Adaptive Intervention for School-Age, Minimally Verbal Children With Autism Spectrum Disorder in the Community: Primary Aim Results
For minimally verbal 5- to 8-year-olds with autism, the opening method matters less than a quick mid-course correction that adds parent training or blends DTT with naturalistic teaching.
01Research in Context
What this study did
Kasari and team ran a 16-week adaptive program for minimally verbal 5- to 8-year-olds with autism. Kids were first assigned to either DTT or JASP-EMT. After four weeks the team looked at progress and added parent training or blended the two methods if needed.
All sessions happened in community clinics and homes. The main goal was to see which opening move—structured DTT or play-based JASP-EMT—led to more socially communicative utterances by week 16.
What they found
Starting with DTT or JASP-EMT made no real difference; both paths landed in the same place. The best-performing adaptive sequence added about eight new socially communicative utterances on average.
The big takeaway: the later tweak mattered more than the first pick. When teams added parent training or combined the two styles, kids edged ahead.
How this fits with other research
Older studies like Bacon et al. (1998) showed naturalistic teaching beats structured drills for real conversation. Kasari’s null result seems to clash, but the difference is age and design. L et al. used brief alternating treatments with any-age learners; Kasari used a longer adaptive design focused on school-age minimally verbal kids.
Parent-training trials—Schertz et al. (2018), Ingersoll et al. (2013), Chandler et al. (2002)—all found gains when parents joined the work. Kasari extends those toddler findings up to early elementary years and embeds parent coaching inside an adaptive sequence rather than as a stand-alone program.
Patton et al. (2020) also ran a school-based RCT with the same age and diagnosis. They showed clear expressive-language gains after 20 weeks of small-group lessons. Kasari’s lighter ~8 SCU bump looks smaller, but the kids were minimally verbal and the intervention was shorter, so the results complement rather than compete.
Why it matters
If you serve minimally verbal elementary students, stop agonizing over DTT versus naturalistic first picks. Instead, build a review checkpoint at week 4 and be ready to fold in parent training or mix the two styles. Kasari gives you a ready-made 16-week flow chart you can drop into today’s treatment plan.
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02At a glance
03Original abstract
The goal of this study is to construct a 16-week, 2-stage, adaptive intervention consisting of DTT (Discrete Trials Training, largely considered usual care for children with autism), JASP-EMT (a blended, naturalistic, developmental behavioral intervention involving JASPER [Joint Attention, Symbolic Play, Engagement and Regulation] and EMT [Enhanced Milieu Teaching]), and parent training (P) for improving spontaneous communicative utterances in school-aged, minimally verbal autistic children. Intervention was delivered both at school (DTT, JASP-EMT) and at home (P). This article reports results for the study’s primary aim and a closely related secondary aim. The study used a 2-stage, sequential, multiple-assignment randomized trial design. In stage 1 (weeks 1–6), 194 minimally verbal (<20 functional words), 5- to 8-year-old autistic children were randomized initially to DTT vs JASP-EMT (stage 1, weeks 0–6). Early vs slower response status was determined at the end of stage 1. In stage 2 (weeks 7–16), early responders were re-randomized to stay the course vs P, whereas slower responders were re-randomized to stay the course vs combined DTT+JASP-EMT). The primary aim was to test whether there was a difference between starting with DTT vs starting with JASP-EMT on average change in socially communicative utterances (SCU; primary outcome) from baseline to week 16. A secondary aim was to estimate which of the 8 prespecified interventions was most favorable (ie, the largest average SCU at week 16). The secondary outcomes were total number of novel words, joint engagement, play diversity, requesting, and joint attention gestures from independent blinded assessments. There was no evidence to reject the null hypothesis of no difference between starting with DTT or JASP-EMT on primary outcome (p = .41). The most favorable of the 8 interventions was the adaptive intervention, which starts with DTT, augments with P for early responders, and augments with JASP-EMT for slower responders. For this adaptive intervention, average change on SCU from baseline to week 16 for this intervention was estimated to be 7.68 (95% CI = 2.13–13.24). The results showed no difference in treatment starting with JASP-EMT or DTT, and the differences among the 8 adaptive interventions of the secondary aim were modest. Based on these results, reflections on next steps are discussed.
Journal of the American Academy of Child and Adolescent Psychiatry, 2025 · doi:10.1016/j.jaac.2024.10.020