Focused stimulation for a child with autism spectrum disorder: a treatment study

Looking back and moving forward: A scoping review of research on preschool autism interventions in the field of speech-language pathology

BACKGROUND & AIMS

Speech-language pathology services are frequently accessed by families of children who have suspected or diagnosed autism. This is expected given that social communication differences are a core feature of autism. This review looked broadly at the state of research in the field of speech-language pathology and preschool autism interventions in order to identify the types of studies that could be used to inform the practices of speech-language pathologists (SLPs), and to identify gaps in the field so they can be addressed in future research. Specifically, we examined the extent of research conducted on interventions delivered (at least in part) by SLPs to preschool children with suspected or diagnosed autism, identified the range of skill development areas targeted within the studies, and explored the characteristics of the interventions (i.e., theoretical models underlying the programs, service delivery models, treatment dosage).

METHODS

A scoping review of articles published between 1980 and 2019 was conducted using the five phases outlined by the Arksey and O'Malley framework: (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results.

MAIN CONTRIBUTION/RESULTS

A total of 114 studies met inclusion criteria with most published since 2010 and conducted within North America. Case study or single-subject study designs were the most frequently used. Interventions delivered solely by SLPs and by multiprofessional teams that included SLPs were relatively equally represented. Across the included studies, nine skill development areas were targeted, but interventions targeting social communication, language, and augmentative communication skills made up the vast majority of studies. There was relatively even distribution of interventions informed by child-centered, clinician-directed, and hybrid models. Explicit information detailing intervention characteristics (e.g., treatment dosage, professional training of clinicians delivering the intervention) was poorly reported in many studies. For those studies providing details, there was a great deal of variability in the nature of interventions (e.g., service delivery models, SLPs' role, dosage).

CONCLUSIONS

This review revealed that research in the area of autism interventions delivered, at least in part, by SLPs has markedly increased over the past 10 years. Still, there remains a need for more research, and greater transparency detailing the nature of the interventions being investigated. The research conducted to date captures the versatility of the SLP's role within preschool autism intervention. Improved reporting and studies with strong methodological rigor focused on capturing the complex and individualized nature of interventions are needed, as are intervention studies aligned with real-world community practice.

IMPLICATIONS

This review provides a comprehensive examination of the status of research on preschool interventions delivered to children with suspected or diagnosed autism within the field of speech-language pathology. Several directions for future research are provided, as are suggestions for improving the clinical applicability of results to further the development of effective, evidence-informed policy and practice in speech-language pathology.

The efficacy of recasts in language intervention: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis critically evaluated the research evidence on the effectiveness of conversational recasts in grammatical development for children with language impairments.

METHOD

Two different but complementary reviews were conducted and then integrated. Systematic searches of the literature resulted in 35 articles for the systematic review. Studies that employed a wide variety of study designs were involved, but all examined interventions where recasts were the key component. The meta-analysis only included studies that allowed the calculation of effect sizes, but it did include package interventions in which recasts were a major part. Fourteen studies were included, 7 of which were also in the systematic review. Studies were grouped according to research phase and were rated for quality.

RESULTS

Study quality and thus strength of evidence varied substantially. Nevertheless, across all phases, the vast majority of studies provided support for the use of recasts. Meta-analyses found average effect sizes of .96 for proximal measures and .76 for distal measures, reflecting a positive benefit of about 0.75 to 1.00 standard deviation.

CONCLUSION

The available evidence is limited, but it is supportive of the use of recasts in grammatical intervention. Critical features of recasts in grammatical interventions are discussed.

Fonoaudiologia e autismo: resultado de três diferentes modelos de terapia de linguagem

TEMA: as dificuldades de comunicação e linguagem são elementos essenciais dos distúrbios do espectro autista, fazendo parte da tríade de sintomas utilizada para o diagnóstico. OBJETIVO: verificar a existência de diferenças observáveis a partir das características do perfil funcional da comunicação e do desempenho sócio-cognitivo de crianças e adolescentes do espectro autístico, atendidos em três diferentes situações terapêuticas, tanto no que diz respeito a um período experimental pré-determinado de intervenção, quanto na manutenção dos resultados obtidos após um igual período de tempo de atendimento fonoaudiológico regular. MÉTODO: os sujeitos foram crianças e adolescentes com diagnósticos psiquiátricos incluídos no espectro autístico em início de processos de terapia fonoaudiológica. Os participantes foram divididos em três grupos de acordo com o desenho terapêutico oferecido por um período de seis meses. RESULTADOS: não indicaram diferenças estatisticamente significativas, embora observáveis. O grupo com mais indicadores de progresso durante o período específico de intervenção diferenciada, foi o grupo A, em que os sujeitos eram atendidos em duplas. O resultado não previsto foi que não só em nenhum dos grupos foi observada diminuição dos índices obtidos, após um período de seis meses, como em algumas situações o número de sujeitos com progresso aumentou após esse período. CONCLUSÃO: os resultados do presente estudo reiteram a adequação de procedimentos de determinação do perfil individual de habilidades e inabilidades de cada sujeito como fundamentação para definições a respeito do modelo de intervenção adotado.

Interventions to Improve Communication

Children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. Available evidence shows that highly structured behavioral methods have important positive consequences for these children, particularly in eliciting first words. However, the limitation of these methods in maintenance and generalization of skills suggests that many children with autism will need to have these methods supplemented with less adult-directed activities to increase communicative initiation and carry over learned skills to new settings and communication partners. Providing opportunities for mediated peer interactions with trained peers in natural settings seems to be especially important in maximizing the effects of this intervention.