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Sandbank M, Pustejovsky JE, Bottema-Beutel K, Caldwell N, Feldman JI, Crowley LaPoint S, Woynaroski T. Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children: A Meta-Analysis. JAMA Pediatr 2024; 178:763-773. [PMID: 38913359 PMCID: PMC11197026 DOI: 10.1001/jamapediatrics.2024.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/20/2024] [Indexed: 06/25/2024]
Abstract
Importance Health professionals routinely recommend intensive interventions (ie, 20-40 hours per week) for autistic children. However, primary research backing this recommendation is sparse and plagued by methodological flaws. Objective To examine whether different metrics of intervention amount are associated with intervention effects on any developmental domain for young autistic children. Data Sources A large corpus of studies taken from a recent meta-analysis (with a search date of November 2021) of early interventions for autistic children. Study Selection Studies were eligible if they reported a quasi-experimental or randomized clinical trial testing the effects of a nonpharmacological intervention on any outcome in participant samples comprising more than 50% autistic children 8 years or younger. Data Extraction and Synthesis Data were independently extracted by multiple coders. Meta-regression models were constructed to determine whether each index of intervention amount was associated with effect sizes for each intervention type, while controlling for outcome domain, outcome proximity, age of participants, study design, and risk of detection bias. Data were analyzed from June 2023 to February 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Main Outcomes and Measures The primary predictor of interest was intervention amount, quantified using 3 different metrics (daily intensity, duration, and cumulative intensity). The primary outcomes of interest were gains in any developmental domain, quantified by Hedges g effect sizes. Results A total of 144 studies including 9038 children (mean [SD] age, 49.3 [17.2] months; mean [SD] percent males, 82.6% [12.7%]) were included in this analysis. None of the meta-regression models evidenced a significant, positive association between any index of intervention amount and intervention effect size when considered within intervention type. Conclusions and Relevance Findings of this meta-analysis do not support the assertion that intervention effects increase with increasing amounts of intervention. Health professionals recommending interventions should be advised that there is little robust evidence supporting the provision of intensive intervention.
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Affiliation(s)
- Micheal Sandbank
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill
| | | | | | - Nicolette Caldwell
- Department of Curriculum and Instruction, University of Arkansas, Fayetteville
| | - Jacob I. Feldman
- Department of Hearing and Speech Sciences, Frist Center for Autism and Innovation at Vanderbilt University, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shannon Crowley LaPoint
- TEACCH Autism Program, Research Fellow, The University of North Carolina at Chapel Hill, Chapel Hill
| | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Vanderbilt Brain Institute, Frist Center for Autism and Innovation at Vanderbilt University, Nashville, Tennessee
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
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2
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Toby LM, Hustyi KM, Hartley BK, Dubuque ML, Outlaw EE, Logue JJ. Development and Preliminary Validation of the Patient Outcome Planning Calculator (POP-C): A Tool for Determining Treatment Dosage in Applied Behavior Analysis. Behav Anal Pract 2024; 17:601-614. [PMID: 38966276 PMCID: PMC11219665 DOI: 10.1007/s40617-023-00861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 07/06/2024] Open
Abstract
Board certified behavior analysts (BCBA) are responsible for determining the medically necessary treatment dosage for patients (i.e., the number of hours of therapy a patient should receive per week to optimize progress) during applied behavior analysis (ABA) therapy. However, because there is currently no standard method for making these determinations, BCBAs must rely on their own clinical judgment. Given that clinical judgment may be underdeveloped in some BCBAs, particularly those who are newly certified, more formal strategies are needed to guide decision making as it relates to medical necessity and treatment dosage. In this article we describe the development of the Patient Outcome Planning Calculator (POP-C), a standardized decision-making tool designed to assist novice practitioners in determining the medically necessary ABA treatment intensity and appropriate treatment setting for individuals with autism spectrum disorder (ASD). We present preliminary reliability data as well as construct validity data indicating statistically significant correlations between the POP-C and several norm-referenced and criterion-referenced assessments commonly used to estimate skill level and the corresponding degree of support needed within the ASD population to inform the ABA treatment model and goals. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-023-00861-6.
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Affiliation(s)
- Lauryn M. Toby
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | | | | | - Molly L. Dubuque
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | - Erica E. Outlaw
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | - Jesse J. Logue
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
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Cui J, Xie H, He X. Evaluation of the Integrated Therapy Model in Preschool Education for Children with Autism Spectrum Disorder in China. J Autism Dev Disord 2023; 53:4474-4482. [PMID: 36083394 DOI: 10.1007/s10803-022-05737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
The Integrated Therapy Model is a practice framework designed to promote multi-disciplinary collaboration to accommodate the holistic needs of children with special education needs. This study evaluated the effectiveness of the model adopted in a pilot preschool in China on children with autism spectrum disorder (ASD). A single-case, ABAB reversal design was employed with three children with ASD, and data were collected using direct observation and semi-structured interviews. The results demonstrated that while the model piloted in China was effective at improving fine motor ability, gross motor ability, imitation and problem behavior, it had mild to questionable effects on self-care and independent living capacity. The implications for the practice and for research on preschool interventions in mainland China is discussed.
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Affiliation(s)
- Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Han Xie
- Department of Social Work and Social Policy, School of Sociology and Population Study, Renmin University of China, Chongde West Building, No.59 Zhongguancun Street, Haitian District, 1002, Beijing, China
| | - Xin He
- Department of Social Work and Social Policy, School of Sociology and Population Study, Renmin University of China, Chongde West Building, No.59 Zhongguancun Street, Haitian District, 1002, Beijing, China.
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Bejnö H, Roll-Pettersson L, Klintwall L, Långh U, Odom SL, Bölte S. Adapting the preschool environment to the needs of children on the autism spectrum in Sweden: A quasi-experimental study. Scand J Occup Ther 2023; 30:278-297. [PMID: 34696666 DOI: 10.1080/11038128.2021.1993330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children on the autism spectrum may receive Early Intensive Behavioural Intervention (EIBI) in Sweden to support development by providing learning opportunities. However, research suggests a need to improve the quality of their learning environment. AIM This pre-registered study (#NCT03634761) aimed to evaluate the Swedish Autism Program Environment Rating Scale (APERS-P-SE) as a means to promote the quality of the pre-school learning environment for children on the autism spectrum, along with outcomes for these children, and their pre-school staff. MATERIAL AND METHODS In a quasi-experimental study, pre-school staff (n = 35) conducted either EIBI supported by in-service training and on-site coaching based on APERS-P-SE assessment (at k = 9 preschools) or EIBI only (k = 8), during an 8-months period. RESULTS The quality of the immediate learning environment (primary outcome) increased significantly in the EIBI/APERS-P-SE preschools. However, changes in child and pre-school staff measures were not significant. CONCLUSIONS AND SIGNIFICANCE In-service training and on-site coaching based on APERS-P-SE assessments can increase the quality of the learning environment in Swedish pre-school. Studies of longer duration and larger sample size are required to determine if using the APERS-P-SE can also achieve desired behavioural change for children-, and impact pre-school staff applying EIBI.
