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Frost KM, Brian J, Gengoux GW, Hardan A, Rieth SR, Stahmer A, Ingersoll B. Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2285-2297. [PMID: 32731748 PMCID: PMC7541530 DOI: 10.1177/1362361320944011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians' uncertainty about choosing the "right" intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.
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Affiliation(s)
- Kyle M. Frost
- Michigan State University, 316 Physics Road, 69F Psychology, East Lansing, MI
| | - Jessica Brian
- Bloorview Research Institute, 150 Kilgour Road Toronto, Ontario
| | - Grace W. Gengoux
- Stanford University School of Medicine, 401 Quarry Road, Stanford, CA
| | - Antonio Hardan
- Stanford University School of Medicine, 401 Quarry Road, Stanford, CA
| | - Sarah R. Rieth
- San Diego State University, 5500 Campanile Drive, San Diego, CA
| | - Aubyn Stahmer
- University of California-Davis MIND Institute, 2825 50th Street, Sacramento, CA
| | - Brooke Ingersoll
- Michigan State University, 316 Physics Road, 105B Psychology, East Lansing, MI
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302
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Liao CY, Ganz JB, Vannest KJ, Wattanawongwan S, Pierson LM, Yllades V, Li YF. Caregiver Involvement in Communication Skills for Individuals with ASD and IDD: a Meta-analytic Review of Single-Case Research on the English, Chinese, and Japanese Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00223-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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303
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Akemoglu Y, Tomeny KR. A Parent-Implemented Shared-Reading Intervention to Promote Communication Skills of Preschoolers with Autism Spectrum Disorder. J Autism Dev Disord 2020; 51:2974-2987. [PMID: 33095351 DOI: 10.1007/s10803-020-04757-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 01/16/2023]
Abstract
In the current study, we examined the effect of a parent-implemented early communication intervention during shared book reading. Three mothers of children with autism spectrum disorder were trained and coached to use a set of reading techniques and evidenced-based naturalistic communication teaching strategies (i.e., modeling, mand-model, and time delay). Using a multiple-baseline design across behaviors, the following three components were examined: (a) the mothers' use of reading techniques with fidelity, (b) the mothers' rate and fidelity in using the three naturalistic teaching strategies, and (c) the children's communication outcomes. After training and coaching, the mothers used the reading techniques and naturalistic teaching strategies with high fidelity. The children initiated more communicative acts upon their mothers' use of time delay.
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Affiliation(s)
- Yusuf Akemoglu
- Department of Special Education and Multiple Abilities, The University of Alabama, 902 University Blvd, Graves 201, Box 870232, Tuscaloosa, AL, 35487, USA.
| | - Kimberly R Tomeny
- Department of Special Education and Multiple Abilities, The University of Alabama, 902 University Blvd, Graves 201, Box 870232, Tuscaloosa, AL, 35487, USA
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304
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Simacek J, Elmquist M, Dimian AF, Reichle J. Current Trends in Telehealth Applications to Deliver Social Communication Interventions for Young Children with or at Risk for Autism Spectrum Disorder. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 8:15-23. [PMID: 33072492 PMCID: PMC7548134 DOI: 10.1007/s40474-020-00214-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/02/2023]
Abstract
Purpose of Review Early, intensive, and high-quality interventions can often improve social communication outcomes for children with autism spectrum disorder (ASD). Many children experience barriers to intervention, resulting in significant delays to intervention onset or missed opportunities for intervention altogether. With constant advances in technology, the field is experiencing a rapid increase in investigation of telehealth applications to intervention delivery. This article highlights the current trends in social communication intervention via telehealth used in early intervention practices for children with ASD over the past 5 years, including a brief review of studies (from 2014 to January 2020) and our team’s experiences in this area. Recent Findings Based on our experience and the 22 studies we identified in this area, we describe the current trends in telehealth applications used and how interventions were delivered. We also provide recommendations, limitations, and future directions on this topic. Summary Telehealth offers innovative intervention delivery options by increasing intervention access, overcoming barriers such as geography and costs of service delivery for young children with ASD.
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Affiliation(s)
- Jessica Simacek
- Institute on Community Integration, University of Minnesota, Minneapolis, MN USA
| | - Marianne Elmquist
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN USA
| | - Adele F. Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, MN USA
| | - Joe Reichle
- Department of Speech, Language, and Hearing Sciences, University of Minnesota, Minneapolis, MN USA
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305
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Kulage KM, Goldberg J, Usseglio J, Romero D, Bain JM, Smaldone AM. How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis. J Autism Dev Disord 2020; 50:2102-2127. [PMID: 30852784 DOI: 10.1007/s10803-019-03967-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0-26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2-16.0), p < 0.001], and Asperger's [23.3% (12.9-38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6-58.0), p = 0.52]. Less than one-third [28.8% (13.9-50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.
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Affiliation(s)
- Kristine M Kulage
- Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA.
| | - Johanna Goldberg
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, 701 West 168th Street, New York, NY, 10032, USA
| | - Danielle Romero
- Lucile Packard Children's Hospital at Stanford, 770 Welch Road, Palo Alto, CA, 94304, USA
| | - Jennifer M Bain
- Department of Neurology, Division of Child Neurology, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, 5th Floor, New York, NY, 10032, USA
| | - Arlene M Smaldone
- Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA
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306
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Huang Y, Wong MKY, Lam WY, Cheng CH, So WC. Gestures in Storytelling by Preschool Chinese-Speaking Children With and Without Autism. Front Psychol 2020; 11:573212. [PMID: 33013608 PMCID: PMC7506162 DOI: 10.3389/fpsyg.2020.573212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022] Open
Abstract
Previous findings on gestural impairment in autism are inconsistent, while scant evidence came from Chinese-speaking individuals. In the present study, preschool Chinese-speaking children with typical development and with autism were asked to generate stories from a set of wordless Cartoon pictures. Two groups were matched in chronological age and language developmental age. Their speech and gestures were coded. Compared to children with typical development, children with autism produced fewer gestures and showed lower gesture rate. Besides, children with autism produced fewer emblems and fewer supplementary gestures compared to their TD peers. Unlike children with typical development, children with autism tend to produce emblems for reinforcing, rather than supplementing information not conveyed in speech. Results showed the impairments in integrating the cross-modal semantic information in children with autism.
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Affiliation(s)
- Ying Huang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Miranda Kit-Yi Wong
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wan-Yi Lam
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun-Ho Cheng
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Chee So
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
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307
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Shea KA, Sellers TP, Smith SG, Bullock AJ. Self-guided behavioral skills training: A public health approach to promoting nurturing care environments. J Appl Behav Anal 2020; 53:1889-1903. [PMID: 33016333 DOI: 10.1002/jaba.769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 12/22/2022]
Abstract
The World Health Organization identified the promotion of "Nurturing Care Environments" as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population-level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population-level dissemination that targeted responsive caregiving. The self-guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on-line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior-specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population-level intervention design and evaluation.
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Affiliation(s)
- Kerry A Shea
- Department of Special Education and Rehabilitation, Utah State University
| | | | - Sandra G Smith
- Department of Special Education and Rehabilitation, Utah State University
| | - Andrea J Bullock
- Department of Special Education and Rehabilitation, Utah State University
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308
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Blanco-Martínez N, Delgado-Lobete L, Montes-Montes R, Ruiz-Pérez N, Ruiz-Pérez M, Santos-del-Riego S. Participation in Everyday Activities of Children with and without Neurodevelopmental Disorders: A Cross-Sectional Study in Spain. CHILDREN-BASEL 2020; 7:children7100157. [PMID: 33019630 PMCID: PMC7600717 DOI: 10.3390/children7100157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 12/27/2022]
Abstract
Children with neurodevelopmental disorders (NDDs) often report significant difficulties performing activities of daily living (ADLs), which may restrict their daily participation. The aim of this study was to investigate the differences in ADLs participation between children with NDDs and typically developing (TD) children, and to explore the associations between different daily participation contexts. A cross-sectional study was conducted that included twenty children with a medical diagnosis of an NDD and 26 sex- and age-matched TD controls. The daily participation across home, community, school, and instrumental living activities was measured using the Child and Adolescent Scale of Participation (CASP). The results show that children with NDDs engaged in lower participation in all CASP contexts (Δ = 1.7-5.5, p < 0.001) and had a significantly higher prevalence of moderate or severe restricted participation than their TD peers (OR = 23.4, 95% CI = 3.6-154.2, p < 0.001). Additionally, a strong association was found between the different contexts of participation (r = 0.642-0.856). Overall, the children with NDDs experienced significant participation restrictions on their daily activities. This study adds to the growing evidence showing that intervention strategies in this population should adopt a participation-oriented approach.
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Affiliation(s)
- Nerea Blanco-Martínez
- Faculty of Health Sciences, Health Integration and Promotion Research Unit (INTEGRA SAÚDE), University of A Coruña, 15011 A Coruña, Spain; (N.B.-M.); (S.S.-d.-R.)
