Changes in language development among autistic and peer children in segregated and integrated preschool settings

Outcomes of children receiving Group-Early Start Denver Model in an inclusive versus autism-specific setting: A pilot randomized controlled trial

A major topic of debate is whether children with autism spectrum disorder should be educated in inclusive or specialized settings. We examined the feasibility and preliminary effectiveness of delivering the Group-Early Start Denver Model to children with autism spectrum disorder in inclusive versus specialized classrooms. We randomly assigned 44 preschoolers with autism spectrum disorder to receive the Group-Early Start Denver Model across one school calendar year in classrooms that included only children with autism spectrum disorder or mostly children who were typically developing. Blind-rated indicators of teaching quality showed similar results across settings, which were above the local benchmark. Children showed improvements across blinded proximal measures of spontaneous vocalization, social interaction, and imitation and across distal measures of verbal cognition, adaptive behavior, and autism symptoms irrespective of intervention setting. Mothers of participants experienced a reduction in stress irrespective of child intervention setting. Across both settings, age at intervention start was negatively associated with gains in verbal cognition. Delivery of Group-Early Start Denver Model in an inclusive setting appeared to be feasible, with no significant differences in teaching quality and child improvements when the program was implemented in inclusive versus specialized classrooms.

Vocalizations of minimally verbal children with autism spectrum disorder across the school year

Little is known about the language trajectories of minimally verbal school-aged children with autism spectrum disorders. The present investigation conducted observations across two elementary schools over an entire school year to analyze the vocal language development of nine minimally verbal children with autism spectrum disorder between the ages of 6 and 10 years, and their educational service providers. A Language Environment Analysis™ device automatically recorded and disaggregated over 743 h of data on child vocalizations, and vocal interactions with adults. Vocalizations did not increase for eight of the nine participants, and conversational counts between participants and adults were near zero across the entire year. These results speak to the need for additional research examining language development and potential intervention strategies among minimally verbal children with autism spectrum disorder.

Sensing Technologies for Autism Spectrum Disorder Screening and Intervention

This paper reviews the state-of-the-art in sensing technologies that are relevant for Autism Spectrum Disorder (ASD) screening and therapy. This disorder is characterized by difficulties in social communication, social interactions, and repetitive behaviors. It is diagnosed during the first three years of life. Early and intensive interventions have been shown to improve the developmental trajectory of the affected children. The earlier the diagnosis, the sooner the intervention therapy can begin, thus, making early diagnosis an important research goal. Technological innovations have tremendous potential to assist with early diagnosis and improve intervention programs. The need for careful and methodological evaluation of such emerging technologies becomes important in order to assist not only the therapists and clinicians in their selection of suitable tools, but to also guide the developers of the technologies in improving hardware and software. In this paper, we survey the literatures on sensing technologies for ASD and we categorize them into eye trackers, movement trackers, electrodermal activity monitors, tactile sensors, vocal prosody and speech detectors, and sleep quality assessment devices. We assess their effectiveness and study their limitations. We also examine the challenges faced by this growing field that need to be addressed before these technologies can perform up to their theoretical potential.

How should the effectiveness of Social Stories to modify the behaviour of children on the autistic spectrum be tested?

Social Stories are an extensively used intervention to address behaviour difficulties of children on the autistic spectrum. This article summarizes what Social Stories are and sets out to determine whether there is any relevant literature demonstrating the effectiveness of this intervention. Whilst the existing literature suggests positive findings with respect to the effectiveness of Social Stories, there is considerable variability in the quality of research methodology, with no single study employing comprehensive, stringent standards. This article highlights the factors that should be considered and addressed when testing the effectiveness of Social Stories, as a means of informing future research.

Views and attitudes of teachers on the educational integration of students with autism spectrum disorders

OBJECTIVES

To investigate the views and attitudes of Greek teachers on educational and vocational integration of students with autism spectrum disorders (ASD).

METHODS

A statistically reliable sample of questionnaires distributed towards a diversified teacher population is evaluated. The mean values of teachers' responses are analyzed with respect to critical independent variables: previous relevant training; and/or experience.

RESULTS

The majority of the sample had a positive view towards the educational and vocational integration of students with ASD. Nevertheless, teachers appear to be sceptical in assuming that these students can be efficiently treated in their classroom. The vast majority of teachers maintain that students with ASD can be trained in technical vocation. However, the absence of support services is highly ranked as the most serious constraint for vocational integration.

