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Toby LM, Hustyi KM, Hartley BK, Dubuque ML, Outlaw EE, Logue JJ. Development and Preliminary Validation of the Patient Outcome Planning Calculator (POP-C): A Tool for Determining Treatment Dosage in Applied Behavior Analysis. Behav Anal Pract 2024; 17:601-614. [PMID: 38966276 PMCID: PMC11219665 DOI: 10.1007/s40617-023-00861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 07/06/2024] Open
Abstract
Board certified behavior analysts (BCBA) are responsible for determining the medically necessary treatment dosage for patients (i.e., the number of hours of therapy a patient should receive per week to optimize progress) during applied behavior analysis (ABA) therapy. However, because there is currently no standard method for making these determinations, BCBAs must rely on their own clinical judgment. Given that clinical judgment may be underdeveloped in some BCBAs, particularly those who are newly certified, more formal strategies are needed to guide decision making as it relates to medical necessity and treatment dosage. In this article we describe the development of the Patient Outcome Planning Calculator (POP-C), a standardized decision-making tool designed to assist novice practitioners in determining the medically necessary ABA treatment intensity and appropriate treatment setting for individuals with autism spectrum disorder (ASD). We present preliminary reliability data as well as construct validity data indicating statistically significant correlations between the POP-C and several norm-referenced and criterion-referenced assessments commonly used to estimate skill level and the corresponding degree of support needed within the ASD population to inform the ABA treatment model and goals. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-023-00861-6.
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Affiliation(s)
- Lauryn M. Toby
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | | | | | - Molly L. Dubuque
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | - Erica E. Outlaw
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | - Jesse J. Logue
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
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2
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Wang L, Li S, Wang C. Using Pivotal Response Treatment to Improve Language Functions of Autistic Children in Special Schools: A Randomized Controlled Trial. J Autism Dev Disord 2024; 54:2081-2093. [PMID: 37101061 PMCID: PMC10132802 DOI: 10.1007/s10803-023-05988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
Language difficulties exert profound negative effects on the cognitive and social development of autistic children. Pivotal Response Treatment (PRT) is a promising intervention for improving social communication in autistic children, but there is a lack of a comprehensive examination of language functions. This study aimed to investigate the effectiveness of PRT in promoting the primary language functions (requesting, labeling, repeating, responding) defined by (Skinner, B. F. (1957). Verbal behavior. Martino Publishing.) theory of verbal behavior in autistic children. Thirty autistic children were randomly divided into the PRT group (Mage = 6.20, SDage = 1.21) and control group (Mage = 6.07, SDage = 1.49). The PRT group were provided with an 8-week training of the PRT motivation component in addition to treatment as usual (TAU) in their schools, whereas the control group only received TAU. Parents of the PRT group were also trained to practice the PRT motivation procedures at home. The PRT group demonstrated greater improvements in all four measured language functions compared to the control group. The improvement in language functions in the PRT group was generalized and maintained at the follow-up assessment. In addition, the PRT intervention enhanced untargeted social and communicative functioning, cognition, motor skills, imitation, and adaptive behaviors in the autistic children. In conclusion, language intervention using the motivation component of PRT is effective in promoting language functions as well as widespread untargeted cognitive and social functions in autistic children.
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Affiliation(s)
- Leilei Wang
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, 38 Tongyan Road, Tianjin, China
- Autism Research Center, Nankai University, Tianjin, China
| | - Shuting Li
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Chongying Wang
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, 38 Tongyan Road, Tianjin, China.
- Autism Research Center, Nankai University, Tianjin, China.
