Measuring Caregiver-Child Interaction in Early Intervention for Neurodevelopmental Disorders: The WHO JERI

• In Event: Placing Observations of Joint Engagement in Cultural Contexts

Abstract

Background: Recent literature has highlighted the need for comprehensive instruments to measure targets for early intervention for developmental disorders and delays, including autism spectrum disorder (ASD). The WHO adaptation of the Joint Engagement Rating Inventory (WHO JERI, Adamson, Bakeman & Suma, 2018) is an 8-item inventory developed to measure relevant intervention targets (Table 1). Items rate a child’s engagement states as well as aspects of the child’s behavior, their caregiver’s behavior and the dyad’s shared activities. The WHO JERI will be implemented internationally for children participating in the WHO Caregiver Skills Training program (WHO-CST) in countries in Europe, Africa, and Asia. All ratings are done by culturally informed raters living and working within the communities they serve. Reported here are findings from initial implementation testing for reliability and construct validity across measures.

Methods: The sample consists of 86 children with autism spectrum disorder (ASD; 67 males) aged 28-60 months recruited for a randomized controlled trial of the WHO-CST in Italy. Autism severity (ADOS-2), cognitive abilities (Griffiths-III) and vocabulary (MCDI) measures were collected at baseline. A free play caregiver-child interaction with a standard toy kit suitable for a range of developmental play levels was videorecorded at baseline, endpoint (3 months post-baseline) and follow-up (6 months post-baseline). Ten consecutive minutes were rated both with a measure of social communication (BOSCC; two 5-min scenes scored separately then averaged) and the WHO JERI (full 10-min) by two reliable raters blind to the study’s hypotheses. For the WHO JERI, ratings were applied in three separate viewings. A total of 256 interactions were rated. To check agreement, 22% of the corpus was independently rated by a second observer. Estimated observer accuracy was computed using the KappaAcc program (Bakeman, 2018). Construct validity of the WHO JERI was investigated by examining the associations of the WHO JERI item scores with theoretically associated variables on other assessments.

Results: Observers' agreement was good: the range of weighted Kappas for ratings within 1 point on the 7-point rating scale was .89–1. Observer estimated accuracy was good, with all items ≥95%. JERI Unengaged and Joint Engagement items show strong (> .5) positive and negative correlations with BOSCC and ADOS composite scores and items covering similar constructs (Spearman r’s range= .68 to .89 and -.76 to -.97, respectively). Correlations between JERI child items and corresponding BOSCC items (range = -.75 to -.85) were higher than correlations with expressive vocabulary or developmental level. Interaction items were strongly correlated with the BOSCC engagement item (range = -.71 to -.86).
Conclusions: The WHO JERI shows reasonable inter-rater agreement. Examination of correlations supports the tool’s construct validity, as the patterns of both the direction and size of correlations shown among WHO JERI items and other study variables are consistent with previous studies and theoretical expectations. WHO JERI training and implementation is both ongoing and planned at additional sites. Construct validity shown here promises to provide culturally sensitive ratings of global measures of caregiver-child interactions implemented with children of varying ages and developmental concerns and living in diverse contexts.

Authors

• Erica Salomone, University of Milano-Bicocca
  Presenting Author

• Michele Settanni, University of Turin
  Non-Presenting Author

• Federica Ferrara, University of Turin
  Non-Presenting Author

• Giulia Foletti, University of Turin
  Non-Presenting Author

• Chiara Servili, Department of Mental Health and Substance Abuse
  Non-Presenting Author