Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders

Using music to assist language learning in autistic children with minimal verbal language: The MAP feasibility RCT

LAY ABSTRACT

Research has shown that autistic individuals often have unusually good musical skills and that combining words and music helps autistic individuals to focus on spoken words. This study tests the idea that music will help with early language learning of preschool autistic children. The results show that when caregivers sing words to autistic children, the children pay more attention to the caregiver than when the words are spoken and that they learn word combinations more easily.

Autism Spectrum Disorder at Home and in School

The diagnosis of autism spectrum disorder (ASD) brings a lifetime of considerations for individuals and their families. The core symptoms of ASD vary in severity and influence behavior and function across all environments. Co-occurring medical, mental health, cognitive, language, learning, and behavioral differences add challenges to those associated with core symptoms. Navigating the preschool, school, and transition ages in the educational setting requires continual reassessment of the strengths, weaknesses, and needs of the student to provide appropriate placement and services.

Automated measures of vocal interactions and engagement in inclusive preschool classrooms

Classroom engagement plays a crucial role in preschoolers' development, yet the correlates of engagement, especially among children with autism spectrum disorder (ASD) and developmental delays (DD), remains unknown. This study examines levels of engagement with classroom social partners and tasks among children in three groups ASD, DD, and typical development (TD). Here, we asked whether children's vocal interactions (vocalizations to and from peers and teachers) were associated with their classroom engagement with social partners (peers and teachers) and with tasks, and whether the association between classroom engagement and vocal interactions differed between children in the ASD group and their peers in the DD and TD groups. Automated measures of vocalizations and location quantified children's vocal interactions with peers and teachers over the course of the school year. Automated location and vocalization data were used to capture both (1) children's vocal output to specific peers and teachers, and (2) the vocal input they received from those peers and teachers. Participants were 72 3-5-year-olds (Mage  = 48.6 months, SD = 7.0, 43% girls) and their teachers. Children in the ASD group displayed lower engagement with peers, teachers, and tasks than children in the TD group; they also showed lower engagement with peers than children in the DD group. Overall, children's own vocalizations were positively associated with engagement with social partners. Thus, although children in the ASD group tend to have lower engagement scores than children in the TD group, active participation in vocal interactions appears to support their classroom engagement with teachers and peers.

A Waitlist Randomized Implementation Trial of Classroom Pivotal Response Teaching for Students With Autism

Classroom Pivotal Response Teaching (CPRT) is a community-partnered adaptation of a naturalistic developmental behavioral intervention identified as an evidence-based practice for autistic children. The current study evaluated student outcomes in a randomized, wait-list controlled implementation trial across classrooms. Participants included teachers (n = 126) and students with autism (n = 308). Teachers participated in 12 hours of didactic, interactive training and additional in-classroom coaching. Generalized Estimating Equations accounted for clustering. Adjusted models evaluated the relative effects of training group, CPRT fidelity, and classroom quality on student outcomes. Results indicate higher CPRT fidelity was associated with greater increases in student learning. Having received CPRT training predicted increased student engagement and greater decreases in reported approach/withdrawal problems. These differences may be linked to the theoretical foundations of CPRT of increasing student motivation and engagement and collaborative adaptation to increase feasibility in schools. Overall, results suggest CPRT may be a beneficial approach for supporting autistic students.

What does it mean for an autism intervention to be evidence-based?

Although there is consensus in the field that individuals on the autism spectrum should receive interventions that are evidence-based, the concept of "evidence-based" is multifaceted and subject to ongoing development and debate. In this commentary, we review historical developments, methodological approaches, as well as areas of controversies and research directions in the establishment of an evidence base for autism intervention. LAY SUMMARY: What does it mean for an autism intervention to be evidence-based? In this commentary, we address this complex issue by examining historical developments, methodological approaches, as well as areas of ongoing debate in the establishment of evidence-based interventions for autism.

The Efficacy of Early Interventions for Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

The superiority of early interventions for children with autism spectrum disorders (ASDs) compared to treatment as usual (TAU) has recently been questioned. This study was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12-132 months). Early interventions led to positive outcomes for cognitive ability (g = 0.32; 95% CI: 0.05, 0.58; p = 0.02), daily living skills (g = 0.35; 95% CI: 0.08, 0.63; p = 0.01), and motor skills (g = 0.39; 95% CI: 0.16, 0.62; p = 0.001), while no positive outcomes were found for the remaining variables. However, when studies without the blinding of outcome assessment were excluded, positive outcomes of early interventions only remained for daily living skills (g = 0.28; 95% CI: 0.04, 0.52; p = 0.02) and motor skills (g = 0.40; 95% CI: 0.11, 0.69; p = 0.007). Although early intervention might not have positive impacts on children with ASDs for several outcomes compared to controls, these results should be interpreted with caution considering the great variability in participant and intervention characteristics.