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Affiliation(s)
- Hampus Bejnö
- Department of Special Education, Stockholm University, Stockholm, Sweden
| | | | - Lars Klintwall
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ulrika Långh
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden
- Autism Center for Young Children, Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | - Samuel L Odom
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Sven Bölte
- Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
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Paquet A, Dionne C, Joly J, Rousseau M, Rivard M, Lemire C. Competency drivers to support implementation of early intensive behavioral intervention in large-scale community-based services: Perspectives of caseworkers and organization representatives. EVALUATION AND PROGRAM PLANNING 2023; 97:102211. [PMID: 36592543 DOI: 10.1016/j.evalprogplan.2022.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/23/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Implementing evidence-based practices in "real-world" settings poses significant challenges. Organizations involved must address this issue by providing supportive infrastructures. Among the elements to consider are competency drivers, which refer to the selection, training, and supervision of caseworkers. The purpose of this study was to describe the perspectives of caseworkers and representatives on competency drivers that organizations put in place to support the implementation of early intensive behavioral intervention (EIBI) in large-scale community-based services. The sample consisted of 109 caseworkers and 23 organization representatives who completed questionnaires. Results demonstrated that respondents consider clinical support and training as key elements in EIBI implementation. However, despite recognizing these factors, respondents reported considerable variability in practices. It appears necessary to better define and plan the implementation of these competency drivers with a view to improving EIBI implementation.
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Affiliation(s)
- Annie Paquet
- Département de psychoéducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, Québec G8Z 4M3, Canada.
| | - Carmen Dionne
- Département de psychoéducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, Québec G8Z 4M3, Canada.
| | - Jacques Joly
- Département de psychoéducation, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec J1K 2R1, Canada.
| | - Myriam Rousseau
- CIUSSS Mauricie Centre-du-Québec, 3090, rue Foucher, Trois-Rivières, Québec G8Z 1M3, Canada.
| | - Mélina Rivard
- Département de psychologie, Université du Québec à Montréal, 100 rue Sherbrooke Ouest, Montréal, Québec H2X 3P2, Canada.
| | - Colombe Lemire
- Département de psychoéducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, Québec G8Z 4M3, Canada.
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Eckes T, Buhlmann U, Holling HD, Möllmann A. Comprehensive ABA-based interventions in the treatment of children with autism spectrum disorder - a meta-analysis. BMC Psychiatry 2023; 23:133. [PMID: 36864429 PMCID: PMC9983163 DOI: 10.1186/s12888-022-04412-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Many studies display promising results for interventions that are based on Applied Behavior Analysis (ABA) in the treatment of autism spectrum disorder (ASD). METHODS This meta-analysis assessed the effects of such treatments on developmental outcomes in children with ASD and on parental stress based on 11 studies with 632 participants. RESULTS Compared to treatment as usual, minimal or no treatment, comprehensive ABA-based interventions showed medium effects for intellectual functioning (standardized mean difference SMD = 0.51, 95% CI [0.09; 0.92]) and adaptive behavior (SMD = 0.37, 95% CI [0.03; 0.70]). Language abilities, symptom severity or parental stress did not improve beyond the improvement in control groups. Moderator analyses indicate that language abilities at intake could influence the effect sizes and the influence of treatment intensity might decrease with older age. CONCLUSIONS Practical implications and limitations are discussed.
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Affiliation(s)
- Theresa Eckes
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Heinz-Dieter Holling
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Anne Möllmann
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany. .,Institute of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany.
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7
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Examining Predictors of Different ABA Treatments: A Systematic Review. Behav Sci (Basel) 2022; 12:bs12080267. [PMID: 36004838 PMCID: PMC9405151 DOI: 10.3390/bs12080267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023] Open
Abstract
In the recent literature, there is a broad consensus on the effectiveness of Applied Behavior Analysis interventions for autism spectrum disorder (ASD). Despite their proven efficacy, research in clinical settings shows that these treatments are not equally effective for all children and the issue of which intervention should be chosen for an individual remains a common dilemma. The current work systematically reviewed studies on predictors and moderators of response to different types of evidence-based treatment for children with ASD. Specifically, our goal was to critically review the relationships between pre-treatment child characteristics and specific treatment outcomes, covering different aspects of functioning (i.e., social, communicative, adaptive, cognitive, motor, global functioning, play, and symptom severity). Our results questioned the binomial “better functioning-better outcome”, emphasizing the complex interplay between pre-treatment child characteristics and treatment outcomes. However, some pre-treatment variables seem to act as prerequisites for a specific treatment, and the issue of “what works for whom and why” remains challenging. Future research should focus on the definition of evidence-based decision-making models that capture those individual factors through which a specific intervention will exert its effects.
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8
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Choi KR, Lotfizadah AD, Bhakta B, Pompa-Craven P, Coleman KJ. Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism. BMC Pediatr 2022; 22:314. [PMID: 35624439 PMCID: PMC9137129 DOI: 10.1186/s12887-022-03383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes. PURPOSE The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder. METHODS This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite. RESULTS There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period. CONCLUSIONS In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.
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Affiliation(s)
- Kristen R Choi
- UCLA School of Nursing, 700 Tiverton Ave, Los Angeles, CA, 90049, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA.
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA.
| | - Amin D Lotfizadah
- Easterseals Southern California, 1063 McGaw Avenue, Suite 100, Irvine, CA, 92614, USA
| | - Bhumi Bhakta
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Paula Pompa-Craven
- Easterseals Southern California, 1063 McGaw Avenue, Suite 100, Irvine, CA, 92614, USA
| | - Karen J Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA
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9
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Analysis of a Statewide Early Intervention Program for Young Children with ASD. J Autism Dev Disord 2021; 52:4994-5006. [PMID: 34797471 DOI: 10.1007/s10803-021-05376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
We evaluated the effectiveness of a statewide Medicaid program providing in-home Early Intensive Behavioral Intervention services to young children with Autism Spectrum Disorder living in a rural southern state. Program effectiveness was assessed via the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R). A multi-level growth model was used to show significant variation among children's initial ABLLS-R scores and their growth trajectories. Hispanic children tended to have lower initial scores but demonstrated similar growth compared to their non-Hispanic peers. Children who were older at initial start in the program appeared to have higher initial composite scores and higher growth trajectories. Children in more populous counties had higher initial scores but grew at similar rates to children in more rural counties.
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10
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Pankewich A, Martin TL, Walters KL, Dubé C. Accuracy and acceptability of eHealth data collection for an early intensive behavioral intervention program. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Amy Pankewich
- Department of Psychology University of Manitoba Winnipeg Manitoba Canada
| | - Toby L. Martin
- Department of Psychology University of Manitoba Winnipeg Manitoba Canada
- St. Amant Research Centre Winnipeg Manitoba Canada
| | - Kerri L. Walters
- Department of Psychology University of Manitoba Winnipeg Manitoba Canada
- St. Amant Research Centre Winnipeg Manitoba Canada
| | - Charmayne Dubé
- Department of Psychology University of Manitoba Winnipeg Manitoba Canada
- New Directions Mississauga Ontario Canada
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Grzadzinski R, Amso D, Landa R, Watson L, Guralnick M, Zwaigenbaum L, Deák G, Estes A, Brian J, Bath K, Elison J, Abbeduto L, Wolff J, Piven J. Pre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda. J Neurodev Disord 2021; 13:49. [PMID: 34654371 PMCID: PMC8520312 DOI: 10.1186/s11689-021-09393-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).
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Affiliation(s)
- Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA.
