Caregiver strategies before intervention moderate caregiver fidelity and maintenance in RCT of JASPER intervention with autistic toddlers.
Parents who already use rich play strategies get more out of JASPER and their toddlers keep gaining joint attention months later.
01Research in Context
What this study did
Shih’s team ran a randomized trial with 82 autistic toddlers. Half the families got ten weeks of JASPER caregiver coaching. The other half got parent-education only.
Trainers scored how well parents used JASPER moves every week. They also checked kids’ joint-attention skills before, after, and three months later.
Parents were split by how many rich play strategies they already showed at intake. The study asked: does starting style change who keeps the gains?
What they found
JASPER parents hit high fidelity faster and stayed there. Control parents never reached the same level.
Kids of high-strategy parents kept growing in joint attention after the program ended. Kids of low-strategy parents stayed flat.
Bottom line: parents who already talk, wait, and expand play get more from JASPER and their kids keep improving.
How this fits with other research
Cappadocia et al. (2012) showed parent synchrony can drive symptom gains. Shih adds a twist: the style parents bring in the door sets the ceiling.
Pé rez-Fuster et al. (2022) also boosted joint attention, but used an augmented-reality game in school. Both studies prove the skill can move; Shih shows caregiver style is one path.
Kourassanis-Velasquez et al. (2019) trained peers instead of parents and still lifted joint attention. Together the papers say: many coaches work, yet caregiver starting skill remains a key lever.
Why it matters
You can predict which families will need extra support simply by watching baseline play. Add booster sessions or pre-teach micro-skills for parents who start low. That small shift may keep child gains rolling long after you close the case.
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02At a glance
03Original abstract
Interventions facilitated by caregivers have gained popularity among those caring for young children with autism. Instructing caregivers on specific techniques to foster social communication skills in their at‐risk or diagnosed autistic children has the potential to alleviate concerns about their children's development. Moreover, it can offer a more intensive early intervention compared to what community providers alone can deliver. This study seeks to explore the correlation between caregiver strategies employed prior to participating in a caregiver‐mediated intervention and the caregiver's fidelity to the intervention, as well as its sustainability during the follow‐up period and child outcomes. This study constitutes a secondary analysis of a randomized controlled trial that compared the joint attention, symbolic play, engagement, and regulation (JASPER) and Psychoeducational Education Intervention (PEI), revealing significant advancements in children's social communication skills with the JASPER intervention. Eighty‐six children (average age 31.5 months) with ASD and their primary caregivers enrolled in the two armed randomized trial evaluating the effect of JASPER versus PEI. Generalized linear mixed models were used to model the longitudinal trajectories of the outcomes. Results indicated that caregivers in the JASPER intervention made more gains in overall JASPER strategies and individual domain strategies (environment, prompt, communication, mirrored pacing) compared to the caregivers in PEI (p's < 0.01) from baseline to exit. While both groups regressed some in overall and subdomain strategies at follow‐up, caregivers in the JASPER intervention maintained more overall, and specifically in communication, and mirrored pacing strategies compared to PEI group (p's < 0.05). Further, baseline caregiver strategies moderated the treatment effect of child's joint attention skills from exit to follow‐up (p = 0.002), where JASPER dyads with high caregiver strategy use at baseline continued to improve in JA skills post exit, whereas all other children did not. In summary, understanding caregiver style of interaction before intervention on caregiver fidelity and maintenance from exit to follow up and child progress is important to improving intervention uptake and child outcomes.
JCPP Advances, 2024 · doi:10.1002/jcv2.12247