81 Pilot testing of BEAR 4 and child 4, and moderate to severe concerns existed for child 2, 3, 5 and 6. Almost all children had a delayed cognitive development. When looking at global level of adaptive functioning as measured by the Vineland Screener, all children had a lower developmental age. Parental levels of education varied from high (university) to low (junior general secondary). Nearly all parents (except one) had a diagnosis and exhibited some autism symptoms as assessed by the SOV. Child outcomes The primary outcome measure is the time spend in total joint engagement (JERI). Results of individual progress pre-and post-intervention are presented in Figure 1. Four children seemed to spend more time in joint engagement after completing the intervention. One child (child 5) seemed to spend less time in joint engagement and another child (child 1) didn’t show any change in time spent in joint engagement. Notably, this participant spent already a high amount of time in joint engagement at baseline. Looking at different types of joint engagement (see Table 3), most improvements are made in coordinated joint engagement and supported joint engagement. Only one child improved on symbol infused joint engagement. Child 3 and child 4 strongly increased in coordinated joint engagement and as such, decreased in supported joint engagement. This is because in supported joint engagement the child and parent are actively involved with the same object or event, but the child is not actively acknowledging the parent’s participation whereas in coordinated joint engagement the child does acknowledge participation of the other. Looking at social communicative development as measured by the BOSCC (see Table 3), half of the children increased in their social communicative development (child 2, child 3 and child 6). Two children (child 4 and child 5) neither increased nor decreased and one child (child 1) slowly decreased in their social communicative development. When looking BITSEA Problem score BITSEA Competence score Dyadic partner Parental education Parental diagnosis SOV 9 15 Mother University Depressive episodes 27 14 9 Mother Junior general secondary Learning disability 34 38 11 Mother Senior secondary vocational Stress/burnout 44 21 5 Mother Senior secondary vocational None 41 12 10 Mother University ADHD 36 24 9 Father Senior secondary vocational Autism 43
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