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3
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MacDonald-Prégent A, Saiyed F, Hyde K, Sharda M, Nadig A. Response to Music-Mediated Intervention in Autistic Children with Limited Spoken Language Ability. J Autism Dev Disord 2024; 54:1438-1452. [PMID: 36637597 DOI: 10.1007/s10803-022-05872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Autistic children with limited spoken language ability (LSLA) often do not respond to traditional interventions, reducing their social inclusion. It is essential to identify effective interventions, and sensitive measures to track their intervention response. METHODS Using data from an RCT comparing music-mediated and play-based interventions, we investigated the impact of spoken language ability on outcomes, and measured response to intervention through natural language sample measures. RESULTS Children with lower verbal IQ, relative to higher verbal IQ, made some greater gains over the course of music-mediated intervention. Natural language samples were helpful in characterizing communication and tracking change. CONCLUSION Music-mediated interventions hold promise as effective interventions for autistic children with LSLA. Natural language samples are robust in characterizing this subgroup.
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Affiliation(s)
- Angela MacDonald-Prégent
- School of Communication Sciences and Disorders, McGill University, 2001 Av. McGill College #8, H3A 1G1, Montréal, QC, Canada.
| | - Fauzia Saiyed
- Department of Psychology, McGill University, 2001 Av. McGill College #4, H3A 1G1, Montréal, QC, Canada
| | - Krista Hyde
- International Laboratory for Brain, Music and Sound Research (BRAMS), University of Montréal, Pavillon Marie-Victorin/ Local A-108, 90 Vincent-d'Indy Av, H2V, Outremont, QC, Canada
| | - Megha Sharda
- International Laboratory for Brain, Music and Sound Research (BRAMS), University of Montréal, Pavillon Marie-Victorin/ Local A-108, 90 Vincent-d'Indy Av, H2V, Outremont, QC, Canada
| | - Aparna Nadig
- School of Communication Sciences and Disorders, McGill University, 2001 Av. McGill College #8, H3A 1G1, Montréal, QC, Canada
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4
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Kauley N, John JR, Barr KR, Wu WT, Grove R, Masi A, Eapen V. Predicting Communication Skills Outcomes for Preschool Children with Autism Spectrum Disorder Following Early Intervention. Neuropsychiatr Dis Treat 2024; 20:35-48. [PMID: 38223372 PMCID: PMC10785686 DOI: 10.2147/ndt.s435740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/25/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention. Methods We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention. Results Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores. Conclusion Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.
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Affiliation(s)
- Nadine Kauley
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Karlen R Barr
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Weng Tong Wu
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Grove
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Anne Masi
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
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5
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Jatkar A, Garrido D, Zheng S, Silverman G, Elsayed H, Davis PH, Lee H, Crais ER, Sideris J, Turner-Brown L, Baranek GT, Watson LR, Grzadzinski R. Toddlers at Elevated Likelihood for Autism: Exploring Sensory and Language Treatment Predictors. JOURNAL OF EARLY INTERVENTION 2023; 45:39-62. [PMID: 36969559 PMCID: PMC10038203 DOI: 10.1177/10538151211067227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Baseline child characteristics may predict treatment outcomes in children with or at elevated likelihood of developing autism (EL-ASD). Little is known about the role of child sensory and language features on treatment outcome. Participants were randomly assigned to a parent-mediated intervention or control condition. Analyses explored the relationship between baseline child sensory and language characteristics and changes in ASD symptoms over approximately 9 months. Higher baseline sensory hyporeactivity was significantly related to less improvement in social communication (SC) for the treatment group only. More baseline atypical vocalizations were significantly related to less improvement on SC across treatment and control groups. This work provides an initial framework to encourage the tailoring of interventions for EL-ASD children, suggesting sensory reactivity and atypical vocalizations may be useful behaviors to consider in treatment planning.
