School-Based Peer-Related Social Competence Interventions for Children with Autism Spectrum Disorder: A Meta-Analysis and Descriptive Review of Single Case Research Design Studies

Feasible Peer-Mediated Intervention for Autistic Children Using Minimal Speech: A Qualitative Intervention Development Process

PURPOSE

Qualitative engagement with stakeholders in the development of interventions can provide insight into strategies to maximize feasibility in real-life settings. We engaged stakeholders (autistic adults, early childhood educators, early childhood sector leaders and policy influencers, parents of autistic children, and speech-language pathologists) to inform the development of an educator-led peer-mediated intervention (PMI) for autistic preschoolers who use minimal speech that is feasible to implement in inclusive early childhood education and care (ECEC) settings.

METHOD

A qualitative iterative intervention design process was utilized. Stakeholders (N = 15) attended an online workshop and completed a document review exploring the acceptability and feasibility of the proposed embedded PMI. A two-step analysis procedure using the Theoretical Domains Framework and template analysis was conducted to identify the barriers, enablers, and supports to the implementation of embedded PMI in early childhood settings.

RESULTS

While embedded PMI was unanimously acceptable to stakeholders, several participants expressed concerns regarding feasibility. Barriers to the successful integration and implementation of PMI in inclusive preschool contexts included access to skills, knowledge, and resources. Participants identified strategies to overcome modifiable barriers and to enhance the existing enablers. These strategies are reflected in the following themes: build on the familiar, build capacity in augmentative and alternative communication, adopt a whole center approach, adapt to meet the needs of the ECEC setting, and engage in proactive implementation.

CONCLUSION

To address barriers to the implementation of embedded PMI, action is needed at various levels: macro (national/policy), meso (organization/setting), and micro (individual).

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25155770.

A dual design thinking - universal design approach to catalyze neurodiversity advocacy through collaboration among high-schoolers

Introduction

Neurodiversity describes the fact that humans all have different brains with unique qualities that contribute to society. Though understanding of neurodiversity is gaining traction among the general public, there remains considerable stigma and prejudice toward neurodiverse people. One way to combat these issues is to teach individuals about neurodiversity and encourage them to develop advocacy skills. Development of such knowledge is especially important for adolescents, as they have the capacity to make small (e.g., interpersonal interactions) and large (e.g., school-wide) impacts.

Methods

Eighty-nine high schoolers participated in a two-week virtual summer camp in 2022; research consent/assent was obtained from 19 (11 neurodiverse/neurodivergent). Campers learned about neurodiversity, Universal Design for Learning (UDL), and Design Thinking (DT) through lectures from researchers and neurodivergent people, as well as group activities and discussions. Campers worked in small groups to design a neurodiversity advocacy project based on the principles of UDL and DT. Each group was facilitated by camp counselors-some of whom were neurodiverse-who were all committed to neurodiversity advocacy. Participants completed questionnaires about autism, ADHD, and dyslexia pre- and post-camp. Some also completed optional post-camp interviews.

Results

Pre-camp stigma toward neurodiverse conditions was generally low. However, autism stigma was significantly higher than dyslexia stigma (Z = -2.24, p = 0.025). After camp, autism stigma decreased (Z = -2.98, p = 0.003;) and autism [t(13) = 3.17, p = 0.007] and ADHD [t(13) = 2.87, p = 0.013] knowledge improved. There were no significant changes in ADHD or dyslexia stigma or dyslexia knowledge. Participants reported enjoying collaborating with other campers and learning about UDL and DT. Thematic analysis of interviews generated four themes: Increased Understanding of Neurodiversity; Increasing Empathy and Becoming Less Judgmental; Creating a Neurodiverse Community; and More Awareness is Needed.

Discussion

This pilot investigation suggests that a virtual summer camp can be effective in improving attitudes toward and knowledge of neurodiversity. Qualitative analysis indicated participants became more accepting after the camp, both in terms of being less judgmental toward neurodiverse people and more self-accepting among neurodivergent campers. Future research should investigate the long-term effects of such a program, particularly with diverse samples of students.