- Faculty of Educational Sciences & Sports, University of Vigo, 36005 Pontevedra, Spain
| | - Laura Delgado-Lobete
- Faculty of Health Sciences, Health Integration and Promotion Research Unit (INTEGRA SAÚDE), University of A Coruña, 15011 A Coruña, Spain; (N.B.-M.); (S.S.-d.-R.)
- Correspondence: ; Tel.: +34-881-014-339
| | - Rebeca Montes-Montes
- TALIONIS Research Group, Centre for Information and Communications Technology Research (CITIC), University of A Coruña, 15008 A Coruña, Spain;
| | - Nuria Ruiz-Pérez
- Faculty of Pharmacy, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
- Faculty of Health Sciences, Catholic University of Ávila, 05005 Ávila, Spain
| | - Marcos Ruiz-Pérez
- University College of Teacher Training, University of Vigo, 36214 Vigo, Spain;
| | - Sergio Santos-del-Riego
- Faculty of Health Sciences, Health Integration and Promotion Research Unit (INTEGRA SAÚDE), University of A Coruña, 15011 A Coruña, Spain; (N.B.-M.); (S.S.-d.-R.)
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309
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Hyman SL, Iadarola S. Simpler Than Possible: Insurance Mandates for Autism Spectrum Disorders. Pediatrics 2020; 146:peds.2020-020396. [PMID: 32900878 DOI: 10.1542/peds.2020-020396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Suzannah Iadarola
- Golisano Children's Hospital, University of Rochester, Rochester, New York
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310
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Klin A, Micheletti M, Klaiman C, Shultz S, Constantino JN, Jones W. Affording autism an early brain development re-definition. Dev Psychopathol 2020; 32:1175-1189. [PMID: 32938507 PMCID: PMC7880583 DOI: 10.1017/s0954579420000802] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The national priority to advance early detection and intervention for children with autism spectrum disorder (ASD) has not reduced the late age of ASD diagnosis in the US over several consecutive Centers for Disease Control and Prevention (CDC) surveillance cohorts, with traditionally under-served populations accessing diagnosis later still. In this review, we explore a potential perceptual barrier to this enterprise which views ASD in terms that are contradicted by current science, and which may have its origins in the current definition of the condition and in its historical associations. To address this perceptual barrier, we propose a re-definition of ASD in early brain development terms, with a view to revisit the world of opportunities afforded by current science to optimize children's outcomes despite the risks that they are born with. This view is presented here to counter outdated notions that potentially devastating disability is determined the moment a child is born, and that these burdens are inevitable, with opportunities for improvement being constrained to only alleviation of symptoms or limited improvements in adaptive skills. The impetus for this piece is the concern that such views of complex neurodevelopmental conditions, such as ASD, can become self-fulfilling science and policy, in ways that are diametrically opposed to what we currently know, and are learning every day, of how genetic risk becomes, or not, instantiated as lifetime disabilities.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Megan Micheletti
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Cheryl Klaiman
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - John N. Constantino
- Departments of Psychiatry and Pediatrics, Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St Louis,MO
| | - Warren Jones
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
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311
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Sparapani N, Solari E, Towers L, McIntyre N, Henry A, Zajic M. Secondary Analysis of Reading-Based Activities Utilizing a Scripted Language Approach: Evaluating Interactions Between Students With Autism and Their Interventionists. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3130-3154. [PMID: 32857639 DOI: 10.1044/2020_jslhr-19-00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Students with autism spectrum disorder (ASD) often exhibit challenges with reading development. Evidence-based interventions and specialized approaches to reading instruction are currently being implemented across educational contexts for learners with ASD (Machalicek et al., 2008), yet there is limited understanding of how core ASD features may impact effective delivery of instruction and student participation. We begin to address this need by evaluating the reciprocity between instructional talk and student participation within a reading intervention utilizing a scripted language approach that was being piloted on students with ASD. Method This study used archival video-recorded observations from the beginning of a reading intervention to examine the interactions between 20 students (18 boys, two girls) with ASD (7-11 years old, M = 9.10, SD = 1.74) and their interventionists (n = 7). Lag sequential analysis was used to examine the frequency of student initiations and responses following the interventionists' use of responsive, open-ended, closed-ended, and directive language. Results Findings describe the types of and illustrate the variability in interactions between students and their interventionists, as well as highlight language categories that are linked to student participation. Conclusions These data provide a snapshot of the nature and quality of interactions between students with ASD and their interventionists. Findings suggest that delivery of instruction, including the language that interventionists use, may be an important area of focus when evaluating the effectiveness of reading-based practices across educational settings for learners with ASD, even within the confines of highly structured interventions.
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Affiliation(s)
- Nicole Sparapani
- University of California, Davis, School of Education
- University of California, Davis, MIND Institute
| | - Emily Solari
- Curry School of Education and Human Development, University of Virginia, Charlottesville
| | - Laurel Towers
- University of California, Davis, School of Education
- University of California, Davis, MIND Institute
| | - Nancy McIntyre
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill
| | - Alyssa Henry
- Curry School of Education and Human Development, University of Virginia, Charlottesville
| | - Matthew Zajic
- Curry School of Education and Human Development, University of Virginia, Charlottesville
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312
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Su PL, Rogers SJ, Estes A, Yoder P. The role of early social motivation in explaining variability in functional language in toddlers with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:244-257. [PMID: 32921137 DOI: 10.1177/1362361320953260] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT About one-third of children with autism spectrum disorder never develop the language that they need in different day-to-day situations. Identifying potential factors that can predict later language development is crucial to understanding why some children with autism spectrum disorder successfully develop language while others do not. This study sought to investigate one of the understudied predictors of language development, social motivation, and to test theories for why this association may occur. Testing the theories requires that we measure children's ability to deliberately and directly communicate with others (i.e. intentional communication) and children's language understanding between the measures of social motivation and later expressive language. We tested 87 children with autism spectrum disorder, aged 14-31 months, at four times over 24 months. We found that children with relatively stronger social motivation had relatively better language use 2 years later. This positive link was partly due to a child's ability to produce intentional communication and to understand language. Although we did not measure parents' talking to their children, a theory that inspired this study suggests that children who use frequent intentional communication probably motivate others to talk with them frequently, which facilitates children's language understanding which leads to the development of expressive language. This theory, if confirmed to be true, can provide guidance for parents who want to help their children learn to talk. Parents could look for intentional communication from their children and respond by talking to their children. Effective intervention on both parent and child targets will likely enhance treatment efficacy. Future work is needed to test these ideas.
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313
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Mutual Gaze: An Active Ingredient for Social Development in Toddlers with ASD: A Randomized Control Trial. J Autism Dev Disord 2020; 51:1921-1938. [PMID: 32894382 PMCID: PMC8124047 DOI: 10.1007/s10803-020-04672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We examined the efficacy of an early autism intervention for use in early childhood intervention (ECI) and mutual gaze as a contributor to social development. Seventy-eight families were randomly assigned to one of three 12-week interventions: Pathways (with a mutual gaze component), communication, or services-as-usual (SAU). The Pathways/SAU comparison concerned the efficacy of Pathways for ECI, and the Pathways/communication comparison, mutual gaze. The Pathways group made significantly more change on social measures, communicative synchrony, and adaptive functioning compared with the SAU group and on social measures compared with the communication group. There were no group differences for communicative acts. The results support Pathways as a potential ECI program and mutual gaze as an active ingredient for social and communication development.
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314
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Talbott MR, Miller MR. Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:688-700. [PMID: 32701034 PMCID: PMC7541743 DOI: 10.1080/15374416.2020.1790382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.