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA.
| | - Dima Amso
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Guralnick
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | | | - Gedeon Deák
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, USA
| | - Annette Estes
- Department of Speech and Hearing Sciences, University of Washington Autism Center, University of Washington, Seattle, WA, USA
| | - Jessica Brian
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Bath
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Jed Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Leonard Abbeduto
- University of California, Davis, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jason Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
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12
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Bejnö H, Bölte S, Linder N, Långh U, Odom SL, Roll-Pettersson L. From Someone Who May Cause Trouble to Someone You Can Play With: Stakeholders' Perspectives on Preschool Program Quality for Autistic Children. J Autism Dev Disord 2021; 52:3890-3908. [PMID: 34499273 PMCID: PMC9349083 DOI: 10.1007/s10803-021-05268-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 12/12/2022]
Abstract
In Sweden, young autistic children typically attend community-based preschool programs, which may not be adapted to their needs. In the current study, stakeholders to autistic children receiving Early Intensive Behavioral Intervention were interviewed following a quasi-randomized study (#NCT03634761) aimed at improving the preschool program quality using the Swedish version of the Autism Program Environment Rating Scale (APERS). Stakeholders provided their perceptions and experiences concerning key factors for high quality preschool programs as well as well as their experiences of the abovementioned APERS study. Applying thematic analysis, stakeholder groups differed in what they emphasized, but all highlighted staff’s competence, children’s inclusion and participation, collaboration, and the learning environment as key program areas that had been positively influenced by the APERS-based intervention.
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Affiliation(s)
- Hampus Bejnö
- Department of Special Education, Stockholm University, 106 91, Stockholm, Sweden.
| | - Sven Bölte
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- KIND, CAP Research Center, Gävlegatan 22 B, 11330, Stockholm, Sweden
| | - Nina Linder
- Department of Special Education, Stockholm University, 106 91, Stockholm, Sweden
| | - Ulrika Långh
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
- Autism Center for Young Children, Habilitation & Health, Stockholm County Council, 104 62, Stockholm, Sweden
- KIND, CAP Research Center, Gävlegatan 22 B, 11330, Stockholm, Sweden
| | - Samuel L Odom
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, CB 8180, Chapel Hill, NC, 27599-8180, USA
| | - Lise Roll-Pettersson
- Department of Special Education, Stockholm University, 106 91, Stockholm, Sweden
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Liao Y, Dillenburger K, Hu X. Behavior analytic interventions for children with autism: Policy and practice in the United Kingdom and China. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:101-120. [PMID: 34098750 DOI: 10.1177/13623613211020976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT The prevalence of autism is increasing, and the development of these children and the lived experience of their families have become a global concern. Applied behavioral analytic intervention is proved to be effective in improving their cognitive abilities, language skills, and social and emotional skills, but the service delivery between developed and developing countries is different. A qualitative study was conducted to explore personal experiences with actual practice fidelity of behavior analytic services for children with autism in a Western developed country (United Kingdom) and an Eastern developing country (China). The study found: (1) a lack of support for autism and behavioral analytic services in both countries; (2) applied behavioral analytic intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular aspect of behavioral analytic interventions was similar and increased with ongoing training. This study emphasizes the need to support children with autism, and to consider regional adaptations of evidence-based practice of behavior analytic interventions for the affected population.
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14
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Gardner-Hoag J, Novack M, Parlett-Pelleriti C, Stevens E, Dixon D, Linstead E. Unsupervised Machine Learning for Identifying Challenging Behavior Profiles to Explore Cluster-Based Treatment Efficacy in Children With Autism Spectrum Disorder: Retrospective Data Analysis Study. JMIR Med Inform 2021; 9:e27793. [PMID: 34076577 PMCID: PMC8209527 DOI: 10.2196/27793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Challenging behaviors are prevalent among individuals with autism spectrum disorder; however, research exploring the impact of challenging behaviors on treatment response is lacking. Objective The purpose of this study was to identify types of autism spectrum disorder based on engagement in different challenging behaviors and evaluate differences in treatment response between groups. Methods Retrospective data on challenging behaviors and treatment progress for 854 children with autism spectrum disorder were analyzed. Participants were clustered based on 8 observed challenging behaviors using k means, and multiple linear regression was performed to test interactions between skill mastery and treatment hours, cluster assignment, and gender. Results Seven clusters were identified, which demonstrated a single dominant challenging behavior. For some clusters, significant differences in treatment response were found. Specifically, a cluster characterized by low levels of stereotypy was found to have significantly higher levels of skill mastery than clusters characterized by self-injurious behavior and aggression (P<.003). Conclusions These findings have implications on the treatment of individuals with autism spectrum disorder. Self-injurious behavior and aggression were prevalent among participants with the worst treatment response, thus interventions targeting these challenging behaviors may be worth prioritizing. Furthermore, the use of unsupervised machine learning models to identify types of autism spectrum disorder shows promise.
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Affiliation(s)
- Julie Gardner-Hoag
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Marlena Novack
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | | | - Elizabeth Stevens
- Fowler School of Engineering, Chapman University, Orange, CA, United States
| | - Dennis Dixon
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | - Erik Linstead
- Fowler School of Engineering, Chapman University, Orange, CA, United States
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15
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Leaf JB, Leaf R, McEachin J, Bondy A, Cihon JH, Detrich R, Eshleman J, Ferguson JL, Foxx RM, Freeman BJ, Gerhardt P, Glenn SS, Miller M, Milne CM, Mountjoy T, Parker T, Pritchard J, Ross RK, Saunders MS, Streff T. The Importance of Professional Discourse for the Continual Advancement of Practice Standards: The RBT® as a Case in Point. J Autism Dev Disord 2021; 51:1789-1801. [PMID: 32761432 PMCID: PMC8084792 DOI: 10.1007/s10803-020-04631-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Behavior Analyst Certification Board (BACB®) created a third level of certification, the Registered Behavior Technician™ (RBT®) in 2014. The RBT® was created based upon the requests of stakeholders who wanted to credential those individuals who make direct contact with clients under the supervision of a Board Certified Behavior Analyst®. There has been tremendous growth in the number of RBTs® with over 60,000 individuals certified to date. The BACB® recently sent out a newsletter outlining changes to the RBT® certification, including the processes of training, supervising, and becoming an RBT®. These changes represent a number of potential concerns. The purpose of this paper is to highlight these concerns and to propose solutions to improve the RBT® certification.
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Affiliation(s)
- Justin B. Leaf
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Ronald Leaf
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | - John McEachin
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Andy Bondy
- Pyramid Educational Consultants, Inc, New Castle, DE USA
| | - Joseph H. Cihon
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | - John Eshleman
- The Chicago School of Professional Psychology, Chicago, IL USA
| | - Julia L. Ferguson
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | | | | | | | | | - Christine M. Milne
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | - Tracee Parker
- Autism Partnership Foundation, BCBA-D. 200 Marina Drive, Seal Beach, CA 90740 USA
| | | | | | | | - Todd Streff
- Streff Behavior Consulting, Foristell, MO USA
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16
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Rodgers M, Simmonds M, Marshall D, Hodgson R, Stewart LA, Rai D, Wright K, Ben-Itzchak E, Eikeseth S, Eldevik S, Kovshoff H, Magiati I, Osborne LA, Reed P, Vivanti G, Zachor D, Couteur AL. Intensive behavioural interventions based on applied behaviour analysis for young children with autism: An international collaborative individual participant data meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1137-1153. [PMID: 33482692 PMCID: PMC8108110 DOI: 10.1177/1362361320985680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LAY ABSTRACT Early intensive applied behaviour analysis-based interventions are designed to support young autistic children's learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis-based interventions might lead to some changes in children's cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.
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17
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Ben-Itzchak E, Zachor DA. Dog training intervention improves adaptive social communication skills in young children with autism spectrum disorder: A controlled crossover study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1682-1693. [PMID: 33752452 DOI: 10.1177/13623613211000501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT There is some evidence that using therapy dogs for children with autism spectrum disorder generally results in improved social communication skills and reduced behavioral problems. However, well-controlled studies that examine its effectiveness are scarce. This study examined the effectiveness of a "Dog Training Intervention." The study included 73 participants diagnosed with autism spectrum disorder (61 males, 12 females) with age range of 2:10-7:6 years (M = 4:10 ± 1:0) who attend autism spectrum disorder-specific special education schools. The study population was divided into two groups. Each group received the dog training intervention during one part of the school year (first half or second half) in addition to the standard interventions provided by the special education school settings. The dog training intervention was given twice weekly for 4 months within the school setting. The group that received the dog training intervention first showed a significant increase in adaptive social and communication skills in comparison to the second group that did not receive the intervention in this period. This improvement was maintained after the dog training intervention. The second group, which received intervention at the second half of the year, showed improvement in communication and socialization adaptive skills only during the period in which they received the dog training intervention. The positive impact on social communication adaptive skills of the dog training intervention among young children with autism spectrum disorder suggests that dogs may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to the interventions provided in special education schools for young children with autism spectrum disorder.
