2.3 Assessment
Quality of shared intention in Dohsa-hou and play sessions:Shared intention in Dohsa-hou sessions was evaluated by the following six-point scale: Indifference (0), looking at the therapist but not trying to confirm the therapist’s intentions (1), looking in the eyes when requesting for something (2), children looking at the therapist and the object (alternately) when the therapist points at the object (e.g., a body part) (3), making eye contact with the therapist in response to the action of the therapist (4), and making eye contact with the therapist spontaneously to show the therapist something (5).
Shared intention in play sessions were evaluated by the following six-point scale: Playing alone without paying attention to the therapist (0), paying attention to the therapist but playing alone (1), responding to encouragement from the therapist but returning to playing alone (2), playing together with the therapist but exhibiting limited motivation to share intentions (3), responding to encouragement from the therapist, sharing toys and playing, and playing together (4), the child seems to encourage the therapist to share their intentions (5).
To assess autistic symptoms, joint attention, and social adaptation, we used the Social Communication Questionnaire (SCQ), the Joint Attention Behavior Scale, and the Japanese version of the Vineland Adaptive Behavior Scale-II. These measures were administered at pre-intervention, session 10, session 16, and follow-up (2 months after the intervention).
Social Communication Questionnaire: The Social Communication Questionnaire (SCQ) is a screening tool to clarify the presence or absence of symptoms related to ASD, consisting of 40 items.29, 30 A higher score indicates higher autistic symptoms. It comprises three symptom domains (reciprocal interpersonal relationships, communication, and limited, repetitive, and stereotyped pattern of behaviors) that correspond to the Autism Diagnostic Interview-Revised (ADI-R), a clinical diagnostic instrument to assess ASD based on parent interviews. These domains were used to evaluate changes in autistic symptoms of the participant. Sara’s overall score was 22 at pre-intervention, which is above the cutoff score for ASD screening.
Joint Attention Behavior Scale: This scale contains 17 items related to joint attention, which 31includes gazing, production and understanding of pointing, alternating gaze, understanding of others’ emotions, and representations. The caregiver responded to the yes/no questions (0/1). The higher the score, the more developed the behavior related to joint attention. She scored 0 at pre-intervention, suggesting profound impairment in joint attention.
Vineland Adaptive Behavior Scale-II: The Vineland Adaptive Behavior Scale-II (Vineland-II) is a semi-structured interview that evaluates the adaptive behavior of individuals. It assesses the four domains of adaptive behavior: communication, daily living skills, social skills, and motor skills. 32, 33 At pre-intervention, Sara’s Vinland-II scores showed profound impairment in total score (Total = 21) and all four domains (communication = 22, daily living skills = 20, social skills =20, and motor skills = 20). The social skills domain (socialization) was repeatedly evaluated (intake, sessions 10 and 16, and follow-up), as this study focused on social relationships and behavior.