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Affiliation(s)
- Alapika Jatkar
- The University of North Carolina at Chapel Hill, Carolina
Institute for Developmental Disabilities, Chapel Hill, NC, USA
| | - Dunia Garrido
- The University of Granada, Mind, Brain, and Behaviors
Research Center, Granada, Spain
| | - Shuting Zheng
- The University of California at San Francisco, San
Francisco, CA, USA
| | - Greyson Silverman
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
| | - Heba Elsayed
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
- Alexandria University, Phoniatrics Unit, Otolaryngology
Department, Egypt
| | - Paige Huguely Davis
- The University of North Carolina at Chapel Hill, Carolina
Institute for Developmental Disabilities, Chapel Hill, NC, USA
| | - Helen Lee
- The University of Southern California, Mrs. T.H. Chan
Division of Occupational Science and Occupational Therapy, Los Angeles, CA,
USA
| | - Elizabeth R. Crais
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
| | - John Sideris
- The University of Southern California, Mrs. T.H. Chan
Division of Occupational Science and Occupational Therapy, Los Angeles, CA,
USA
| | - Lauren Turner-Brown
- The University of North Carolina at Chapel Hill, Department
of Psychiatry, Chapel Hill, NC, USA
| | - Grace T. Baranek
- The University of Southern California, Mrs. T.H. Chan
Division of Occupational Science and Occupational Therapy, Los Angeles, CA,
USA
| | - Linda R. Watson
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
| | - Rebecca Grzadzinski
- The University of North Carolina at Chapel Hill, Carolina
Institute for Developmental Disabilities, Chapel Hill, NC, USA
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Examining Predictors of Different ABA Treatments: A Systematic Review. Behav Sci (Basel) 2022; 12:bs12080267. [PMID: 36004838 PMCID: PMC9405151 DOI: 10.3390/bs12080267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023] Open
Abstract
In the recent literature, there is a broad consensus on the effectiveness of Applied Behavior Analysis interventions for autism spectrum disorder (ASD). Despite their proven efficacy, research in clinical settings shows that these treatments are not equally effective for all children and the issue of which intervention should be chosen for an individual remains a common dilemma. The current work systematically reviewed studies on predictors and moderators of response to different types of evidence-based treatment for children with ASD. Specifically, our goal was to critically review the relationships between pre-treatment child characteristics and specific treatment outcomes, covering different aspects of functioning (i.e., social, communicative, adaptive, cognitive, motor, global functioning, play, and symptom severity). Our results questioned the binomial “better functioning-better outcome”, emphasizing the complex interplay between pre-treatment child characteristics and treatment outcomes. However, some pre-treatment variables seem to act as prerequisites for a specific treatment, and the issue of “what works for whom and why” remains challenging. Future research should focus on the definition of evidence-based decision-making models that capture those individual factors through which a specific intervention will exert its effects.
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7
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Pivotal Response Treatment with and without robot-assistance for children with autism: a randomized controlled trial. Eur Child Adolesc Psychiatry 2022; 31:1871-1883. [PMID: 34106357 PMCID: PMC9663375 DOI: 10.1007/s00787-021-01804-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/15/2021] [Indexed: 01/26/2023]
Abstract
Pivotal response treatment (PRT) is a promising intervention focused on improving social communication skills in children with autism spectrum disorder (ASD). Since robots potentially appeal to children with ASD and may contribute to their motivation for social interaction, this exploratory randomized controlled trial (RCT) was conducted comparing PRT (PRT and robot-assisted PRT) with treatment-as-usual (TAU). Seventy-three children (PRT: n = 25; PRT + robot: n = 25; TAU: n = 23) with ASD, aged 3-8 years were assessed at baseline, after 10 and 20 weeks of intervention, and at 3-month follow-up. There were no significant group differences on parent- and teacher-rated general social-communicative skills and blindly rated global functioning directly after treatment. However, at follow-up largest gains were observed in robot-assisted PRT compared to other groups. These results suggest that robot-assistance may contribute to intervention efficacy for children with ASD when using game scenarios for robot-child interaction during multiple sessions combined with motivational components of PRT. This trial is registered at https://www.trialregister.nl/trial/4487 ; NL4487/NTR4712 (2014-08-01).
