DTT + JASPER for Autism

Recruiting at 2 trial locations

Overseen By Consuelo Garcia, BS

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Los Angeles

Disqualifiers: Sensory impairments, Genetic syndromes, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

140 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial focuses on finding the best way to improve language skills in preschoolers with autism who have limited verbal abilities. It aims to determine how different intervention methods, such as DTT (Discrete Trial Training, a form of Applied Behavior Analysis) and JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation), can enhance communication by age six. The study tests various combinations and intensities of these treatments to tailor the approach to each child's needs. Eligible children have been diagnosed with autism, have fewer than 20 functional words in their vocabulary, and have participated in early intervention or preschool for at least three months. As an unphased trial, this study offers a unique opportunity to contribute to pioneering research that could significantly enhance communication strategies for children with autism.

Do I need to stop my current medications for the trial?

The trial requires that participants have stable medication for the past 6 months, so you should not change your current medications if you want to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that both JASPER and DTT are safe and well-tolerated treatments for children with autism. JASPER, a play-based therapy, helps children improve social skills and communication without major side effects. Studies have found that children in these programs demonstrate significant improvements in joint attention and play skills, which are crucial for development.

DTT, or Discrete Trial Training, is a teaching method that breaks down skills into small, easy-to-learn steps. Research supports its effectiveness for children with autism, ages 3 to 11. This method teaches new skills through repetition and positive feedback.

Both treatments aim to enhance developmental skills in children with autism, and studies report no significant adverse effects, suggesting they are safe and well-tolerated options for young children. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the DTT (Discrete Trial Training) and JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) techniques for autism because they offer tailored, responsive approaches to therapy. Unlike current standard treatments like Applied Behavior Analysis (ABA), these methods can adapt to a child's individual response rate. If a child responds quickly to either DTT or JASPER, they continue with the same treatment, but slower responders receive either an enhanced or intensified version of their therapy. This flexibility allows for more personalized and potentially more effective interactions, aiming to improve developmental outcomes in children with autism.

What evidence suggests that this trial's treatments could be effective for autism?

Research has shown that JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation), one of the treatments in this trial, can greatly enhance social communication skills in children with autism. Studies indicate that children participating in JASPER often experience improved joint engagement and play skills. Joint engagement is crucial, accounting for 69% of the improvement in children's social communication abilities.

Similarly, Discrete Trial Training (DTT), another treatment option in this trial, is a proven method for assisting children with autism. DTT breaks skills into smaller, manageable steps and has improved social skills through structured teaching. Research has found that children with autism who participate in DTT show significant improvements in specific behaviors and learning outcomes. Both JASPER and DTT effectively help children with autism develop essential communication and social skills. ^{1 2 6 7 8}

Are You a Good Fit for This Trial?

The PRISM study is for preschoolers aged 36-59 months with Autism Spectrum Disorder who speak less than 20 functional words. They must have had over 3 months of early intervention, stable medication for the past half year, and a nonverbal mental age above one year. Children with sensory/motor impairments or genetic syndromes like Down Syndrome are not eligible.

Inclusion Criteria

I am between 3 and 5 years old.

My child has been diagnosed with autism.

You have certain changes in your genes that can be treated with medication.

Exclusion Criteria

I likely haven't been exposed to AAC.

I do not have sensory, motor impairments, or known genetic syndromes.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Stage 1 Treatment

Participants receive either JASPER or DTT intervention for 10 weeks, 2 hours per week

10 weeks

2 visits per week (in-person)

Stage 2 Treatment

Early responders continue with the same intervention; slow responders are re-randomized to either intensify the current intervention or switch to Combined & Enhanced Treatment (CET)

10 weeks

2-4 visits per week (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 10 weeks post-treatment and at age 6

Long-term

What Are the Treatments Tested in This Trial?

Interventions

• DTT
• JASPER

Trial Overview This trial tests an adaptive two-stage language development approach over 20 weeks for minimally verbal children with ASD in community settings. It aims to personalize treatment by choosing between DTT (Discrete Trial Training), JASPER, and CET interventions based on each child's needs.