Intervention Goals for Preschoolers With Language Difficulties and Disorders: A Scoping Review Using the International Classification of Functioning, Disability and Health Framework

PURPOSE

The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from birth to 5;0 [years;months]) with language difficulties and disorders within the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for two language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition).

METHOD

The scoping review followed Arksey and O'Malley (2005) guidelines. Articles were retrieved from speechBITE, with age (under 5 years), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components, and the distribution of goals across ICF components was compared for studies involving children with the two language difficulty/disorder subtypes.

RESULTS

A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the activities component of the ICF framework, followed by participation (26%), environmental factors (20%), body functions and structures (3%), and personal factors (3%). Most participation-focused goals were reported from intervention studies involving preschoolers with a language difficulty/disorder associated with a biomedical condition.

CONCLUSIONS

Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice.

Examining Feasibility and Outcomes of the PEERS® for Preschoolers Program

Social impairments characteristic of autism spectrum disorder (ASD) are evident in early childhood and often worsen. There is a paucity of evidence-based interventions explicitly targeting social skill development for young children with ASD and few actively integrate caregivers. The PEERS® program, an evidence-based caregiver-assisted social skills program, was extended for young children with ASD (i.e., PEERS® for Preschoolers (P4P)). This pilot study expands upon initial results by examining the feasibility of a briefer intervention period and the effectiveness in improving child social skills among 15 children with ASD. Results suggest P4P recruitment, participant retention, and implementation are feasible across clinicians and sites. Further, P4P appears to improve social skills, maintained post-intervention. Future research might examine mechanisms that lead to results.

A granular perspective on inclusion: Objectively measured interactions of preschoolers with and without autism

Children's preschool experiences have consequences for development. However, it is not clear how children's real-time interactions with peers affect their language development; nor is it clear whether these processes differ between children with autism spectrum disorder (ASD) and two other groups of children, those with general developmental delays (DD) and typically developing (TD) children. We used objective measures of movement and vocalizations to quantify children's real-time dyadic vocal interactions and quantify classroom social networks. Participants included 56 preschoolers (22 female; M = 50.14 months) in five inclusive classrooms for children with ASD or DD and their TD peers. Each class was observed monthly on two to five occasions. Overall, children vocalized more to peers who had vocalized more to them in the previous observation. These dyadic vocalization patterns were associated with group differences in social network analyses. Modularity, the cohesiveness of group ties, was lower among children with ASD than it was among TD children or children with DD. Individually, children with ASD exhibited lower total levels of vocalizations with peers (lower degree centrality) than TD children and children with DD. In an exploratory analysis with a subset of the participants, children's degree centrality was strongly associated with their end-of-year assessed language abilities, even when accounting for mean differences between groups. Findings highlight the impact peers and social networks play in real-time language use and in the developing language abilities of children with ASD in inclusion classrooms. LAY SUMMARY: This study objectively measured associations between children's peer vocal interactions and assessed language abilities in inclusion classrooms for children with autism spectrum disorder (ASD) and their peers. All children benefited from peers talking to them, but children with ASD were less central to classroom speech networks than were typically developing children. Children's centrality to social speech networks, regardless of ASD status, was associated with assessed language abilities.

Longitudinal stability of salivary microRNA biomarkers in children and adolescents with autism spectrum disorder

BACKGROUND

Autism spectrum disorder (ASD) is a complex neurological condition with increasing prevalence. Few tools accurately predict the developmental trajectory of children with ASD. Such tools would allow clinicians to provide accurate prognoses and track the efficacy of therapeutic interventions. Salivary RNAs that reflect the genetic-environmental interactions underlying ASD may provide objective measures of symptom severity and developmental outcomes. This study investigated whether salivary RNAs previously identified in childhood ASD remain perturbed in older children. We also explored whether RNA candidates changed with therapeutic intervention.

METHOD

A case-control design was used to characterize levels of 78 saliva RNA candidates among 96 children (48 ASD, 48 non-ASD, mean age: 11 years). Thirty-one children (22 ASD, 9 non-ASD developmental delay, mean age: 4 years) were followed longitudinally to explore changes of RNA candidates during early intervention. Saliva RNA and standardized behavioral assessments were collected for each participant. Associations between candidate RNAs and behavioral scores were determined in both groups via Spearman Correlation. Changes in candidate RNAs across two time-points were assessed in the younger cohort via Wilcoxon rank-sum test.

RESULTS

Seven RNAs were associated with VABS-II and BASC scores in the older group ([R] >0.25, FDR< 0.15). Within the younger cohort, 12 RNAs displayed significant changes over time (FDR< 0.05). Three microRNAs were associated with behavioral scores and changed over time (miR-182-5p, miR-146b-5p, miR-374a-5p).

CONCLUSION

Several salivary RNAs are strongly associated with autistic behaviors in older individuals with ASD and change as early as three months after therapy initiation in younger children. These molecules could be used to track treatment effectiveness and provide prognoses. Further validation is necessary.