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Affiliation(s)
- Esther Ben-Itzchak
- Bruckner Autism Research Center, Department of Communication Disorders, Ariel University, Israel
| | - Ditza A Zachor
- The Autism Center/ALUT, Department of Pediatrics, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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18
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Idris AB, Abdulrahim R, Al-Mamari W, Shih A, Kantaris M. A SWOT analysis of parent-mediated intervention for children with autism spectrum disorder: Oman as a Regional Model. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:773-780. [PMID: 36210904 PMCID: PMC9542413 DOI: 10.1080/20473869.2021.1895700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/28/2020] [Accepted: 02/22/2021] [Indexed: 06/16/2023]
Abstract
The prevalence of autism in the Arabian Gulf region is on the rise leading to overstretching of the pre-existing intervention services. The World Health Organization Caregiver Skills Training Program is a novel renovation being studied around the globe to overcome the scarcity of resources, improve autistic children's outcome and empower parents with comparable results to therapist-based models. Recently, Oman achieved great success in advocating for autism and initiated the first screening program for autism in the region. This review aims to use a Strength, Weakness, Opportunities and Threats (SWOT) analysis matrix to investigate the potential for using a parent-mediated intervention program as a supplementary approach to the currently used therapist-based intervention model in the country as an example for Gulf region.
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Affiliation(s)
- Ahmed B. Idris
- Developmental Unit, Child Health Department, Sultan Qaboos University Hospital, Oman
| | - Reem Abdulrahim
- Department of Genetic, Sultan Qaboos University Hospital, Oman
| | - Watfa Al-Mamari
- Developmental Unit, Child Health Department, Sultan Qaboos University Hospital, Oman
| | - Andy Shih
- Senior Vice President, Public Health and Inclusion, Autism Speaks
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19
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Cheung Y, Man Kit Cheung A, Ho Yan Luk E, Man Fung Y, Mountjoy T, Cihon JH, Leaf JB. An evaluation of a comprehensive training package for interventionists providing behavioral intervention for children with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 66:358-369. [PMID: 34150198 PMCID: PMC7942800 DOI: 10.1080/20473869.2020.1827208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/23/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
There has been rapid growth in the number of behavior analysts and interventionists in the world today. With this growth it is imperative to ensure that each behavior analyst and interventionist receives quality training. The training should be comprehensive (i.e. training multiple areas of behavior analysis) and should not conclude until the trainee is able to perform each behavior analytic procedure to a high degree of fidelity. The purpose of this study was to evaluate the effectiveness of a training package to train four participants how to implement multiple behavior analytic procedures. Using a multiple baseline design across participants the results indicate that each participant improved their implementation of behavioral intervention. Additionally, the participants maintained their skills over time.
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Affiliation(s)
| | | | | | | | | | - Joseph H. Cihon
- Autism Partnership Foundation, Seal Beach, CA, USA
- The Institute for Behavioral Studies, Endicott College, Beverly, MA, USA
| | - Justin B. Leaf
- Autism Partnership Foundation, Seal Beach, CA, USA
- The Institute for Behavioral Studies, Endicott College, Beverly, MA, USA
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20
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Rodgers M, Marshall D, Simmonds M, Le Couteur A, Biswas M, Wright K, Rai D, Palmer S, Stewart L, Hodgson R. Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-306. [PMID: 32686642 PMCID: PMC7397479 DOI: 10.3310/hta24350] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early intensive applied behaviour analysis-based interventions are intensive interventions for autistic children that are often delivered on a one-to-one basis for 20-50 hours per week. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of early intensive applied behaviour analysis-based interventions for autistic children, based on current evidence. METHODS A systematic review and individual participant data meta-analysis were conducted to evaluate the clinical effectiveness of an early intensive applied behaviour analysis-based intervention for autistic children. An economic analysis included a review of existing analyses and the development of a new model. RESULTS Twenty studies were included in the clinical review. Individual participant data were retrieved from 15 of these studies. Results favoured the interventions when assessing adaptive behaviour after 2 years compared with treatment as usual/eclectic interventions (mean difference 7.00, 95% confidence interval 1.95 to 12.06). In analyses of cognitive ability (intelligence quotient), results favoured the interventions by approximately 10 points after 1 year (mean difference 9.16, 95% confidence interval 4.38 to 13.93) and 2 years (mean difference 14.13, 95% confidence interval 9.16 to 19.10). Evidence for other outcomes was limited and meta-analyses were generally inconclusive. There was no evidence that the effect of the interventions varied with characteristics of the children, but data were limited. Adopting a £30,000 per quality-adjusted life-year threshold, the results of the cost-effectiveness analysis indicate that early intensive applied behaviour analysis-based interventions would need to generate larger benefits or cost savings to be cost-effective. Adopting a public sector perspective and making pessimistic assumptions about long-term effects, the incremental cost-effectiveness ratio for early intensive applied behaviour analysis-based therapy compared with treatment as usual is £189,122 per quality-adjusted life-year. When optimistic assumptions are made, the incremental cost-effectiveness ratio is £46,768 per quality-adjusted life-year. Scenario analyses indicated that these interventions can potentially be cost-effective if long-term improvements persist into adulthood, or if they have significant impact on educational placement. Care should be taken when interpreting these scenarios owing to the limited data. LIMITATIONS All included studies were at risk of bias, there was substantial heterogeneity and effects varied considerably across studies. The effect of intervention on autism symptom severity, language development and school placement remains uncertain because of the limited data. The long-term effects are unclear owing to a lack of follow-up data. CONCLUSIONS This review found limited evidence that early intensive applied behaviour analysis-based interventions may improve cognitive ability and adaptive behaviour, but the long-term impact of the interventions remains unknown. The economic analysis is constrained by the limited effectiveness evidence, but suggests that these interventions are unlikely to be cost-effective unless clear long-term benefits, or a substantial change in which schools children attend, can be identified. FUTURE WORK Further studies into the effectiveness of early intensive applied behaviour analysis-based interventions may be warranted if they include well-defined, alternative interventions as comparators and collect relevant outcomes. Consideration should be given to future studies that not only address whether or not early intensive applied behaviour analysis-based interventions are clinically effective, but also aim to identify which components of early intensive applied behaviour analysis-based interventions might drive effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068303. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dheeraj Rai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
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21
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Roll-Pettersson L, Gena A, Eldevik S, Moderato P, Sigurdardottir ZG, Dillenburger K, Keenan M, Ala’i-Rosales S. Higher education and behavior analysis in Europe: creating a unified approach for the training of autism professionals. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/15021149.2020.1758990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | - Angeliki Gena
- Institute of Systemic Behavior Analysis, National and Kapodistrian University of Athens, Athens, Greece
| | - Sigmund Eldevik
- Department of Behavioral Science, Oslo Metropolitan University, Oslo, Norway
| | - Paolo Moderato
- Istituto Europeo per Lo Studio Del Comportamento Umano – IESCUM, Università IULM, Milano, Italy
| | | | | | - Mickey Keenan
- School of Psychology, Ulster University, Coleraine, N. Ireland
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22
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Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Feldman JI, Canihuante M, Woynaroski T. Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1537-1560. [PMID: 32384865 PMCID: PMC7842122 DOI: 10.1044/2020_jslhr-19-00167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/31/2019] [Accepted: 01/15/2020] [Indexed: 05/10/2023]
Abstract
Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.