How Is the Trial Designed?

Group I: JASPER Active Control 1 Intervention

Child will spend 2 hours per week (2 days, 1 hour per day) for the first 10 weeks doing JASPER. If the child is an early responder, he/she will remain in the same course for the following 10 weeks. If child is a slow responder, he/she will be randomized for either combined \& enhanced treatment (CET) for 2 hours a week (2 days, 1 hour per day) or Intensified JASPER for 4 hours a week (4 days, 1 hour per day).

Group II: DTT Active Control 1 Intervention

Child will spend 2 hours per week (2 days, 1 hour per day) for the first 10 weeks doing DTT. If the child is an early responder, he/she will remain in the same course for the following 10 weeks. If child is a slow responder, he/she will be randomized for either combined \& enhanced treatment (CET) for 2 hours a week (2 days, 1 hour per day) or Intensified DTT for 4 hours a week (4 days, 1 hour per day).

DTT is already approved in United States for the following indications:

Approved in United States as Discrete Trial Training for:

• Autism Spectrum Disorder
• Developmental Delays

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

Published Research Related to This Trial

A new automated gaming platform designed for children with autism focuses on improving key skills like Imitation and Joint Attention through engaging games, showing promise for intensive intervention in home settings.

In a 3-month trial with 10 children, parents reported improvements in their child's concentration (78%), flexibility (89%), and self-esteem (44%), indicating the platform's potential effectiveness in enhancing developmental skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

GOLIAH: A Gaming Platform for Home-Based Intervention in Autism - Principles and Design. Bono, V., Narzisi, A., Jouen, AL., et al.[2020]

The GOLIAH gaming platform, used alongside traditional treatment for children with autism spectrum disorder (ASD), showed improvements in joint attention and imitation skills over a 6-month period, although it did not significantly outperform standard treatment alone.

Parents reported no increase in stress levels while using GOLIAH, suggesting that the gaming intervention may be a supportive tool without adding to parental burdens, warranting further investigation in larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

GOLIAH (Gaming Open Library for Intervention in Autism at Home): a 6-month single blind matched controlled exploratory study. Jouen, AL., Narzisi, A., Xavier, J., et al.[2020]

In a pilot study involving minimally verbal children with autism aged 3 to 5, the JASPER intervention showed significant improvements in play diversity and engagement compared to a control group receiving standard ABA therapy.

The JASPER treatment, which included just 30 minutes of intervention twice a week, led to increased initiation of gestures and reduced unengaged time in the classroom, highlighting its potential effectiveness in addressing core deficits in autism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preschool based JASPER intervention in minimally verbal children with autism: pilot RCT. Goods, KS., Ishijima, E., Chang, YC., et al.[2021]

A study involving children aged 24 to 48 months found that those with autism spectrum disorder (ASD) showed no differences in visual attention or manual actions during toy play compared to typically developing children.

The results indicate that children with ASD are capable of exploring toys similarly to their peers, highlighting the importance of context in understanding their exploratory behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using head-mounted eye tracking to examine visual and manual exploration during naturalistic toy play in children with and without autism spectrum disorder. Yurkovic, JR., Lisandrelli, G., Shaffer, RC., et al.[2021]

A study involving 58 children with autism aged 3 to 4 years showed that targeted interventions for joint attention and symbolic play significantly improved relevant behaviors compared to a control group.

Children receiving joint attention training initiated more joint attention behaviors, while those in the symbolic play group demonstrated greater diversity and higher levels of play, indicating the effectiveness of these interventions in enhancing developmental skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Kasari, C., Freeman, S., Paparella, T.[2007]

In a study involving young children at risk for autism spectrum disorder, both discrete trial training and pivotal response training were effective in teaching language, play, and imitation skills over a 12-week period.