CONCLUSION

Training and experience substantially influenced teachers' views and attitudes in a positive way towards the integration of students with ASD.

A meta-analysis of the effects of placement on academic and social skill outcome measures of students with disabilities

This study involved an investigation of differences between outcome measures of students with disabilities placed in more integrated settings with those of students placed in less integrated settings. A meta-analysis was conducted using the findings from 24 studies published in peer-reviewed journals from 1980 through 2013. Results from the analyses suggest that there were significant differences (p<0.0001) between placement settings with the majority of students with disabilities in more integrated settings outperforming those in less integrated settings on both academic and social outcome measures. Overall these findings, combined with those from two prior meta-analytic studies, provide evidence spanning over 80 years suggesting separate settings are not as beneficial as are more integrated settings. Implications related to practice and policy, as well as avenues for future study, are discussed.

Issues, Policies, and Recommendations for Improving the Education of Learners With Autism Spectrum Disorders

Children and youth with autism spectrum disorders (ASD) create significant challenges to educators and the educational system not only based on their ever-increasing numbers but also because of the questions and debates surrounding how best to provide them an appropriate and effective education. These issues include the skills, knowledge, and professional credentials of educators who teach learners with ASD, which settings are best suited for their educational experiences, and what and how children and youth with ASD should be taught. In this article the authors address these three core elements that underpin the education of pupils with ASD and offer recommendations for improving the present system.

Autism spectrum disorders and epilepsy: moving towards a comprehensive approach to treatment

The biological and phenotypic heterogeneity of children with autism spectrum disorders (ASD) and epilepsy presents a significant challenge to the development of effective treatment protocols. There is no single treatment or treatment protocol for children with ASD or epilepsy. Children with co-occurring ASD and epilepsy should undergo a comprehensive assessment that includes investigation of underlying biological etiologies as well assessment of cognitive, language, affective, social and behavioral function prior to initiating treatment. The comprehensive treatment of children with ASD is based on a combination of therapeutic psychosocial interventions in combination with pharmacological agents. A process-oriented approach to assessment and intervention allows careful analysis of the child's response to treatment such that treatment protocols may be revised secondary to any changes in developmental trajectory of the child with ASD and epilepsy. The possibility of developing pharmacological interventions that target both ASD and epilepsy awaits definitive evidence. The best hope for good developmental outcomes in children with ASD and epilepsy is early recognition and comprehensive treatment of both the ASD and epilepsy.

A case study in the misrepresentation of applied behavior analysis in autism: the gernsbacher lectures

I know that most men, including those at ease with problems of the greatest complexity, can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others, and which they have woven, thread by thread, into the fabrics of their life. (Tolstoy, 1894)This article presents a case study in the misrepresentation of applied behavior analysis for autism based on Morton Ann Gernsbacher's presentation of a lecture titled "The Science of Autism: Beyond the Myths and Misconceptions." Her misrepresentations involve the characterization of applied behavior analysis, descriptions of practice guidelines, reviews of the treatment literature, presentations of the clinical trials research, and conclusions about those trials (e.g., children's improvements are due to development, not applied behavior analysis). The article also reviews applied behavior analysis' professional endorsements and research support, and addresses issues in professional conduct. It ends by noting the deleterious effects that misrepresenting any research on autism (e.g., biological, developmental, behavioral) have on our understanding and treating it in a transdisciplinary context.

Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review

BACKGROUND

Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD.

METHODS AND FINDINGS

Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration.

CONCLUSIONS

While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.

What clinical characteristics of children with autism influence their inclusion in regular classrooms?

BACKGROUND

This study took place in the context of recent legislation enacted in several countries--including France--and aimed at promoting inclusion of children with intellectual disabilities. It focuses on young children with autism and examines the links between the children's characteristics and their weekly hours of regular-classroom inclusion and intervention in specialised setting.

METHOD

Standardised clinical and sociodemographic data were collected for 77 children with autism, along with data about their interventional programmes.

RESULTS

The study showed that the number of hours of inclusion at school was influenced by the children's behavioural and adaptive characteristics, as well as by the socioprofessional category of their parents, although these factors did not affect the number of hours spent in specialised setting. Moreover, the total amount of time per week spent in interventional services of any kind was very small for some of the children.

CONCLUSION

The time spent in special-intervention services and regular classrooms combined did not add up to an adequate number of weekly hours for these children, particularly those exhibiting at least one of the following characteristics: low adaptation level, major behavioural problems or low socioprofessional category of parents.