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8
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Rogers SJ, Yoder P, Estes A, Warren Z, McEachin J, Munson J, Rocha M, Greenson J, Wallace L, Gardner E, Dawson G, Sugar CA, Hellemann G, Whelan F. A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism. J Am Acad Child Adolesc Psychiatry 2021; 60:710-722. [PMID: 32853704 PMCID: PMC8057785 DOI: 10.1016/j.jaac.2020.06.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/30/2020] [Accepted: 08/17/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This randomized, multisite, intent-to-treat study tested the effects of 2 levels of treatment intensity (number of hours) and 2 treatment styles on the progress of young children with autism spectrum disorder (ASD). We predicted that initial severity of developmental delay or autism symptoms would moderate the effects of intensity and style on progress in 4 domains: autism symptom severity, expressive communication, receptive language, and nonverbal ability. METHOD A total of 87 children with ASD, mean age 23.4 months, were assigned to 1 of 2 intervention styles (naturalistic developmental/behavioral or discrete trial teaching), each delivered for either 15 or 25 hours per week of 1:1 intervention for 12 months by trained research staff. All caregivers received coaching twice monthly. Children were assessed at 4 timepoints. Examiners and coders were naive to treatment assignment. RESULTS Neither style nor intensity had main effects on the 4 outcome variables. In terms of moderating the effects of initial severity of developmental delay and of autism symptom severity, neither moderated the effects of treatment style on progress in any of the 4 domains. In terms of treatment intensity, initial severity moderated effect of treatment intensity on only 1 domain, namely, change in autism symptom severity; in a secondary analysis, this effect was found in only 1 site. CONCLUSION Neither treatment style nor intensity had overall effects on child outcomes in the 4 domains examined. Initial severity did not predict better response to 1 intervention style than to another. We found very limited evidence that initial severity predicted better response to 25 vs 15 hours per week of intervention in the domains studied. CLINICAL TRIAL REGISTRATION INFORMATION Intervention Effects of Intensity and Delivery Style for Toddlers With Autism: https://clinicaltrials.gov/; NCT02272192.
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Affiliation(s)
| | - Paul Yoder
- Vanderbilt University, Nashville, Tennessee
| | | | | | | | | | - Marie Rocha
- University of California, Davis MIND Institute, Davis
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9
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Pivotal Response Treatment for School-Aged Children and Adolescents with Autism Spectrum Disorder: A Randomized Controlled Trial. J Autism Dev Disord 2021; 51:4506-4519. [PMID: 33559019 DOI: 10.1007/s10803-021-04886-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Pivotal Response Treatment (PRT) is promising for children with Autism Spectrum Disorder (ASD), but more methodologically robust designed studies are needed. In this randomized controlled trial, forty-four children with ASD, aged 9-15 years, were randomly allocated to PRT (n = 22) or treatment-as-usual (TAU; n = 22). Measurements were obtained after 12- and 20-weeks treatment, and 2-month follow-up. PRT resulted in significant greater improvements on parent-rated social-communicative skills after 12 weeks treatment (p = .004, partial η2 = 0.22), compared to TAU. Furthermore, larger gains in PRT compared to TAU were observed on blindly rated global functioning, and parent-rated adaptive socialization skills and attention problems. Implications for clinical practice and suggestions for future research are discussed.
