INFLUENCE THE AFFECT , LANGUAGE ACQUISITION , SOCIAL ENGAGEMENT AND BEHAVIOR IN YOUNG AUTISTIC CHILDREN ? AN EARLY INTERVENTION STUDY

Ова истражување покажува рандомизиран експериментален дизајн за процена на влијанието на терапијата за посредство на таткото во подобрувањето на вештините за играње, афектот, јазикот, социјалните вештини и однесувањето меѓу 30 клинички дијагностицирани деца со аутизам на возраст од 3-5 години. Стандардизираните листи, како што се: Опсервација базирана на играње (PBO), Грифитовата скала за ментален развој (GMDS), Винеландовата скала за социјална зрелост (VSMS) и Ренделовиот краток прашалник, беа спроведени пред и по интервенцијата. Беше дизајнирана посебна програма за вклучување на татковците во процесите за грижа и негување на овие деца, којашто беше имплементирана 6 месеци, а по тој период децата беа повторно проценети. Како приоритет на интервенцијата, беа набљудувани дефицитот во вештините за играње и развојните задоцнувања во експресивниот и рецептивниот јазик. The present study adopts a randomized experimental design to evaluate the impact of a father-mediated therapy to improve the play skills, affect, language, social skills and behavior among 30 clinically diagnosed autistic children at the age of 3-5 years. Standardized inventories such as, The Play Based Observation (PBO), The Griffiths Mental Developmental Scales (GMDS), The Vineland Social Maturity Scale (VSMS) and the Rendel Shorts Questionnaire were administered pre and post intervention. A special program that involved fathers in the caregiving and nurturing processes of these children was designed and implemented for 6 months after which the children were reassessed. Prior to the intervention, deficits in play skills and developmental delays across expressive and receptive language were observed.

The present study adopts a randomized experimental design to evaluate the impact of a father-mediated therapy to improve the play skills, affect, language, social skills and behavior among 30 clinically diagnosed autistic children at the age of 3-5 years.Standardized inventories such as, The Play Based Observation (PBO), The Griffiths Mental Developmental Scales (GMDS), The Vineland Social Maturity Scale (VSMS) and the Rendel Shorts Questionnaire were administered pre and post intervention.A special program that involved fathers in the caregiving and nurturing processes of these children was designed and implemented for 6 months after which the children were reassessed.Prior to the intervention, deficits in play skills and developmental delays across expressive and receptive language were observed.
Достапни пристапи се применетата анализа на однесувањето (ABA), развојните модели, структуираното учење, говорната и јазичната терапија, терапија за социјалните вештини и окупационата терапија (18).Постојат докази дека раната интензивна интервенција во од-attention seems to be necessary for functional speech (10).Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name.Autistic individuals display many forms of repetitive or restricted behaviour.The Repetitive Behaviour Scale-Revised (RBS-R) can be used to evaluate such behaviour (11).They could also have compulsive behaviour such as to follow rules, in arranging objects in stacks or lines (12).Unusual eating behaviour occurs in about three-quarters of children with ASD.Selectivity is the most common problem, although eating rituals and food refusal also occur (13).US and Japanese practice is to screen all children for ASD at 18 and 24 months, using autism-specific formal screening tests.In contrast, in the UK, children whose families or doctors recognize possible signs of autism are screened (14).Screening tools include the Modified Checklist for Autism in Toddlers (M-CHAT), the Early Screening of Autistic Traits Questionnaire, and the First Year Inventory; initial data on M-CHAT and its predecessor CHAT on children aged 18-30 months suggests that it is best used in a clinical setting (15).The main goals when treating children with autism are to lessen associated deficits and family distress, and to increase the quality of life and functional independence.Families and the educational system are the main resources for treatment (16).Intensive, sustained special education programs and behaviour therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviours (17).Available approaches include applied behaviour analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy (18).There is some evidence that early intensive behavioural intervention, a model for 20 to 40 hours a week for multiple years, is an effective behavioural treatment for some children with  (20).It is not known whether treatment programs for children lead to significant improvements after the children grow up, and the limited research on the effectiveness of adult residential programs shows mixed results (21).The increase in father research in recent years has added to our understanding of the contribution of fathers to communication and other areas of development for children who are typically developing.Fathers have been largely overlooked particularly in studies aimed at intervention efficacy.The aim of this study is to examine if paternal involvement in the nurturing and caring processes of autistic children can enhance their social skills, play behaviour and language.

Учесници Participants
Примерокот е составен од All the children (N=30) completed the Play Based Observation (PBO), The Griffiths Mental Developmental Scales-Extended Revised (GMDS-ER), The Vineland Social Maturity Scale (VSMS) and the Rendel Shorts Questionnaire.Inventories were administered only after obtaining informed consent from the parents.Test administersexplained to the parents that the obtained information will only be used to help the children through the treatment process and will not be used as diagnostic labels.All the inventories were administered by the Psychologist, speech therapist and theoccupational therapist.The children from control group were given recommendations by the psychologist for improving language, social skills and behaviour based on the results obtained from the tests.Parents were encouraged to continue engaging the child at home for 6 months.The home program was provided in a written format that would be used at home by the primary care giver.Fathers were only passively involved and parents were asked to revisit the clinic after 6 months.

