100 Chapter 5 Primary outcome Joint engagement in the parent-child interaction. A semi-structured 12 minute videotaped interaction between parent and child will be collected for each dyad at T1, T2 and T3. A standardized set of toys in two boxes (A and B) will be presented. Parents will be asked to engage in free play with box A for four minutes, followed by blowing bubbles for two minutes. Next, parents are asked to repeat the aforementioned, but now with the box B. The videotapes will be coded by observers blind to the group status and scored for the time and quality spend in different engagement states using Joint Engagement Rating Inventory (JERI; Adamson & Suma, 2020). Recordings will be subsequently coded for four engagement states (total joint engagement, supported joint engagement, coordinated joint engagement and symbol-infused joint engagement). The four items are each defined with 7 points providing information about both quantity and quality of engagement states. The low anchor (1) indicates that there are no episodes of joint engagement during the interaction, whereas the high anchor (7) indicates that the child almost always spends time in the joint engagement state during interaction. The midpoint of 4 characterizes a child who is in joint engagement for approximately half of the scene in several brief or a few relatively sustained episodes. Inter-rater reliability between students/research assistants is deemed reliable when there is a minimum of 80% agreement between observers, based on 15% percent of the tapes. The first author (MS) was trained by one of the developers of the JERI until high accuracy was obtained on all four joint engagement states. For the RCT, students and research assistants will be trained by MS in coding video records with use of the JERI. Secondary outcomes Social-communicative development. Change in social-communicative development is measured by the measured by the Brief Observation of Social Communication Change (BOSCC; Grzadzinski et al., 2016). At T1, T2 and T3, BOSCC will be rated based on the same twelve minutes videotaped parent-child dyadic interaction as the joint engagement measure (BOSCCparent). At T1 and T3, an additional BOSCC will be conducted by a skilled examiner. Here, the child is interacting with a professional examiner who has not been part of the intervention (BOSCCprofessional). The BOSCC consists of 15 coding items associated with key features of ASD, such as making eye contact, unusual sensory interests and the frequency and function of social overtures. The difference in total score between measurement moments is indicative for change in behaviour in the social-communicative domain. The BOSCC is a promising outcome measure and is derived from the Autism Diagnostic Observation Schedule-2 (ADOS-2; Lord et al., 2012) – the “golden standard” measure that has long been used as outcome measure in early intervention studies. Research shows that this new instrument has satisfactory interand intra-rater reliability (18, 33). Next, the ADOS-2 (toddler, module 1 and/or module 2) will be administered at T1 and T3. The ADOS-2 is a semi-structured play observation, where the clinician elicits social, communicative, stereotyped and play behaviour to observe symptoms
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