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10
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Gibson JL, Pritchard E, de Lemos C. Play-based interventions to support social and communication development in autistic children aged 2-8 years: A scoping review. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:23969415211015840. [PMID: 36381525 PMCID: PMC9620698 DOI: 10.1177/23969415211015840] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS Play is used by practitioners from across disciplinary backgrounds as a natural and enjoyable context for providing intervention and support in early childhood. In the case of autism interventions, many therapies are based on the association between social play and the development of social skills, language development, and communication skills, as these are often particular areas of challenge for autistic children. However, play is a wide-ranging concept and the extant literature on play-based interventions is large and heterogeneous. This means it is challenging for practitioners and families to navigate the evidence base and make choices about differing intervention strategies. This review aims to provide a comprehensive map of the research on this topic and to develop a conceptual framework to inform clinical decision-making. METHODS An initial stakeholder consultation confirmed the relevance of the topic to practitioners and autistic people. A scoping review methodology (preregistered) was used to identify relevant literature. We systematically searched seven databases to find peer-reviewed primary intervention studies of play-based approaches targeting language, social and communication outcomes for autistic children aged 2-8 years. We then summarised the literature using narrative synthesis and Evidence Gap Maps (EGMs). The literature was summarised according to a range of characteristics, including study design, population characteristics, agent of intervention and outcomes measured, among others. These summaries were then used to develop a framework for some key considerations for practitioners appraising play-based approaches. RESULTS 388 studies met inclusion criteria. Approximately 21% of studies were RCTs, and over 50% had ≤10 participants. Over 45% of studies reported multiple relevant outcomes, with social play skills being the most common single intervention target. Girls and minority background groups are under-represented. A range of intervention types were identified, and some high-level categorisations are proposed.Main contribution: On the basis of the evidence synthesis we suggest important dimensions for appraisal of play-based interventions, including the role of play within an intervention (as a context, a key developmental mechanism, or a component of a larger approach), the underpinning philosophy (e.g. behaviourist or developmental), and the role of the practitioner (providing parent feedback, 1:1 intervention, group facilitation). CONCLUSIONS The wide range of approaches uncovered by this review is a testament to the wonderful diversity inherent to both play and autism. However, research could usefully focus on consolidating the evidence base for existing approaches, rather than aiming for further diversification. Implications: The conceptual framework proposed in this review can help practitioners appraise the literature and aid their advice to families when making shared intervention decisions.
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Affiliation(s)
- Jenny L Gibson
- Jenny L Gibson, Play & Communication
Lab, Play in Education Development and Learning Research Centre, Faculty of
Education, University of Cambridge, Cambridge, UK.
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11
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Popovic SC, Starr EM, Koegel LK. Teaching Initiated Question Asking to Children with Autism Spectrum Disorder Through a Short-Term Parent-Mediated Program. J Autism Dev Disord 2020; 50:3728-3738. [PMID: 32112233 DOI: 10.1007/s10803-020-04426-2] [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] [Indexed: 11/28/2022]
Abstract
This study investigated whether a brief parent-mediated intervention would increase the frequency of question asking in children with ASD. Mothers participated in a 3-week training consisting of 2-h sessions twice weekly. Data were collected in the context of concurrent multiple baseline design. Results demonstrate all three children increased frequency of question asking with two children maintaining gains. All three children demonstrated generalization of question asking to novel items, family members, and/or settings. Affect improved for two of the three children. Overall, mothers were able to reach Fidelity of Implementation during most sessions and rated the intervention as highly acceptable. Results are discussed in regard to the feasibility of providing a short-term parent-implemented intervention to increase social initiations through question asking.
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Affiliation(s)
- Svetlana C Popovic
- Faculty of Education, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada.
| | - Elizabeth M Starr
- Faculty of Education, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Lynn K Koegel
- Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry and Child Development, Stanford University, 410 Quarry Road, Stanford, CA, 94305, USA
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12
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Is Earlier Better? The Relationship between Age When Starting Early Intervention and Outcomes for Children with Autism Spectrum Disorder: A Selective Review. AUTISM RESEARCH AND TREATMENT 2020; 2020:7605876. [PMID: 32832154 PMCID: PMC7421097 DOI: 10.1155/2020/7605876] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Abstract
Although the conventional wisdom is that “earlier is better” when it comes to intervention for children with ASD, it is not clear what evidence exists to support this notion. This review examined a group of studies that addressed outcomes for young children with ASD who started early intervention at a range of ages. The review was selective by including only papers that examined the age of initiation of treatment as well as baseline cognitive, language, or adaptive level and, in addition, employed a method to control for the covariance between early ability level and age of beginning intervention. Fourteen studies were identified and then compared on methods and outcomes. The support for “earlier is better” was mixed, but it was clear that complex relationships among predictor variables need to be explored in order to understand the role of age of starting early intervention for later outcomes.
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13
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Sinai-Gavrilov Y, Gev T, Mor-Snir I, Vivanti G, Golan O. Integrating the Early Start Denver Model into Israeli community autism spectrum disorder preschools: Effectiveness and treatment response predictors. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2081-2093. [PMID: 32662280 PMCID: PMC7543011 DOI: 10.1177/1362361320934221] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.