Interventions for Young Children's Mental Health: A Review of Reviews

To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.

Diagnosis and treatment of children and adolescents with autism and ADHD

Attention-deficit/hyperactivity disorder (ADHD) and autism are neurodevelopmental disorders that emerge in childhood. There is increasing recognition that ADHD and autism frequently co-occur. Yet, questions remain among clinicians regarding the best ways to evaluate and treat co-occurring autism and ADHD. This review outlines issues relevant to providing evidence-based practice to individuals and families who may be experiencing difficulties associated with co-occurring autism and ADHD. After describing the complexities of the co-occurrence of autism and ADHD, we present practical considerations for best practice assessment and treatment of co-occurring autism and ADHD. Regarding assessment, this includes considerations for interviewing parents/caregivers and youth, using validated parent and teacher rating scales, conducting cognitive assessments, and conducting behavior observations. Regarding treatment, consideration is given to behavioral management, school-based interventions, social skills development, and the use of medications. Throughout, we note the quality of evidence that supports a particular component of assessment or treatment, highlighting when evidence is most relevant to those with co-occurring autism and ADHD across stages of development. In light of the current evidence for assessment and treatment of co-occurring autism and ADHD, we conclude by outlining practical implications for clinical and educational practice.

Association Between High-Need Education-Based Funding and School Suspension Rates for Autistic Students in New Zealand

IMPORTANCE

Autistic students often experience poor educational outcomes that have implications for later life, including unemployment, interactions with the criminal justice system, increased risk for substance abuse, and low socioeconomic status. Improving educational outcomes is critical for ensuring that autistic young people can reach their potential.

OBJECTIVE

To quantify differences in suspension rates between autistic and nonautistic students and to assess whether high-need education-based funding for autistic students is associated with reduced rates of school suspension.

DESIGN, SETTING, AND PARTICIPANTS

This national cohort study used linked health and education data from New Zealand's Integrated Data Infrastructure. Data were obtained for students aged 5 to 16 years from January 1 to December 31, 2018, and analyzed July 7, 2021, to January 1, 2022. A novel case identification method was used to identify autistic students.

EXPOSURES

High-need education-based funding (Ongoing Resourcing Scheme [ORS]) obtained before 2019.

MAIN OUTCOMES AND MEASURES

Rates of suspension from school. Crude and adjusted analyses of the association between suspension rates and autism among the full population with adjustment made for sociodemographic characteristics (sex, age, ethnicity, deprivation, and urban or rural profile of residence) were conducted using complete-case, 2-level random intercept logistic multivariable regressions. To assess the association between ORS funding and suspension, analysis was restricted to autistic students.

RESULTS

Of the 736 911 students in the study population, 9741 (1.3%) were identified as autistic (median [SD] age, 10 [3.2] years; 7710 [79.1%] boys), and 727 170 (98.7%) as nonautistic (median [SD] age, 10 [3.4] years; 369 777 [50.9%] boys). School suspension was experienced by 504 autistic students (5.2%) and 13 845 nonautistic students (1.9%). After adjustment for demographic characteristics, autistic students had significantly higher odds of suspension than their nonautistic peers (adjusted odds ratio, 2.81; 95% CI, 2.55-3.11). Of the 9741 autistic students, 2895 (29.7%) received high-need education-based (ORS) funding. Suspensions were experienced by 57 autistic students (2.0%) with high-need funding and 447 autistic students (6.5%) without high-need funding. After adjustment for demographic characteristics, co-occurring conditions, and level of disability support need, autistic students with high-need funding had significantly lower odds of suspension than autistic students without high-need funding (adjusted odds ratio, 0.29; 95% CI, 0.21-0.40).