Recommendations for reporting independent variables in outcome studies of early and intensive behavioral intervention for autism

Early and intensive behavioral intervention (EIBI) has been established as an effective treatment for autism. However, the complexity and intensity of EIBI programs make it difficult to fully report all critical aspects of the independent variable. Consequently, scientific reports of EIBI outcomes have been criticized for providing less than comprehensive treatment descriptions. In an effort to address this problem, the present article provides a template to aid outcome researchers in (a) clearly reporting each participant's curricular targets and (b) describing critical aspects of treatment.

Educational placements and service use patterns of individuals with autism spectrum disorders

This project was undertaken to identify child characteristics associated with educational placement and service use in high-functioning children with autism spectrum disorders. The sample of 101 (nine females) had a mean age of 12 +/- 3 years (mean IQ = 101.77 +/- 19.50). Results indicate that lower-cognitive ability and communication skill were associated with placement in special education. Based on parent-report, most students stayed in the same placement (regular or special education) in which they began first grade and the majority of students received special services in their schools (most often speech/language intervention). Findings highlight the emphasis placed on certain child characteristics (e.g., cognitive ability), with far less emphasis on other areas (e.g., degree of social deficit), in educational placement and service provision.

[Intervention in autistic disorders: status quo, evidence-based, questionable and doubtful techniques]

OBJECTIVE

We describe and critically discuss intervention methods that have been used to modify autistic behaviors.

METHODS

Early intervention methods, training of social skills, pharmacological treatment and alternative approaches are reviewed in the light of the empirical evidence.

RESULTS

Autism is a persistent and phenotypically heterogeneous disorder for which no cure has been found to date. However, individually composed care and therapies can lead to remarkable quantitative improvement.

CONCLUSIONS

Further research is needed to evaluate the true impact of psychological and biological intervention techniques in autistic disorders. Among other things, the therapy studies carried out up to now often lack an adequate diagnostic assessment.

Assessing change in early intervention programs for children with autism

Assessing the efficacy of any intervention can be a difficult task. In the case of children with autism who require comprehensive and long-lasting interventions, the task becomes even more difficult. In this paper, intervention studies based on comprehensive interventions for young children with autism are reviewed and examined in reference to elements that are essential to a well-designed treatment study, e.g., randomization/matching procedures, and outcome measures. Given the complexity of these comprehensive intervention programs, and the few data available on interventions with clear empirical validation, a plea is made for studies to consider the active ingredients or component parts of an intervention, e.g., number of hours, type of setting, and teaching approach. Suggestions are further made for improving future studies, including more rigorous designs, and measuring change.

Measures in intervention research with young children who have autism

In this paper, the outcome measures used in intervention research with young children with autism were analyzed. Two types of literature were reviewed: reports evaluating specific intervention practices and reports of complete intervention programs. A description of the types of measures used in each literature source and measurement practices reported were analyzed and described. In addition, the intervention program literature was reviewed to determine whether factors that may mediate outcomes were measured. Finally, the literature was reviewed to identify instances in which multiple risk and opportunity factors were analyzed to account for variations in outcomes.

Communication intervention for children with autism: a review of treatment efficacy

Empirical studies evaluating speech and language intervention procedures applied to children with autism are reviewed, and the documented benefits are summarized. In particular, interventions incorporating sign language, discrete-trial training, and milieu teaching procedures have been used successfully to expand the communication repertoires of children with autism. Other important developments in the field stem from interventions designed to replace challenging behaviors and to promote social and scripted interactions. The few studies of the parent and classroom training studies that included language measures also are analyzed. This article seeks to outline the extent to which previous research has helped identify a compendium of effective instructional practices that can guide clinical practice. It also seeks to highlight needs for further research to refine and extend current treatment approaches and to investigate more comprehensive treatment packages.

The Scottish Centre for autism preschool treatment programme. II: The results of a controlled treatment outcome study

This article evaluates the effectiveness of a developmentally based early intervention programme. Two groups of children were compared, a treatment group and a no-treatment control group. Standardized assessments were administered before and after the intervention period by an independent clinician. Pre-treatment comparisons revealed that the control group had a significantly higher pre-treatment IQ; but the two groups were comparable for age, mental age, socioeconomic status and number of hours of non-experimental therapy. Results demonstrated that children in the treatment group improved significantly more than those in the control group on measures of joint attention, social interaction, imitation, daily living skills, motor skills and an adaptive behaviour composite. A measure of requesting behaviour fell short of statistical significance. The total stress index reduced for treatment group parents and increased for the control group parents (but not significantly). The results of the study are considered to support the efficacy of this treatment approach.

