Publications by authors named "Tanya Paparella"

8 Publications

  • Page 1 of 1

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

Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism.

J Consult Clin Psychol 2015 Jun 30;83(3):554-63. Epub 2015 Mar 30.

Department of Human Development and Psychology, University of California Los Angeles.

Objective: This study compared effects of two parent-mediated interventions on joint engagement outcomes as augmentations of an early intervention program for toddlers with autism spectrum disorder (ASD).

Method: Participants included 86 toddlers (range 22-36 months) with ASD and their primary caregiver. Caregiver-child dyads were randomized to receive 10 weeks of hands-on parent training in a naturalistic, developmental behavioral intervention (joint attention, symbolic play, engagement and regulation-JASPER) or a parent-only psychoeducational intervention (PEI). Dose was controlled in terms of researcher-parent contact and early intervention services received by the child.

Results: Results yielded significant effects of the JASPER intervention on the primary outcome of joint engagement. The treatment effect was large (Cohen's f² = .69) and maintained over the 6-month follow-up. JASPER effects were also found on secondary outcomes of play diversity, highest play level achieved, and generalization to the child's classroom for child-initiated joint engagement. The PEI intervention was found to be effective in reducing parenting stress associated with child characteristics. All secondary effects were generally small to moderate.

Conclusions: These data highlight the benefit of a brief, targeted, parent-mediated intervention on child outcomes. Future studies may consider the combination of JASPER and PEI treatments for optimal parent and child outcomes. Trial registry no. NCT00999778.
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http://dx.doi.org/10.1037/a0039080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755315PMC
June 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

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