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Affiliation(s)
- Meagan R Talbott
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
| | - Meghan R Miller
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
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315
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Bernhardt JB, Lam GYH, Thomas T, Cubells JF, Bohlke K, Reid M, Rice CE. Meaning in Measurement: Evaluating Young Autistic Adults' Active Engagement and Expressed Interest in Quality-of-Life Goals. AUTISM IN ADULTHOOD 2020; 2:227-242. [PMID: 36601444 PMCID: PMC8992872 DOI: 10.1089/aut.2019.0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The need for support programs and meaningful measurement of outcomes with autistic adults is growing. To date, success in autism intervention has been defined based on changes in discretely defined, observable behaviors with limited consideration of the person's experience, motivations, or the complex contexts in which these skills are used. Behavioral skill-building interventions are effective at increasing or decreasing specific behaviors, but a purely behavioral focus is not enough for meaningful improvements in adult quality of life (QoL). To reflect real-life impact, intervention and measurement must go beyond quantitative estimates of changes in skills regardless of context of use and focus on enhancing and evaluating functional outcomes and adult QoL that includes active engagement with the adult and provides rigor in qualitative evaluation. This article reports on efforts to assess active engagement of verbally fluent young autistic adults in a supported university-based residential pilot program built around self-set wellness goals for healthy, engaged, responsible, and empowered adult living. Program evaluation used an exploratory process for evaluating QoL learning, while also being open to how future work can discern participant meanings in measurement. The pilot used a mixed-methods approach to measure entry skills and interests, codetermine personal wellness goals, inform program content with participants, and measure QoL learning in terms of active engagement, expressed interest, and changes in self-appraisal of competence, confidence, and identity. Participants' QoL learning, replication of QoL learning measurement methods, and further exploration of strategies to put participant meanings in QoL learning measurement are discussed. Lay summary Why was this study done?: This study piloted a measurement strategy for deciding what to measure and support in real-world contexts of independent living and on-campus experiences in a 3-week residential program for young autistic adults.What was the purpose of this study?: The study aimed to measure and support autistic adults' quality of life (QoL) learning in terms of the extent to which pursuing self-set wellness goals, with supports, positively impacted autistic adults' active engagement (e.g., participation in wellness activities), and expressed interest (e.g., willingness to participate).Why was this program developed?: The program was developed because more young adults on the spectrum are aging into adulthood without personalized, respectful, and meaningful supports to promote engaged adult living. We wanted to build on our experience and feedback from autistic adults, family, and partners who have engaged in weekly social engagement groups on a university campus and called for more comprehensive transition programs.What did the program do?: The project was a pilot of an on-campus program aimed at facilitating personally meaningful improvements in QoL through empowering autistic adults to act on their personal motivations, interests, and goals. It also emphasized learning through experiences in real-life contexts, in collaboration with other participants, campus resources, community members, and program staff.How did the researchers evaluate the new program?: The program team used both quantitative and qualitative methods. Quantitative methods included standard self-report tools that autistic adults used to rate their safety needs, adult self-direction skills, autism-related self-concept, priority of self-set wellness goals, and confidence in abilities to achieve and learn more about one's own wellness goals. Predetermined qualitative methods included analysis of themes from participants' narrative data from their wellness interviews with participants and open-response items from self-report tools. The program was also responsive through a preprogram wellness interview with parents, staff's field notes about of participants' behaviors, conversational interactions with participants, and team discussions. Researchers contextualized and synthesized the data into narrative case studies about each participant's wellness journey.What were the early findings and what do they add to what was already known?: Results showed that the program was able to facilitate participants' QoL learning in personal wellness goals in collaboration with campus and community resources. Participants expressed meaningful changes in their expressed interests, active engagement, and self-concept through participating in this brief residential on-campus program.What are potential weaknesses of this pilot?: Weaknesses included a short time period of 3 weeks, a small participant count of 5, and the resource-intense supports needed for the program.What are the next steps?: The next steps are to adjust the program based on participant feedback and pursue creation of a multiyear program to continue piloting the measurement and support strategies for facilitating autistic adults' active wellness engagement and self-determined independent living.How will these findings and this work help autistic adults now or in the future?: This work informs future wellness interventions for measuring and supporting autistic adults' efforts to self-determine meaningful changes to their QoL.
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Affiliation(s)
- Jamie B. Bernhardt
- Department of Psychiatry and Behavioral Sciences, Emory Autism Center, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Gary Yu Hin Lam
- Department of Educational Psychology, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Toni Thomas
- Department of Psychiatry and Behavioral Sciences, Emory Autism Center, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Joseph F. Cubells
- Department of Psychiatry and Behavioral Sciences, Emory Autism Center, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kelsey Bohlke
- Department of Psychiatry and Behavioral Sciences, Emory Autism Center, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Morganne Reid
- Department of Psychology, Catholic University of America, Washington, District of Columbia, USA
| | - Catherine E. Rice
- Department of Psychiatry and Behavioral Sciences, Emory Autism Center, School of Medicine, Emory University, Atlanta, Georgia, USA
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316
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Ben-Itzchak E, Nachshon N, Zachor DA. Having Siblings is Associated with Better Social Functioning in Autism Spectrum Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:921-931. [PMID: 30280363 DOI: 10.1007/s10802-018-0473-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sibling relationships play a unique developmental role, especially in emotional and social domains. In autism spectrum disorder (ASD), social-communication skills are often impaired in comparison to typical development. Therefore, studying siblings' effects on social skills of the child with ASD is important. This retrospective study examined how autism severity and functioning were affected by having older and younger sibling/s, the sex of the index child and of the sibling, and the number of siblings. The study population included 150 participants with ASD (mean age = 4:0 ± 1:6), divided into three equal groups (no sibling, older and younger siblings), matched for cognitive level. The evaluation included neurological and standardized behavioral, cognitive, and functional assessments. Children with ASD with older siblings showed less severe social interaction deficits and better social adaptive skills than only children. No significant differences in autism severity and adaptive functioning were noted between the group with younger siblings and the other groups. The more older siblings the affected child had, the better their social functioning. The sex of the participants with ASD and that of the sibling were not associated with social functioning. Social interaction deficits, the presence of older or younger siblings for children with ASD, and higher cognitive ability contributed significantly to the explained variance (48.9%) in social adaptive skills. These findings emphasize that older siblings positively influence the social skills of their younger sibling with ASD. The effect of typically developing younger siblings was modest and seen only in children with ASD and better cognition.
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Affiliation(s)
- Esther Ben-Itzchak
- Bruckner Center for Research in Ausim, Department of Communication Disorders, Ariel University, 40700, Ariel, Israel. .,The Autism Center, Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.
| | - Noa Nachshon
- Bruckner Center for Research in Ausim, Department of Communication Disorders, Ariel University, 40700, Ariel, Israel
| | - Ditza A Zachor
- The Autism Center, Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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317
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Chen N, Miller S, Milbourn B, Black MH, Fordyce K, Van Der Watt G, Alach T, Masi A, Frost G, Tucker M, Eapen V, Girdler S. "The big wide world of school": Supporting children on the autism spectrum to successfully transition to primary school: Perspectives from parents and early intervention professionals. Scand J Child Adolesc Psychiatr Psychol 2020; 8:91-100. [PMID: 33520781 PMCID: PMC7685497 DOI: 10.21307/sjcapp-2020-009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The transition to primary school is often a complex and uncertain time for autistic children and their families. Understanding how best to develop school readiness and support transition to primary school for autistic children is essential. School readiness and transition planning are influenced by a range of personal and contextual factors, and it is important to understand the perspectives of the various stakeholders involved in the transition process. Methods: A qualitative exploration employing focus groups and interviews was undertaken with early intervention (EI) staff (n = 45) and parents (n = 18) across Australia to understand their perspectives on school readiness and the transition to primary school. Results: Thematic analysis identified four emerging themes facilitating transition including: 1) building the child; 2) building the parents; 3) building the receiving school; and, 4) connecting the system. Conclusion: Findings highlight the need to consider school readiness and transition planning from a holistic perspective, ensuring clear, collaborative and ongoing communication between parents, teachers and EI staff, using a strength-based approach, and individualizing transition planning.
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Affiliation(s)
- Nigel Chen
- School of Occupational Therapy Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,Curtin Autism Research Group, Curtin University, Perth, Western Australia, Australia
| | - Scott Miller
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,Autism Association of Western Australia, Perth, Western Australia, Australia.,Autism Specific Early Learning and Care Centre, Perth, Western Australia, Australia
| | - Ben Milbourn
- School of Occupational Therapy Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,Curtin Autism Research Group, Curtin University, Perth, Western Australia, Australia
| | - Melissa H Black
- School of Occupational Therapy Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,Curtin Autism Research Group, Curtin University, Perth, Western Australia, Australia
| | - Kathryn Fordyce
- St Giles Society North West Tasmania Autism Specific Early Learning and Care Centre, Burnie, Tasmania, Australia
| | - Gerdamari Van Der Watt
- Autism Association of Western Australia, Perth, Western Australia, Australia.,Autism Specific Early Learning and Care Centre, Perth, Western Australia, Australia
| | - Tasha Alach
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,Autism Association of Western Australia, Perth, Western Australia, Australia.,Autism Specific Early Learning and Care Centre, Perth, Western Australia, Australia
| | - Anne Masi
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Frost
- Anglicare SA Daphne St Autism Specific Early Learning and Care Centre, Prospect South Australia, Australia
| | - Madonna Tucker
- AEIOU Foundation, Queensland Autism Specific Early Learning and Care Centre, Nathan, Queensland, Australia
| | - Valsamma Eapen
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Academic Unit of Child Psychiatry, South West Sydney (AUCS), ICAMHS, Mental Health Centre, Liverpool, New South Wales, Australia
| | - Sonya Girdler
- School of Occupational Therapy Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Australia.,Curtin Autism Research Group, Curtin University, Perth, Western Australia, Australia
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318
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Social origins of self-regulated attention during infancy and their disruption in autism spectrum disorder: Implications for early intervention. Dev Psychopathol 2020; 32:1362-1374. [PMID: 32693862 DOI: 10.1017/s0954579420000796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To understand the complex relationships between autism spectrum disorder (ASD) and other frequently comorbid conditions, a growing number of studies have investigated the emergence of ASD during infancy. This research has suggested that symptoms of ASD and highly related comorbid conditions emerge from complex interactions between neurodevelopmental vulnerabilities and early environments, indicating that developing treatments to prevent ASD is highly challenging. However, it also suggests that attenuating the negative effects of ASD on future development once identified is possible. The present paper builds on this by conceptualizing developmental delays in nonsocial skills as the potential product of altered caregiver-infant interactions following the emergence of ASD during infancy. And, following emerging findings from caregiver-infant dyadic head-mounted eye-tracking (D-ET) research, it also suggests that a multiple pathway model of joint attention can provide mechanistic insights into how ASD alters the ability of caregiver and infant to create a context for infant learning. The potential for this view to inform early intervention is further discussed and illustrated through D-ET data collected prior to and following a brief, parent-mediated intervention for infant ASD. While promising, further research informing how a multiple pathway model of joint attention can inform ASD early intervention is needed.