Examining the current practices of the individualized family services plan with young children with disabilities in Saudi Arabia

Early intervention programs play an important role in supporting young children with disabilities and developmental disorders in acquiring various life skills before they reach school-going age. The present study aims to examine the current practices of the Individualized Family Service Plan (IFSP) for young children with disabilities in Saudi Arabia using a quantitative design. A sample of 212 early intervention providers-males (n = 35; 16.5%) and females (n = 177; 83.5%)-were surveyed. The IFSP questionnaire was based on Maryland State's IFSP form. The order of the dimensions employed in the study from the highest to the lowest was as follows: initial data, the present level of the child's development, permissions, early intervention services, information about the child and the family, and transition services. The findings of the study revealed that the current practices of the IFSP for young children with disabilities in Saudi Arabia were at the 'often' level.

Universal Teacher-Child Interaction Training in Early Special Education: A Pilot Cluster-Randomized Control Trial

Using a pilot matched-pairs cluster-randomized control trial, we evaluated the acceptability and preliminary outcomes of universal Teacher-Child Interaction Training (TCIT-U) with students with disabilities in early special education programs. Twelve classrooms (clusters) were paired by age and type and then randomly assigned within pairs to either TCIT-U (81 students, 20 teachers) or wait-list control (63 students, 16 teachers) with services as usual. We analyzed the effects of TCIT-U on (a) teachers' skills acquisition via masked observational coding and (b) students' behavior and developmental functioning via teacher questionnaires. For child-directed interaction skills, teachers receiving TCIT-U exhibited significantly greater increases in behavior descriptions and labeled praise than teachers who did not receive TCIT-U at posttreatment and follow-up. No significant group differences were observed in use of teacher-directed interaction skills. Qualitative data from teachers expanded on these findings, suggesting that teachers found child-directed interaction skills more acceptable than teacher-directed interaction skills. Teachers receiving TCIT-U reported small but significant improvements in student behavior problems and socioemotional functioning at posttreatment and follow-up, as compared to wait-list students. We discuss considerations for future implementation and tailoring of TCIT for young students with disabilities, which may have positive impacts on future cohorts of students beyond teachers' initial training.

Inclusive Early Childhood Education for Children With and Without Autism: Progress, Barriers, and Future Directions

University-affiliated lab and model schools play an important role in creating educational innovations in inclusive early childhood education (ECE) for young children with Autism Spectrum Disorder (ASD). In the United States, access to inclusive high-quality ECE programs for young children with disabilities has been required by law for over 40 years, has been recommended by leading professional organizations, and has been emphasized in federal public policy initiatives. Yet, improvement in the rates of young children with disabilities experiencing inclusion has been limited. This review article consists of three parts. First, we identify and describe four barriers to wide-scale implementation of inclusive ECE programs for children with ASD in the US. These barriers include (1) the fragmented nature of the ECE system in the United States, (2) the age at which ASD is typically first diagnosed in the community, (3) the diverse presentation/support needs of children with ASD, and (4) the thoughts and feelings of parents of children without disability about inclusion. Second, we used a snowball sampling approach to identify nine leading university-affiliated, inclusive lab and model schools for young children with ASD. By describing these programs, we highlight similarities and differences between programs, and capture the unique ways in which these programs adapt to local conditions, resources, and barriers (e.g., federal and state regulations, funding sources, community resources, institutional structures and priorities, professional orientation and training, access to families and staff). Finally, we propose a roadmap for researchers focused on the development, evaluation, and implementation of community-viable inclusive ECE programs in ASD. This roadmap leverages synergies between inclusive university-affiliated lab and model preschools in ASD, and proposes the formation of a research network that creates an infrastructure for cross-program collaboration.

Early screening of autism spectrum disorder using cry features

The increase in the number of children with autism and the importance of early autism intervention has prompted researchers to perform automatic and early autism screening. Consequently, in the present paper, a cry-based screening approach for children with Autism Spectrum Disorder (ASD) is introduced which would provide both early and automatic screening. During the study, we realized that ASD specific features are not necessarily observable in all children with ASD and in all instances collected from each child. Therefore, we proposed a new classification approach to be able to determine such features and their corresponding instances. To test the proposed approach a set of data relating to children between 18 to 53 months which had been recorded using high-quality voice recording devices and typical smartphones at various locations such as homes and daycares was studied. Then, after preprocessing, the approach was used to train a classifier, using data for 10 boys with ASD and 10 Typically Developed (TD) boys. The trained classifier was tested on the data of 14 boys and 7 girls with ASD and 14 TD boys and 7 TD girls. The sensitivity, specificity, and precision of the proposed approach for boys were 85.71%, 100%, and 92.85%, respectively. These measures were 71.42%, 100%, and 85.71% for girls, respectively. It was shown that the proposed approach outperforms the common classification methods. Furthermore, it demonstrated better results than the studies which used voice features for screening ASD. To pilot the practicality of the proposed approach for early autism screening, the trained classifier was tested on 57 participants between 10 to 18 months. These 57 participants consisted of 28 boys and 29 girls and the results were very encouraging for the use of the approach in early ASD screening.

