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.