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319
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Gevarter C, Horan K, Sigafoos J. Teaching Preschoolers With Autism to Use Different Speech-Generating Device Display Formats During Play: Intervention and Secondary Factors. Lang Speech Hear Serv Sch 2020; 51:821-838. [DOI: 10.1044/2020_lshss-19-00092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
Children with autism spectrum disorder (ASD) and complex communication needs are increasingly taught to use tablet-based speech-generating devices (SGDs). An important issue in designing such interventions is the selection of an appropriate format for displaying vocabulary. The purpose of this study was to determine (a) whether young children with ASD can be taught to use different SGD vocabulary display formats and (b) whether there are differences across the formats on a range of secondary measures (e.g., preference and generalization).
Method
Five preschoolers with ASD (and prior experience with simpler aided augmentative and alternative communication) were taught to use grid and visual scene display SGDs during a play-based intervention. Acquisition of functional responding was assessed using a single-case experimental design. Secondary variables included error types, antecedents for communication, preference, and generalization.
Results
All participants increased their use of functional target vocabulary using both the grid and the simple visual scene display. Of the five participants, three showed similar performance with both formats, whereas two had slightly higher rates of functional responding with the grid. Individualized differences across participants and formats were apparent across secondary variables (e.g., preference, error types, generalization).
Conclusions
Both simple grid and visual scene displays may be viable options when teaching functional use of SGDs to children with ASD who have prior aided augmentative and alternative communication experience. Analyzing secondary variables beyond device acquisition (e.g., generalization, preference) may have implications for individualizing intervention.
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Affiliation(s)
- Cindy Gevarter
- Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque
| | | | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, New Zealand
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320
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Leadbitter K, Macdonald W, Taylor C, Buckle KL. Parent perceptions of participation in a parent-mediated communication-focussed intervention with their young child with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2129-2141. [PMID: 32667223 PMCID: PMC7539598 DOI: 10.1177/1362361320936394] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Paediatric Autism Communication Therapy is a parent-mediated, video-aided, communication-focussed intervention for young children with autism spectrum disorder. It has been shown in a UK randomised controlled trial to lead to improvements in parent–child communication and family quality of life, together with a sustained reduction in child autism symptom severity. This qualitative study examined parental perceptions of their participation in Paediatric Autism Communication Therapy within the context of the randomised controlled trial. Semi-structured interviews were carried out with 18 parents within 12 months of completion of the therapy. The thematic analysis provides insights into parents’ hopes, expectations, and learning processes when working with Paediatric Autism Communication Therapy therapists and carrying out daily practice in the home. Parents reported positive changes in their interaction and relationship with their child and improvements to their child’s communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnostic therapy. Practical difficulties were also emphasised. Implications for the clinical practice of parent-mediated interventions with young children with autism spectrum disorder are discussed.
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321
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Azad GF, Minton KE, Mandell DS, Landa RJ. Partners in School: An Implementation Strategy to Promote Alignment of Evidence-Based Practices Across Home and School for Children with Autism Spectrum Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:266-278. [PMID: 32653973 DOI: 10.1007/s10488-020-01064-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
When parents and teachers align their practices across home and school, it may optimize services for children with autism spectrum disorder (ASD). Partners in School is a multi-faceted implementation strategy designed to improve ASD services in schools. The goal is to increase parents' and teachers' use of evidence-based practices (EBPs) and to align those EBPs across settings. We piloted Partners in School with 49 parent-teacher dyads to assess administration and the factors associated with reported fidelity to the model. Specifically, we measured the number of intervention steps both parents and teachers completed (reported alignment) and the characteristics associated with intervention alignment. Partners in School involves parent-teacher participation in a pre-consultation interview, an in-person consultation meeting, active implementation of the same EBPs in their respective settings, and a post-consultation interview. Parents and teachers also completed surveys pre- and post-consultation. On average, parents and teachers completed approximately five EBP steps on their own in their respective settings (i.e., at home or at school). Of these five steps, parents and teachers both completed three of the same EBPs steps, on average. Different factors were related to reported alignment for parents versus teachers; however, a similarity noted for both parents and teachers was that communication variables were associated with reported alignment. Our findings indicate the important role of communication in aligning stakeholders for ASD service delivery models.
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Affiliation(s)
- Gazi F Azad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Kyla E Minton
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, Baltimore, MD, 21211, USA
| | - David S Mandell
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St., 3rd Fl., Philadelphia, PA, 19104, USA
| | - Rebecca J Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Ave, Baltimore, MD, 21211, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA
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322
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Shire SY, Shih W, Bracaglia S, Kodjoe M, Kasari C. Peer engagement in toddlers with autism: Community implementation of dyadic and individual Joint Attention, Symbolic Play, Engagement, and Regulation intervention. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2142-2152. [PMID: 32643385 DOI: 10.1177/1362361320935689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Although young children may participate in education and intervention programs that take place in classrooms or groups, there is little information about how toddlers with special needs, and specifically toddlers with autism, are engaging with their peers. This study takes place in a public center-based early intervention program for toddlers with autism. Classrooms of toddlers were randomly assigned to an individual social communication intervention or the same intervention adapted to include a peer. Children in both groups made gains in social communication and play skills. Children who had the peer intervention were more engaged with peers when an adult was present, but not when the children were unsupported. This article adds information about early skills that may be important for children to master so that they have more success when trying to interact with their peers. These skills include understanding language (referred to as "receptive language" at 12 months or more) and play skills including building and stacking (referred to as "combination play"-for example, building with blocks or completing a puzzle) and extending familiar actions to themselves, others, and figures (referred to as "presymbolic play"-for example, putting a bottle to the doll or to themselves). Understanding which skills to target can help practitioners focus their instruction to build children's skills toward connecting with peers through play.
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Affiliation(s)
| | - Wendy Shih
- University of California, Los Angeles, USA
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323
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Zheng JJ, Zou R, Huang S, Song TJ, Yu X. Enriched Environment Rearing from Birth Reduced Anxiety, Improved Learning and Memory, and Promoted Social Interactions in Adult Male Mice. Neuroscience 2020; 442:138-150. [PMID: 32652178 DOI: 10.1016/j.neuroscience.2020.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
Rearing rodents in an enriched environment (EE), with increased sensory stimulations and social interactions, is a well-established model for naturally increasing neural activity. It is well-known that EE-rearing of rodents from adolescence or during adulthood leads to extensive biochemical, morphological, electrophysiological and behavioral changes. Here, we examine the effects of EE-rearing from birth on adult behavior. Through a battery of assays, we found that mice EE-reared from birth had better acquisition and consolidation of memory, in both aversive-based fear conditioning and reward-based contextual association tasks. Moreover, EE-reared mice showed reduced anxiety in novel environments and enhanced social interactions. Together, these results demonstrated that EE-rearing from birth significantly improved motor ability, learning and memory and sociability, while reducing anxiety. A better understanding of how early environmental influences affect behavior is not only important for understanding neural circuit wiring, but also provides insight into developing more effective intervention programs for neurodevelopmental disorders.
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Affiliation(s)
- Jing-Jing Zheng
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Rong Zou
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Shajin Huang
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Tian-Jia Song
- School of Life Sciences, Peking-Tsinghua Center for Life Sciences, and Peking University McGovern Institute, Peking University, Beijing 100871, China.
| | - Xiang Yu
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China; School of Life Sciences, Peking-Tsinghua Center for Life Sciences, and Peking University McGovern Institute, Peking University, Beijing 100871, China.