CONCLUSIONS AND RELEVANCE

In this cohort study, the findings of disparities in suspension rates between autistic and nonautistic students underscore the challenges faced in providing inclusive education for all young people, regardless of disability status. This study found that high-need funding was associated with reduced suspension rates among autistic students, suggesting that if appropriate supports are afforded to autistic students, a more inclusive education can be provided.

Evaluating the effectiveness of a reverse inclusion Social Skills intervention for children on the Autism Spectrum

Schools need effective, generalizable, and socially valid social skills interventions to better support the social inclusion and peer relationships of their students on the autism spectrum. We evaluated a Pivotal Response Treatment-based, naturalistic social skills intervention implemented daily by school personnel in reverse inclusion school settings with four students on the autism spectrum (K-2nd grade). Using a single-case experimental design, results indicated that the students on the autism spectrum showed increases in the percent of time engaged in cooperative play with peers during the intervention (p = .0026) and moderate changes in social interactions were determined through systematic visual analysis. However, these changes in social behaviors did not generalize to natural inclusive school settings.

Social Deficits or Interactional Differences? Interrogating Perspectives on Social Functioning in Autism

Social dysfunction is a key characteristic of autism. Determining and treating autism-related social deficits have been challenging. The medical model views interpersonal difficulties in autism as a localized set of deficits to be managed, whereas the neurodiversity movement calls for the accommodation of differences by the larger community. One common assumption underlying these perspectives is a misalignment in social behaviors between autistic individuals and neurotypicals. This paper reviews and interrogates current perspectives on social functioning in autism to uncover the intricacies of such a notion. Even though extant literature has alluded to a misalignment in social behaviors between autistic and neurotypical individuals, it is uncertain where this disparity lies. Implications for future research and practice are discussed.

The current practices of Australian speech-language pathologists in providing communication services to children with autism spectrum disorder

PURPOSE

Evidence-Based Practice (EBP) is fundamental to speech-language pathology practice. Australian speech-language pathologists (SLPs) who treat communication disorders in children with autism spectrum disorder (ASD) face unique challenges in implementing EBP. Challenges may include selecting an intervention from a myriad of available interventions for use within a complex population. Identification of current practices of Australian SLPs in communication service provision to children with ASD will provide a baseline for use of EBP and may guide future efforts to engage in EBP.

METHOD

A total of 109 Australian SLPs who provide communication services to children with ASD completed an online survey. Descriptive and inferential statistics were used to analyse service delivery and participant experiences of EBP.

RESULT

The most common barrier to delivering EBP was inadequate resources. The most utilised strategy was discussing evidence with colleagues. Most participants reported using therapies which did not adhere to a standard protocol, such as eclectic approaches. The majority also reported use of outcome measures which they believe adequately represent functional communication changes for their client.

CONCLUSION

Resource limitations may result in over-reliance on interventions lacking empirical support and over-reliance on subjective outcome measurement tools. Reflective practice and self-evaluation of communication services to children with ASD may support improved provision of EBP.

A Systematic Review of Play-Based Interventions Targeting the Social Communication Skills of Children with Autism Spectrum Disorder in Educational Contexts

Children with autism spectrum disorder (ASD) experience social communication difficulties which can be compounded by increased social demands and expectations of the school environment. Play offers a unique context for social communication development in educational settings. This systematic review aimed to synthesize play-based interventions for the social communication skills of children with ASD in educational contexts and identified nine studies. Overall, studies in this review provided a promising evidence base for supporting social communication skills through play in education for children with ASD. The review also highlighted gaps in research on play-based interventions for the social communication skills of children with ASD within naturalistic educational settings.

