Vol.:(0123456789) 1 3 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-018-3584-z ORIGINAL PAPER Efcacy of the ASAP Intervention for Preschoolers with ASD: A Cluster Randomized Controlled Trial Brian A. Boyd 1,9  · Linda R. Watson 2  · Stephanie S. Reszka 1  · John Sideris 3,4  · Michael Alessandri 5  · Grace T. Baranek 1,3  · Elizabeth R. Crais 2  · Amy Donaldson 6  · Anibal Gutierrez 5  · LeAnne Johnson 7  · Katie Belardi 2,8 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract The advancing social-communication and play (ASAP) intervention was designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum disorder are trained to implement the intervention in order to improve these children’s social-communication and play skills. In this 4-year, multi-site efcacy trial, classrooms were randomly assigned to ASAP or a business-as-usual control condition. A total of 78 classrooms, including 161 children, enrolled in this study. No signifcant group diferences were found for the primary outcomes of children’s social-communication and play. However, children in the ASAP group showed increased classroom engagement. Addition- ally, participation in ASAP seemed to have a protective efect for one indicator of teacher burnout. Implications for future research are discussed. Keywords Autism spectrum disorder · ASAP · Randomized controlled trial · School interventions · Engagement · Social- communication Introduction Difculties in social-communicative functioning and sym- bolic play are core diagnostic features of autism spectrum disorder (ASD) in early childhood. More importantly for intervention planning, the quality and quantity of social- communication and object play behaviors during the pre- school years are highly predictive of long-term developmen- tal and functional outcomes. For example, joint attention (a component of social-communication) and symbolic play (a component of object play; Ungerer et al. 1981) are two “pivotal skills” for children with ASD, in that they constitute early foundations upon which later social-communicative and language skills are built (Laakso et al. 1999; Mundy and Crowson 1997). Pivotal skills are not only assumed to provide a foundation for the acquisition of later skills, but also are assumed to facilitate the development of those skills through incidental learning even in the absence of formal instruction (Rogers and Vismara 2008). Joint attention entails an intentional sharing of attention to objects or events that are external to either communi- cation partner. Behaviors representing joint attention acts include pointing, showing, giving, and coordinated look- ing between one’s communication partner and the object or event of interest. Although both are communicative, joint attention acts difer from requests for objects because joint attention involves coordinating attention for the purpose of sharing interest instead of for the instrumental purpose of obtaining an object. Joint attention plays an important role in language development, perhaps due to the social motiva- tional roots of communicating to share interest with another person (Laakso et al. 1999; Slaughter and McConnell 2003). Also, there are important transactional efects related to a child’s initiation of joint attention; for example, when young children initiate joint attention bids, they engage their com- municative partners and elicit types of verbal input that promote language learning (Calandrella and Wilcox 2000; Yoder and Warren 2002; Yoder et al. 1994). In addition to joint attention, functioning at a symbolic level is also essential for language development. For exam- ple, symbolic functioning permits us to understand that the word “cat” does not just refer to the cat that may reside in our home, but rather to a cat schema which includes Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10803-018-3584-z) contains supplementary material, which is available to authorized users. Extended author information available on the last page of the article