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Affiliation(s)
| | | | - Shannon Crowley
- Lynch School of Education and Human Development, Boston College, MA
| | - Margaret Cassidy
- College of Arts and Sciences, Vanderbilt University, Nashville, TN
| | - Jacob I. Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | | | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Vanderbilt Brain Institute, Nashville, TN
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23
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Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Feldman JI, Canihuante M, Woynaroski T. Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1537-1560. [PMID: 32384865 DOI: 10.1044/2020_jslhr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.
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Affiliation(s)
| | | | - Shannon Crowley
- Lynch School of Education and Human Development, Boston College, MA
| | - Margaret Cassidy
- College of Arts and Sciences, Vanderbilt University, Nashville, TN
| | - Jacob I Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | | | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Vanderbilt Brain Institute, Nashville, TN
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24
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Långh U, Perry A, Eikeseth S, Bölte S. Quality of Early Intensive Behavioral Intervention as a Predictor of Children's Outcome. Behav Modif 2020; 45:911-928. [PMID: 32436396 DOI: 10.1177/0145445520923998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has directed surprisingly little attention to the quality of Early Intensive Behavioral Intervention (EIBI) in autism spectrum disorder (ASD) as a potential predictor of outcome. Therefore, using a preschool delivery model within a sample of 30 children, we examined the predictive power of EIBI quality on treatment outcome. EIBI quality was assessed at baseline by the York Measure of Quality of Intensive Behavioral Intervention (YMQI) and treatment outcome was evaluated after a period of 4 to 6 months using a battery of behavioral tests and scales to evaluate treatment success. Multinomial logistic regressions demonstrated that general EIBI quality predicted clinically significant change at follow-up. Particularly improvements in basic language and learning skills and global clinical impression were observed. Specific quality indicators that influenced overall treatment success were treatment organization, teaching level and differential reinforcement. In addition to previously examined predictors of EIBI treatment effects, such as child characteristics and intervention quantity, our findings highlight the importance of adequate EIBI quality assurance.
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Affiliation(s)
- Ulrika Långh
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Karolinska Institutet, Stockholm, Sweden.,Autism Center for Young Children, Habilitation & Health, Stockholm County Council, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Adrienne Perry
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Svein Eikeseth
- Department of Behavioral Science, Oslo Metropolitan Uninversity, Norway
| | - Sven Bölte
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Region Stockholm, Stockholm, Sweden
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25
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Changes in Developmental Trajectories of Preschool Children with Autism Spectrum Disorder during Parental Based Intensive Intervention. Brain Sci 2020; 10:brainsci10050289. [PMID: 32408610 PMCID: PMC7287674 DOI: 10.3390/brainsci10050289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Research highlights the positive effects of early intensive intervention with parent and school involvement for preschool children with Autism Spectrum Disorder (ASD) on general developmental outcomes and social skills in randomized controlled trials. However, given the inter-individual variability in the response to treatment, it is necessary to investigate intervention effects in terms of mediators and moderators in order to explain variability and to highlight mechanisms of change. Methods: 25 children in the experimental group were exposed to early intensive intervention and 14 children in the control group were subjected to “as usual” intervention. The initial assessment was obtained at the time of diagnosis (T1) and the follow-up assessment was conducted after 15 months of intervention (T2) in both groups. Results: Participants in the experimental group achieved more prominent gains in both cognitive and socio-interactive skills. The role of specific factors able to predict general quotient and language quotient after intervention were investigated, pointing out the contribution of personal–social and performance abilities. Conclusions: The findings support the importance of parental involvement in targeting ASD core symptoms. Further, results informed our understanding of early predictors in order to identify specific elements to be targeted in the individualized intervention design.
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26
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Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Dunham K, Feldman JI, Crank J, Albarran SA, Raj S, Mahbub P, Woynaroski TG. Project AIM: Autism intervention meta-analysis for studies of young children. Psychol Bull 2020; 146:1-29. [PMID: 31763860 PMCID: PMC8783568 DOI: 10.1037/bul0000215] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this comprehensive systematic review and meta-analysis of group design studies of nonpharmacological early interventions designed for young children with autism spectrum disorder (ASD), we report summary effects across 7 early intervention types (behavioral, developmental, naturalistic developmental behavioral intervention [NDBI], TEACCH, sensory-based, animal-assisted, and technology-based), and 15 outcome categories indexing core and related ASD symptoms. A total of 1,615 effect sizes were gathered from 130 independent participant samples. A total of 6,240 participants, who ranged in age from 0-8 years, are represented across the studies. We synthesized effects within intervention and outcome type using a robust variance estimation approach to account for the nesting of effect sizes within studies. We also tracked study quality indicators, and report an additional set of summary effect sizes that restrict included studies to those meeting prespecified quality indicators. Finally, we conducted moderator analyses to evaluate whether summary effects across intervention types were larger for proximal as compared with distal effects, and for context-bound as compared to generalized effects. We found that when study quality indicators were not taken into account, significant positive effects were found for behavioral, developmental, and NDBI intervention types. When effect size estimation was limited to studies with randomized controlled trial (RCT) designs, evidence of positive summary effects existed only for developmental and NDBI intervention types. This was also the case when outcomes measured by parent report were excluded. Finally, when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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27
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Siddiqua A, Duku E, Georgiades K, Mesterman R, Janus M. Neighbourhood-level prevalence of teacher-reported Autism Spectrum Disorder among kindergarten children in Canada: A population level study. SSM Popul Health 2019; 10:100520. [PMID: 31872037 PMCID: PMC6909034 DOI: 10.1016/j.ssmph.2019.100520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/03/2019] [Accepted: 11/18/2019] [Indexed: 12/17/2022] Open
Abstract
Number of children with ASD per neighbourhood varies from none to as high as 21. Developmental vulnerabilities were not associated with levels of clustering. Highest level of clustering of children with ASD was found in Nova Scotia.
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Affiliation(s)
- Ayesha Siddiqua
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
| | - Kathy Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
| | - Ronit Mesterman
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
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Suivi qualitatif de l’évolution de 120 enfants porteurs de troubles du spectre autistique pris en charge par la méthode des 3i. EVOLUTION PSYCHIATRIQUE 2019. [DOI: 10.1016/j.evopsy.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Stevens E, Dixon DR, Novack MN, Granpeesheh D, Smith T, Linstead E. Identification and analysis of behavioral phenotypes in autism spectrum disorder via unsupervised machine learning. Int J Med Inform 2019; 129:29-36. [DOI: 10.1016/j.ijmedinf.2019.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 02/25/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Elizabeth Stevens
- Chapman University, Schmid College of Science and Technology, Orange, CA, United States
| | - Dennis R Dixon
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | - Marlena N Novack
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | - Doreen Granpeesheh
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | - Tristram Smith
- University of Rochester Medical Center, Rochester, NY, United States
| | - Erik Linstead
- Chapman University, Schmid College of Science and Technology, Orange, CA, United States.