Education for students with neurodevelopmental disabilities-Resources and educational adjustments

Children with neurodevelopmental disorders are more likely to face challenges of various kinds throughout their schooling due to their vulnerability factors. Although certain evidence-based practices have been recognized to be effective in supporting academic performance or social and personal adjustment, transferring these practices to school realities remains a challenge. Indeed, the educational trend favored for more than 20 years promotes the development of all students in the most natural context possible. The objective of this chapter is to shed light on how resources and EBPs can be organized in an inclusive education context. A tiered framework, commonly adopted as different models across the world, is presented and used to demonstrate how interventions can be prioritized for the difficulties and special needs of specific (e.g., ADHD, dyslexia, and developmental coordination disorder) and complex (e.g., autism spectrum disorder) neurodevelopmental disorders. The chapter ends with a discussion of the conditions and drivers of intervention fidelity and effectiveness in an inclusive context and, more specifically, support for teachers and parents.

Classroom Teachers' Implementation of the Social Stations Intervention to Improve the Verbal Initiations and Responses of Students with Autism

Students with autism often show challenges in social communication, particularly in initiating and responding behaviors. While the classroom offers a natural context for peer interactions, few interventions are designed specifically for classroom settings. This study investigated the effects of a classroom-teacher implemented social communication intervention, known as Social Stations, on the initiating and responding behaviors of students with autism. The study was set in an inclusive primary school, with the teacher embedding the intervention into the student's daily literacy lessons. All students with autism showed significant improvements in the targeted behaviors, with improvements maintained over time. This study suggests that social communication interventions can be implemented by teachers as part of a daily classroom program.

Meeting the communication needs of students on the autism spectrum in Australian classrooms: Adjustments reported by educators and specialists

PURPOSE

The purpose of this study was to examine educators' and specialists' provision of communication adjustments for students on the autism spectrum in mainstream and supported education settings.

METHOD

Secondary analysis of data collected from educators and specialists in the Australian Autism Educational Needs Analysis was undertaken. Thematic analysis of adjustment descriptions identified 11 categories. The use of the 11 specific adjustment categories with reference to (a) participant group (educator versus specialists), and (b) setting (mainstream versus supported) were described and associations investigated using Chi-square analyses.

RESULT

Only 32% of the 381 educators and specialists reported using adjustments. Of the adjustments reported, those categorised as "Multimodal Communication", "Structured Teaching", and "Assistive Technology" were frequently included by both groups. Significant associations were apparent between groups and the use of specific adjustments including naturalistic communication strategies. Significant differences were evident in the proportion of specific adjustments used by participants in supported as opposed to mainstream settings.

CONCLUSION

Possible reasons for the differences in the adjustments reported by educators and specialists and the role that setting may play in these are discussed. These include resourcing, the choice of adjustment being driven by school setting rather than student need, and possible differences between professionals in describing the adjustments made.

Training Teachers to Implement Classroom Pivotal Response Teaching during Small-group Instruction: A Pilot Study

Background: Providing effective education to students with autism spectrum disorder (ASD) poses a significant challenge to educators. Although several evidence-based practices (EBPs) have been developed, few have been systematically implemented in educational settings. Pivotal response treatment (PRT) is a naturalistic behavioral intervention that has been adapted for implementation in the school context. Methods: This pilot study used a concurrent multiple baseline design across seven teachers and students with ASD to examine the effectiveness of teacher training in classroom pivotal response teaching (CPRT) on teacher fidelity of implementation during small-group instruction and students' communication skills and maladaptive behaviors in schools for special education in the Netherlands. Results: Results indicated no replicated effect of CPRT training on teachers' fidelity of implementation or children's communications skills and maladaptive behavior, although teachers reported high satisfaction with the CPRT training. Discussion: Implications for clinical practice and directions for future research are discussed.