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324
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Rodgers M, Marshall D, Simmonds M, Le Couteur A, Biswas M, Wright K, Rai D, Palmer S, Stewart L, Hodgson R. Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-306. [PMID: 32686642 PMCID: PMC7397479 DOI: 10.3310/hta24350] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early intensive applied behaviour analysis-based interventions are intensive interventions for autistic children that are often delivered on a one-to-one basis for 20-50 hours per week. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of early intensive applied behaviour analysis-based interventions for autistic children, based on current evidence. METHODS A systematic review and individual participant data meta-analysis were conducted to evaluate the clinical effectiveness of an early intensive applied behaviour analysis-based intervention for autistic children. An economic analysis included a review of existing analyses and the development of a new model. RESULTS Twenty studies were included in the clinical review. Individual participant data were retrieved from 15 of these studies. Results favoured the interventions when assessing adaptive behaviour after 2 years compared with treatment as usual/eclectic interventions (mean difference 7.00, 95% confidence interval 1.95 to 12.06). In analyses of cognitive ability (intelligence quotient), results favoured the interventions by approximately 10 points after 1 year (mean difference 9.16, 95% confidence interval 4.38 to 13.93) and 2 years (mean difference 14.13, 95% confidence interval 9.16 to 19.10). Evidence for other outcomes was limited and meta-analyses were generally inconclusive. There was no evidence that the effect of the interventions varied with characteristics of the children, but data were limited. Adopting a £30,000 per quality-adjusted life-year threshold, the results of the cost-effectiveness analysis indicate that early intensive applied behaviour analysis-based interventions would need to generate larger benefits or cost savings to be cost-effective. Adopting a public sector perspective and making pessimistic assumptions about long-term effects, the incremental cost-effectiveness ratio for early intensive applied behaviour analysis-based therapy compared with treatment as usual is £189,122 per quality-adjusted life-year. When optimistic assumptions are made, the incremental cost-effectiveness ratio is £46,768 per quality-adjusted life-year. Scenario analyses indicated that these interventions can potentially be cost-effective if long-term improvements persist into adulthood, or if they have significant impact on educational placement. Care should be taken when interpreting these scenarios owing to the limited data. LIMITATIONS All included studies were at risk of bias, there was substantial heterogeneity and effects varied considerably across studies. The effect of intervention on autism symptom severity, language development and school placement remains uncertain because of the limited data. The long-term effects are unclear owing to a lack of follow-up data. CONCLUSIONS This review found limited evidence that early intensive applied behaviour analysis-based interventions may improve cognitive ability and adaptive behaviour, but the long-term impact of the interventions remains unknown. The economic analysis is constrained by the limited effectiveness evidence, but suggests that these interventions are unlikely to be cost-effective unless clear long-term benefits, or a substantial change in which schools children attend, can be identified. FUTURE WORK Further studies into the effectiveness of early intensive applied behaviour analysis-based interventions may be warranted if they include well-defined, alternative interventions as comparators and collect relevant outcomes. Consideration should be given to future studies that not only address whether or not early intensive applied behaviour analysis-based interventions are clinically effective, but also aim to identify which components of early intensive applied behaviour analysis-based interventions might drive effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068303. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dheeraj Rai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
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325
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Grzadzinski R, Janvier D, Kim SH. Recent Developments in Treatment Outcome Measures for Young Children With Autism Spectrum Disorder (ASD). Semin Pediatr Neurol 2020; 34:100806. [PMID: 32446440 PMCID: PMC7248125 DOI: 10.1016/j.spen.2020.100806] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Significant advancements have been made in early intervention programs for children with Autism spectrum disorder (ASD). However, measuring treatment response for children with ASD is difficult due to the heterogeneity of changes in symptoms, which can be subtle, especially over a short period of time. Here we outline the challenge of evaluating treatment response with currently available measures as well as newly developed or refined measures that may be useful in clinical trials for young children with ASD. Continued development of treatment outcome measures will help the field identify and compare efficacious interventions and tailor treatments for children with ASD.
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Affiliation(s)
- Rebecca Grzadzinski
- University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC.
| | - Denisse Janvier
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
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326
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Valeri G, Casula L, Menghini D, Amendola FA, Napoli E, Pasqualetti P, Vicari S. Cooperative parent-mediated therapy for Italian preschool children with autism spectrum disorder: a randomized controlled trial. Eur Child Adolesc Psychiatry 2020; 29:935-946. [PMID: 31549310 DOI: 10.1007/s00787-019-01395-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
Parent-mediated intervention is widely used for pre-schoolers with autism spectrum disorder (ASD). Previous studies indicate small-to-moderate effects on social communication skills, but with a wide heterogeneity that requires further research. In this randomized controlled trial (RCT), cooperative parent-mediated therapy (CPMT) an individual parent coaching program for young children with ASD was administered to preschool children with ASD. All children received the same low-intensity psychosocial intervention (LPI) delivered in community settings, to evaluate the potential additional benefit of CPMT. Thirty-four participants with ASD (7 females; 27 males; aged 2, 6, 11 years) and their parents were included in the trial. The primary blinded outcome was social communication skills, assessed using the ADOS-G social communication algorithm score (ADOS-G SC). Secondary outcomes included ASD symptom severity, parent-rated language abilities and emotional/behavioral problems, and self-reported caregiver stress. Evaluations were made at baseline and post-treatment (at 6 months) by an independent multidisciplinary team. Results documented that CPMT showed an additional benefit on LPI with significant improvements of the primary blinded outcome, socio-communication skills, and of some secondary outcomes such as ASD symptom severity, emotional problems and parental stress related to parent-child dysfunctional interaction. No additional benefit was found for language abilities. Findings of our RCT show that CPMT provide an additional significant short-term treatment benefit on ASD core symptoms, when compared with active control group receiving only LPI.
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Affiliation(s)
- Giovanni Valeri
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, Italy
| | - Laura Casula
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, Italy
| | - Deny Menghini
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, Italy
| | | | - Eleonora Napoli
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, Italy
| | - Patrizio Pasqualetti
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
| | - Stefano Vicari
- Department of Neuroscience, IRCCS Children's Hospital Bambino Gesù, Piazza Sant' Onofrio, 4 00165, Rome, Italy.
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327
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D'Agostino S, Douglas SN, Horton E. Inclusive Preschool Practitioners' Implementation of Naturalistic Developmental Behavioral Intervention Using Telehealth Training. J Autism Dev Disord 2020; 50:864-880. [PMID: 31802319 DOI: 10.1007/s10803-019-04319-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This single-case investigation was designed to evaluate the effects of telehealth training on practitioner implementation of a naturalistic developmental behavioral intervention (NDBI). Six general education preschool practitioners engaged in an intervention with six children with varying disabilities in inclusive classroom settings. The telehealth training package included a collaborative approach to intervention planning, online training module, video self-evaluation, and performance feedback via videoconferencing. Following telehealth training, practitioners reached criteria for implementation fidelity and increased communication opportunities. Additionally, child participants increased communication behaviors above baseline levels. All behaviors generalized to a different activity context and maintained over time. Social validity was measured and results suggest high levels of acceptability for the telehealth training package.
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Affiliation(s)
- Sophia D'Agostino
- Hope College, Van Zoeren Hall, 41 Graves Place, Holland, MI, 49423, USA.
| | - Sarah N Douglas
- Human Development and Family Studies, 1C Human Ecology, Michigan State University, East Lansing, MI, 48824, USA
| | - Elizabeth Horton
- Hope College, Van Zoeren Hall, 41 Graves Place, Holland, MI, 49423, USA
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328
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Bradshaw J, Trumbull A, Stapel-Wax J, Gillespie S, George N, Saulnier C, Klaiman C, Woods J, Call N, Klin A, Wetherby A. Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1874-1884. [PMID: 32594763 DOI: 10.1177/1362361320928829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Early intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
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Affiliation(s)
| | | | - Jennifer Stapel-Wax
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Scott Gillespie
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Nisha George
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Celine Saulnier
- Emory University, USA.,Neurodevelopmental Assessment & Consulting Services, USA
| | - Cheryl Klaiman
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | | | - Nathan Call
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
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329
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Language Growth in Young Children with Autism: Interactions Between Language Production and Social Communication. J Autism Dev Disord 2020; 51:644-665. [PMID: 32588273 DOI: 10.1007/s10803-020-04576-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Young children with autism spectrum disorder (ASD) present with a broad range of spoken language abilities, as well as delays in precursor skills such as gesture production and joint attention skills. While standardized assessments describe language strengths, the Communication and Symbolic Behavior Scales (CSBS-DP) is a particularly robust measure as it additionally characterizes precise aspects of social communication. This study provides a unique contribution by assessing the interactional effects of CSBS-DP Social Composite performance with early language samples on later language outcomes. Our results indicate that multiple social communication elements significantly interact with early spoken language to predict later language. Our findings also highlight the transactional relationship between early spoken vocabulary and social communication skills that bolster language development growth.