Including children with autism in general education classrooms. A review of effective strategies

Children with autism can benefit from participation in inclusive classroom environments, and many experts assert that inclusion is a civil right and is responsible for nurturing appropriate social development. However, most children with autism require specialized supports to experience success in these educational contexts. This article provides a review of the empirical research that has addressed procedures for promoting successful inclusion of students with autism. Strategies reviewed include antecedent manipulations, delayed contingencies, self-management, peer-mediated interventions, and other approaches that have been demonstrated in the literature to be useful. The article concludes with a discussion of future research needs.

Parent-directed, intensive early intervention for children with pervasive developmental disorder

We examined parent-directed, intensive early intervention for children with Pervasive Developmental Disorder. Children's parents recruited paraprofessional therapists and requested consultations on how to implement the UCLA treatment model in their homes (Smith & Lovaas, 1998). Parents and therapists then received six one-day workshops over a five-month period, with additional consultations for the next 2-3 years. Six boys participated (intake age 35-45 months, intake IQ 45-60). The study addressed 1) the children's skill acquisition during the first five months of treatment; 2) outcome 2-3 years later; 3) treatment quality; and 4) parents' impressions. Five of 6 children rapidly acquired skills when treatment began, but only 2 clearly improved on standardized tests at the 2-3 year follow-up. Therapists usually employed correct treatment procedures but were less consistent than therapists employed at a clinic. Parents reported high satisfaction with treatment. These mixed results highlight the need for multimodal assessment of parent-directed treatment.

Effects of fluoxetine treatment in young children with idiopathic autism

Thirty-seven children, aged between 2 and 7 years, with idiopathic autism underwent an open-label trial of fluoxetine treatment. All had assessment of diagnosis, developmental status, and family psychiatric history. Independent developmental testing before and after starting fluoxetine permitted quantification of language acquisition in a subgroup. Twenty-two of the 37 children had a beneficial treatment response sustained during continuing treatment for 13 to 33 months (mean 21 months). Eleven had an excellent response and were able to attend mainstream classrooms. Eleven had a good response though they remained identifiably autistic. Fifteen children had no benefit. Responders showed behavioral, language, cognitive, affective, and social improvements. Responders with adequate testing showed marked increases in language acquisition at every stage of development as compared with (1) pretreatment status, (2) responses to other treatments, (3) ability in non-language (matching) tasks, and (4) historical controls from the literature. The response to fluoxetine strongly correlated with a family history of major affective disorder. These preliminary findings implicate serotonergic mechanisms in autistic symptomatology and warrant further study with controlled trials.

Prognosis in autism: do specialist treatments affect long-term outcome?

Many different treatments have been claimed to have a dramatic impact on children with autism. This paper reviews what is known about the outcome in adult life and examines the limitations and advantages of a variety of intervention approaches. It concludes that there is little evidence of any "cure" for autism, but appropriately structured programmes for education and management in the early years can play a significant role in enhancing functioning in later life.

Full inclusion and students with autism

The concept of "full inclusion" is that students with special needs can and should be educated in the same settings as their normally developing peers with appropriate support services, rather than being placed in special education classrooms or schools. According to advocates the benefits of full inclusion are increased expectations by teachers, behavioral modeling of normally developing peers, more learning, and greater self-esteem. Although the notion of full inclusion has appeal, especially for parents concerned about their children's rights, there is very little empirical evidence for this approach, especially as it relates to children with autism. This manuscript addresses the literature on full inclusion and its applicability for students with autism. Although the goals and values underlying full inclusion are laudable, neither the research literature nor thoughtful analysis of the nature of autism supports elimination of smaller, highly structured learning environments for some students with autism.

Changes in cognitive and language functioning of preschool children with autism

Preschool children with autism and their normally developing peers were compared on the Stanford-Binet IV and Preschool Language Scale before and after 1 school year. Both measures showed that although the children with autism functioned at a lower level than their normally developing peers, the children with autism had narrowed this gap after treatment, making a nearly 19-point increase in IQ and an 8-point gain in language quotient. The IQ measure remained stable for the normally developing peers while their language showed a 7.73-point increase. The data support the notion that young children with autism can make very significant developmental gains.