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Peters SZ, Brumbaugh KM, Blackwell A. The Effects of Virtual Caregiver Coaching in Antigua & Barbuda on the Implementation of EMT Language Support Strategies in Naturalistic Environments. Int J Telerehabil 2023; 15:e6586. [PMID: 38162934 PMCID: PMC10754242 DOI: 10.5195/ijt.2023.6586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
This single-case multiple baseline design investigation set out to determine the effectiveness of using a telepractice service delivery model to coach caregivers in Antigua & Barbuda in the use of Enhanced Milieu Teaching (EMT) language support strategies with a child with language impairment. A slightly modified version of the Teach-Model-Coach-Review (TMCR) method was used during virtual instruction to train a caregiver on the language support strategies of environmental arrangement, matched turns, expansions, and time delay with milieu prompting. The caregiver attended sessions three times a week for up to 45 minutes for four weeks. The results of this study indicated a positive relationship between the intervention and caregiver use of strategies. The caregiver demonstrated increased responsiveness to the child's communication attempts and exhibited the use of language support strategies across activities. This study suggests that telepractice can be an effective service delivery model for providing coaching to caregivers.
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Affiliation(s)
- Sensemillah Z. Peters
- Speech-Language Pathology Program, Rocky Mountain University of Health Professions, Provo, Utah, USA
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2
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Donolato E, Toffalini E, Rogde K, Nordahl‐Hansen A, Lervåg A, Norbury C, Melby‐Lervåg M. Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1368. [PMID: 38024782 PMCID: PMC10680434 DOI: 10.1002/cl2.1368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole. Objectives This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders. Search Methods The last electronic search was conducted in April 2022. Selection Criteria Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities. Data Collection and Analysis The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate. Main Results We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor. Authors’ Conclusions In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.
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Affiliation(s)
| | | | - Kristin Rogde
- Department of Special Needs EducationUniversity of OsloOsloNorway
| | | | | | - Courtenay Norbury
- Division of Psychology & Language SciencesUniversity College LondonLondonUK
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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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4
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Roberts MY, Stern YS, Grauzer J, Nietfeld J, Thompson S, Jones M, Kaat AJ, Kaiser AP. Teaching Caregivers to Support Social Communication: Results From a Randomized Clinical Trial of Autistic Toddlers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:115-127. [PMID: 36525627 PMCID: PMC10023141 DOI: 10.1044/2022_ajslp-22-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Studies of early caregiver-mediated interventions targeting social communication of young autistic children have yielded variable child outcomes. This study examined the effects of combining two caregiver-mediated interventions on caregiver strategy use and child social communication and language outcomes. METHOD This was a multisite parallel randomized controlled trial. Participants included 120 caregivers and their autistic children between 24 and 36 months of age. Dyads were randomly assigned to receive a hybrid intervention that combined Enhanced Milieu Teaching (EMT) and Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) or to a behavior management control condition, each delivered over 6 months. Caregivers in the JASP-EMT group received twice-weekly, in-home, and hour-long sessions. Outcomes were measured at baseline, the end of intervention (T1), and 6 months later (T2) and included a naturalistic language sample procedure, standardized measures, and caregiver report measures. This trial was registered at clinicaltrials.gov (NCT02595697). RESULTS Child outcomes did not differ between conditions at T1 or T2 for child primary (social communication) or secondary (language, play, and autism symptoms) outcomes. Relative to control group caregivers, intervention group caregivers demonstrated significantly higher use of JASP-EMT strategies at T1 and T2, with the exception of two strategies (Responsiveness and Matched Responsiveness), which were used significantly more by control group caregivers. Neither autism severity nor baseline caregiver responsiveness moderated outcomes. Post hoc analyses revealed significant correlations between specific strategies and all child outcomes. CONCLUSIONS Twice-weekly caregiver-mediated intervention that taught caregivers of autistic children to use social communication support strategies did not yield significant child outcomes. Future studies should examine possible sources for the lack of main effects including unexpected differences in linguistic features of caregiver input, changes in control group caregiver behavior, and insufficient intervention dosage. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21714278.
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Affiliation(s)
- Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Yael S. Stern
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jennifer Nietfeld
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Suzanne Thompson
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Maranda Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Aaron J. Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ann P. Kaiser
- Department of Special Education, Vanderbilt University, Nashville, TN
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Im-Bolter N, de la Roche L. What parents want: A qualitative analysis of a parent-implemented intervention for autistic children. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2023; 8:23969415231189606. [PMID: 37546520 PMCID: PMC10399253 DOI: 10.1177/23969415231189606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background and aims Guidelines regarding social cognitive interventions for autistic children suggest incorporating a holistic approach. This includes increasing the family's understanding of difficulties associated with autism, integrations of natural environments, and parents as active agents in the intervention while being supported for their well-being. The current availability of holistic parent-implemented interventions for autistic children is limited, with no qualitative understanding of how parents view the benefits for themselves or their children. Method The current study expands the literature regarding holistic approaches through a qualitative understanding of parent perceptions of a parent-implemented social communication intervention for autistic children (TalkAbility™), which incorporates a 6-month follow-up. This study sought to gain a deeper understanding from parents on their perceptions of a holistic approach, including the impact on themselves, their families, and their autistic child. Results Following Braun and Clarke's model of thematic analysis, data was coded into four themes: (a) communication difficulties, frustrations, and progress, (b) social relationships and concerns, (c) communication strategies, and (d) thoughts and emotions surrounding TalkAbility™. Conclusions Parents report that many components of a holistic approach are instrumental in encouraging social communication in their autistic child. Results highlight the importance of considering parent experiences regarding interventions for their child's social communication skills through a qualitative viewpoint. Implications Knowing the intervention aspects that parents view as most valuable allows targeted program modifications that reflect actual parent needs. Further understanding regarding the influence of holistic parent-implemented social communication interventions on child communication skills, parenting frustrations, and parent-child relationships is needed.
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Affiliation(s)
- Nancie Im-Bolter
- Department of Psychology, Trent University, Peterborough, ON, Canada; Department of Psychology, Queen's University, Kingston, ON, Canada
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Gottfried T, Elefant C, Gold C. Music-oriented parent counseling to promote improvement in level of parental stress, quality of life and the use of music in everyday life among parents of children with autism: A mixed-methods randomized controlled study. NORDIC JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1080/08098131.2022.2131890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tali Gottfried
- Graduate Program for Special Education, Herzog College, Jerusalem, Israel
| | - Cochavit Elefant
- School for Creative Arts Therapies, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | - Christian Gold
- GAMUT – The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
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Daniolou S, Pandis N, Znoj H. The Efficacy of Early Interventions for Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:5100. [PMID: 36079029 PMCID: PMC9457367 DOI: 10.3390/jcm11175100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
The superiority of early interventions for children with autism spectrum disorders (ASDs) compared to treatment as usual (TAU) has recently been questioned. This study was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12-132 months). Early interventions led to positive outcomes for cognitive ability (g = 0.32; 95% CI: 0.05, 0.58; p = 0.02), daily living skills (g = 0.35; 95% CI: 0.08, 0.63; p = 0.01), and motor skills (g = 0.39; 95% CI: 0.16, 0.62; p = 0.001), while no positive outcomes were found for the remaining variables. However, when studies without the blinding of outcome assessment were excluded, positive outcomes of early interventions only remained for daily living skills (g = 0.28; 95% CI: 0.04, 0.52; p = 0.02) and motor skills (g = 0.40; 95% CI: 0.11, 0.69; p = 0.007). Although early intervention might not have positive impacts on children with ASDs for several outcomes compared to controls, these results should be interpreted with caution considering the great variability in participant and intervention characteristics.
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Affiliation(s)
- Sofia Daniolou
- Department of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland
| | - Hansjörg Znoj
- Department of Psychology, University of Bern, 3012 Bern, Switzerland
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Kwok E, Cermak CA, Hatherly K, Cunningham BJ. Intervention Goals for Preschoolers With Language Difficulties and Disorders: A Scoping Review Using the International Classification of Functioning, Disability and Health Framework. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1-70. [PMID: 35302873 DOI: 10.1044/2021_ajslp-21-00226] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from birth to 5;0 [years;months]) with language difficulties and disorders within the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for two language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition). METHOD The scoping review followed Arksey and O'Malley (2005) guidelines. Articles were retrieved from speechBITE, with age (under 5 years), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components, and the distribution of goals across ICF components was compared for studies involving children with the two language difficulty/disorder subtypes. RESULTS A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the activities component of the ICF framework, followed by participation (26%), environmental factors (20%), body functions and structures (3%), and personal factors (3%). Most participation-focused goals were reported from intervention studies involving preschoolers with a language difficulty/disorder associated with a biomedical condition. CONCLUSIONS Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice.