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Seeking Team Collaboration, Dialogue and Support: The Perceptions of Multidisciplinary Staff-Members Working in ASD Preschools. J Autism Dev Disord 2019; 49:4634-4645. [PMID: 31440870 DOI: 10.1007/s10803-019-04175-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Autism spectrum disorder (ASD) impacts various developmental domains, requiring interventions by professionals from multiple disciplines. In Israel, ASD community preschools' multidisciplinary teams aim to provide each child with an integrative intervention program. The current study focused on the working experience of 21 professionals from multidisciplinary teams in ASD-preschools, with special emphasis on their perceptions of the intra-staff dialogue in their teams. Interviews were transcribed verbatim and analyzed through grounded theory. Arising themes covered: challenges characterizing the delivery of intervention to children with ASD in a community setting; challenges met by professionals when attempting to navigate multidisciplinary teamwork; and factors that facilitate multidisciplinary work. Practices that support multidisciplinary team cohesion at the team, the organizational, and the policy-making levels are discussed.
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Bejnö H, Roll-Pettersson L, Klintwall L, Långh U, Odom SL, Bölte S. Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden. J Autism Dev Disord 2019; 49:1853-1862. [PMID: 30617551 PMCID: PMC6483964 DOI: 10.1007/s10803-018-03870-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Increasing rates of autism spectrum disorder (ASD) and younger age at diagnosis pose a challenge to preschool intervention systems. In Sweden, most young autistic children receive intervention service in community-based preschool programs, but no tool is yet available to assess the quality of the preschool learning environment. This study adapted the Autism Program Environment Rating Scale Preschool/Elementary to Swedish community context (APERS-P-SE). Following translation and a multistep modification process, independent experts rated the content validity of the adaptation. Findings indicate high cross-cultural validity of the adapted APERS-P-SE. The cultural adaption process of the APERS-P-SE highlights similarities and differences between the American and Swedish preschool systems and their impact on early ASD intervention.
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Affiliation(s)
- Hampus Bejnö
- Department of Special Education, Stockholm University, Stockholm, Sweden.
| | | | - Lars Klintwall
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ulrika Långh
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden.,Autism Center for Young Children, Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | - Samuel L Odom
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
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32
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Brookman-Frazee L, Roesch S, Chlebowski C, Baker-Ericzen M, Ganger W. Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services: A Cluster Randomized Clinical Trial. JAMA Psychiatry 2019; 76:574-583. [PMID: 30840040 PMCID: PMC6551846 DOI: 10.1001/jamapsychiatry.2019.0011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. OBJECTIVE To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. INTERVENTIONS The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. MAIN OUTCOMES AND MEASURES Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. RESULTS In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = -0.38; P = .02) and ECBI Problem (B = -1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = -1.36; P < .001) relative to the usual care group (B = -0.98; P < .001) and a significantly larger decrease in ECBI Problem scores in the AIM HI group (B = -1.22; P < .001) relative to the usual care group (B = -0.20; P = .29). Therapist fidelity moderated these intervention effects. CONCLUSIONS AND RELEVANCE The present findings support the effectiveness of training therapists to deliver the AIM HI model to children with ASD receiving publicly funded mental health services. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02416323.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla,Child and Adolescent Services Research Center, San Diego, California,Rady Children’s Hospital–San Diego, University of California San Diego School of Medicine, La Jolla
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, California
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, La Jolla,Child and Adolescent Services Research Center, San Diego, California
| | - Mary Baker-Ericzen
- Child and Adolescent Services Research Center, San Diego, California,Rady Children’s Hospital–San Diego, University of California San Diego School of Medicine, La Jolla
| | - William Ganger
- Child and Adolescent Services Research Center, San Diego, California,San Diego State University Research Foundation, San Diego, California
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Preschool Interventions for Children with Autism Spectrum Disorder: a Review of Effectiveness Studies. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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Ben-Itzchak E, Zachor DA. Toddlers to teenagers: Long-term follow-up study of outcomes in autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:41-50. [PMID: 31055934 DOI: 10.1177/1362361319840226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This prospective study examined the developmental changes over time of adolescents diagnosed in toddlerhood with autism spectrum disorder and searched for child characteristics at toddlerhood that predict outcome at adolescence. The study included 65 participants who were divided into low cognitive (developmental quotient < 85; N = 41) and high cognitive (developmental quotient ⩾ 85; N = 21) groups in adolescence. Participants underwent a comprehensive assessment of cognitive ability, adaptive skills, and autism severity. Significant differences in the current clinical phenotypes and in developmental changes over time were found between the two cognitive groups. At baseline, the high cognitive group had significantly less severe social communication deficits. Only the high cognitive group showed a decrease in social communication deficits over time. Although the two groups did not differ in their adaptive skills at the time of diagnosis, the high cognitive group had better adaptive skills at adolescence. Better adaptive communication skills in toddlerhood were associated with better outcome at adolescence in cognitive ability, adaptive skills, and fewer autism symptoms. Less impaired baseline social affect and better cognitive ability predicted higher cognitive level and adaptive skills at adolescence. Cognitive potential of individuals with autism spectrum disorder plays an important role in long-term outcome and comprehensive evaluations at toddlerhood have strong prognostic value in adolescence.
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35
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Oliveira TRDS, Nascimento AA, Pellicani AD, Torres GMX, Silva KD, Guedes-Granzotti RB. Speech therapy intervention in a teenager with autism spectrum disorder: a case report. REVISTA CEFAC 2018. [DOI: 10.1590/1982-021620182068518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Autism Spectrum Disorder is a neurodevelopmental disorder that affects socio-communicative and behavioral abilities. In the language aspect, there is a greater impairment at the pragmatic level and in non-verbal aspects. The objective of this study was to characterize the severity of Autism Spectrum Disorder in an adolescent, pre-and post-speech-language therapy, and describe the process of speech-language intervention using Picture Exchange Communication System allied to the principles of behavioral analysis applied to language. The Autism Treatment Evaluation Checklist with the parents was applied. Then, a therapeutic program of 14 sessions of 50 minutes was developed, one per week, and then the questionnaire was reapplied. In the course of the therapeutic process, it was possible to observe an increase in the number of figure exchanges independently, an increase in the number of vocalizations with communicative intention or functional speech, longer time of visual contact and social smile, reduction of inappropriate behaviors with a significant improvement in the Autism Treatment Evaluation Checklist score.
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36
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Lotfizadeh AD, Kazemi E, Pompa-Craven P, Eldevik S. Moderate Effects of Low-Intensity Behavioral Intervention. Behav Modif 2018; 44:92-113. [PMID: 30136599 DOI: 10.1177/0145445518796204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared clinical outcomes in a treatment group of 98 individuals who received between 8 and 15 weekly hours (M = 10.6; SD = 1.7) of applied behavior analysis (ABA) intervention with a comparison group of 73 individuals who received another provision, including some ABA, (between 1.4-8 weekly hours, M = 5.7; SD = 1.6). After 2 years, the treatment group made greater gains than the comparison group on language and social skills, and other areas assessed by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). We evaluated the outcome on adaptive skills for a smaller sample of participants using the Vineland Adaptive Behavior Scales II (VABS), but found no significant differences between the treatment (n = 17) and comparison groups (n = 11). Although the treatment group made important and clinically meaningful gains, the gains were moderate. These findings underline the importance of intervention intensity and provide further support for a dose-response relationship between ABA intervention hours and outcomes.
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Affiliation(s)
| | - Ellie Kazemi
- California State University, Northridge, Los Angeles, USA
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37
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Rivard M, Morin M, Mello C, Terroux A, Mercier C. Follow-Up of Children With Autism Spectrum Disorder 1 Year After Early Behavioral Intervention. Behav Modif 2018; 43:490-517. [PMID: 29726269 DOI: 10.1177/0145445518773692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effectiveness of early intensive behavioral intervention (EIBI) for children with autism spectrum disorders (ASDs) has been demonstrated by many studies and meta-analyses. Although it is considered an exemplary practice in several countries, few studies have investigated the maintenance of gains made in EIBI over time. Thirty-two children were assessed at posttreatment and 1-year follow-up after they attended a low-to-moderate-intensity (10 to 20 hr per week) EIBI program delivered by a public rehabilitation center. Between baseline and posttreatment, children showed significant gains in most areas of intellectual functioning and a significant decrease of autism symptom severity, but no change in adaptive behavior. Gains in intellectual functioning were maintained over a 1-year period after treatment termination, but autism symptom severity had increased to approximately pretreatment levels during that interval. Considerable individual variability was noted in the evolution of outcomes.