Autism and Education

Determining the most effective strategies to educate children and youth with autism spectrum disorder (ASD) can be daunting. Dr Stephen Shore, an autism advocate who is on the spectrum, said, "If you've met one person with autism, you've met one person with autism." Individuals diagnosed with ASD present with unique strengths and difficulties and experience characteristics of their disability in different ways. General and special educators must be prepared with a variety of evidence-based practices and instructional strategies to engage and educate students diagnosed with autism. This article discusses current methods, techniques, evidence, and controversies for educating individuals diagnosed with autism.

Employing Evidence-Based Practices for Children with Autism in Elementary Schools

The purpose of this study was to test the efficacy of a comprehensive program model originally developed by the National Professional Development Center on Autism Spectrum Disorder (NPDC). Sixty elementary schools with 486 participants were randomly assigned to an NPDC and services as usual condition (SAU). Significantly greater changes in program quality occurred in the inclusive NPDC programs as compared with the SAU schools. Teachers in NPDC schools reported using more evidence-based practices (EBPs) and implemented EBPs with significantly greater fidelity than teachers in SAU schools. Autistic students in NPDC schools had significantly higher total attainment of educational goals than students in SAU schools, and the two groups made equivalent progress on standardized assessment outcomes across the school year.

Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis

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.

The Effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum Disorder: A Meta-analysis

This meta-analysis examined the effects of early interventions on social communication outcomes for young children with autism spectrum disorder. A systematic review of the literature included 1442 children (mean age 3.55 years) across 29 studies. The overall effect size of intervention on social communication outcomes was significant (g = 0.36). The age of the participants was related to the treatment effect size on social communication outcomes, with maximum benefits occurring at age 3.81 years. Results did not differ significantly depending on the person implementing the intervention. However, significantly larger effect sizes were observed in studies with context-bound outcome measures. The findings of this meta-analysis highlight the need for further research examining specific components of interventions associated with greater and more generalized gains.

Autism and Education

Determining the most effective strategies to educate children and youth with autism spectrum disorder (ASD) can be daunting. Dr Stephen Shore, an autism advocate who is on the spectrum, said, "If you've met one person with autism, you've met one person with autism." Individuals diagnosed with ASD present with unique strengths and difficulties and experience characteristics of their disability in different ways. General and special educators must be prepared with a variety of evidence-based practices and instructional strategies to engage and educate students diagnosed with autism. This article discusses current methods, techniques, evidence, and controversies for educating individuals diagnosed with autism.

Implementation Fidelity and Common Elements of High Quality Teaching Sequences for Students with Autism Spectrum Disorder in COMPASS

BACKGROUND

Evidence-based educational instruction includes teaching elements common across different approaches as well as specific elements of the chosen evidence-based practice. We were interested in evaluating the use and impact of common elements of teaching. Specifically, we adopted a model of elements of high quality teaching sequences and developed and tested an instructional quality index to capture evidence-based features within teaching sequences (Grisham-Brown & Ruble, 2014).

METHOD

The current investigation examined 29 special education teachers who received a consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple & McGrew, 2012) that results in personalized teaching plans for young students with ASD and embeds elements of evidence-based teacher coaching of self-reflection and performance-based feedback. We analyzed the teaching plans to understand which of the common elements were present, and if teachers demonstrated improved performance after coaching.

RESULTS

Analysis of the use of common elements during the first and fourth coaching session demonstrated that all teachers showed improvement. Most importantly, the use of common elements correlated with student goal attainment outcomes.

CONCLUSIONS

These results suggest that common elements of teaching sequences which we view as core features of teaching quality, can be improved as a result of coaching, and most importantly, are associated with students' educational outcomes.

Examining Trajectories of Daily Living Skills over the Preschool Years for Children with Autism Spectrum Disorder

Preschool children with autism spectrum disorder (ASD) experience slower development of daily living skills (DLS) that are essential for independent functioning compared to typically developing children. Few studies have examined the trajectories of DLS in preschoolers with ASD and the existing literature has reported conflicting results. This study examined DLS trajectories and potential covariates for preschoolers with ASD from a multi-site longitudinal study following children from diagnosis to the end of grade 1. Multi-level modeling was conducted with DLS domain scores from the Vineland Adaptive Behavior Scales-2. The results demonstrated a positive trajectory of increasing scores over time, associations of age of diagnosis, developmental level, stereotypy, and language skills with the mean score at T4 or age 6 years, whereas rate of change was only associated with ASD symptom severity, such that an improvement in DLS trajectory was associated with lower and improving ASD symptom severity.

Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions.  This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.

