Prescreening:
Before the study, the investigators at each site will review existing assessment
information for each participant with autism, which may include age, gender, IQ, autism,
and behavioral scales, and verbal language functioning to confirm the children that meet
the inclusion criteria.
Each dyad's involvement will last over the course of approximately 12 months. The first 3
months will be the intervention and data will be collected throughout. Follow-up data
will be collected 3, 6, and 9 months after the intervention is concluded.
The study will involve the following components:
Pre-Assessments：
For children with ASD:
After each dyad is enrolled, the research team assessor/evaluator will administer either
the Childhood Autism Rating Scale (CARS) or Autism Diagnostic Observation Schedule
(ADOS). Children with ASD in China will be assessed using CARS while the children with
ASD will be assessed with ADOS. Further, Vineland Adaptive Behavior Scales will be used
for children in both countries
For typically developing children:
The current reading achievement of all typically developing siblings will be assessed by
the research team assessor. For siblings in the U.S., DIBELS GK-1 level will be used to
assess if the siblings will be able to read words and nonsense words fluently. For
siblings in China, different combinations of letters (pinyin) will be assessed.
For parents:
Parents will complete a demographic survey online using their participant ID.
Pretest/Baseline Early literacy: During each session, the research team assessor will ask
the children with ASD in the U.S. to read Grade K to Grade 1 letters, words, and nonsense
words. If the children could meet the Benchmark goals for core support per DIBELS
benchmark goals for Grade K-1, they will then be asked to read a narrative passage for 1
minute and answer questions related to whom, where, and when as well as the actions and
internal responses of the characters.
For children with ASD in China, the research team assessor will ask them to read pinyins
using the pinyin matrix. If the children could read 70% pinyins correctly, they will then
be asked to read a narrative passage with pinyin for 1 minute and answer questions
related to whom, where, and when as well as the actions and internal responses of the
characters.
Social reciprocity: Parents will place toys, games, and books in a location at home and
ask the siblings to play with each other for 15 minutes. The entire 15-minute session
will be video recorded and then coded using the Playground Observation of Peer Engagement
(POPE) and Reciprocity datasheets.
The assessment for early literacy and social reciprocity skills lasts for a minimum of
five days.
Sibling Relationship Quality: Parents will complete one Sibling Inventory of Behavior
scale.
Sibling Self-Efficacy scale: The TD sibling will complete a self-efficacy scale.
Sibling and parent interview: The investigators will interview the parents and siblings
regarding everyday sibling interaction and relationship and the influence of the sibling
with autism on the daily life of the typically developing sibling. The investigators will
use some guiding questions to begin the interviews. Questions that elicit additional
details or responses for examples and feelings (e.g., Tell me more. How do you feel? Do
you have an example?) may be used depending on the answers. The interview will take place
online for approximately 1 hour using a teleconference tool (e.g., Zoom), and interviews
will be both audio and video recorded.
Random assignments:
In each country, children will be randomly assigned to a treatment-as-usual group and a
sibling-mediated intervention group with 10 in each group.
Treatment-as-usual/sibling interaction group:
Parents will place toys, games, and books in a location at home and ask the siblings to
spend time with each other for 20-30 minutes, at least three times a week for a total of
three months. All sessions will be video recorded. The families in the treatment-as-usual
group will receive the intervention after the procedure is completed.
Sibling-mediated intervention group:
The sibling-mediated intervention will start with three 45-minute training sessions for
the typically developing sibling via telecommunication (e.g., Zoom) on how to use the
model-lead-test strategy (i.e., model the correct response, guided practice of the
correct response and test the correct response) and the self-monitoring checklist. During
training, parents will be present and may be asked to pretend to be learners.
After the training sessions, the first phase, Compliance Training Phase, will begin. At
the beginning of each session, parents will give the TD sibling an activity schedule
consisting of the tasks (e.g., a series of questions) for the session. The TD sibling
will follow the activity schedule to present the tasks (e.g., asking children with ASD a
series of common questions) and use the self-monitoring checklist to deliver
model-lead-test when needed. In the initial sessions, the instructor will be present to
prompt the TD sibling to deliver the intervention and correctly use the self-monitoring
checklist. After each session, the instructor will deliver feedback until the typically
developing sibling meets the mastery criterion (i.e., at least 85% correct across five
sessions). Once mastery is met, the research team instructor will then review videos
every 3-5 days and deliver feedback to the TD sibling. The compliance training phase will
last for 9-15 sessions.
During the intervention phase, the research team interventionist will start by briefly
meeting with the TD sibling to introduce the self-monitoring checklists for early
literacy and social reciprocity. The TD siblings will then follow the visual activity
schedule (e.g., the list of the tasks: reading, social play; the order of the activities
may change daily) and use the self-monitoring checklists when teaching reading and social
reciprocity.
For reading, each week, the investigator will identify 3-5 words in a children's book,
the typically developing sibling will read the children's book to the sibling with ASD
and pausing upon the target words. The sibling with ASD will be asked to read the target
words. If the child with ASD could not read the target words, the typically developing
sibling will teach how to read words using model-lead-test. If the child with ASD read
the target words correct, the typically developing sibling will provide praise or any
other rewards (e.g., high-five, tickle, etc.) as identified by parents. The book will be
changed weekly.
For social reciprocity, the parents will bring toys and games and ask the typically
developing sibling to play with their sibling with ASD. During the play, after a few
physical actions and verbalizations from the typically developing sibling, the typically
developing sibling will teach the sibling with ASD to respond with a reciprocal physical
action and conversation. If the sibling with ASD responds with a physical action along
with conversation, the typically developing sibling will provide praise or any other
social rewards.
Similar to the compliance phase, the instructor will initially monitor and deliver
feedback over Zoom to the TD sibling in each session until mastery, followed by a
variable schedule (e.g., every 3-5 sessions).
Ongoing data collection on the readings and social reciprocity from the children with ASD
will be conducted. The compliance training and intervention phases will last 3 months.
Posttest/Post-intervention The procedure for the posttest/post-intervention phase is the
same as pretest/baseline phase. In addition, both children in each dyad will complete a
social validity questionnaire.
3-month, 6-month, and 9-month follow-ups Three follow-ups will be conducted after 3, 6,
and 9 months after the completion of the intervention. The procedure is the same as
pretest/baseline phase.