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Affiliation(s)
- Elaine Kwok
- CanChild, McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
- Richard and Roxelyn Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Carly A Cermak
- School of Communication Sciences and Disorders, London, Ontario, Canada
| | - Kathryn Hatherly
- School of Communication Sciences and Disorders, London, Ontario, Canada
| | - Barbara Jane Cunningham
- CanChild, McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
- School of Communication Sciences and Disorders, London, Ontario, Canada
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9
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Colombet C, Alcaraz C, de la Tribonnière X, Morsa M, Rattaz C, Baghdadli A. Self-reported needs of caregivers of people with Autism Spectrum Disorder. J Autism Dev Disord 2022:10.1007/s10803-022-05499-x. [PMID: 35441919 DOI: 10.1007/s10803-022-05499-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Autism spectrum disorder (ASD) has a major impact on caregivers. We aimed to describe caregivers' perceptions concerning their level of knowledge about ASD and their needs to better adapt education and training programs. METHODS This was a descriptive cross-sectional study conducted through a declarative and self-administered survey in France. RESULTS 1,013 individuals answered the questionnaire in 2020. If most caregivers felt they had sufficient knowledge about ASD, they still expressed a high level of needs regarding acquiring knowledge, identifying available resources, and finding social/emotional support. CONCLUSIONS This study highlights the high level of needs of caregivers and their expectations of improving their knowledge and skills to help the person with ASD.
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Affiliation(s)
- Claire Colombet
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France.
| | - Céline Alcaraz
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France
| | - Xavier de la Tribonnière
- Unité transversale d'éducation du patient (UTEP), CHU Montpellier, Montpellier, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Maxime Morsa
- Laboratoire Education et Pratiques de Santé (UR3412), Université Paris Sorbonne Paris Nord, Bobigny, France
| | - Cécile Rattaz
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
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10
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MacKenzie KT, Eack SM. Interventions to Improve Outcomes for Parents of Children with Autism Spectrum Disorder: A Meta-Analysis. J Autism Dev Disord 2021; 52:2859-2883. [PMID: 34189683 DOI: 10.1007/s10803-021-05164-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
This meta-analysis examines the impact of parent interventions on outcomes for parents of children with ASD. A systematic review of the literature produced 37 studies that met inclusion criteria. Random-effects models revealed small but significant impacts of intervention on parental outcomes, primarily in parenting confidence and mental health. No improvements were observed in caregiving burden, family adjustment, physical health, or stress. Significant heterogeneity was observed; however, no moderation effects were detected for intervention or sample characteristics. These findings suggest parent interventions improve parenting confidence and, to a lesser degree, mental health. More work is needed to develop interventions that address a wider range of outcomes for parents of children with ASD. Limitations and implications for future research are discussed.
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Affiliation(s)
- Kristen T MacKenzie
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.,Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
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11
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Ong SY, Roslan S, Ahmad NA, Ayub AFM, Ping CL, Zaremohzzabieh Z, Ahrari S. A Mixed-Methods Evaluation of Parent-Assisted Children's Friendship Training to Improve Social Skills and Friendship Quality in Children with Autism in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2566. [PMID: 33806563 PMCID: PMC7967648 DOI: 10.3390/ijerph18052566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
Background: This study evaluates the effectiveness of parent-assisted children's friendship training intervention for enhancing friendship quality and social skills among children with autism spectrum disorders (ASD). We conducted a quasi-experimental study to investigate the effective outcomes of social skills and friendship quality in the pre-and post-parent-assisted CFT intervention phases; Methods: to conduct a 12-week field session, 30 children with their parents were selected. The Social Skills Improvement System Rating Scales and the Quality of Play Questionnaire-Parent were used to assess the effectiveness of the parent-assisted children's friendship training during pre-and post-intervention. A semi-structured interview with parents was conducted at the end of the session; Results: findings revealed that intervention improved the social skills of these children. Additionally, the friendship quality of children with ASD improved before and after the intervention, however, engagement remained unchanged. Parents also showed some sort of improvement after the session as they reported a heightened sense of fear and resistance, awareness, learning and adjustment, change is not easy, and identifying support; Conclusions: there was clear evidence that children with ASD benefitted from parent-assisted CFTs in terms of social skills and friendship quality. However, larger and controlled studies are required to draw firm conclusions about this kind of intervention.
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Affiliation(s)
- Sing Yee Ong
- Faculty of Educational Studies, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia; (S.Y.O.); (N.A.A.); (A.F.M.A.); (Z.Z.); (S.A.)
| | - Samsilah Roslan
- Faculty of Educational Studies, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia; (S.Y.O.); (N.A.A.); (A.F.M.A.); (Z.Z.); (S.A.)
| | - Nor Aniza Ahmad
- Faculty of Educational Studies, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia; (S.Y.O.); (N.A.A.); (A.F.M.A.); (Z.Z.); (S.A.)
| | - Ahmad Fauzi Mohd Ayub
- Faculty of Educational Studies, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia; (S.Y.O.); (N.A.A.); (A.F.M.A.); (Z.Z.); (S.A.)
| | - Chen Lee Ping
- Department of Psychology, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia;
| | - Zeinab Zaremohzzabieh
- Faculty of Educational Studies, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia; (S.Y.O.); (N.A.A.); (A.F.M.A.); (Z.Z.); (S.A.)
| | - Seyedali Ahrari
- Faculty of Educational Studies, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia; (S.Y.O.); (N.A.A.); (A.F.M.A.); (Z.Z.); (S.A.)
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Rojas-Torres LP, Alonso-Esteban Y, Alcantud-Marín F. Early Intervention with Parents of Children with Autism Spectrum Disorders: A Review of Programs. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E294. [PMID: 33333900 PMCID: PMC7765314 DOI: 10.3390/children7120294] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
The aim of this article was to analyze the evidence regarding the effectiveness of intervention programs for children with autism based on the participation of their parents. To obtain the data, a systematic search was carried out in four databases (PsycARTICLES (ProQuest), ERIC (ProQuest), PubMed (ProQuest), and Scopus). The retrieved documents were refined under the inclusion/exclusion criteria, and a total of 51 empirical studies were selected. These studies were first classified according to the function of the intervention objective and, later, by the methodology applied (19 studies were based on comprehensive interventions, 11 focused on the nuclear symptoms of autism spectrum disorder (ASD), 12 focused on the promotion of positive parenting, and nine interactions focused on child play). Once all of the documents had been analyzed, the evidence indicated scientific efficacy in most studies, mainly in those based on child development and the application of behavioral analysis principles. Moreover, the positive influence of parent participation in such programs was demonstrated.
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Affiliation(s)
| | - Yurena Alonso-Esteban
- Department of Developmental and Educational Psychology, Universitat de Valencia, 46010 Valencia, Spain
| | - Francisco Alcantud-Marín
- Department of Developmental and Educational Psychology, Universitat de Valencia, 46010 Valencia, Spain
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13
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Deb SS, Retzer A, Roy M, Acharya R, Limbu B, Roy A. The effectiveness of parent training for children with autism spectrum disorder: a systematic review and meta-analyses. BMC Psychiatry 2020; 20:583. [PMID: 33287762 PMCID: PMC7720449 DOI: 10.1186/s12888-020-02973-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Various parent training interventions have been shown to have some effect on the symptoms of children with autism. We carried out a systematic review and meta-analyses to assess effectiveness of parental training for children with autism on their symptoms and parental stress. METHODS Four electronic databases, CINAHL, EMBASE, MEDLINE and PsycINFO were searched until March 2020 for relevant literature. Two reviewers independently screened bibliographies using an eligibility checklist and extracted data using a structured proforma. We have also carried out meta-analyses when data were available for pooling. RESULTS Seventeen papers from 15 studies were included for data analysis. Fifteen papers showed a positive treatment effect when compared with the control group, although not always significant. Meta-analysis based on pooled data from only two studies in each respective intervention, showed small to moderate treatment effects for three interventions, DIR/Floortime, Pivotal Response and Parent focused training respectively. CONCLUSIONS As in previous systematic reviews there was a mild to moderate treatment effects of three specific types of interventions respectively. However, it was difficult to draw any definitive conclusion about the effectiveness and generalisability of any intervention because of the wide variation in the interventions, control groups, outcome measures, small sample size, small number of studies in meta-analysis, overlap between the intervention and control procedures used in the included studies. There is an urgent need for experts in various international centres to jointly standardise a parent training intervention for children with autism and carry out a large scale RCT to assess its clinical and economic effectiveness. Research Registry Unique Identifying Number: reviewregistry915.
