatric Health Med Ther 2015 19;6:65-78. Epub 2015 May 19.

Department of Child Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.

We provide an overview of studies in the past 10 years (2004-2014) that have aimed to improve joint attention (JA) in young children at risk for, or with, autism spectrum disorder. Thirteen randomized controlled trial (RCT) interventions were found, which received particular focus. Three studies used intervention methods with a developmental orientation and focused on caregiver-mediated methods. Others used combined developmental and behavioral approaches and delivered intervention via trained interventionists, caregivers, and teachers. Interventions ranged widely in density, both with respect to the amount of intervention delivered weekly and the total duration of intervention. Fourteen single-subject research design (SSRD) studies and one quasi-experimental pre-post design study were also included. Notably absent in the RCTs were studies using only behavioral methods, while behavioral methods dominated in the SSRDs. The outcomes of the RCTs using combined behavioral and developmental methods generally demonstrate short-term social communication gains. While some studies demonstrated long-term maintenance and positive outcomes in related areas such as language, many did not. The mixed results for language outcomes indicate a need for further investigation. In addition, future studies should further examine participants' developmental readiness and intervention dose in relation to outcome, as well as aim to isolate active ingredients of interventions.
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http://dx.doi.org/10.2147/PHMT.S41921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683273PMC
May 2015

Brief Report: Linking Early Joint Attention and Play Abilities to Later Reports of Friendships for Children with ASD.

J Autism Dev Disord 2015 Jul;45(7):2259-66

Department of Child Psychiatry, 78-243B Semel Institute for Neuroscience and Human Behavior, UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024-1759, USA,

This study examined the influence of early joint attention and play in children with autism on child- and parent-reported friendship quality 5 years later. Initially, children participated in developmental, joint attention, and play measures. At follow-up (age 8-9), parents and children completed the Friendship Qualities Scale (Bukowski et al. in J Soc Personal Relatsh 11:471-484, 1994) rating the child's friendship on companionship, help, security, closeness, and conflict. Parents and children described their children's friendships similarly except children's ratings were significantly higher than their parents on companionship. Children with better joint attention at age three reported their friendships to have higher closeness and lower conflict. Children with better initial play reported greater helpfulness. This study provides preliminary evidence linking early core abilities to later friendship qualities.
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http://dx.doi.org/10.1007/s10803-015-2369-xDOI Listing
July 2015

Electrophysiological evidence of heterogeneity in visual statistical learning in young children with ASD.

Dev Sci 2015 Jan 13;18(1):90-105. Epub 2014 May 13.

Department of Psychiatry, UCLA Semel Institute of Biobehavioral Sciences, USA.

Statistical learning is characterized by detection of regularities in one's environment without an awareness or intention to learn, and it may play a critical role in language and social behavior. Accordingly, in this study we investigated the electrophysiological correlates of visual statistical learning in young children with autism spectrum disorder (ASD) using an event-related potential shape learning paradigm, and we examined the relation between visual statistical learning and cognitive function. Compared to typically developing (TD) controls, the ASD group as a whole showed reduced evidence of learning as defined by N1 (early visual discrimination) and P300 (attention to novelty) components. Upon further analysis, in the ASD group there was a positive correlation between N1 amplitude difference and non-verbal IQ, and a positive correlation between P300 amplitude difference and adaptive social function. Children with ASD and a high non-verbal IQ and high adaptive social function demonstrated a distinctive pattern of learning. This is the first study to identify electrophysiological markers of visual statistical learning in children with ASD. Through this work we have demonstrated heterogeneity in statistical learning in ASD that maps onto non-verbal cognition and adaptive social function.
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http://dx.doi.org/10.1111/desc.12188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231013PMC
January 2015

Two to ten years: developmental trajectories of joint attention in children with ASD who received targeted social communication interventions.

Autism Res 2014 Apr 18;7(2):207-15. Epub 2014 Feb 18.

Semel Institute for Neuroscience & Human Behavior, UCLA, Los Angeles, California.

This study follows 40 children who were participants in a randomized controlled early intervention trial (Kasari et al.) from early childhood (2-5 years of age) to elementary school age (8-10 years). To fully utilize the available longitudinal data, the general linear mixed model was the primary analytical approach. The growth trajectories of joint attention skills (pointing, coordinated joint looking, and showing) and expressive language outcomes in these children were estimated based on five time points during the measurement period. The children were grouped by diagnosis at the last follow-up (autism, autism spectrum disorder (ASD), no diagnosis) and by their original treatment group assignment (joint attention, symbolic play, control), and differences between these groups were evaluated. Results showed that joint attention skills of coordinated joint looking and showing increased over time, and pointing to share interest increased over the first year measured and decreased thereafter. These trajectories were influenced by both original treatment assignment and diagnostic status at follow-up. In addition, a cross-lagged panel analysis revealed a causal relationship between early pointing and later language development. This study highlights the longitudinal and developmental importance of measures of early core deficits in autism, and suggests that both treatment and ASD symptomatology may influence growth in these skills over time.
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http://dx.doi.org/10.1002/aur.1360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036529PMC
April 2014

Parent-child interactions in autism: characteristics of play.