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330
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Big data approaches to develop a comprehensive and accurate tool aimed at improving autism spectrum disorder diagnosis and subtype stratification. LIBRARY HI TECH 2020. [DOI: 10.1108/lht-08-2019-0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAutism spectrum disorder (ASD) is a complex neurodevelopmental disorder that is difficult to diagnose accurately due to its heterogeneous clinical manifestations. Comprehensive models combining different big data approaches (e.g. neuroimaging, genetics, eye tracking, etc.) may offer the opportunity to characterize ASD from multiple distinct perspectives. This paper aims to provide an overview of a novel diagnostic approach for ASD classification and stratification based on these big data approaches.Design/methodology/approachMultiple types of data were collected and recorded for three consecutive years, including clinical assessment, neuroimaging, gene mutation and expression and response signal data. The authors propose to establish a classification model for predicting ASD clinical diagnostic status by integrating the various data types. Furthermore, the authors suggest a data-driven approach to stratify ASD into subtypes based on genetic and genomic data.FindingsBy utilizing complementary information from different types of ASD patient data, the proposed integration model has the potential to achieve better prediction performance than models focusing on only one data type. The use of unsupervised clustering for the gene-based data-driven stratification will enable identification of more homogeneous subtypes. The authors anticipate that such stratification will facilitate a more consistent and personalized ASD diagnostic tool.Originality/valueThis study aims to utilize a more comprehensive investigation of ASD-related data types than prior investigations, including proposing longitudinal data collection and a storage scheme covering diverse populations. Furthermore, this study offers two novel diagnostic models that focus on case-control status prediction and ASD subtype stratification, which have been under-explored in the prior literature.
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331
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Billeci L, Caterino E, Tonacci A, Gava ML. Behavioral and Autonomic Responses in Treating Children with High-Functioning Autism Spectrum Disorder: Clinical and Phenomenological Insights from Two Case Reports. Brain Sci 2020; 10:brainsci10060382. [PMID: 32560365 PMCID: PMC7348738 DOI: 10.3390/brainsci10060382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 02/02/2023] Open
Abstract
In this study, we aimed to evaluate the process applied in subjects with Autism Spectrum Disorder (ASD) to elaborate and communicate their experiences of daily life activities, as well as to assess the autonomic nervous system response that subtend such a process. This procedure was evaluated for the first time in two eight-year-old girls with high-functioning ASDs. The subjects performed six months of training, based on the cognitive–motivational–individualized (c.m.i.®) approach, which mainly consisted in building domestic procedures and re-elaborating acquired experiences through drawing or the use of icons made by the children. Together with behavioral observations, the response of the autonomic nervous system during such re-elaboration was recorded. A change in communicative and interactive competences was observed, moving from a condition of spontaneity to one in which the girls were engaged in relating their experiences to a parent. Autonomic response highlighted how, in communicating their own experiences, they achieved a state of cognitive activation, which enabled a greater communicative and emotional connection with the interlocutor. This is a proof-of-concept study on the application of the c.m.i.®, which needs to be extensively validated in the clinical setting.
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Affiliation(s)
- Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy, 56124 Pisa, Italy;
| | - Ettore Caterino
- Azienda USL Sudest Toscana, Centro Autismo UFSMIA di Grosseto, Ospedale di Castel del Piano, 58033 Grosseto, Italy;
| | - Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy, 56124 Pisa, Italy;
- Correspondence:
| | - Maria Luisa Gava
- Associazione Nazionale Famiglie di Persone con Disabilità Intellettiva e/o Relazionale (ANFFAS), 18100 Imperia, Italy;
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332
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Phase 2 and Later of COVID-19 Lockdown: Is it Possible to Perform Remote Diagnosis and Intervention for Autism Spectrum Disorder? An Online-Mediated Approach. J Clin Med 2020; 9:jcm9061850. [PMID: 32545809 PMCID: PMC7357157 DOI: 10.3390/jcm9061850] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/23/2023] Open
Abstract
COVID-19 is still in phase 2. The lockdown has been significantly reduced compared to phase 1. The centers and institutions that deal with the diagnosis and intervention of children with autism spectrum disorder (ASD) require rapid functional adaptation to respond to patients’ needs. The possibility of using technology to activate and manage diagnostic (preliminary diagnosis) and intervention processes should be explored. Two developed telemedicine working models for diagnosis and intervention, including synchronous and asynchronous transmissions, are presented. They are proposals not yet supported by the data. The diagnosis step is composed by two different and consecutives phases: (A) pre-specialistic consultation (PSC) and (B) specialistic assessment. The intervention step implemented well-recognized evidence-based models for preschoolers, school-aged, and older children in an online format. Parents’ support is also included. The described working models have the purpose of carrying out preliminary specialistic answers to the families without aiming to replace preferable in-person assessment. Based on previous research findings, the telemedicine approach is accepted by parents, increases their sense of competence, increases the parent intervention adhesion, and improves the social communication competencies for children with ASD. In conclusion, the presented working models must be considered partial responses to the current emergency status and at the same time as possible integrations into traditional approaches.
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333
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The Effects of the Early Start Denver Model for Children with Autism Spectrum Disorder: A Meta-Analysis. Brain Sci 2020; 10:brainsci10060368. [PMID: 32545615 PMCID: PMC7349854 DOI: 10.3390/brainsci10060368] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023] Open
Abstract
This meta-analysis examined the effects of the Early Start Denver Model (ESDM) for young children with autism on developmental outcome measures. The 12 included studies reported results from 640 children with autism across 44 unique effect sizes. The aggregated effect size, calculated using a robust variance estimation meta-analysis, was 0.357 (p = 0.024), which is a moderate effect size with a statistically significant overall weighted averaged that favored participants who received the ESDM compared to children in control groups, with moderate heterogeneity across studies. This result was largely driven by improvements in cognition (g = 0.412) and language (g = 0.408). There were no significant effects observed for measures of autism symptomology, adaptive behavior, social communication, or restrictive and repetitive behaviors.
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334
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Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Feldman JI, Canihuante M, Woynaroski T. Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1537-1560. [PMID: 32384865 PMCID: PMC7842122 DOI: 10.1044/2020_jslhr-19-00167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/31/2019] [Accepted: 01/15/2020] [Indexed: 05/10/2023]
Abstract
Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.
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Affiliation(s)
| | | | - Shannon Crowley
- Lynch School of Education and Human Development, Boston College, MA
| | - Margaret Cassidy
- College of Arts and Sciences, Vanderbilt University, Nashville, TN
| | - Jacob I. Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | | | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Vanderbilt Brain Institute, Nashville, TN
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335
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Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Feldman JI, Canihuante M, Woynaroski T. Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1537-1560. [PMID: 32384865 DOI: 10.1044/2020_jslhr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.
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Affiliation(s)
| | | | - Shannon Crowley
- Lynch School of Education and Human Development, Boston College, MA
| | - Margaret Cassidy
- College of Arts and Sciences, Vanderbilt University, Nashville, TN
| | - Jacob I Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | | | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Vanderbilt Brain Institute, Nashville, TN
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336
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Pisman MD, Luczynski KC. Caregivers can implement play-based instruction without disrupting child preference. J Appl Behav Anal 2020; 53:1702-1725. [PMID: 32406094 DOI: 10.1002/jaba.705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 01/30/2023]
Abstract
Young children diagnosed with autism spectrum disorder often require systematic teaching to learn new skills, and caregivers can teach their children by embedding learning opportunities in a play-based context. However, researchers have not evaluated procedures to train caregivers how to implement a combination of strategies designed to establish rapport and early language skills while maintaining play as a preferred context. Caregiver-child dyads composed of 2 mothers and their sons were recruited to participate. A multiple-probe design across strategies was used to demonstrate the efficacy of behavioral skills training on the mothers' integration of parallel play, child-directed interaction, teaching requests (mands), and teaching labels (tacts). Both children acquired the target requests and labels as a function of their mothers' teaching. By assessing the children's preferences, we confirmed the teaching strategies did not decrease toy engagement or the value of playing with their mother. We obtained stimulus generalization of the mothers' implementation of the strategies from a clinic to their home and maintenance of mother and child performance across a month.
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Affiliation(s)
- Maegan D Pisman
- University of Nebraska Medical Center's Munroe-Meyer Institute
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337
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Staff Perceptions and Implementation Fidelity of an Autism Spectrum Disorder Care Pathway on a Child/Adolescent General Psychiatric Inpatient Service. J Autism Dev Disord 2020; 51:158-168. [PMID: 32394312 DOI: 10.1007/s10803-020-04509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates, general psychiatric settings are not designed to meet their unique needs. Previous evaluations of an ASD-Care Pathway (ASD-CP) on a general psychiatric unit revealed sustained reductions in crisis interventions (intramuscular medication use, holds/restraints; Cervantes et al. in J Autism Dev Disord 49(8):3173-3180, https://doi.org/10.1007/s10803-019-04029-6 , 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082-4089, https://doi.org/10.1007/s10803-018-3666-y , 2018). The current study investigated staff perceptions of the ASD-CP (N = 30), and examined rates of ASD-CP implementation fidelity in relation to patient outcomes (N = 28). Staff identified visual communication aids and reward strategies as most helpful. The number of days of reward identification early in the inpatient stay was associated with fewer crisis interventions later in a patient's stay.
