JASPER Joint Attention, Symbolic Play and Engagement Regulation Visual: JASPER (Joint-Attention Symbolic Play Engagement Regulation) is a treatment approach developed by Dr. Connie Kasari at UCLA’s Center for Autism Research and Treatment. Kasari and her colleagues have tested this approach in a series of rigorous short-term research studies. Connie Kasari, Ph.D. Center for Autism Research and Treatment, UCLA: My research has been, um, really focused on core deficits in children with autism, and children with autism have a specific problem or delay in their use of joint-attention gestures. Peter Mundy, Ph.D. Director of Educational Research at the MIND Institute: When babies come into the world, they’re not able to coordinate their attention with somebody else. It has to develop slowly, and it does. It develops between about four months and twenty-four months. And until they’re able to attend to what other people attend to, it’s relatively difficult for them, for them to learn from other people. And until they learn to, uh, coordinate their attention with other people, it’s hard for them to understand what words are. We learn to follow the gaze and follow the attention of somebody else. That’s like learning to comprehend language. Dr. Mundy: But then we start to be creative. We start to generate language, and we also start to generate bids to direct the attention of other people. It’s that generation of things developing the capacity to share information, to express ourselves or to share our point of view that children with autism have a particularly difficult time with. Parker, Age 5 Diagnosed with autism at age 3 Charlotte Mucchetti Parker’s Therapist: More triangle. Want red. Charlotte: We’re almost half-way through intervention with Parker. Um, he is minimally verbal, so he doesn’t use expressive language, um, to communicate his wants and needs very independently. Um, so what we work on in our intervention is increasing his engagement in play activities with, um, an adult and then increasing his use of language in those activities. Charlotte with Parker: Dump in. Charlotte: When Parker started, he was using one to two words, and so I kept all my language at one to two words. Charlotte: All thick squares. Charlotte: As we’ve gone through intervention, he’s now using three to four words, and so I will use three to four words. And we try to match the frequency as well, so if he is not talking very often, I’m going to model language less often. Charlotte: Go. Charlotte: One of the things that Parker’s really interested in is trucks, and when he first came into our intervention it was hard for him to really play functionally and interactively with trucks. So we started by just having two trucks at a time, minimal materials and, uh, modeling some different play action. Charlotte with Parker: Want red truck. Charlotte: One of the things that’s hard to notice when you’re watching this type of intervention is how, how much structure and facilitation actually is going on: moving materials around, making sure the environment is set up in a way that is conducive to them being able to generate their own ideas but not being overstimulated. If I saw that he was really getting hyperfocused on an object and wasn’t able to be engaged with that object, I would remove it from the environment so that we could move on. Charlotte with Parker: Put square in. More square in. Put square in. And put square in. Katie Ibay Parker’s Mother: I keep very detailed notes about where he is when he starts any type of new therapy, and then, um, I periodically, about every two to three weeks, document any progress. What this program has shown us is, um, by the adults or the other child doing less, speaking less; it actually forces Parker to initiate and be spontaneous, whether it be action or speech. Um, and, and that’s been the greatest learning and the greatest difference between other therapies that I’ve seen. Katie: He goes to a public school in L.A. Unified called Castle Heights. It’s a preschool program for children with autism. In addition to that he has, um, behavioral therapy after school, speech therapy, occupational therapy, um, a program called Neuro-fit, um, so he’s, he’s a busy boy. He works about forty-five hours a week. Connie Kasari, Ph.D. Center for Autism Research and Treatment, UCLA: In the first intervention study that we did, we, uh, took children from all the same early-intervention program that was based on Applied Behavior Analysis, so these were children getting thirty hours of intervention a week. And what we found from this very short-term but intensive intervention, if we taught joint-attention skills, the kids did more joint-attention. Or if we taught play skills, the children did better on play. But if we didn’t teach either of those and they just got the ABA program, they didn’t improve in those skills. And more importantly when we tested the kids a year later, we found that, um, initiating joint-attention skills were associated with better language skills. Dr. Kasari: We now call that treatment approach JASPER. Visual: Joint Attention Symbolic Play Engagement Regulation Dr. Kasari: So, ‘Joint Attention Symbolic Play Engagement and Regulation.’ Dr. Kasari: Within a lot of these different kinds of interventions, there are more alike than they are different. They’re all in a sense a combination of some developmental principles and behavioral principles. Katie: We’ll get four-or-five-word sentences from him now, where as before we were lucky if we got a two-word phrase. Katie: His play before was very much what I would consider self-stimulatory or a stim, um, where he would utilize toys to make a certain noise that he found attractive or, um, or to, to fill containers, empty containers. It was all, tended to be repetitive action. Now what we see from Parker is incredible. He, uh, he’s pretending with toys. He is, um, you know, using a dump truck to actually dump things, which, you know, to most parents doesn’t seem that exciting. But for me it’s like New Year’s Day! Katie: Parker has, a, just a delicious little personality, and I just want the rest of the world to get to know him in the way that I do. And the only way the rest of the world is going to get to know him is with language.