The effectiveness of each training method varied by child and skill domain, indicating that early learning rates could help predict long-term treatment success and guide personalized intervention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Varied treatment response in young children with autism: A relative comparison of structured and naturalistic behavioral approaches. Jobin, A.[2021]

Pivotal Response Training (PRT) effectively taught 7 children with autism to engage in symbolic play, resulting in all participants demonstrating complex and creative play behaviors comparable to typical peers.

The children not only generalized their newly learned play skills to different toys and settings but also maintained these behaviors three months after training, indicating lasting benefits and improved interaction skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching symbolic play skills to children with autism using pivotal response training. Stahmer, AC.[2019]

In a study involving 58 preschool children with autism, both joint attention (JA) and symbolic play (SP) interventions led to greater expressive language gains compared to a control group after 5-6 weeks of daily sessions.

Children with the lowest initial language levels showed significantly better language outcomes from the JA intervention compared to the SP and control groups, highlighting the importance of targeting JA skills in early autism treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Language outcome in autism: randomized comparison of joint attention and play interventions. Kasari, C., Paparella, T., Freeman, S., et al.[2022]

The study involved three children with autism spectrum disorder and focused on teaching them to recognize their play partners' toy preferences during structured play dates.

Using a training method that included rules, preference questions, prompting, and praise, the children successfully learned to offer toys that matched their partners' interests, showing that this approach can generalize to untrained play partners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching children with autism to identify and respond appropriately to the preferences of others during play. Najdowski, AC., St Clair, M., Fullen, JA., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10907925/

Examining the Effects of Discrete Trials, Mass Trials, and ... This study determined the effectiveness of applied behavior analysis (ABA) interventions combining discrete trial training, mass trials, and naturalistic ...

2. mastermindbehavior.com mastermindbehavior.com/post/the-effectiveness-of-dtt-discrete-trial-training-in-aba-therapy

The Effectiveness of DTT (Discrete Trial Training) in ABA ... Discrete Trial Training (DTT) is a structured teaching approach within Applied Behavior Analysis (ABA) used to help children with autism learn ...

3. files.eric.ed.gov files.eric.ed.gov/fulltext/ED595333.pdf

Discrete Trial Training (DTT) - ---EBP Brief Packet DTT is an evidence-based practice for children with autism spectrum disorder (ASD) from 3 to 11 years old. • DTT breaks down a skill or behavior into separate ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38618362/

Replicative Study of the Impacts of Applied Behavior ... Over five months, individuals with autism who underwent ABA treatments demonstrated a statistically significant enhancement in general target behaviors.

5. researchgate.net researchgate.net/publication/389715775_Effect_of_Discrete_Trial_Training_Intervention_on_Social_Skills_Development_of_Children_with_Autism_Spectrum_Disorder

Effect of Discrete Trial Training Intervention on Social Skills ... The present study examined the effect of Discreet Trail Training (DTT) intervention on improving social skills of children with Autism Spectrum Disorder (ASD).

6. moveupaba.com moveupaba.com/blog/discrete-trial-training-dtt-techniques-and-benefits/

Discrete Trial Training DTT: Techniques and Benefits Discrete Trial Training (DTT): Learn the techniques, benefits, and how this ABA-based method breaks down skills for effective learning.

7. afirm.fpg.unc.edu afirm.fpg.unc.edu/wp-content/uploads/Discrete-Trial-Training-Brief-Packet-Sam-AFIRM-Team-Updated-2025-1.pdf

Discrete Trial Training Brief Packet - AFIRM Based on the principles of applied behavior analysis (ABA), discrete trial training (DTT) is used to develop a new response to a stimulus. DTT is based upon the ...

8. astroaba.com astroaba.com/blog/discrete-trial-training-dtt-in-aba-therapy-a-step-by-step-guide

Discrete Trial Training (DTT) in ABA Therapy: A Step-by- ... Data collection during each trial ensures progress is tracked, helping refine the teaching process. Overall, DTT combines structure, repetition, ...