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Affiliation(s)
| | | | - Catherine Mello
- 2 The Pennsylvania State University - Berks, Reading, PA, USA
| | - Amélie Terroux
- 3 Centre de réadaptation en déficience intellectuelle et trouble envahissant du développement de la Montérégie-Est, St-Hubert, Québec, Canada
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38
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Hong ER, Neely L, Gerow S, Gann C. The effect of caregiver-delivered social-communication interventions on skill generalization and maintenance in ASD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 74:57-71. [PMID: 29360047 DOI: 10.1016/j.ridd.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/06/2017] [Accepted: 01/15/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND Although caregiver-delivered social communication interventions have been considered scientifically proven practices for individuals with autism spectrum disorders, it is not well examined if these types of intervention modes are truly effective in promoting skill generalization and maintenance within those individuals with autism spectrum disorders. AIMS The purpose of this meta-analysis was to evaluate the status of the extant literature regarding the measures on generalization and/or maintenance of effects of caregiver-delivered communication interventions for children with autism spectrum disorders. METHODS AND PROCEDURES This systematic literature review and meta-analysis evaluated peer-reviewed research regarding the effects of caregiver-implemented interventions on the maintenance and generalization of the social-communication skills for children with autism spectrum disorders. A total of 34 articles were included following a systematic search. Articles were summarized according to the following categories: (a) generalization dimension, (b) generalization assessment design, (c) maintenance assessment design, (d) generalization/maintenance teaching strategy, and (e) latency to maintenance probes. After application of design standards, aggregate Tau-U and non-overlap of pairs effect sizes were calculated with a total of 67 separate contrasts across seven studies. OUTCOMES AND RESULTS Overall, effect size scores ranged from small to large effects across all comparisons. On average, most of the baseline to maintenance and generalization comparisons produced moderate to large effects. Whereas, small to moderate or even deteriorate effects were found in most of the intervention to maintenance and generalization comparisons. CONCLUSIONS AND IMPLICATIONS The findings in this review suggest that caregiver-delivered social-communication interventions are likely to result in mixed effects on skill generalization and maintenance within children with autism spectrum disorders. Implications for future research and practice are discussed.
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Affiliation(s)
- Ee Rea Hong
- University of Tsukuba, Disability Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki-ken 305-8572, Japan.
| | - Leslie Neely
- The University of Texas at San Antonio, Educational Psychology, 501 W. Cesar E. Chavez Blvd., San Antonio, TX 78207, United States.
| | - Stephanie Gerow
- Baylor University, School of Education, Marrs McLean Science 316, One Bear Place #97301, Waco, TX 76798, United States.
| | - Candace Gann
- Oklahoma State University, School of Teaching, Learning and Educational Sciences, 225 Willard Hall, Stillwater, OK 74078, United States.
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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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40
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Långh U, Hammar M, Klintwall L, Bölte S. Allegiance and knowledge levels of professionals working with early intensive behavioural intervention in autism. Early Interv Psychiatry 2017; 11:444-450. [PMID: 27060473 DOI: 10.1111/eip.12335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/24/2015] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviour modification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI. METHODS Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected. RESULTS Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance. CONCLUSIONS Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.
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Affiliation(s)
- Ulrika Långh
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Autism Center for Young Children, Habilitation and Health, Stockholm County Council, Stockholm, Sweden
| | - Martin Hammar
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Lars Klintwall
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Behavioural Science, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Sven Bölte
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
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41
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Rudovic O, Lee J, Mascarell-Maricic L, Schuller BW, Picard RW. Measuring Engagement in Robot-Assisted Autism Therapy: A Cross-Cultural Study. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00036] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Långh U, Cauvet E, Hammar M, Bölte S. Cross-Cultural Validation of the York Measure of Quality of Intensive Behavioral Intervention. Behav Modif 2017; 41:808-828. [PMID: 28691542 DOI: 10.1177/0145445517719397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Early intensive behavioral intervention (EIBI) is widely applied in young children with autism spectrum disorder. Little research has addressed the significance of adherence to EIBI practices for treatment outcomes. The York Measure of Quality of Intensive Behavioral Intervention (YMQI) was designed to assess EIBI quality delivery in Ontario, Canada. The objective of this study was to examine the cross-cultural validity of the YMQI in a clinical Swedish community sample of 30 boys and four girls with autism aged 2.5 to 6 years. Internal consistency was alpha = .87 for the full scale YMQI. Interrater reliability among three raters on 97 video-recorded therapy sequences was .71 (intraclass correlation coefficient [ICC]), and intrarater reliability of two raters re-scoring 15 sequences after 6 months was ICC = .87. The convergent validity of the YMQI with EIBI expert ratings was r = .49. Findings endorse the psychometric properties of the YMQI and its usability outside of Anglo-Saxon countries.
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Affiliation(s)
- Ulrika Långh
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
| | - Elodie Cauvet
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
| | - Martin Hammar
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
| | - Sven Bölte
- 1 Karolinska Institutet, Stockholm, Sweden.,2 Stockholm County Council, Stockholm, Sweden
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Rivard M, Mercier C, Morin M, Lépine A. Le point de vue de parents d’enfants présentant un trouble du spectre de l’autisme en regard d’un programme public d’intervention comportementale. ACTA ACUST UNITED AC 2017. [DOI: 10.7202/1039257ar] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
L’intervention comportementale intensive (ICI) est implantée depuis 2003 dans les services publics québécois destinés aux enfants de 2 à 5 ans ayant un trouble du spectre de l’autisme. Ce choix a été fait sur la base de l’avis d’experts et des données probantes à l’effet que l’ICI représente l’intervention la plus efficace pour les jeunes enfants ayant ce type de trouble. Bien que les effets de l’ICI soient largement documentés, la perception des familles quant aux services d’ICI reçus demeure peu étudiée. À partir d’entretiens effectués auprès de 52 familles, le point de vue des parents concernant les services d’ICI a été abordé selon trois dimensions : l’appréciation générale, les effets perçus sur l’enfant et la famille ainsi que le niveau de satisfaction. Les données ont été recueillies à partir de questions ouvertes, d’un questionnaire structuré et de l’Échelle de satisfaction des services (CSQ-8). Les parents participants rapportent que l’équipe d’intervention, les modalités d’intervention ainsi que le contenu de l’intervention des services ICI sont les principaux points forts des services évalués. Des améliorations pourraient néanmoins être apportées à certaines modalités de dispensation des services, ainsi qu’à l’accessibilité, aux mouvements de personnel et à l’implication des parents. Tous les parents, sauf un, rapportent des effets positifs chez l’enfant, notamment sur les plans de la communication, du fonctionnement cognitif et des aspects sociaux. Les services ont aussi des effets sur le bien-être des parents, leurs habiletés parentales et la vie quotidienne familiale. Plus de 95 % des répondants se sont déclarés satisfaits ou très satisfaits des modalités du programme ICI. Le niveau général de satisfaction est également très élevé.