Autism 2013 Mar 4;17(2):147-61. Epub 2013 Feb 4.

Division of Child Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024-1759, USA.

Although the literature on parent-child interactions in young children with autism has examined dyadic style, synchrony, and sustained engagement, the examination of parental skill in sustaining and developing play skills themselves has not been targeted. This study examined the extent to which parents of young children with autism match and scaffold their child's play. Sixteen dyads of parents and their children with autism participated in this study along with 16 matched dyads of typically developing children. Both groups were administered a structured play assessment and were observed during a 10-min free play situation. Strategies of play were examined and results revealed that parents of children with autism initiated more play schemes and suggested and commanded play acts more than parents of typical children. They also responded to their child's play acts more often with a higher level play act, while parents of typical children matched/expanded their responses to their child. Parent imitation was also related to longer sequences of play. The findings can guide further research and play intervention for parents.
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http://dx.doi.org/10.1177/1362361312469269DOI Listing
March 2013

Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play.

J Am Acad Child Adolesc Psychiatry 2012 May 6;51(5):487-95. Epub 2012 Apr 6.

Center for Autism Research and Treatment, University of California at Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA.

Objective: This study examines the cognitive and language outcomes of children with an autism spectrum disorder (ASD) over a 5-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 5-year follow-up.

Results: In all, 80% of children had achieved functional use of spoken language with baseline play level predicting spoken language at the 5-year follow-up. Of children who were using spoken language at age 8 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 8 years.

Conclusions: This study is 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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http://dx.doi.org/10.1016/j.jaac.2012.02.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338205PMC
May 2012

The emergence of nonverbal joint attention and requesting skills in young children with autism.

J Commun Disord 2011 Nov-Dec;44(6):569-83. Epub 2011 Aug 22.

University of California Los Angeles, Los Angeles, USA.

Unlabelled: Joint attention (JA) skills are deficient in children with autism; however, children with autism seem to vary in the degree to which they display joint attention. Joint attention skills refer to verbal and nonverbal skills used to share experiences with others. They include gestures such as pointing, coordinated looks between objects and people, and showing. Some nonverbal gestures are used to request rather than merely to share. These requesting gestures include reaching, pointing to request, and giving to gain assistance. Although these skills also relate to expressive language development, we know little about when they emerge and how they change as language develops in children with autism. Several studies report the emergence of nonverbal requests in children with autism to be similar to that of typically developing children, but other studies report impairments in such skills. This study investigates the emergence of nonverbal JA and requesting skills in typically developing children and in children with autism with expressive language ages between 12 and 60 months, using both a both cross-sectional and a longitudinal design. Results suggest that the sequence of JA skill emergence in autism differs from a normative model, while the sequence of requesting skills emerges in accord with typical development. Furthermore, several joint attention skills appeared to emerge later than in typical children. With regards to intervention it appears that a curriculum based on a normative developmental model for the emergence of requesting skills is mostly appropriate for use with children with autism. However, since children with autism acquired nonverbal joint attention skills in a sequence that differed from a normative model, it might be that a non-normative autism-specific joint attention curriculum would be more likely to benefit children with autism.

Learning Outcomes: The reader will (1) identify 3 specific initiating gestures used to communicate for the purpose of joint attention, (2) identify 2 specific nonverbal responsive joint attention skills, (3) be able to state that children with autism appear to develop specific nonverbal requesting gestures in a similar sequence to typically developing children, (4) be able to state that children with autism appear to develop specific nonverbal joint attention gestures in a different sequence than that of typically developing children, and (5) be able to identify 2 specific nonverbal joint attention skills that appear significantly impaired in children with autism relative to typically developing children.
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http://dx.doi.org/10.1016/j.jcomdis.2011.08.002DOI Listing
March 2012

Language outcome in autism: randomized comparison of joint attention and play interventions.

J Consult Clin Psychol 2008 Feb;76(1):125-37

Psychological Studies in Education, University of California Los Angeles, Los Angeles, CA 90095, USA.