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Affiliation(s)
| | - Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meera Roy
- Worcestershire Health and Care NHS Trust, Worcester, UK
| | | | - Bharati Limbu
- Imperial College London Faculty of Medicine, London, UK
| | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
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Carruthers S, Charman T, El Hawi N, Kim YA, Randle R, Lord C, Pickles A. Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent-Mediated Early Autism Intervention. Autism Res 2020; 14:411-425. [PMID: 33274842 PMCID: PMC7898818 DOI: 10.1002/aur.2449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022]
Abstract
Measuring outcomes for autistic children following social communication interventions is an ongoing challenge given the heterogeneous changes, which can be subtle. We tested and compared the overall and item-level intervention effects of the Brief Observation of Social Communication Change (BOSCC), Autism Diagnostic Observation Schedule (ADOS-2) algorithm, and ADOS-2 Calibrated Severity Scores (CSS) with autistic children aged 2-5 years from the Preschool Autism Communication Trial (PACT). The BOSCC was applied to Module 1 ADOS assessments (ADOS-BOSCC). Among the 117 children using single or no words (Module 1), the ADOS-BOSCC, ADOS algorithm, and ADOS CSS each detected small non-significant intervention effects. However, on the ADOS algorithm, there was a medium significant intervention effect for children with "few to no words" at baseline, while children with "some words" showed little intervention effect. For the full PACT sample (including ADOS Module 2, total n=152), ADOS metrics evidenced significant small (CSS) and medium (algorithm) overall intervention effects. None of the Module 1 item-level intervention effects reached significance, with largest changes observed for Gesture (ADOS-BOSCC and ADOS), Facial Expressions (ADOS), and Intonation (ADOS). Significant ADOS Module 2 item-level effects were observed for Mannerisms and Repetitive Interests and Stereotyped Behaviors. Despite strong psychometric properties, the ADOS-BOSCC was not more sensitive to behavioral changes than the ADOS among Module 1 children. Our results suggest the ADOS can be a sensitive outcome measure. Item-level intervention effect plots have the potential to indicate intervention "signatures of change," a concept that may be useful in future trials and systematic reviews. LAY SUMMARY: This study compares two outcome measures in a parent-mediated therapy. Neither was clearly better or worse than the other; however, the Autism Diagnostic Observation Schedule produced somewhat clearer evidence than the Brief Observation of Social Communication Change of improvement among children who had use of "few to no" words at the start. We explore which particular behaviors are associated with greater improvement. These findings can inform researchers when they consider how best to explore the impact of their intervention.
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Affiliation(s)
- Sophie Carruthers
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.,National & Specialist Services, Child & Adolescent Mental Health Services Directorate, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nicole El Hawi
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Young Ah Kim
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Rachel Randle
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Catherine Lord
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
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Madarevic M, Van Leeuwen K, Warreyn P, Noens I. Conceptualisation of Parenting in Research on Young Children with or at Elevated Likelihood of Autism: a Systematic Review of Observational Measures. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00217-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Freitag CM, Jensen K, Teufel K, Luh M, Todorova A, Lalk C, Vllasaliu L. Empirisch untersuchte entwicklungsorientierte und verhaltenstherapeutisch basierte Therapieprogramme zur Verbesserung der Kernsymptome und der Sprachentwicklung bei Klein- und Vorschulkindern mit Autismus-Spektrum-Störungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:224-243. [DOI: 10.1024/1422-4917/a000714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Zusammenfassung. Der vorliegende systematische Überblicksartikel basiert auf Vorarbeiten im Rahmen der Erstellung der AWMF-S3-Leitlinien zur Therapie von Autismus-Spektrum-Störungen (ASS). Das Ziel ist, den aktuellen Stand evidenzbasierter Interventionen zur Behandlung der Kernsymptomatik sowie sprachlichen Förderung im Kleinkind- und Vorschulalter für Kinder mit ASS darzustellen. Einschlusskriterien: entwicklungsorientierte oder verhaltenstherapeutisch basierte, manualisierte Intervention für Kinder mit ASS nach DSM-III (R), DSM-IV (TR), DSM-5 oder ICD-10, Alter < 7 Jahre, Publikationsdatum 1.1.2011 bis 31.8.2018. Iterativ-hierarchischer Prozess für den Studieneinschluss: systematisches Review > randomisiert kontrollierte > kontrollierte klinische Studie. Zielgrößen der eingeschlossenen Studien: zentrale autismusspezifische Symptomatik oder entwicklungspsychologisch belegte Vorläuferfertigkeiten oder Verbesserung der sprachlichen Fertigkeiten. Die Interventionen wurden (1) anhand ihrer wöchentlichen Frequenz sowie (2) anhand der therapeutischen Inhalte sortiert. Spezifische Therapieinhalte, wie die Förderung elterlicher Synchronizität sowie kindlicher gemeinsamer Aufmerksamkeit, Symbolspiel und Imitation einerseits oder die umfassende Förderung verschiedener Entwicklungsbereiche andererseits, wurden in den entsprechenden Studien untersucht. Die soziale Interaktion und Kommunikation verbesserte sich langfristig durch das frühe Training elterlicher Synchronizität und kindlicher Reziprozität sowie durch niedrigfrequente, umfassende, entwicklungsorientierte Therapieprogramme, denen das natürliche Lernformat zugrunde liegt. Hochfrequente, am diskreten Lernformat orientierte Programme zeigten diesbezüglich keine Effekte. Sprachliche Fertigkeiten verbesserten sich ebenfalls durch umfassende Förderung. Der Artikel summiert abschließend die Empfehlungen zu der in diesem Artikel untersuchten Fragestellung.
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Affiliation(s)
- Christine M. Freitag
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main
| | - Katrin Jensen
- Institut für Medizinische Biometrie und Informatik (IMBI), Universitätsklinikum Heidelberg
| | - Karoline Teufel
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main
| | - Marvin Luh
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main
| | - Antoaneta Todorova
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main
| | - Christopher Lalk
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main
| | - Leonora Vllasaliu
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main
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Smith TE, Holmes SR, Sheridan SM, Cooper JM, Bloomfield BS, Preast JL. The Effects of Consultation-based Family-school Engagement on Student and Parent Outcomes: A Meta-analysis. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2020. [DOI: 10.1080/10474412.2020.1749062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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18
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Yazdani S, Capuano A, Ghaziuddin M, Colombi C. Exclusion Criteria Used in Early Behavioral Intervention Studies for Young Children with Autism Spectrum Disorder. Brain Sci 2020; 10:E99. [PMID: 32069875 PMCID: PMC7071598 DOI: 10.3390/brainsci10020099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
This literature review evaluated early behavioral intervention studies of Autism Spectrum disorder (ASD) based on their participant exclusion criteria. The studies included were found through searching PsycINFO and PubMed databases, and discussed behavioral interventions for children up to 5 years of age with ASD and utilized a group research design. Studies reviewed were categorized into three groups: Restrictive exclusion criteria, loosely defined exclusion criteria, and exclusion criteria not defined. Results indicated that studies that used restrictive exclusion criteria demonstrated greater differences in terms of outcomes between experimental and control groups in comparison to studies that used loosely defined exclusion criteria and/or did not define any exclusion criteria. We discussed implications for the generalizability of the studies' outcomes in relationship to exclusion criteria.
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Affiliation(s)
- Sahr Yazdani
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA;
| | - Angela Capuano
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA; (A.C.); (M.G.)
| | - Mohammad Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA; (A.C.); (M.G.)
| | - Costanza Colombi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA; (A.C.); (M.G.)
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Manohar H, Kandasamy P, Chandrasekaran V, Rajkumar RP. Can RCTs capture it all?-Need for qualitative studies on parent-mediated interventions for children with Autism Spectrum Disorder. Asian J Psychiatr 2020; 48:101915. [PMID: 31896437 DOI: 10.1016/j.ajp.2019.101915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is a global rise in the prevalence of Autism Spectrum Disorder (ASD) and treatment gap exists across settings. In low-resource settings, there is a lack of professionals and specialist centres for intervention delivery. 'Parent-mediated interventions' is an essential strategy to bridge the existing treatment gap. While RCTs are required to establish evidence base, understanding parental perspectives is pivotal in designing culturally-relevant intervention models, to enhance parental involvement and sustainability. The current paper focuses on the results of a qualitative study to understand the parent perspectives and change process before and after a parent-mediated intervention program. METHODS 30 children (2-6 years) recently diagnosed to have ASD, participated in a brief parent-mediated interventions focusing on core-deficits, for 12 weeks. Parents were asked to narrate their experiences and perception of their child's disorder and interventions before and after the intervention program, during one-on-one in-depth interview. A narrative guide was used to generate response. The narratives were recorded verbatim and thematic content analysis was carried out. RESULTS Repetitive themes reflecting impact of the child's disorder, treatment impact and change process was examined. The broad themes generated included: 1) Change in perception of the child's developmental disorder after involvement in intervention process. 2) Change in parental attitudes from 'lack of hope' to 'positive and appropriate expectations' 3) Gain in knowledge and empowerment 4) Stress reduction 5) Appreciation of micro-gains 6) Validation of 'hands-on training'. Behavioural interventions were the preferred treatment of choice in 66 % of parents, followed by combination therapy in 22 % and pharmacotherapy alone in 12 %. CONCLUSION Parent's narratives highlighted the acceptability and feasibility of the parent-mediated interventions in our cultural setting. Understanding parental perspectives, more so when interventions are parent-mediated, is essential for tailoring interventions as well as improving sustainability.