Predictors of Expressive Language Change for Children with Autism Spectrum Disorder Receiving AAC-Infused Comprehensive Intervention

Comprehensive interventions for children with autism spectrum disorder (ASD) often incorporate augmentative and alternative communication (AAC); however, variability in outcomes exists even among children who access similar intervention. This study investigated predictors of expressive language change for 48 children with ASD aged 31 to 67 months receiving AAC-infused intervention. The relationships between participants' initial responses to AAC and expressive language change were examined. Commonly reported predictors (IQ, chronological age, ASD symptomatology) did not significantly predict expressive language change. AAC factors (visual attention, object play, word learning) entered at Step 2 of a hierarchical multiple regression, explained an additional 42% of the variance. The findings provide preliminary data on child characteristics associated with expressive language changes within AAC-infused comprehensive interventions.

A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual

OBJECTIVE

This single-blind, randomized, multisite, intent-to-treat study was designed to replicate and extend Dawson et al.'s (Pediatrics. 2010;125: e17-e23) randomized controlled trial testing the effects of the Early Start Denver Model (ESDM), an intensive play- and routines-based intervention delivered in natural settings.

METHOD

A randomized controlled trial was conducted at 3 universities. One hundred eighteen children 14 to 24 months old with autism spectrum disorder were enrolled and randomly assigned to ESDM or community interventions for 27 months. Eighty-one children completed the full treatment course and all assessments; data from all 118 children were used in analyses. Children assigned to the ESDM intervention received 3 months of weekly parent coaching followed by 24 months of 15 hour per week (on average) 1:1 treatment weekly on average in homes or daycare settings from supervised therapy assistants while parents received coaching 4 hours monthly from a certified ESDM therapist.

RESULTS

For the primary analyses, there were time-by-group and time-by-group-by-site interactions for language outcome. In the significant 3-way interaction involving site, 2 sites showed a significant ESDM advantage and the third site showed no significant group differences. In the planned 2-way analysis that pooled data across all 3 sites, there was a significant advantage found for the ESDM group. For the secondary analyses, there were no significant differences between the ESDM and community groups involving developmental quotient, autism severity, or adaptive behavior. The treatment effect of group on language outcomes was not moderated by baseline developmental quotient, autism severity, or language.

CONCLUSION

Results of the primary analysis provide a partial replication of Dawson et al.'s 2010 language findings.

CLINICAL TRIAL REGISTRATION INFORMATION

Intensive Intervention for Toddlers with Autism; https://clinicaltrials.gov/; NCT00698997.

Visual supports at home and in the community for individuals with autism spectrum disorders: A scoping review

Visual supports are recommended in autism spectrum disorder clinical guidelines. They can reduce anxiety, increase predictability, support communication and improve participation. They are implemented regularly in schools, but evidence about home visual supports is limited. This article reports results of a scoping literature review, alongside qualitative evaluation with parents and professionals. We report findings from 34 studies, identifying four categories of visual support and heterogeneity in participant characteristics, intervention methods, environments and outcome measures. Qualitative data from questionnaires (n = 101) and focus groups generated key themes about home visual supports, through thematic analysis: (1) Accessibility, (2) Participation-focussed (3) Individualisation, (4) Teaching Methods, (5) Consistency, and (6) Information and Training. We propose consensus with terminology and implications for practice and research.

An evaluation of the TEACCH approach for teaching functional skills to adults with autism spectrum disorders and intellectual disabilities

BACKGROUND

The Treatment & Education of Autistic and Communication Related Handicapped Children (TEACCH) approach has been widely adopted around the world, but most previous studies focus on applying it to teaching children with autism spectrum disorders (ASD) who have high functioning or without intellectual disabilities.

AIMS

This study evaluated the application and effectiveness of a TEACCH approach in teaching functional skills to young adults with ASD who have mild to moderate intellectual disabilities.

METHODS AND PROCEDURES

The study employed an experimental design which compared the training goal attainment of an experimental (n = 32) and a comparison (n = 31) group. We administered the TEACCH Transitional Assessment Profile (TTAP) to identify suitable areas of training and devised three individualized training goals for each participant using the goal attainment scaling (GAS) methodology. The experimental group participated in a standardized, individualized, 20-session training program based on the TEACCH approach, on top of their regular training in day activity centers.

RESULTS

All the participants showed improvements in functional skills over the baseline, mid-program, and post-program assessments (F = 146.66, p <  .001). The experimental group had significantly larger improvement in the GAS scores than the comparison group (F = 15.40, p <  .001). There were no significant changes between the pre- and post-program TTAP scores of both groups.

CONCLUSIONS AND IMPLICATIONS

The TEACCH approach is effective in teaching specific functional skills to young adults with ASD and mild to moderate intellectual disabilities. The clinical and research implications of the study are discussed.