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Affiliation(s)
| | - Tali Gev
- Bar-Ilan University, Israel.,The Association for Children at Risk, Israel
| | | | | | - Ofer Golan
- Bar-Ilan University, Israel.,The Association for Children at Risk, Israel.,University of Cambridge, UK
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14
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Jobin A. Varied treatment response in young children with autism: A relative comparison of structured and naturalistic behavioral approaches. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:338-351. [PMID: 31311289 PMCID: PMC6962565 DOI: 10.1177/1362361319859726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heterogeneity of treatment response is common in children with autism spectrum disorder. Thus, many providers vary the intervention used based on child characteristics and learning domain. An improved understanding of how to match treatments to different children and domain areas may enhance efforts to individualize treatment and improve treatment response. This study evaluated the relative efficacy of discrete trial training and pivotal response training for teaching young children at risk for autism spectrum disorder receptive and expressive language, play, and imitation skills. Using a single-subject adapted alternating treatments design, children received both the treatments for 12 weeks. Data were collected during treatment and at 3-month follow-up. All participants acquired target skills in both treatments and demonstrated some generalization, maintenance, and spontaneous skill use. Pivotal response training and discrete trial training were each more effective for some children and domains. The results suggest that early rates of learning may be predictive of longer-term treatment response and useful in informing treatment decisions.
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Affiliation(s)
- Allison Jobin
- Child and Adolescent Services Research Center (CASRC), University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Herbrecht E, Lazari O, Notter M, Kievit E, Schmeck K, Spiegel R. Short-Term and Highly Intensive Early Intervention FIAS: Two-Year Outcome Results and Factors of Influence. Front Psychiatry 2020; 11:687. [PMID: 32765322 PMCID: PMC7381178 DOI: 10.3389/fpsyt.2020.00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/30/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Comprehensive behaviorally or developmentally based early intervention programs have been shown to be effective in improving cognitive, social communicative, and adaptive skills of children with autism spectrum disorder (ASD). Besides the definition of relevant outcome predictors, the question of whether early intensive intervention positively changes core autism symptoms in children, as well as their long-term outcome, is an important issue for current research. The primary objective of the current study was to examine whether symptomatic and behavioral changes in children up to 4.5 years with ASD were sustained one and two years after an initial 18 days of intensive FIAS (Frühintervention bei autistischen Störungen) intervention. METHODS We analyzed the data of 32 young children with moderately severe to severe ASD who had been treated at the FIAS center between January 2011 and July 2017 and who had completed their 2-year follow-up in summer 2019. RESULTS ADOS total scores decreased significantly from baseline to the 1-year follow-up and from baseline to the 2-year follow-up (p < 0.01), with the most prominent change being from baseline to 2-year follow-up. The DD-C-GAS, a global scale used to assess four areas of everyday functioning, showed highly significant improvements on all subdomains. We found mostly significant correlations between results on both rating instruments at all time points, yet mostly no meaningful correlation between their changes over time. There was a close and statistically significant relationship between parents' treatment adherence and ADOS scores, indicating that the better parents' treatment adherence, the lower the children scored on the ADOS at 1- and 2-year follow-up. Overall, improvement on both scales was virtually independent of age and autism symptom severity at baseline, suggesting that older (>43 months) and more severely affected children (ADOS total score >20) may benefit from the FIAS intervention to the same extent as younger children do. CONCLUSIONS The results of the study indicate that the FIAS approach of providing an initial highly intensive 18-day intervention period, followed by 2 years of less intensive follow-up care had an impact on the core autism symptoms as well as the adaptive functioning of children with ASD.