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Affiliation(s)
- Harshini Manohar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
| | - Preeti Kandasamy
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
| | - Venkatesh Chandrasekaran
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
| | - Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
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20
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Developing an Evaluation Framework for Parent Education and Training in Autism Spectrum Disorder: Results of a Multi-stakeholder Process. J Autism Dev Disord 2020; 49:4468-4481. [PMID: 31463631 DOI: 10.1007/s10803-019-04176-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the need for parent education and training programmes in autism spectrum disorder (ASD), there is no generally-accepted evaluation framework to select programmes for different settings. Here we generated an evaluation framework using a multi-stakeholder, implementation science approach. Purposive sampling identified ASD experts, implementation/health systems experts, and parents/carers of individuals with ASD. A consensus-building stakeholder workshop with 14 stakeholders and thematic analysis was used to generate themes and components of the framework. Main themes included 'Outcomes' (parent, child, family and community), 'Processes and Procedures' (accessibility, acceptability, psychological process, and referral pathways) and 'Implementation Landscape' (sustainability, scalability, integration and coordination, and monitoring and evaluation). We propose that the evaluation framework and Evaluation Framework Checklist generated could guide clinicians, researchers and policy-makers.
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Bang JY, Adiao AS, Marchman VA, Feldman HM. Language nutrition for language health in children with disorders: a scoping review. Pediatr Res 2020; 87:300-308. [PMID: 31454828 PMCID: PMC6962542 DOI: 10.1038/s41390-019-0551-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 11/09/2022]
Abstract
The quantity and quality of child-directed speech-language nutrition-provided to typically-developing children is associated with language outcomes-language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments-preterm birth, intellectual disability, and autism-addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children's language development? We identified 635 potential studies and reviewed 57 meeting study criteria. Child-directed speech to children with all conditions was comparable to speech to language-matched children; caregivers were more directive toward children with disorders. Most associations between child-directed speech and outcomes were positive. However, several interventions had minimal effects on child language. Trials with large samples, intensive interventions, and multiple data sources are needed to evaluate child-directed speech as a means to prevent language impairment. Clinicians should counsel caregivers to use high quality child-directed speech and responsive communication styles with children with these conditions.
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Affiliation(s)
- Janet Y Bang
- Department of Psychology, School of Humanities and Sciences, Stanford University, Stanford, CA, USA
| | - Aubrey S Adiao
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Virginia A Marchman
- Department of Psychology, School of Humanities and Sciences, Stanford University, Stanford, CA, USA
| | - Heidi M Feldman
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA.
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Manohar H, Kandasamy P, Chandrasekaran V, Rajkumar RP. Brief Parent-Mediated Intervention for Children with Autism Spectrum Disorder: A Feasibility Study from South India. J Autism Dev Disord 2019; 49:3146-3158. [PMID: 31053990 DOI: 10.1007/s10803-019-04032-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study assesses the acceptability and feasibility of a brief parent-mediated home-based intervention for children with autism spectrum disorder (ASD), deliverable in resource-limited settings, with an emphasis on addressing parental stress from a socio-cultural perspective. 50 children (2-6 years), with a DSM 5 diagnosis of ASD were randomized to intervention (n = 26) or active control group (n = 24). The intervention based on naturalistic developmental behavioral approach, focusing on joint attention, imitation, social and adaptive skills was structured to be delivered in five outpatient sessions over 12 weeks. All children were followed up at 4, 8 and 12 weeks. Parents of children randomized to the intervention group reported more improvements across parental stress and child outcome measures compared to those in the control group. The intervention was found to be acceptable and feasible, with high fidelity measures and retention rates.
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Affiliation(s)
- Harshini Manohar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
| | - Preeti Kandasamy
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
| | - Venkatesh Chandrasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
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Smith TE, Sheridan SM, Kim EM, Park S, Beretvas SN. The Effects of Family-School Partnership Interventions on Academic and Social-Emotional Functioning: a Meta-Analysis Exploring What Works for Whom. EDUCATIONAL PSYCHOLOGY REVIEW 2019. [DOI: 10.1007/s10648-019-09509-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yang YH. Review of Early Intervention for Children with Autism Spectrum Disorder: Focused on Randomized Controlled Trials. Soa Chongsonyon Chongsin Uihak 2019; 30:136-144. [PMID: 32595334 PMCID: PMC7298910 DOI: 10.5765/jkacap.180035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/07/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
Early identification and intervention for autism spectrum disorder (ASD) were reported to be important for outcomes or clinical courses. However, there have been a few robust evidences for effectiveness of early intervention until now. This review aims to identify the effectiveness of early intervention by investigating the randomized controlled trial (RCT) of early intervention for autism. There are some RCT studies using behavioral program. Although there are some significant findings, the outcome measurements and small sample size are the limitations. Further studies are needed.
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Affiliation(s)
- Young-Hui Yang
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Korea
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Caregiver-Implemented Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review of Coaching Components. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00186-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Trembath D, Gurm M, Scheerer NE, Trevisan DA, Paynter J, Bohadana G, Roberts J, Iarocci G. Systematic review of factors that may influence the outcomes and generalizability of parent‐mediated interventions for young children with autism spectrum disorder. Autism Res 2019; 12:1304-1321. [DOI: 10.1002/aur.2168] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/10/2019] [Indexed: 12/25/2022]
Affiliation(s)
- David Trembath
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Mandeep Gurm
- Department of PsychologySimon Fraser University Burnaby British Columbia Canada
| | - Nichole E. Scheerer
- Department of PsychologySimon Fraser University Burnaby British Columbia Canada
| | - Dominic A. Trevisan
- Faculty of EducationSimon Fraser University Burnaby British Columbia Canada
- Child Study CenterYale University New Haven Connecticut
| | - Jessica Paynter
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Gal Bohadana
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Jacqueline Roberts
- Griffith Institute for Educational ResearchGriffith University Mount Gravatt, Queensland Australia
| | - Grace Iarocci
- Department of PsychologySimon Fraser University Burnaby British Columbia Canada
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Roberts MY, Curtis PR, Sone BJ, Hampton LH. Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis. JAMA Pediatr 2019; 173:671-680. [PMID: 31107508 PMCID: PMC6537769 DOI: 10.1001/jamapediatrics.2019.1197] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language. OBJECTIVE To examine the association between parent training and language and communication outcomes in young children. DATA SOURCES Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018. STUDY SELECTION Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included. MAIN OUTCOMES AND MEASURES Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment. RESULTS This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedges g, -0.33 [0.06]; P < .001). The association between parent training and parent use of language support strategies was large (mean [SE] Hedges g, 0.55 [0.11], P < .001). Children with developmental language disorder had the largest social communication outcomes (mean [SE] Hedges g, 0.37 [0.17]); large and significant associations were observed for receptive (mean [SE] Hedges g, 0.92 [0.30]) and expressive language (mean [SE] Hedges g, 0.83 [0.20]). Children at risk for language impairments had moderate effect sizes across receptive language (mean [SE] Hedges g, 0.28 [0.15]) and engagement outcomes (mean [SE] Hedges g, 0.36 [0.17]). CONCLUSIONS AND RELEVANCE The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.
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Affiliation(s)
- Megan Y. Roberts
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Philip R. Curtis
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Bailey J. Sone
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Lauren H. Hampton
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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Estes A, Swain DM, MacDuffie KE. The effects of early autism intervention on parents and family adaptive functioning. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2019; 2:21. [PMID: 31583390 PMCID: PMC6776235 DOI: 10.21037/pm.2019.05.05] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This review describes the effects of intervention for young children with autism spectrum disorder (ASD) on parents. Like all children, children with ASD bring both negative and positive experiences for parents and families-from increased resource needs, to higher levels of parenting-related stress, to positive personal growth for family members. It is increasingly recognized that, although children with ASD are the primary targets of early ASD intervention, ASD intervention also impacts parents. From the time emerging developmental concerns begin to be identified, through the process of obtaining a diagnosis and initiating services, parents play a central role in addressing the needs of young children with ASD, including implementing and supporting early intervention. Parents experience the impact of intervention directly, through interaction with providers within the health care and educational systems. Parents also experience indirect impacts of ASD intervention due to accelerated developmental progress of children who are benefitting from services and when children make slower progress than expected or have challenging behaviors. Parental stress and psychological well-being are legitimate targets of intervention and compelling research objectives, needing no additional justification. However, parents are also the major contributors to family adaptive functioning-the activities families employ to support positive outcomes for children with ASD (e.g., family-orchestrated child experiences, parent-child interaction, child health and safety functions; Guralnick, 1997). A parent's ability to carry out adaptive functions is, in part, related to their levels of stress and psychological well-being. Thus, there is a transactional process in which parents are both impacted by and have an impact on ASD interventions for their child. Evaluating the effect of ASD intervention on parents is needed to develop new strategies for helping parents and children with ASD reach their full potential. This review will provide an overview of research on the impact of early ASD intervention on parents. Evidence regarding the impact of three types of intervention (i.e., early intensive behavioral intervention, parent-implemented intervention, and programs directly targeting parent stress) on parent well-being and family adaptive functioning will be reviewed. Potential moderators of the impact of ASD intervention on parents and family adaptive functioning will be discussed. We conclude that research on the impact of ASD intervention on parents of young children with ASD is a promising avenue for improving the lives of children with ASD and their families.