This study reports results of a randomized controlled trial aimed at joint attention (JA) and symbolic play (SP) in preschool children with autism, with prediction to language outcome 12 months later. Participants were 58 children (46 boys) with autism between 3 and 4 years of age. Children were randomized to a JA intervention, an SP intervention, or control group. Interventions were conducted 30 min daily for 5-6 weeks. Assessments of JA skills, SP skills, mother-child interactions, and language development were collected at 4 time points: pre- and postintervention and 6 and 12 months postintervention by independent testers. Results indicate that expressive language gains were greater for both treatment groups compared with the control group, and results could not be explained by differences in other interventions in which children participated. For children beginning treatment with the lowest language levels, the JA intervention improved language outcome significantly more than did the SP or control interventions. These findings suggest clinically significant benefits of actively treating JA and SP skills in young children with autism.
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http://dx.doi.org/10.1037/0022-006X.76.1.125DOI Listing
February 2008

Children with autism's response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills.

Autism 2007 Nov;11(6):535-46

University of California, Los Angeles, USA.

Thirty-five children diagnosed with autism were randomly assigned to either a joint attention or a symbolic play intervention. During the 5-8 week treatment, three novel probes were administered to determine mastery of joint attention skills. The probes consisted of auditory and visual stimuli, such as a loud spider crawling or a musical ball bouncing. The current study examined affect, gaze, joint attention behaviors, and verbalizations at three different time points of intervention. Results revealed that children randomized to the joint attention group were more likely to acknowledge the probe and engage in shared interactions between intervener and probe upon termination of intervention. Additionally, the joint attention group improved in the proportion of time spent sharing coordinated joint looks between intervener and probe. These results suggest that generalization of joint attention skills to a novel probe did occur for the group targeting joint attention and provides further evidence of the effectiveness of the joint attention intervention.
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http://dx.doi.org/10.1177/1362361307083255DOI Listing
November 2007

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study.

J Child Psychol Psychiatry 2006 Jun;47(6):611-20

UCLA, CA 90095, USA.

Background: Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism. These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts (see Kasari, Freeman, & Paparella, 2001). In this study, we examine the efficacy of targeted interventions of joint attention and symbolic play.

Methods: Participants were 58 children with autism aged 3 and 4 years (46 boys). Children were randomized to a joint attention intervention, a symbolic play intervention, or control group. Interventions were conducted 30 minutes daily for 5-6 weeks. Both structured assessments of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors.

Results: Results indicate that both intervention groups improved significantly over the control group on certain behaviors. Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction. The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers.

Conclusions: This randomized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism. Future studies need to examine the long-term effects of these early interventions on children's development.
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http://dx.doi.org/10.1111/j.1469-7610.2005.01567.xDOI Listing
June 2006

Empathy and response to distress in children with Down syndrome.

J Child Psychol Psychiatry 2003 Mar;44(3):424-31

Graduate School of Education & Information Studies, University of California, Los Angeles, 90095, USA.

Background: Most studies of empathy have focused on young children, and those who are typically developing. Thus, we know little about the emergence and manifestation of empathy in non-normally developing children.

Method: Empathy and response to distress in others were examined in 30 children with Down syndrome, 22 children with nonspecific etiologies of mental retardation, and 22 typically developing children.

Results: Results indicated that compared to the other children, children with Down syndrome responded to distress in others by looking to them more, and offering more comfort in the form of prosocial responses. However, in a hypothetical empathy situation, children with Down syndrome were less likely to feel the same emotion as the protagonist than were the typical children. Children with Down syndrome differed from the children with nonspecific mental retardation only in their response to distress in others. The children with nonspecific mental retardation were more similar to than different from the MA-matched typical children.

Conclusions: These results suggest some etiology-associated differences in empathy and response to distress in children with mental retardation.
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http://dx.doi.org/10.1111/1469-7610.00132DOI Listing
March 2003

Characteristics and qualities of the play dates of children with Down syndrome: emerging or true friendships?

Am J Ment Retard 2002 Jan;107(1):16-31

University of California, Los Angeles 90095-1521, USA.

Although research on typical development suggests that friendship is a social relationship based on interactions with certain criteria, the qualities, definitions, and characteristics of friendship are not well-understood among children with atypical development. In this study, the interactions of 27 dyads of children in a play-date situation were examined; one dyad member had Down syndrome. The peers brought were more often the same gender, age, and ethnicity. Dyads who were similar in gender, CA, and classroom experiences had better quality interactions. Twenty dyads met strict friendship criteria and, thus, could be classified as friends. These friend dyads were more positive in affect, more often involved in turn-taking, and played at higher levels than did children categorized as simply playmates.
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http://dx.doi.org/10.1352/0895-8017(2002)107<0016:CAQOTP>2.0.CO;2DOI Listing
January 2002