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338
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Haine-Schlagel R, Rieth S, Dickson KS, Brookman-Frazee L, Stahmer A. Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1215-1237. [PMID: 32237157 DOI: 10.1002/jcop.22347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/31/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
AIMS Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies. METHODS A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input. RESULTS Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies. CONCLUSIONS Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.
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Affiliation(s)
- Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Sarah Rieth
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Kelsey S Dickson
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Lauren Brookman-Frazee
- Child & Adolescent Services Research Center, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Aubyn Stahmer
- Child & Adolescent Services Research Center, San Diego, California
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
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339
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London MD, Mackenzie L, Lovarini M, Dickson C, Alvarez-Campos A. Animal Assisted Therapy for Children and Adolescents with Autism Spectrum Disorder: Parent perspectives. J Autism Dev Disord 2020; 50:4492-4503. [PMID: 32333302 DOI: 10.1007/s10803-020-04512-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Animal-Assisted Therapy (AAT) is an intervention for children with Autism Spectrum Disorder (ASD). This study explores parent perspectives of the impact of five AAT sessions involving trained dogs with their children with ASD. A phenomenological qualitative approach was used to explore first-hand perspectives of parents. In-depth, semi-structured interviews were conducted. Data were analyzed using thematic analysis. Seventeen parents reported that the presence of the dogs facilitated their children's engagement, enjoyment, and motivation. Parents also reported that this contributed to gains in the child's communication with others and the dog (n = 11, 64.7%), behavioral regulation (n = 12, 70.6%), and community participation (n = 14, 82.3%). These findings indicate that parents supported the use of AAT and that dogs facilitated therapeutic gains.
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Affiliation(s)
- Maeve Doyle London
- Discipline of Occupational Therapy, The University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, The University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - Meryl Lovarini
- Discipline of Occupational Therapy, The University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia
| | - Claire Dickson
- Occupational Therapist, Assistance Dogs Australia, Engadine, Sydney, Australia
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340
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Zaidman-Zait A, Mirenda P, Szatmari P, Duku E, Smith IM, Zwaigenbaum L, Vaillancourt T, Kerns C, Volden J, Waddell C, Bennett T, Georgiades S, Ungar WJ, Elsabbagh M. Profiles and Predictors of Academic and Social School Functioning among Children with Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:656-668. [DOI: 10.1080/15374416.2020.1750021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Anat Zaidman-Zait
- Department of School Counseling and Special Education, Tel Aviv University
| | - Pat Mirenda
- Department of Educational and Counselling Psychology and Special Education, University of British Columbia
| | - Peter Szatmari
- Centre for Addiction and Mental Health, University of Toronto
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | | | | | | | - Connor Kerns
- Department of Educational and Counselling Psychology and Special Education, University of British Columbia
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Stelios Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University
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341
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Eysenbach G, Haber N, Voss C, Tamura S, Daniels J, Ma J, Chiang B, Ramachandran S, Schwartz J, Winograd T, Feinstein C, Wall DP. Toward Continuous Social Phenotyping: Analyzing Gaze Patterns in an Emotion Recognition Task for Children With Autism Through Wearable Smart Glasses. J Med Internet Res 2020; 22:e13810. [PMID: 32319961 PMCID: PMC7203617 DOI: 10.2196/13810] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/28/2019] [Accepted: 02/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several studies have shown that facial attention differs in children with autism. Measuring eye gaze and emotion recognition in children with autism is challenging, as standard clinical assessments must be delivered in clinical settings by a trained clinician. Wearable technologies may be able to bring eye gaze and emotion recognition into natural social interactions and settings. OBJECTIVE This study aimed to test: (1) the feasibility of tracking gaze using wearable smart glasses during a facial expression recognition task and (2) the ability of these gaze-tracking data, together with facial expression recognition responses, to distinguish children with autism from neurotypical controls (NCs). METHODS We compared the eye gaze and emotion recognition patterns of 16 children with autism spectrum disorder (ASD) and 17 children without ASD via wearable smart glasses fitted with a custom eye tracker. Children identified static facial expressions of images presented on a computer screen along with nonsocial distractors while wearing Google Glass and the eye tracker. Faces were presented in three trials, during one of which children received feedback in the form of the correct classification. We employed hybrid human-labeling and computer vision-enabled methods for pupil tracking and world-gaze translation calibration. We analyzed the impact of gaze and emotion recognition features in a prediction task aiming to distinguish children with ASD from NC participants. RESULTS Gaze and emotion recognition patterns enabled the training of a classifier that distinguished ASD and NC groups. However, it was unable to significantly outperform other classifiers that used only age and gender features, suggesting that further work is necessary to disentangle these effects. CONCLUSIONS Although wearable smart glasses show promise in identifying subtle differences in gaze tracking and emotion recognition patterns in children with and without ASD, the present form factor and data do not allow for these differences to be reliably exploited by machine learning systems. Resolving these challenges will be an important step toward continuous tracking of the ASD phenotype.
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Affiliation(s)
| | - Nick Haber
- Graduate School of Education, Stanford University, Stanford, CA, United States
| | - Catalin Voss
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | | | | | - Jeffrey Ma
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Bryan Chiang
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Shasta Ramachandran
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Jessey Schwartz
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Terry Winograd
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Carl Feinstein
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Dennis P Wall
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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342
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Moody CT, Laugeson EA. Social Skills Training in Autism Spectrum Disorder Across the Lifespan. Child Adolesc Psychiatr Clin N Am 2020; 29:359-371. [PMID: 32169267 DOI: 10.1016/j.chc.2019.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.
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343
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Weitlauf AS, Broderick N, Stainbrook JA, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dykens EM, Juárez AP, Warren ZE. Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT. Pediatrics 2020; 145:S81-S92. [PMID: 32238534 PMCID: PMC8025402 DOI: 10.1542/peds.2019-1895k] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up. METHODS Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time. RESULTS Both groups improved during active treatment in all subdomains of parent stress (β = -1.42, -1.25, -0.92; P < 0.001), depressive symptoms, and anxiety symptoms (β = -0.62 and -0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (β = -1.91 and -1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (β = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems. CONCLUSIONS Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.
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Affiliation(s)
| | | | | | | | | | - Amy G Nicholson
- Departments of Pediatrics and
- Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | | | - Elisabeth M Dykens
- Departments of Pediatrics and
- Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - A Pablo Juárez
- Departments of Pediatrics and
- Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Departments of Special Education and
| | - Zachary E Warren
- Departments of Pediatrics and
- Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Departments of Special Education and
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344
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Stahmer AC, Rieth SR, Dickson KS, Feder J, Burgeson M, Searcy K, Brookman-Frazee L. Project ImPACT for Toddlers: Pilot outcomes of a community adaptation of an intervention for autism risk. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:617-632. [PMID: 31565955 PMCID: PMC7102932 DOI: 10.1177/1362361319878080] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study reports child and family outcomes from a community-based, quasi-experimental pilot trial of Project ImPACT for Toddlers that is a parent-mediated, naturalistic, developmental behavioral intervention for children with or at-risk for autism spectrum disorder developed through a research-community partnership. Community early interventionists delivered either Project ImPACT for Toddlers (n = 10) or Usual Care (n = 9) to families based on Part C assigned provider. Twenty-five families participated, with children averaging 22.76 months old (SD = 5.06). Family and child measures were collected at intake, after 3 months of service, and after a 3-month follow-up. Results indicate significantly greater improvements in positive parent-child interactions for Project ImPACT for Toddlers than usual care families, as well as large, but non-significant, effect sizes for Project ImPACT for Toddlers families in children's social and communication skills.
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Affiliation(s)
- Aubyn C Stahmer
- University of California, Davis, Department of Psychiatry and Behavioral Science, UC Davis Health, MIND Institute
- Child and Adolescent Services Research Center (CASRC)
| | - Sarah R Rieth
- Child and Adolescent Services Research Center (CASRC)
- San Diego State University, Department of Child and Family Development
| | - Kelsey S. Dickson
- Child and Adolescent Services Research Center (CASRC)
- San Diego State University, Department of Child and Family Development
| | - Josh Feder
- Fielding Graduate University, School of Leadership Studies, PhD Program in Infant and Early Childhood Development
- University of California, San Diego, Department of Psychiatry
| | | | - Karyn Searcy
- TERI Crimson Center for Speech & Language
- San Diego State University, School of Speech, Language, and Hearing Sciences
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center (CASRC)
- University of California, San Diego, Department of Psychiatry
- Autism Discovery Institute, Rady Children’s Hospital-San Diego
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345
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McDonald NM, Hyde C, Choi AB, Gulsrud AC, Kasari C, Nelson CA, Jeste SS. Improving Developmental Abilities in Infants With Tuberous Sclerosis Complex: A Pilot Behavioral Intervention Study. INFANTS AND YOUNG CHILDREN 2020; 33:108-118. [PMID: 32467653 PMCID: PMC7255424 DOI: 10.1097/iyc.0000000000000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic syndrome that confers risk for neurodevelopmental disorders, including autism spectrum disorder and intellectual disability. Delays in social communication and early cognitive abilities are observable as early as 9 months of age in children with TSC; however, there have been no studies of early behavioral intervention in TSC. We conducted a pilot study of an evidence-based, parent-mediated behavioral intervention focused on improving early social communication and play skills in 5 children with TSC (aged 1-3 years). Participants showed maintenance and sometimes gains in developmental abilities, relative to peers, following intervention. Parents generally found the intervention to be helpful and were able to administer the intervention with fidelity. Preliminary results demonstrate initial feasibility of an early play-based, parent-mediated intervention and support the need for a large-scale, randomized clinical trial in TSC.