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Affiliation(s)
- Annette Estes
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Deanna M. Swain
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Rogerson J, Falkmer M, Cuomo B, Falkmer T, Whitehouse AJO, Granich J, Vaz S. Parental experiences using the Therapy Outcomes by You (TOBY) application to deliver early intervention to their child with autism. Dev Neurorehabil 2019; 22:219-227. [PMID: 29485349 DOI: 10.1080/17518423.2018.1440259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE As computer-based interventions become commonplace for parents of children with neurodevelopmental disorders, this study sought to understand the experience of using a parent-delivered supplementary early intervention therapy for children with autism spectrum disorder grounded in a variety of behavioral, sensory, developmental, and relationship-based approaches and delivered via a tablet device. METHODS Parental experiences using the 'Therapy Outcomes by You' (TOBY) application were collected through semi-structured interviews with 17 parents. RESULTS Parents reported TOBY facilitated parent-child engagement, provided ideas for therapeutic activities, created feelings of empowerment, and positively impacted their child's development. Barriers to use included preparation time, execution of the intervention, and individual strengths and weaknesses of their child. CONCLUSION The overall parental experience of TOBY was positive when use of the application aligned with parental proficiency, opportunities for use, and importantly, the needs of the child.
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Affiliation(s)
- Jessica Rogerson
- a School of Occupational Therapy & Social Work , CHIRI, Curtin University , Perth , Western Australia
| | - Marita Falkmer
- a School of Occupational Therapy & Social Work , CHIRI, Curtin University , Perth , Western Australia.,b School of Education and Communication, CHILD Programme , Institute of Disability Research, Jönköping University , Jönköping , Sweden
| | - Belinda Cuomo
- a School of Occupational Therapy & Social Work , CHIRI, Curtin University , Perth , Western Australia
| | - Torbjorn Falkmer
- a School of Occupational Therapy & Social Work , CHIRI, Curtin University , Perth , Western Australia.,c School of Health and Welfare , Jönköping University , Jönköping , Sweden.,d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Andrew J O Whitehouse
- e Telethon Kids Institute , The University of Western Australia , Perth , Western Australia
| | - Joanna Granich
- e Telethon Kids Institute , The University of Western Australia , Perth , Western Australia
| | - Sharmila Vaz
- a School of Occupational Therapy & Social Work , CHIRI, Curtin University , Perth , Western Australia
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Tiede G, Walton KM. Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:2080-2095. [DOI: 10.1177/1362361319836371] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Naturalistic developmental behavioral intervention is an emerging class of interventions for young children with autism spectrum disorder. The present article is a meta-analysis of outcomes of group-design studies ( n = 27) testing interventions using naturalistic developmental behavioral intervention strategies. Small, significant positive effects of naturalistic developmental behavioral intervention were found for expressive language ( g = 0.32), reduction in symptoms of autism spectrum disorder ( g = −0.38), and play skills ( g = 0.23). Larger effects were found for social engagement ( g = 0.65) and overall cognitive development ( g = 0.48). A marginal effect was found for joint attention ( g = 0.14) and receptive language ( g = 0.28). For joint attention, improvement was moderated by hours of professional involvement. Evidence of publication and reporting bias was present for language outcomes. This meta-analysis grows the evidence base for naturalistic developmental behavioral interventions, particularly in the key areas of social engagement and cognition.
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Waddington H, van der Meer L, Sigafoos J. Supporting parents in the use of the early start Denver model as an intervention program for their young children with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 67:23-36. [PMID: 34141396 PMCID: PMC7942780 DOI: 10.1080/20473869.2019.1585694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 05/25/2023]
Abstract
Parents are the logical intervention agents for young children with autism spectrum disorder (ASD). The early start Denver model (ESDM) is a promising early intervention approach for children with ASD that can be implemented by parents. This study evaluated the effects of training parents in the use of the ESDM. We used a non-concurrent multiple probe across participants design to evaluate the effects of providing five mothers of young children with ASD with one hour per week of training for 12 weeks. Outcome measures included mothers use of the ESDM techniques and measures of the children's levels of engagement and imitation, and expressive language skills. Maintenance of outcomes after one month was also assessed. Results showed four of the five mothers increased the percentage of ESDM techniques that they were using usually or consistently. Four of the five children showed some improvement on at least one of the child outcome measures. This suggests mixed results for supporting parents in the use of the ESDM. Implications and future research directions are discussed.
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Affiliation(s)
- Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Larah van der Meer
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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Davlantis KS, Estes A, Dawson G, Rogers SJ. A novel method for measuring learning opportunities provided by parents to young children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1563-1574. [PMID: 30623667 DOI: 10.1177/1362361318817303] [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: 01/23/2023]
Abstract
The aim of this study was to develop a measurement approach to assess the learning opportunities provided by parents to their young children with autism spectrum disorder during a free play task and to examine the relationship between learning opportunities and child performance on measures of cognition, autism spectrum disorder symptoms, and language. Participants were 91 children with autism spectrum disorder ages 12-24 months and their parents. Ordinary least squares regression was used. Results showed that children whose parents provided more learning opportunities had significantly higher cognitive scores and significantly higher vocabulary comprehension and production. The psychometric properties of the measurement approach were investigated and results indicated that it may be psychometrically sound.
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Affiliation(s)
| | | | - Geraldine Dawson
- 3 Duke Center for Autism and Brain Development, Duke University School of Medicine, USA
| | - Sally J Rogers
- 4 Medical Investigaton of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, USA
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Brignell A, Chenausky KV, Song H, Zhu J, Suo C, Morgan AT. Communication interventions for autism spectrum disorder in minimally verbal children. Cochrane Database Syst Rev 2018; 11:CD012324. [PMID: 30395694 PMCID: PMC6516977 DOI: 10.1002/14651858.cd012324.pub2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) has an estimated prevalence of around 1.7% of the population. People with ASD often also have language difficulties, and about 25% to 30% of children with ASD either fail to develop functional language or are minimally verbal. The ability to communicate effectively is an essential life skill, and difficulties with communication can have a range of adverse outcomes, including poorer academic achievement, behavioural difficulties and reduced quality of life. Historically, most studies have investigated communication interventions for ASD in verbal children. We cannot assume the same interventions will work for minimally verbal children with ASD. OBJECTIVES To assess the effects of communication interventions for ASD in minimally verbal children. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase as well as 12 other databases and three trials registers in November 2017. We also checked the reference lists of all included studies and relevant reviews, contacting experts in the field as well as authors of identified studies about other potentially relevant ongoing and unpublished studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of communication-focused interventions for children (under 12 years of age) diagnosed with ASD and who are minimally verbal (fewer than 30 functional words or unable to use speech alone to communicate), compared with no treatment, wait-list control or treatment as usual. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS This review includes two RCTs (154 children aged 32 months to 11 years) of communication interventions for ASD in minimally verbal children compared with a control group (treatment as usual). One RCT used a verbally based intervention (focused playtime intervention; FPI) administered by parents in the home, whereas the other used an alternative and augmentative communication (AAC) intervention (Picture Exchange Communication System; PECS) administered by teachers in a school setting.The FPI study took place in the USA and included 70 participants (64 boys) aged 32 to 82 months who were minimally verbal and had received a diagnosis of ASD. This intervention focused on developing coordinated toy play between child and parent. Participants received 12 in-home parent training sessions for 90 minutes per session for 12 weeks, and they were also invited to attend parent advocacy coaching sessions. This study was funded by the National Institute of Child Health and Human Development, the MIND Institute Research Program and a Professional Staff Congress-City University of New York grant. The PECS study included 84 minimally verbal participants (73 boys) aged 4 to 11 years who had a formal diagnosis of ASD and who were not using PECS beyond phase 1 at baseline. All children attended autism-specific classes or units, and most classes had a child to adult ratio of 2:1. Teachers and parents received PECS training (two-day workshop). PECS consultants also conducted six half-day consultations with each class once per month over five months. This study took place in the UK and was funded by the Three Guineas Trust.Both included studies had high or unclear risk of bias in at least four of the seven 'Risk of bias' categories, with a lack of blinding for participants and personnel being the most problematic area. Using the GRADE approach, we rated the overall quality of the evidence as very low due to risk of bias, imprecision (small sample sizes and wide confidence intervals) and because there was only one trial identified per type of intervention (i.e. verbally based or AAC).Both studies focused primarily on communication outcomes (verbal and non-verbal). One of the studies also collected information on social communication. The FPI study found no significant improvement in spoken communication, measured using the expressive language domain of the Mullen Scale of Early Learning expressive language, at postintervention. However, this study found that children with lower expressive language at baseline (less than 11.3 months age-equivalent) improved more than children with better expressive language and that the intervention produced expressive language gains in some children. The PECS study found that children enrolled in the AAC intervention were significantly more likely to use verbal initiations and PECS symbols immediately postintervention; however, gains were not maintained 10 months later. There was no evidence that AAC improved frequency of speech, verbal expressive vocabulary or children's social communication or pragmatic language immediately postintervention. Overall, neither of the interventions (PECS or FPI) resulted in maintained improvements in spoken or non-verbal communication in most children.Neither study collected information on adverse events, other communication skills, quality of life or behavioural outcomes. AUTHORS' CONCLUSIONS There is limited evidence that verbally based and ACC interventions improve spoken and non-verbal communication in minimally verbal children with ASD. A substantial number of studies have investigated communication interventions for minimally verbal children with ASD, yet only two studies met inclusion criteria for this review, and we considered the overall quality of the evidence to be very low. In the study that used an AAC intervention, there were significant gains in frequency of PECS use and verbal and non-verbal initiations, but not in expressive vocabulary or social communication immediately postintervention. In the study that investigated a verbally based intervention, there were no significant gains in expressive language postintervention, but children with lower expressive language at the beginning of the study improved more than those with better expressive language at baseline. Neither study investigated adverse events, other communication skills, quality of life or behavioural outcomes. Future RCTs that compare two interventions and include a control group will allow us to better understand treatment effects in the context of spontaneous maturation and will allow further comparison of different interventions as well as the investigation of moderating factors.