Теарпија со посредство на таткото
Father-mediated therapy Father involvement program focused on increasing the father's role in the caretaking process of the child and to be actively involved in building the communication, social intent and play behaviour of the child.
The psychologist structured the play of the child and began focusing on building eye contact and reciprocity during play.Context related words were introduced and free play was encouraged.The psychologist then, helped the child imitate, respond and understand cause and effect play.The psychologist initially demonstrated the play with each toy, and after the child was comfortable the child was allowed to touch and explore the toy.The psychologist demonstrated the use of repeating words spoken by echolalic children contextually to improve the vocabulary skills and reinforced the attempts of the child every time a voluntary effort was made to communicate.Appropriate gestures and pointing to objects were used during play along with pictures to increase joint attention.Fathers were then requested to learn and demonstrate these skills the following sessions.Feedback was provided and ways to improve father engagement with the child were discussed.

Improvising attachment, language and behaviour
Татковците научија да изградат приврзаност и препознатливи вештини и да бидат поекспресивни со децата додека си играат the ball or rolling a toy were suggested as play activities to improve reciprocity and eye contact.Fathers were taught to use simple toys that children could imitate and also learn cause and effect association. Symbolic play with the use of cars or telephone was also suggested to be used.Fathers were provided with a regime to follow every day and to make time for outdoor play activities.
During the sessions, fathers touched and called the child every time they engaged with them to enhance recognition to name call.They were taught to whisperto the child and point to objects in the room or to toys to improve recognition of objects and to engage in joint attention.Fathers were encouraged to use simple picture books to help children understand object use and recognition.At the end of every week, fathers were encouraged to take their children to a park or a social gathering to help them understand and respond to social cues.Fathers were also encouraged to take a small toy bag wherever they went to engage their children, such as during travel.Fathers were taught to provide simple massages to children like head and face tapping to reduce repetitive behaviour and to increase attentiveness.At bedtime, children would sleep beside their father while being sang to or could be shown a picture book.This intervention focused primarily on fathers spending quality time with their children and not just being available.This intervention model was recommended to be followed for 6 months after which the children in both groups were reassessed.Using descriptive statistics, the pre and post intervention results were analysed using repeated measures analysis of variance.We obtained the p value and established the significance using 95% and 99% confidence intervals.We also compared the control and the treatment group, pre and post intervention as within subject factor and obtained regression co-efficient.

Мерки Measures
Опсервација Children in the control group, pre intervention exhibited low levels of engaging meaningfully in play and did not improve much after intervention.

Fig.1. Represents the subjective scores on the affect and play skills on Play Based Observation (PBO) pre and post intervention for the control group
Групата со третман покажа извонредно подобрување по интервенцијата во нивната вклученост и разбирање на играта.
The treatment group showed remarkable improvement post intervention in their engagement and understanding of play.On the contrary, the treatment groupshowed increasedscores on the age equivalent for language post intervention (M=42.26,SD=2.25) and was found to be statistically significant (p<0.01).The calculated value for the regression co-efficient was also found to be significant.

Behavioural profile Pre and Post intervention
Findings on the Rendel Shorts Questionnaire revealed that the control group after the intervention did not make significant improvements in behaviours, though there was a slight reduction of stereotypical behaviours and repetition of words.The severity of behaviours reduced post intervention (M=9.13,SD=0.5) as compared to the pre intervention scores (M=9.60,SD=0.98) but there were no significant changes (p>0.01).On the contrary, children in the treatment group showed significant changes in behaviour after being engaged by their fathers.Attachment to parents, recognition to name call and repetitive behaviours dramatically reduced from scores on pre intervention (M=9.13,SD=1.30) to that of post intervention (M=4.28,SD=0.46).The differences in the means were observed to be statistically significant at the 99% confidence interval.

Заклучок Conclusion
Ова simple activities of daily living.The limitation of the study was in the small sample size used for conducting a clinical study.Follow up studies could have also been done and the study fails to take into account the mother's contribution to during the intervention.A third group could have also been included so as to compare father involvement with mothers.
Although the study has limitations, it still purports to build on existent literature by offering a broader conceptualization of fatherchild relationships and by applying observational methods to the exploration offather involvement in helping children with autism.
Research of this kind will prove beneficial to clinicians and providersserving this population of families.The results of the study is particularly encouraging as it helps us understand that we can break the stereotypy that only mothers are capable of performing the care giving role and that fathers too are equally important.Further, studies that pertain to more specific attributes of father-child interaction are recommended.

Table 5 .
Represents the mean and standard deviations of the age equivalents on each domain of the Vineland Social Maturity Scale (VSMS) pre and post intervention in the treatment group