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Affiliation(s)
- Evelyn Herbrecht
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Olga Lazari
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Marianne Notter
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Esther Kievit
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - René Spiegel
- Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
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A Systematic Review of Linguistic and Verbal Behavior Outcomes of Pivotal Response Treatment. J Autism Dev Disord 2019; 50:766-778. [PMID: 31768719 DOI: 10.1007/s10803-019-04307-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pivotal Response Treatment (PRT) is a popular intervention for improving targeted and untargeted communication skills for learners with autism. We systematically reviewed communication outcomes reported in experimental research to determine linguistic forms and verbal behavior functions associated with PRT. We found most researchers aggregated results or did not report sufficient detail to determine linguistic forms and/or verbal behavior functions. Generalization of communication skills to untargeted people, settings, materials, and/or activities was evident. However, only one study clearly indicated untargeted linguistic forms emerged following PRT, and no researchers described results that indicated improved generalized and collateral verbal behavior functions. We suggest PRT researchers more clearly define and report primary, generalized, and collateral communication-specific outcomes in order to advance research and practice.
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Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses. J Autism Dev Disord 2019; 49:3477-3493. [PMID: 31127486 PMCID: PMC6667419 DOI: 10.1007/s10803-019-04061-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed.
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Verschuur R, Huskens B, Korzilius H, Bakker L, Snijder M, Didden R. Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:499-514. [PMID: 31538812 PMCID: PMC6985992 DOI: 10.1177/1362361319876213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.
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Affiliation(s)
- Rianne Verschuur
- Radboud University, The Netherlands.,Dr. Leo Kannerhuis, The Netherlands
| | | | | | | | - Michelle Snijder
- Karakter Child and Adolescent Psychiatry University Center, The Netherlands
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Nuske HJ, Pellecchia M, Lushin V, Rump K, Seidman M, Ouellette RR, Cooney D, Maddox BB, Lawson GM, Song A, Reisinger EM, Mandell DS. Do Student Characteristics Affect Teachers' Decisions to Use 1:1 Instruction? J Autism Dev Disord 2019; 49:2864-2872. [PMID: 30972654 DOI: 10.1007/s10803-019-04004-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
One-to-one instruction is a critical component of evidence-based instruction for students with autism spectrum disorder, but is not used as often as recommended. Student characteristics may affect teachers' decisions to select a treatment and/or implement it. This study examined the associations between students' clinical and demographic characteristics and teachers' reported use of discrete trial training (DTT) and pivotal response training (PRT). Children's higher sensory symptoms, lower social approach, lower verbal skills and higher self-regulation difficulties were associated with more frequent 1:1 DTT and PRT. Results suggest that teachers give more frequent 1:1 instruction to children with more observable impairments, do not match children to type of 1:1 intervention, and may inadvertently neglect other students for whom individualized intervention may still be beneficial.
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Affiliation(s)
- Heather J Nuske
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Melanie Pellecchia
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Viktor Lushin
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Keiran Rump
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Max Seidman
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Ouellette
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Diana Cooney
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenna B Maddox
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gwendolyn M Lawson
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber Song
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica M Reisinger
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Mandell
- Penn Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bacon EC, Osuna S, Courchesne E, Pierce K. Naturalistic language sampling to characterize the language abilities of 3-year-olds with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:699-712. [PMID: 29754501 DOI: 10.1177/1362361318766241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Characterization of language in naturalistic settings in autism spectrum disorder has been lacking, particularly at young ages, but such information is important for parents, teachers, and clinicians to better support language development in real-world settings. Factors contributing to this lack of clarity include conflicting definitions of language abilities, use of non-naturalistic standardized assessments, and restricted samples. The current study examined one of the largest datasets of naturalistic language samples in toddlers with autism spectrum disorder, and language delay and typically developing contrast groups at age 3. A range of indices including length of phrase, grammatical markings, and social use of language was assayed during a naturalistic observation of a parent-child play session. In contrast to historical estimates, results indicated only 3.7% of children with autism spectrum disorder used no words, and 34% were minimally verbal. Children with autism spectrum disorder and language delay exhibited similar usage of grammatical markings, although both were reduced compared to typically developing children. The greatest difference between autism spectrum disorder and language delay groups was the quantity of social language. Overall, findings highlight a range of language deficits in autism spectrum disorder, but also illustrate that the most severe level of impairments is not as common in naturalistic settings as previously estimated by standardized assessments.
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