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Affiliation(s)
- Amanda Brignell
- Murdoch Children's Research Institute50 Flemington RoadParkvilleVictoriaAustralia3052
| | - Karen V Chenausky
- Beth Israel Deaconess Medical CenterNeurology ‐ Palmer 130b330 Brookline AvenueBostonMAUSA02215
| | - Huan Song
- University of IcelandCenter of Public Health Sciences, Faculty of MedicineReykjavíkIceland
- Karolinska InstitutetDepartment of Medical Epidemiology and BiostatisticsStockholmSweden
| | - Jianwei Zhu
- Shandong Provincial Hospital Affiliated to Shandong UniversityDepartment of OrthopaedicsNo.324, Jingwu RoadJinanShandongChina250021
| | - Chen Suo
- Fudan UniversityDepartment of Epidemiology, School of Public HealthDongan road 130ShanghaiChina200438
| | - Angela T Morgan
- Murdoch Children's Research Institute50 Flemington RoadParkvilleVictoriaAustralia3052
- The University of MelbourneDepartment of Audiology and Speech PathologyMelbourneVictoriaAustralia3053
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Parent-Mediated Intervention for One-Year-Olds Screened as At-Risk for Autism Spectrum Disorder: A Randomized Controlled Trial. J Autism Dev Disord 2018; 47:3520-3540. [PMID: 28861651 DOI: 10.1007/s10803-017-3268-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Theoretically, interventions initiated with at-risk infants prior to the point in time a definitive autism spectrum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efficacy of a parent-mediated early intervention called Adapted Responsive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identified by community screening with the First Year Inventory as at-risk of later ASD diagnoses. We found minimal evidence for main effects of ART on child outcomes. However, ART group parents showed significantly greater increases in responsiveness to their infants than control group parents. Further, significant indirect (mediation) effects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change.
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Tachibana Y, Miyazaki C, Mikami M, Ota E, Mori R, Hwang Y, Terasaka A, Kobayashi E, Kamio Y. Meta-analyses of individual versus group interventions for pre-school children with autism spectrum disorder (ASD). PLoS One 2018; 13:e0196272. [PMID: 29763417 PMCID: PMC5953451 DOI: 10.1371/journal.pone.0196272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
There is little evidence regarding the effects of individual and group intervention for children with autism spectrum disorder (ASD) on important outcomes. We performed meta-analyses using a random effects model to investigate the effectiveness of the individual and group intervention studies and to compare the effectiveness of these two types if possible. The main analysis which excluded studies at a high risk of bias (Analysis I) included 14 randomised controlled trials targeting children with ASD≤6 years of age (594 children). The results suggested that both individual and group interventions showed significant effects compared to the control condition on "reciprocity of social interaction towards others" (standard mean difference[SMD] [95%confidence interval{CI}] = 0.59[0.25, 0.93], p = 0.16; 0.45[0.02, 0.88], p = 0.39, respectively). Only individual interventions showed significant effects compared to the control condition on "parental synchrony" (SMD [95%CI] = 0.99 [0.70, 1.29], p<0.01). Our results showed no significant differences between individual and group interventions in effects on "autism general symptoms" (no study available for group intervention), "developmental quotient" (no study available for group intervention), "expressive language" (p = 0.56), "receptive language" (p = 0.29), "reciprocity of social interaction towards others" (p = 0.62), or "adaptive behaviour" (p = 0.43). We also performed sensitivity analyses including studies that had been excluded due to being at a high risk of potential bias (Analysis II). The results suggested that "reciprocity of social interactions towards others" showed significant effects for individual intervention compared to the control condition (0.50[0.31,0.69], p<0.001) but not for group intervention (0.23[-0.33, 0.78], p = 0.42). Individual intervention also showed significant effects on "parental synchrony" (0.98[0.30,1.66], p = 0.005) in the sensitivity analysis. The results also suggested no significant difference on all the outcomes between the individual and group interventions. We also reanalysed the data using cluster-robust standard errors as sensitivity analyses (Analysis III). Analysis III showed no significant effects in the intervention condition compared to the control condition on all the outcomes for both individual and group interventions. When Analysis II was reanalysed using cluster-robust standard errors (Analysis IV), individual interventions showed significant effects compared to the control condition on "reciprocity of social interaction towards others" and "parental synchrony" (mean estimate[95%CI], robust standard error, p = 0.50[0.20, 0.81], 0.13, 0.006; and 1.06[0.08, 2.05], 0.42, 0.04, respectively), and none of the outcomes showed significant effects under the intervention condition compared to the control condition for group interventions. The discrepancies in the results between the main analysis (Analysis I) and the sensitivity analyses (Analyses II, III, and IV) may be due to the small number of included studies. Since the outcome of "reciprocity of social interaction towards others" can be a dependent variable that is usually measured in a context-bound setting with the child's parent, we cannot conclude that individual interventions for pre-school children with ASD have significant effects on generalised skills for engaging in reciprocal interactions with others, even if the interventions have significant effects on the outcome. However, the outcomes of "reciprocity of social interaction towards others" may be promising targets for both individual and group interventions involving pre-school children with ASD. "Parental synchrony" may also be a promising target for individual interventions. TRIAL REGISTRATION (CRD42011001349).
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Affiliation(s)
- Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
- Smart Aging International Research Center, IDAC, Tohoku University, Sendai, Japan
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
| | - Celine Miyazaki
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Masashi Mikami
- Department of Biostatistics, Clinical Research Centre, National Centre for Child Health and Development, Tokyo, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yeonhee Hwang
- Department of Education, Tohoku Fukushi University, Sendai, Japan
| | - Akiko Terasaka
- Department of Educational Collaboration, Osaka Kyoiku University, Osaka, Japan
| | - Eriko Kobayashi
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
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Manohar H, Kuppili PP, Kandasamy P, Chandrasekaran V, Rajkumar RP. Implications of comorbid ADHD in ASD interventions and outcome: Results from a naturalistic follow up study from south India. Asian J Psychiatr 2018; 33:68-73. [PMID: 29544110 DOI: 10.1016/j.ajp.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder commonly associated with Attention Deficit Hyperactivity Disorder (ADHD), the prevalence ranging from 14-70%. The current study attempted to assess the impact of comorbid ADHD in children with ASD, in terms of challenges in diagnosis, treatment, intervention outcomes and parental stress and coping through a naturalistic design. METHODS Fifty children aged 2-6 years with ASD were recruited, assessed and followed up for six months. Twenty children were found to have comorbid ADHD. Severity of ASD and ADHD was assessed by Childhood Autism rating scale and Connor's abbreviated rating scale respectively. Parental stress and coping was assessed by Family Interview for stress and coping. RESULTS The diagnosis of ASD was apparently obscured by ADHD symptoms in about 22% of cases, as only diagnosis of ADHD was made at the time of referral to our centre. ADHD was the most common comorbidity followed by intellectual disability and seizure disorder. About 66% of children received combination of pharmacological and behavioral interventions. Clonidine was the most common medication to be used and was well tolerated. The improvement in ADHD symptomatology showed positive correlation with improvement with ASD-specific interventions as reflected by change in severity scores. Severity of ADHD significantly also predicted parental stress and coping, and thereby engagement in ASD-specific interventions. CONCLUSION The current study highlights the need for screening and early diagnosis of comorbid ADHD in children with ASD and vice versa considering the management challenges. In case of multiple comorbid neurodevelopmental disorders, early interventions for one disorder can improve the outcome of the other.