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Affiliation(s)
- Nicole M McDonald
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Carly Hyde
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - April Boin Choi
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Amanda C Gulsrud
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Connie Kasari
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Charles A Nelson
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Shafali S Jeste
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
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346
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Vibert BA, Dufek S, Klein CB, Choi YB, Winter J, Lord C, Kim SH. Quantifying Caregiver Change Across Early Autism Interventions Using the Measure of NDBI Strategy Implementation: Caregiver Change (MONSI-CC). J Autism Dev Disord 2020; 50:1364-1379. [PMID: 31925669 PMCID: PMC7103564 DOI: 10.1007/s10803-019-04342-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aimed to provide initial validity and reliability of the Measure of NDBI Strategy Implementation-Caregiver Change (MONSI-CC), a novel measure that captures changes in caregivers' implementation of NDBI strategies during early intervention. The MONSI-CC was applied to 119 observations of 43 caregiver-child dyads of preschoolers with autism spectrum disorders (ASD). The MONSI-CC showed high inter-rater and test-retest reliability and captured significant improvements in caregivers' implementation of NDBI strategies. Significant associations between improvements in caregiver NDBI implementation and improvements in the child's ASD symptoms also emerged. Our work shows promising evidence for the utility of the MONSI-CC to evaluate implementation of NDBI strategies by caregivers as a mediating and moderating factor for treatment effects on children with ASD.
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Affiliation(s)
| | - Sarah Dufek
- University of California, Davis, MIND Institute, Sacramento, CA, USA
| | - Claire B Klein
- Center for Autism and the Developing Brain, Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Rd, White Plains, NY, USA
| | - Yeo Bi Choi
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Jamie Winter
- Center for Autism and the Developing Brain, Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Rd, White Plains, NY, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Rd, White Plains, NY, USA.
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347
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Maye M, Sanchez VE, Stone-MacDonald A, Carter AS. Early Interventionists' Appraisals of Intervention Strategies for Toddlers with Autism Spectrum Disorder and Their Peers in Inclusive Childcare Classrooms. J Autism Dev Disord 2020; 50:4199-4208. [PMID: 32193762 DOI: 10.1007/s10803-020-04456-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Mounting evidence supports several naturalistic developmental behavioral interventions (NDBI) for toddlers and preschoolers within inclusive childcare centers and preschools. However, these interventions pose many barriers to community implementation. As part of a larger project to create an adapted NDBI for early educators in childcare centers, we surveyed 101 early interventionists who had worked with a toddler with autism within the last 12 months. Early interventionists rated 22-of-31 NDBI strategies to be significantly more effective for All Toddlers versus Toddlers with Autism. However, when comparing the top 10 rated strategies between groups, there was a large degree of overlap. Moreover, many of these highly rated NDBI strategies are consistent with best practice accreditation and early education standards within the United States.
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Affiliation(s)
- Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health System, 3A32, 3rd Floor, One Ford Place, Detroit, MI, 48202, USA. .,University of Massachusetts Boston, Boston, USA.
| | - Victoria E Sanchez
- Division of Developmental Medicine, Boston Children's Hospital, Boston, USA.,University of Massachusetts Boston, Boston, USA
| | - Angela Stone-MacDonald
- Department of Curriculum and Instruction, University of Massachusetts Boston, Boston, USA.,University of Massachusetts Boston, Boston, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, USA.,University of Massachusetts Boston, Boston, USA
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348
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Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurol 2020; 19:434-451. [PMID: 32142628 DOI: 10.1016/s1474-4422(20)30034-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
Abstract
Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.
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349
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Maye M, Gaston D, Godina I, Conrad JA, Rees J, Rivera R, Lushin V. Playful but Mindful: How to Best Use Positive Affect in Treating Toddlers With Autism. J Am Acad Child Adolesc Psychiatry 2020; 59:336-338. [PMID: 32089193 PMCID: PMC7087471 DOI: 10.1016/j.jaac.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
Abstract
The best-tested treatments for toddlers with autism spectrum disorder (ASD) are grounded in the principles of applied behavioral analysis (ABA) and blended with developmental science. Examples include Project ImPACT1 and Early Start Denver Model,2 among others. ABA-based behavioral interventions use conditioned reinforcement of target behaviors by giving the child access to desired objects and activities as a consequence of performing target behaviors. Unlike the original ABA technique, discrete trial training, ABA-based naturalistic developmental-behavioral interventions (NDBIs) occur in natural environments and employ operant conditioned reinforcement of target behaviors by capitalizing on the child's interests in objects and activities.1-3 NDBIs are highly recommended for toddlers and children with autism.3 Clinical manuals for NDBIs emphasize that clinicians should use modulations of voice and exaggerated facial expressions and gestures to engage toddlers.1-4 These behaviors are often referred to as positive affect, increased animation, modulation of child affect, or playfulness. Given the range of clinician behaviors described across these constructs and the commonalities between them, within this article we will henceforth refer to the following behaviors as playfulness: positive affect, increased animation, modulation of child affect, and exaggerated facial expressions and gestures. Most NDBIs indicate that playfulness should be thoughtfully employed throughout NDBI sessions in conjunction with other NDBI strategies (eg, contingent responsiveness, balanced turns, child choice) to maintain engagement and build social reciprocity with the child as the clinician and child work together toward treatment goals. However, our clinical and supervisory experiences suggest that many clinicians do not consistently use playfulness as an intervention tool. Instead, according to our observations, many clinicians largely employ neutral affect when providing treatment to toddlers with ASD, even while employing NDBI strategies such as following the child's lead, contingent responsiveness, and balanced turns. This article presents our clinical perspective on the utility of playfulness for treating toddlers with ASD.
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Affiliation(s)
- Melissa Maye
- Center for Mental Health, University of Pennsylvania School of Medicine, Philadelphia
| | - Daphney Gaston
- Center for Mental Health, University of Pennsylvania School of Medicine, Philadelphia
| | - Irina Godina
- University Settlement Early Intervention Program, New York, NY
| | | | - Joanne Rees
- School of Health Professions, Brooklyn Campus, Long Island University, Brooklyn, NY
| | - Rebecca Rivera
- School of Health Professions, Brooklyn Campus, Long Island University, Brooklyn, NY
| | - Victor Lushin
- Center for Mental Health, University of Pennsylvania School of Medicine, Philadelphia.
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350
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Ruble LA, Love AMA, Wong V, Grisham-Brown JL, McGrew JH. Implementation Fidelity and Common Elements of High Quality Teaching Sequences for Students with Autism Spectrum Disorder in COMPASS. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 71:101493. [PMID: 32863861 PMCID: PMC7453638 DOI: 10.1016/j.rasd.2019.101493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Evidence-based educational instruction includes teaching elements common across different approaches as well as specific elements of the chosen evidence-based practice. We were interested in evaluating the use and impact of common elements of teaching. Specifically, we adopted a model of elements of high quality teaching sequences and developed and tested an instructional quality index to capture evidence-based features within teaching sequences (Grisham-Brown & Ruble, 2014). METHOD The current investigation examined 29 special education teachers who received a consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple & McGrew, 2012) that results in personalized teaching plans for young students with ASD and embeds elements of evidence-based teacher coaching of self-reflection and performance-based feedback. We analyzed the teaching plans to understand which of the common elements were present, and if teachers demonstrated improved performance after coaching. RESULTS Analysis of the use of common elements during the first and fourth coaching session demonstrated that all teachers showed improvement. Most importantly, the use of common elements correlated with student goal attainment outcomes. CONCLUSIONS These results suggest that common elements of teaching sequences which we view as core features of teaching quality, can be improved as a result of coaching, and most importantly, are associated with students' educational outcomes.
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Affiliation(s)
- Lisa A Ruble
- University of Kentucky, 237 Dickey Hall, 40506, Lexington
| | | | - Venus Wong
- University of Kentucky, 237 Dickey Hall, 40506, Lexington
| | | | - John H McGrew
- University of Kentucky, 237 Dickey Hall, 40506, Lexington
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