School Age Outcomes of Children with Autism Spectrum Disorder Who Received Community-Based Early Interventions

This study followed children with Autism Spectrum Disorder (ASD) from early intervention into their early schooling years, when they were aged between 6 and 9 years, on autism symptom severity and cognitive functioning. The children, matched at pre-intervention, were compared on type of community provided service: 31 were in receipt of community-based group Early Start Denver Model and 28 had received other community provisions for ASD. Irrespective of groups, cognitive functioning was found to have significantly improved by school age compared to pre-intervention. Autism symptom severity increased during the same developmental period, seemingly driven by an increase in restricted and repetitive behaviours over time. In contrast, both groups displayed improved social affect by school age.

Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder

Naturalistic developmental behavioral intervention is an emerging class of interventions for young children with autism spectrum disorder. The present article is a meta-analysis of outcomes of group-design studies ( n = 27) testing interventions using naturalistic developmental behavioral intervention strategies. Small, significant positive effects of naturalistic developmental behavioral intervention were found for expressive language ( g = 0.32), reduction in symptoms of autism spectrum disorder ( g = −0.38), and play skills ( g = 0.23). Larger effects were found for social engagement ( g = 0.65) and overall cognitive development ( g = 0.48). A marginal effect was found for joint attention ( g = 0.14) and receptive language ( g = 0.28). For joint attention, improvement was moderated by hours of professional involvement. Evidence of publication and reporting bias was present for language outcomes. This meta-analysis grows the evidence base for naturalistic developmental behavioral interventions, particularly in the key areas of social engagement and cognition.

Validation of the Repetitive Behavior Scale-Revised in Spanish-Speakers Participants with Autism Spectrum Disorder

Restricted and repetitive behavior (RRB) is one of the two key diagnostic features of autism spectrum disorder (ASD). DSM-5 highlights the importance of severity-based diagnostic modifiers assigned on the basis of intensity of needed supports. Therefore, there is a need for available measures that assess the severity of RRB. The repetitive behavior scale-revised (RBS-R) is probably the most used informant-based rating scale for the assessment of RRB and interests observed in ASD. The present study examined the psychometric properties of the Spanish version of the RBS-R in a sample of 233 participants with ASD, aged 3 to 63 years. Results revealed a six-factor model, good internal consistency, and concurrent-divergent validity. These findings suggest the utility of the Spanish version of RBS-R.

Comparing the 1-year impact of preschool autism intervention programs in two Canadian provinces

Autism spectrum disorder (ASD) is associated with early differences in children's social interactions, communication, and play/interests. In many countries, considerable resources are invested in early intensive behavioral intervention (EIBI) programs for children with ASD, which aim to build adaptive skills and prevent or treat problem behavior. However, these programs vary widely in structure and delivery. Research evidence supports the efficacy of EIBI, but large knowledge gaps remain about the effectiveness of publicly funded EIBI programs. With policy-makers as formal research partners, we compared children's progress over 1 year in public preschool programs in adjacent Canadian provinces, New Brunswick (NB) and Nova Scotia (NS). In NB, children received up to 20 hr/week of comprehensive EIBI in a publicly funded, privately provided program. In NS, children received up to 15 hr/week of Pivotal Response Treatment and Positive Behavior Support delivered through the publicly funded healthcare system. In this observational parallel cohort study, we collected parent-reported data on 298 NB preschoolers (76.5% boys) and 221 NS preschoolers (86.9% boys) at EIBI start and 1 year later. Multilevel analysis revealed significant differences at baseline: NS children were older, with lower adaptive functioning and more severe ASD symptoms than NB children. Despite these pre-treatment differences that favor NB, children in both provinces showed similar adaptive functioning gains and reductions of maladaptive behavior. No changes were seen in mean ASD symptom severity in either province over time. Results highlight the value of evaluating interventions in their implementation contexts, and have important implications for devising optimal ASD policy. Autism Research 2019, 12: 667-681. © 2019 International Society for Autism Research,Wiley Periodicals, Inc. LAY SUMMARY: We need to know more about the impact of different forms of early intensive behavioral intervention (EIBI) for young children with autism spectrum disorder (ASD). We showed that preschoolers with ASD gained important skills while in public EIBI programs in two Canadian provinces. We also saw that differences in how EIBI programs are structured and characteristics of children who are served may affect outcomes. For these reasons, policy making requires evidence that fits the local context.

Instruments for augmentative and alternative communication for children with autism spectrum disorder: a systematic review

New technologies designed to improve the communication of autistic children can also help to promote interaction processes and cognitive and social development. The aim of this study was to analyze the instruments used to improve the communication skills of children with autism spectrum disorder. We searched the PubMed and Web of Science databases using the descriptors "autism", "Asperger", "education", "children" and "assistive technology" and selected articles that met the following inclusion criteria: (i) original research; (ii) written in English; (iii) based on participants with a primary diagnosis of autism spectrum disorder; and (iv) tested an instrument designed to promote communication in children with autism spectrum disorder. Our search retrieved 811 articles, of which 34 met the inclusion criteria. Data on 26 instruments were extracted, and the measurement properties of the instruments were combined with information about their outcomes and presentation. The most commonly used interventions were the Treatment and Education of Autistic and Related Communication Handicapped Children program and the Picture Exchange Communication System. The Treatment and Education of Autistic and Related Communication Handicapped Children program was shown to produce improvements in the communication skills, socialization and self-care skills of children with autism spectrum disorder. The Picture Exchange Communication System produced inconsistent results. The results of the identified studies confirm the significant importance of these instruments in improving the communicative process of autistic children.