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Affiliation(s)
- Harshini Manohar
- Junior resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
| | - Pooja Patnaik Kuppili
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
| | - Preeti Kandasamy
- Assistant Professor of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
| | - Venkatesh Chandrasekaran
- Additional Professor and Head of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
| | - Ravi Philip Rajkumar
- Assistant Professor of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
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Abstract
With advances in the field's ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.
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Affiliation(s)
- Rebecca J. Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tachibana Y, Miyazaki C, Ota E, Mori R, Hwang Y, Kobayashi E, Terasaka A, Tang J, Kamio Y. A systematic review and meta-analysis of comprehensive interventions for pre-school children with autism spectrum disorder (ASD). PLoS One 2017; 12:e0186502. [PMID: 29211740 PMCID: PMC5718481 DOI: 10.1371/journal.pone.0186502] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There has an increasing number of published trials on psychosocial intervention programmes for pre-school children with autism spectrum disorder (ASD). To achieve better quality of unbiased evidence for the effectiveness of ASD interventions, it is necessary to conduct a comprehensive review that covers studies with adequate quality standards, such as randomised controlled trials (RCTs), and different types of intervention In this study, we categorize interventions for ASD as behavioural, social-communication focused, and multimodal developmental based on Howlin's classification of early interventions for children with ASD. The aim of this study was to compare these three models and investigate the strengths and weaknesses of each type of intervention and to identify the approaches that contribute to a successful outcome for children with autism. METHODS We performed a systematic review and meta-analysis. We included RCTs targeting children with ASD 6 years old or younger. A random effects model was used to present the effect estimate for the outcomes. This study also performed combined meta-analyses of all the three models to investigate the overall effectiveness of the intervention programmes. RESULTS 32 randomized controlled studies were found to be eligible for inclusion. The synthesized data included 594 children from 14 RCTs. There was no statistically significant difference in the effects on autism general symptoms between the social-communication-focused model and the multimodal developmental model (p = 0.83). The results suggest that there is evidence of an effect on 'reciprocity of social interaction towards others' (standard mean difference [95% confidential interval] = 0.53[0.29,0.78], p<0.01) and 'parental synchrony' (SMD = 0.99[0.70,1.29], p<0.01). CONCLUSION The small number of studies included in the present study limited the ability to make inferences when comparing the three models and investigating the strengths and weaknesses of each type of intervention with respect to important outcomes. Since the outcome of 'reciprocity of social interaction towards others' could be a dependent variable that might be context-bound to interactions with the child's parent, we cannot conclude the interventions for pre-school children with ASD have significant effects on a generalized skill to engage in reciprocal interactions with others. However, the outcomes of 'reciprocity of social interaction towards others' and 'parental synchrony' may be promising targets for interventions involving pre-school children with ASD. TRIAL REGISTRATION Prospero CRD42011001349.
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Affiliation(s)
- Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
- Smart Aging International Research Center, IDAC, Tohoku University, Sendai, Japan
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
| | - Celine Miyazaki
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Erika Ota
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yeonhee Hwang
- Department of Education, Tohoku Fukushi University, Sendai, Japan
| | - Eriko Kobayashi
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Akiko Terasaka
- Department of Educational Collaboration, Osaka Kyoiku University, Osaka, Japan
| | - Julian Tang
- Department of Education for Clinical Research, National Centre for Child Health and Development, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
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Schertz HH, Odom SL, Baggett KM, Sideris JH. Mediating Parent Learning to Promote Social Communication for Toddlers with Autism: Effects from a Randomized Controlled Trial. J Autism Dev Disord 2017; 48:853-867. [DOI: 10.1007/s10803-017-3386-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Visser JC, Rommelse NNJ, Lappenschaar M, Servatius-Oosterling IJ, Greven CU, Buitelaar JK. Variation in the Early Trajectories of Autism Symptoms Is Related to the Development of Language, Cognition, and Behavior Problems. J Am Acad Child Adolesc Psychiatry 2017; 56:659-668. [PMID: 28735695 DOI: 10.1016/j.jaac.2017.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/15/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objectives of this study were to model more homogeneous subgroups within autism spectrum disorder (ASD) based on early trajectories of core symptoms; and to further characterize these subgroups in terms of trajectories of language, cognition, co-occurring (attention-deficit/hyperactivity disorder [ADHD]-related) traits and clinical outcome diagnosis. METHOD Children (N = 203) referred for possible ASD at ages 1 to 4 years were assessed at three time points at intervals ranging from 9 months to 3 years. Assessments included standardized measures for ASD (Autism Diagnostic Observation Schedule [ADOS]), language (ADOS-language item), nonverbal IQ (NV-IQ; different tests adequate to chronological/mental age), and parent-reported behavioral problems (Infant-Toddler Social and Emotional Assessment, Child Behavior Checklist). RESULTS Latent-class growth curve analysis with ADOS total scores led to the identification of three main stable and two small improving groups: a severe-stable group (19.5% of sample)-the only group without considerable language improvement-showed persistent low NV-IQ and marked increase in attention problems over time; a moderate-stable group (21.7%) with below-average increasing NV-IQ; and a mild-stable group (48%) with stable-average NV-IQ and the highest scores on ADHD-related traits, whose ASD outcome diagnoses increased despite stable-low ASD scores. Two groups (each 5.4%) improved: one moved from severe to moderate ASD scores, and the other moved from moderate to mild/nonspectrum scores. Both of these groups improved on language, NV-IQ, and ADHD-related traits. CONCLUSION Results support the high stability of ASD symptoms into various severity levels, but also highlight the significant contribution of non-ASD domains in defining and explaining the different ASD trajectories.
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Affiliation(s)
- Janne C Visser
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands.
| | - Nanda N J Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen
| | | | | | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, and King's College London, Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen
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Abstract
OBJECTIVE This study examined the relationship between mothers' pragmatics and child language in autism spectrum disorder (ASD) and non-ASD language delay (LD) mother-child dyads. METHODS Participants consisted of 20 dyads of mothers and their toddlers aged 24 to 48 months, with ASD (n = 10) or non-ASD LD (n = 10). Groups were matched on child chronological age, language, and cognition. Maternal pragmatic language was qualified based on the degree of pragmatic violations during a semistructured interview, and was examined in relation to both child language, as measured by the Preschool Language Scale-4 and maternal use of language facilitation strategies during play. RESULTS Lower rates of maternal pragmatic violations were associated with higher expressive language scores in children with ASD, and with higher receptive language scores for children with non-ASD LD. Within ASD dyads, maternal pragmatic violations were negatively related to mothers' use of linguistic expansions. CONCLUSION These findings indicate that parental pragmatics likely contribute to early language learning, and that the effects of maternal pragmatics on early language in ASD may be indirect (e.g., through parents' use of facilitative strategies). Parent-mediated language interventions for ASD should therefore consider parent pragmatics, especially given that pragmatic differences have been identified in unaffected family members of individuals with ASD.
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Parsons L, Cordier R, Munro N, Joosten A, Speyer R. A systematic review of pragmatic language interventions for children with autism spectrum disorder. PLoS One 2017; 12:e0172242. [PMID: 28426832 PMCID: PMC5398499 DOI: 10.1371/journal.pone.0172242] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022] Open
Abstract
There is a need for evidence based interventions for children with autism spectrum disorder (ASD) to limit the life-long, psychosocial impact of pragmatic language impairments. This systematic review identified 22 studies reporting on 20 pragmatic language interventions for children with ASD aged 0-18 years. The characteristics of each study, components of the interventions, and the methodological quality of each study were reviewed. Meta-analysis was conducted to assess the effectiveness of 15 interventions. Results revealed some promising approaches, indicating that active inclusion of the child and parent in the intervention was a significant mediator of intervention effect. Participant age, therapy setting or modality were not significant mediators between the interventions and measures of pragmatic language. The long-term effects of these interventions and the generalisation of learning to new contexts is largely unknown. Implications for clinical practice and directions for future research are discussed.