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Affiliation(s)
- Mélina Rivard
- Université du Québec à Montréal. Correspondance : Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal (Québec) H3C 3P8, 514-987-3000 poste 5235
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44
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Studer N, Gundelfinger R, Schenker T, Steinhausen HC. Implementation of early intensive behavioural intervention for children with autism in Switzerland. BMC Psychiatry 2017; 17:34. [PMID: 28109262 PMCID: PMC5251245 DOI: 10.1186/s12888-017-1195-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/05/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a major gap between the US and most European countries regarding the implementation of early intensive behavioural intervention (EIBI) for children with autism. The present paper reports on the current status of EIBI in Switzerland and on the effectiveness of EIBI under clinical conditions in a Swiss pilot project. METHODS The paper combines a narrative report of the care system for children with autism in Switzerland and an initial evaluation of EIBI as implemented in the Department of Child and Adolescent Psychiatry, University of Zurich. RESULTS The current situation of the implementation of EIBI for children with autism in Switzerland is characterized by marked deficits in its acceptance. Major reasons include insufficient governmental approval and lacking legal and financial support. In addition, ignorance among health care providers and educational professionals has contributed to this situation precluding that children with autism receive the most beneficial assistance. The authors have initiated and been working in an intervention centre offering EIBI for a decade and report on their experience with the implementation of EIBI. Based on their clinical practice, they document that EIBI also works efficiently under ordinary mental health service conditions. CONCLUSIONS EIBI needs to be implemented more intensively in Switzerland. Although the effects of EIBI as implemented in Zurich are promising, the results are not as pronounced as under controlled research conditions.
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Affiliation(s)
- Nadja Studer
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Swiss Early Intervention Project in Autism, Swiss EIPA, Gland, Switzerland
| | - Ronnie Gundelfinger
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Swiss Early Intervention Project in Autism, Swiss EIPA, Gland, Switzerland
| | - Tanja Schenker
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
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Milne S, McDonald J, Kayrouz N. Determinants of developmental progress in pre-schoolers referred for neuro-developmental diagnosis. J Paediatr Child Health 2016; 52:1004-1011. [PMID: 27599109 DOI: 10.1111/jpc.13274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 11/29/2022]
Abstract
AIM To determine factors associated with change in developmental progress in pre-schoolers referred to a developmental clinic. METHODS Of 360 pre-schoolers referred to a Child Assessment clinic for neuro-developmental diagnosis before 3.6 years, 190 (53%) were reassessed prior to school entry and recruited to this study. They were assessed with the Bayley Scales of Infant and Toddler Development (3rd edn) before 3.5 years and the Griffiths Mental Development Scales before school entry. The influence of medical and environmental variables on improvement or deterioration in scores (±0.5 SD) was examined using logistic regression. RESULTS Consistent scores were present in 51.6% of children, and associated with environmental variables. Children with stable scores were more likely to live in a suburb of social advantage (OR = 3.2; 95%CI = 1.37-7.64, P = 0.008) or to come from families dependent on welfare or public housing (OR=4.8; 95%CI = 2.19-10.49, P < 0.001). Improvement was seen in 18.1% of children; they were more likely to have commenced therapy after the first assessment (OR = 2.4; 95%CI = 1.05-5.58, P = 0.038). Deterioration of scores was seen in 30% of children. Children with a mild delay on initial assessment were less likely to deteriorate (OR = 2.9; 95%CI = 1.16-7.04, P = 0.022), while lower scores were more likely in children with neuro-motor disabilities (OR = 10.8; 95%CI = 2.64-44.58, P < 0.001), and chromosomal variations of both known and unknown significance (OR = 4.4; 95%CI = 1.54-12.76, P = 0.006). CONCLUSIONS Socio-economic advantage and disadvantage are associated with stable scores, but introducing intervention is associated with improved scores. Deterioration is most likely in children with chromosomal variations or neuro-motor disabilities, and regular reassessment of these children is recommended.
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Affiliation(s)
- Susan Milne
- Paediatric Allied Health, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Jenny McDonald
- Paediatric Allied Health, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Norma Kayrouz
- Paediatric Allied Health, Campbelltown Hospital, Sydney, New South Wales, Australia
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Utilisation of evidence-based practices by ASD early intervention service providers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:167-180. [DOI: 10.1177/1362361316633032] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and use of strategies, organisational culture, individual attitudes, sources of information and considerations informing intervention choices by early intervention providers. An online survey was completed by 72 early intervention providers from four organisations across Australia. Providers reported high levels of trust and access of information from internal professional development, therapists and external professional development. A range of considerations including child factors, family values and research were rated as important in informing intervention choices. Participants reported greater knowledge and use of evidence-based and emerging practices than unsupported. Levels of use were linked to levels of knowledge, as well as some organisational and attitudinal factors. Areas for future research and implications are discussed.
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Dixon DR, Linstead E, Granpeesheh D, Novack MN, French R, Stevens E, Stevens L, Powell A. An Evaluation of the Impact of Supervision Intensity, Supervisor Qualifications, and Caseload on Outcomes in the Treatment of Autism Spectrum Disorder. Behav Anal Pract 2016; 9:339-348. [PMID: 27920965 DOI: 10.1007/s40617-016-0132-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ample research has shown the benefits of intensive applied behavior analysis (ABA) treatment for autism spectrum disorder (ASD); research that investigates the role of treatment supervision, however, is limited. The present study examined the relationship between mastery of learning objectives and supervision hours, supervisor credentials, years of experience, and caseload in a large sample of children with ASD (N = 638). These data were retrieved from a large archival database of children with ASD receiving community-based ABA services. When analyzed together via a multiple linear regression, supervision hours and treatment hours accounted for only slightly more of the observed variance (r2 = 0.34) than treatment hours alone (r2 = 0.32), indicating that increased supervision hours do not dramatically increase the number of mastered learning objectives. In additional regression analyses, supervisor credentials were found to have a significant impact on the number of mastered learning objectives, wherein those receiving supervision from a Board Certified Behavior Analyst (BCBA) mastered significantly more learning objectives. Likewise, the years of experience as a clinical supervisor showed a small but significant impact on the mastery of learning objectives. A supervisor's caseload, however, was not a significant predictor of the number of learning objectives mastered. These findings provide guidance for best practice recommendations.
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Affiliation(s)
- Dennis R Dixon
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
| | - Erik Linstead
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Doreen Granpeesheh
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
| | - Marlena N Novack
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
| | - Ryan French
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Elizabeth Stevens
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Laura Stevens
- Schmid College of Science and Technology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Alva Powell
- Center for Autism and Related Disorders, 21600 Oxnard Street, Suite 1800, Woodland Hills, CA 91367 USA
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Assessing Spoken Language Outcomes in Children with ASD: a Systematic Review. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0068-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ensino de linguagem receptiva para crianças com autismo : comparando dois procedimentos. ACTA COLOMBIANA DE PSICOLOGIA 2015. [DOI: 10.14718/acp.2015.18.2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Este trabalho comparou a eficiência de um treino de Discriminação Simples-Condicional (DSC), que empregou blocos de tentativas e três estímulos desde o seu início, com a do treino de Discriminação Condicional (DC), no ensino de linguagem receptiva para três crianças com autismo. Com cada criança foram treinadas nove relações palavra falada-figura em cada tipo de treino. O treino DSC consistiu na redução gradual de tentativas por bloco (de seis blocos de três tentativas, na Fase 1 para nove blocos de duas tentativas, na Fase 2), até sua randomização total, na Fase 3. O treino DC foi idêntico à Fase 3 de DSC, porém com outros estímulos. O treino DC se mostrou mais eficiente para o estabelecimento da linguagem receptiva, mas o treino DSC foi mais efetivo para a manutenção do repertório. Discutem-se as implicações desses resultados para a área aplicada e direções para novos estudos.
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