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

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

Differences in teachers verbal responsiveness to groups of children with ASD who vary in cognitive and language abilities

BACKGROUND

This study aimed to examine whether verbal responsiveness in special education teachers varied among subgroups of children with autism spectrum disorder (n = 112) who differed in cognitive and language abilities.

METHODS

Participants were divided into clusters using cluster analysis based on standardised cognitive and language tests using k-mean clustering. For each child, a 15-min video of free play in school setting was collected. Three types of responsive utterances were coded: follow-in directives for behaviour, follow-in directives for language and follow-in comments.

RESULTS

Results showed that the three groups did not differ in overall verbal responsiveness after controlling for engagement, classroom type, age and gender. However, groups differ in follow-in directives for language, but not in follow-in directives for behaviours or follow-in comments. Compared with children with autism spectrum disorder who had higher cognitive and language ability, children with more severe impairments received fewer follow-in directives for language. Moreover, children with more cognitive and language impairments produced fewer amount of vocal/verbal acts, which results in receiving fewer verbal responses from their teachers. Additionally, teachers from the three groups did not differ in their responses to the child's verbal/vocal acts when the number of the child's verbal/vocal acts were controlled for.

CONCLUSION

Findings suggest child characteristics are related to the type of teachers' verbal responses in preschools. This difference in follow-in directives for questions may be related to language or other outcomes that warrant further investigations.

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

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

Early Detection and Intervention of ASD: A European Overview

Over the last several years there has been an increasing focus on early detection of Autism Spectrum Disorder (ASD), not only from the scientific field but also from professional associations and public health systems all across Europe. Not surprisingly, in order to offer better services and quality of life for both children with ASD and their families, different screening procedures and tools have been developed for early assessment and intervention. However, current evidence is needed for healthcare providers and policy makers to be able to implement specific measures and increase autism awareness in European communities. The general aim of this review is to address the latest and most relevant issues related to early detection and treatments. The specific objectives are (1) analyse the impact, describing advantages and drawbacks, of screening procedures based on standardized tests, surveillance programmes, or other observational measures; and (2) provide a European framework of early intervention programmes and practices and what has been learnt from implementing them in public or private settings. This analysis is then discussed and best practices are suggested to help professionals, health systems and policy makers to improve their local procedures or to develop new proposals for early detection and intervention programmes.

Inconsistent staffing and its impact on service delivery in ASD early-intervention

BACKGROUND

Inconsistent staffing (high turnover, casual workforce) is problematic in organisations, with the potential to impact both staff and services provided. Research has primarily focused on the impacts of inconsistent staffing in child welfare and community services with little evidence surrounding their ability to impact the outcomes for children with Autism Spectrum Disorders attending early-intervention services.

AIM

The aim of this study was to explore staff views regarding the impact of staff turnover on the delivery of group based early intervention for children with ASD.

METHODS AND PROCEDURES

We conducted five focus groups involving 29 professional (e.g. teachers, behaviour therapists), para-professional (e.g. child care workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim for use in thematic analysis.

OUTCOMES AND RESULTS

Two central themes, comprising five categories emerged to encompass participants' views. "Impacts on Staff" accounted for the challenges existing staff felt when working with new and untrained staff in the centre. Participants also expressed concerns for the "Impacts on Service Delivery" that resulted from dynamic staffing, affecting fidelity of interventions and the program itself.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that lacking a consistent staffing structure is problematic when attempting to provide high quality early intervention services to children with ASD and suggest that future research should investigate the extent of inconsistent staffing, impacts of inconsistent staffing on providing intervention, and develop a range of tools to help measure these effects.

How Are Child Restricted and Repetitive Behaviors Associated with Caregiver Stress Over Time? A Parallel Process Multilevel Growth Model

The impact of raising a child with autism spectrum disorder (ASD) is frequently accompanied by elevated caregiver stress. Examining the variables that predict these elevated rates will help us understand how caregiver stress is impacted by and impacts child behaviors. This study explored how restricted and repetitive behaviors (RRBs) contributed concurrently and longitudinally to caregiver stress in a large sample of preschoolers with ASD using parallel process multilevel growth models. Results indicated that initial rates of and change in RRBs predicted fluctuations in caregiver stress over time. When caregivers reported increased child RRBs, this was mirrored by increases in caregiver stress. Our data support the importance of targeted treatments for RRBs as change in this domain may lead to improvements in caregiver wellbeing.