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Affiliation(s)
- Lauren Parsons
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia
| | - Reinie Cordier
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia
| | - Natalie Munro
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Annette Joosten
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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43
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Pijl MKJ, Rommelse NNJ, Hendriks M, De Korte MWP, Buitelaar JK, Oosterling IJ. Does the Brief Observation of Social Communication Change help moving forward in measuring change in early autism intervention studies? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 22:216-226. [DOI: 10.1177/1362361316669235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The field of early autism research is in dire need of outcome measures that adequately reflect subtle changes in core autistic behaviors. This article compares the ability of a newly developed measure, the Brief Observation of Social Communication Change (BOSCC), and the Autism Diagnostic Observation Schedule (ADOS) to detect changes in core symptoms of autism in 44 toddlers. The results provide encouraging evidence for the Brief Observation of Social Communication Change as a candidate outcome measure, as reflected in sufficient inter- and intra-rater reliability, independency from other child characteristics, and sensitivity to capture change. Although the Brief Observation of Social Communication Change did not evidently outperform the Autism Diagnostic Observation Schedule on any of these quality criteria, the instrument may be better able to capture subtle, individual changes in core autistic symptoms. The promising findings warrant further study of this new instrument.
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Affiliation(s)
- Mirjam KJ Pijl
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nanda NJ Rommelse
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monica Hendriks
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon WP De Korte
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
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DeFilippis M, Wagner KD. Treatment of Autism Spectrum Disorder in Children and Adolescents. PSYCHOPHARMACOLOGY BULLETIN 2016; 46:18-41. [PMID: 27738378 PMCID: PMC5044466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Autism spectrum disorder is a diagnosis that includes significant social communication deficits/delays along with restricted patterns of interests and behaviors. The prevalence of this diagnosis has increased over the past few decades, and it is unclear whether this is solely attributable to the increased awareness of milder forms of the disorder among medical providers. The current treatment options for the core symptoms of autism are limited to psychosocial therapies, such as applied behavior analysis. Medications have been most effective in treating the associated behavioral symptoms of autism, though studies have examined potential benefits in some of the core symptoms of autism with certain medications, especially the repetitive behaviors often seen with this diagnosis. Risperidone and aripiprazole are currently the only medications FDA approved for symptoms associated with autism spectrum disorders, targeting the irritability often seen with this diagnosis. Children and adolescents with autism spectrum disorder appear to be more susceptible to adverse effects with medications; therefore, initiation with low doses and titrating very slowly is recommended. Some complementary alternative treatments have been researched as possible treatments in autism, though evidence supporting many of these is very limited.
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Affiliation(s)
- Melissa DeFilippis
- Drs. DeFilippis, MD, Wagner, MD, PhD, Department of Psychiatry and Behavioral Sciences University of Texas Medical Branch, USA
| | - Karen Dineen Wagner
- Drs. DeFilippis, MD, Wagner, MD, PhD, Department of Psychiatry and Behavioral Sciences University of Texas Medical Branch, USA
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Reed P, Howse J, Ho B, Osborne LA. Relationship between perceived limit-setting abilities, autism spectrum disorder severity, behaviour problems and parenting stress in mothers of children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:952-959. [PMID: 27474117 DOI: 10.1177/1362361316658775] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parenting stress in mothers of children with autism spectrum disorder (ASD) is high and impacts perceptions about parenting. This study examined the relationship between parenting stress and observer-perceived limit-setting ability. Participants' perceptions of other parents' limit-setting ability were assessed by showing participants video clips of parenting behaviours. Mothers of 93 children with autism spectrum disorder completed an online survey regarding the severity of their own child's autism spectrum disorder (Social Communication Questionnaire), their child's behaviour problems (Strengths and Difficulties Questionnaire) and their own levels of parenting stress (Questionnaire on Resources and Stress). They were shown five videos of other parents interacting with children with autism spectrum disorder and were asked to rate the limit-setting abilities observed in each video using the Parent-Child Relationship Inventory. Higher parenting stress negatively related to judgements about others' limit-setting skills. This mirrors the literature regarding the relationship between self-reported parenting stress and rating child behaviour more negatively. It suggests that stress negatively impacts a wide range of judgements and implies that caution may be required when interpreting the results of studies in which parenting skills are assessed by self-report.
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46
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Pickard KE, Wainer AL, Bailey KM, Ingersoll BR. A mixed-method evaluation of the feasibility and acceptability of a telehealth-based parent-mediated intervention for children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:845-55. [PMID: 26862084 DOI: 10.1177/1362361315614496] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Research within the autism spectrum disorder field has called for the use of service delivery models that are able to more efficiently disseminate evidence-based practices into community settings. This study employed telehealth methods in order to deliver an Internet-based, parent training intervention for autism spectrum disorder, ImPACT Online. This study used mixed-methods analysis to create a more thorough understanding of parent experiences likely to influence the adoption and implementation of the program in community settings. Specific research questions included (1) What are parents' perceptions of the online program? (2) How does ImPACT Online compare to other services that parents are accessing for their children? And (3) Do parents' experience in, and perceptions of, the program differ based on whether they received a therapist-assisted version of the program? Results from 28 parents of a child with autism spectrum disorder indicate that parents saw improvements in their child's social communication skills and their own competence during the course of the program, regardless of whether they received therapist assistance. However, qualitative interviews indicate that parents who received therapist assistance were more likely endorse the acceptability and observability of the program. These findings support the potential for Internet-based service delivery to more efficiently disseminate evidence-based parent training interventions for autism spectrum disorder.
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47
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Tanner K, Hand BN, O'Toole G, Lane AE. Effectiveness of Interventions to Improve Social Participation, Play, Leisure, and Restricted and Repetitive Behaviors in People With Autism Spectrum Disorder: A Systematic Review. Am J Occup Ther 2015; 69:6905180010p1-12. [PMID: 26356653 DOI: 10.5014/ajot.2015.017806] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
People with autism spectrum disorder (ASD) commonly experience difficulties with social participation, play, and leisure along with restricted and repetitive behaviors that can interfere with occupational performance. The objective of this systematic review was to evaluate current evidence for interventions within the occupational therapy scope of practice that address these difficulties. Strong evidence was found that social skills groups, the Picture Exchange Communication System, joint attention interventions, and parent-mediated strategies can improve social participation. The findings were less conclusive for interventions to improve play and leisure performance and to decrease restricted and repetitive behaviors, but several strategies showed promise with moderately strong supporting evidence. Occupational therapists should be guided by evidence when considering interventions to improve social participation, play, leisure, and restricted and repetitive behaviors in people with ASD. Additional research using more robust scientific methods is needed for many of the currently available strategies.
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Affiliation(s)
- Kelly Tanner
- Kelly Tanner, PhD, OTR/L, is Occupational Therapy Research Coordinator, Nationwide Children's Hospital, Columbus, OH, and Lecturer, Occupational Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus;
| | - Brittany N Hand
- Brittany N. Hand, MOT, OTR/L, is PhD Student, Occupational Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Gjyn O'Toole
- Gjyn O'Toole, MEdStud, GradDip TEFL, BA, Dip Occ Therapy, is Senior Lecturer, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alison E Lane
- Alison E. Lane, PhD, OTR/L, is Associate Professor, University of Newcastle, Callaghan, New South Wales, Australia
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Smith T, Iadarola S. Evidence Base Update for Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 44:897-922. [DOI: 10.1080/15374416.2015.1077448] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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49
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Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins DL, Wetherby A, Choueiri R, Kasari C, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S. Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics 2015; 136 Suppl 1:S41-59. [PMID: 26430169 PMCID: PMC9923900 DOI: 10.1542/peds.2014-3667d] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This article reviews current evidence for autism spectrum disorder (ASD) screening based on peer-reviewed articles published to December 2013. Screening provides a standardized process to ensure that children are systematically monitored for early signs of ASD to promote earlier diagnosis. The current review indicates that screening in children aged 18 to 24 months can assist in early detection, consistent with current American Academy of Pediatrics' recommendations. We identify ASD-specific and broadband screening tools that have been evaluated in large community samples which show particular promise in terms of accurate classification and clinical utility. We also suggest strategies to help overcome challenges to implementing ASD screening in community practice, as well as priorities for future research.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
| | | | | | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California; and
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts
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50
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Zwaigenbaum L, Bauman ML, Choueiri R, Kasari C, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins D, Wetherby A, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR. Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research. Pediatrics 2015; 136 Suppl 1:S60-81. [PMID: 26430170 PMCID: PMC9923898 DOI: 10.1542/peds.2014-3667e] [Citation(s) in RCA: 332] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on "teachable moments," and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
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