Principals’ and Teachers’ Reports of Successful Teaching Strategies With Children With High-Functioning Autism Spectrum Disorder

Little research has been conducted on the evidence base for educational interventions implemented by teachers targeting students with high-functioning autism spectrum disorder (HFASD). Research examining particular techniques perceived as effective may facilitate guidelines for the application of evidence-based practices. A principal and teacher of students with HFASD from each of 29 different schools provided information on their current teaching interventions. Principals participated in an online survey designed to ascertain support for HFASD learners in their school, whereas teachers completed an online reflective journal to document methods they used in the classroom. Both teachers and principals found numerous strategies such as structure and incorporating needs to be successful. Inappropriate communication, disorganisation, and a lack of understanding were considered unhelpful. These results have implications for current practices in classrooms.

Validation of the Pictorial Infant Communication Scale for preschool-aged children with autism spectrum disorder

Joint attention, or the shared focus of attention between objects or events and a social partner, is a crucial milestone in the development of social communication and a notable area of deficit in children with autism spectrum disorder. While valid parent-report screening measures of social communication are available, the majority of these measures are designed to assess a wide range of behaviors. Targeted assessment of joint attention and related skills is primarily limited to semi-structured, examiner-led interactions, which are time-consuming and laborious to score. The Pictorial Infant Communication Scale is an efficient parent-report measure of joint attention that can be used as a complement to structured assessments in fully characterizing early social communication development. This study examined the psychometric properties of the Pictorial Infant Communication Scale. Results revealed a high degree of internal consistency and strong intercorrelations between subscales. Additionally, confirmatory factor analysis supported a three-factor model of joint attention. Furthermore, significant correlations between the Pictorial Infant Communication Scale and direct clinical measures of child joint attention, language skills, and autism spectrum disorder symptom severity were suggestive of concurrent validity. Findings suggest that the Pictorial Infant Communication Scale is a promising tool for measuring joint attention skills in preschool-aged children with autism spectrum disorder.

Intervention effects on spoken-language outcomes for children with autism: a systematic review and meta-analysis

BACKGROUND

Although spoken-language deficits are not core to an autism spectrum disorder (ASD) diagnosis, many children with ASD do present with delays in this area. Previous meta-analyses have assessed the effects of intervention on reducing autism symptomatology, but have not determined if intervention improves spoken language. This analysis examines the effects of early interventions on spoken-language in children with ASD.

METHOD

A systematic review of 1756 studies of children with ASD who participated in early intervention resulted in the inclusion of 26 studies in the current review. These studies included 1738 participants with ASD who were, on average, 3.3 years old (SD = 0.91).

RESULTS

This random-effects meta-analysis of spoken-language outcomes for children with ASD who received early intervention as compared with usual treatments yielded a significant overall mean effect size of g = 0.26 (CI = 0.11 to 0.42). On average, children with ASD significantly increased their use of spoken-language following experimental early interventions. Treatments delivered simultaneously by a clinician and a parent resulted in greater gains in spoken-language than treatments delivered by a clinician or parent only. No other participant or study characteristics predicted individual-study effect sizes.

CONCLUSIONS

Early intervention improves spoken-language outcomes for children with ASD, and the largest effects are found when both parent and clinician implement the intervention. Recommendations for practice include adding systematic parent training to interventions for spoken language to potentially improve outcomes. Future research should report standard language measures as well as child (cognitive ability and socio-economic status) and intervention characteristics to improve evidence related to the effects of interventions on spoken communication in children with ASD.

The Association between Adult Participation and the Engagement of Preschoolers with ASD

The ability for a child to engage in the classroom is associated with better academic outcomes. Yet, there is limited information on how child characteristics of autism and adult behavior impact engagement. This study examined (1) the pattern of adult participation and child engagement in preschool classrooms that serve children with ASD, (2) the associations between child engagement and adult participation, and (3) how characteristics of ASD (autism severity, language ability, and challenging behavior) moderate the relationship between adult participation and child engagement. Overall, children were less likely to be engaged when adults were actively or passively participating with them. Moderators impacted this relationship. Children with higher levels of autism severity were more likely to be engaged when adults were actively or passively participating with them. Similarly, children with lower language abilities were more likely to be engaged when adults were actively or passively participating with them. Finally, children with higher levels of challenging behaviors were less likely to be engaged when adults were actively or passively participating with them. These findings have important implications for how adults can best support the engagement of children with ASD.

Knowledge and use of intervention practices by community-based early intervention service providers

This study investigated staff attitudes, knowledge and use of evidence-based practices (EBP) and links to organisational culture in a community-based autism early intervention service. An EBP questionnaire was completed by 99 metropolitan and regionally-based professional and paraprofessional staff. Participants reported greater knowledge and use of EBPs compared to emerging and unsupported practices. Knowledge and use of EBPs were linked to each other independent of significant correlations with organisational culture and attitudes. Knowledge and use of EBPs was greater in metropolitan than regional locations and paraprofessionals reported greater use of unsupported practices and lower levels of knowledge and use of EBPs than professionals. The implications of these findings for the facilitation of knowledge transfer are discussed.