The Role of Executive Functioning in Predicting Social Competence in Children with and without Autism Spectrum Disorder

All children with autism spectrum disorder (ASD) experience social difficulties but they differ with regard to the type and severity of their challenges. Potentially powerful interventions targeting social skills in children with ASD may have limited effectiveness if they are not tailored to the child's specific needs. One factor that may influence social competence is executive functioning (EF). EF may impact social competence by facilitating higher-order strategies such as emotional and cognitive regulation which are necessary for social interactions. Participants included 132 children and adolescents, aged 7-13, including 77 with ASD (M = 10.11, SD = 1.94), and 55 without ASD (M = 9.54, SD = 1.67). Caregivers completed the Behavior Rating Inventory of Executive Functioning, Version 2 (BRIEF-2) Parent Form, assessing everyday EF skills, and the Multidimensional Social Competence Scale (MSCS). Hierarchical multiple regression analyses were conducted separately for the group without ASD and the group with ASD, with MSCS entered as the dependent variables and EF indices and scales of the BRIEF-2 as the main predictor variables. EF deficits in emotional control predicted poor emotion regulation for both children with and without ASD. For the group without ASD, better emotional control and initiation skills predicted empathic concern and social knowledge, respectively. Challenges in self-monitoring significantly predicted difficulties with social inferencing and social knowledge for children with ASD. The findings highlight the importance of targeting specific EF skills that contribute to various aspects of social competence to increase the effectiveness of interventions for children with ASD. Autism Res 2020, 13: 1856-1866. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: We examined whether parents' ratings of their children's higher-order thinking skills (e.g., paying attention, organizing and planning, initiating tasks, regulating emotions, self-monitoring) predicted social competence among children with and without autism spectrum disorder (ASD). For children without ASD, emotional control and initiation skills were strongly linked to their displays of empathy and social knowledge, respectively. For children with ASD, their abilities to be aware of their own behaviors and its impact on others were strongly related to their ability to interpret social cues and their social knowledge. For both groups, the ability to regulate their emotions were important predictors of their ability to modulate their emotions in social contexts.

Theory of mind goes to school: Does educational environment influence the development of theory of mind in middle childhood?

Previous research has shown that the development of theory of mind (ToM) depends on various individual and social factors, but very little research has examined the role of the natural educational environment in the development of ToM in middle childhood. In accordance with the importance of social factors in development, in this longitudinal study of 156 typically developing children, we investigated whether educational setting-classes containing children with disabilities (inclusive) or without such children (general education)-is associated with enhanced ToM development. ToM was measured with the ToM Scale, the Chocolate task and the Faux Pas Recognition Test. Analysis showed that ToM development was better among children educated in inclusive classes than among those educated in traditional classes. The results have implications for ToM development among children with and without disabilities as well as for educational practice.

Moderators of School Intervention Outcomes for Children with Autism Spectrum Disorder

A prior cluster randomized controlled trial (RCT) compared outcomes for a comprehensive school intervention (schoolMAX) to typical educational programming (services-as-usual [SAU]) for 103 children with autism spectrum disorder (ASD) without intellectual disability. The schoolMAX intervention was superior to SAU in improving social-cognitive understanding (emotion-recognition), social/social-communication skills, and ASD-related impairment (symptoms). In the current study, a range of demographic, clinical, and school variables were tested as potential moderators of treatment outcomes from the prior RCT. Moderation effects were not evident in demographics, child IQ, language, or ASD diagnostic symptoms, or school SES. Baseline externalizing symptoms moderated the outcome of social-cognitive understanding and adaptive skills moderated the outcome of ASD-related symptoms (no other comorbid symptoms or adaptive skills ratings moderated outcomes on the three measures). Overall, findings suggest that the main effects of treatment were, with two exceptions, unaffected by third variables.

Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism

Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.

Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit

Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.

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.

Thinning Schedules of Reinforcement Following Functional Communication Training for Children with Intellectual and Developmental Disabilities: A Meta-analytic Review

Functional communication training (FCT) is an evidence-based practice used to mitigate challenging behavior by increasing functional communication skills. To increase the practicality and feasibility of FCT in natural settings, thinning schedules of reinforcement are typically programmed following FCT. In this review, we meta-analyzed 28 studies that incorporated a thinning schedule procedure following FCT for 51 children with intellectual and developmental disabilities ages 8 and younger. Using Tau-U, the results demonstrated overall moderate effect sizes for both challenging behavior and functional communication responses. Additionally, moderator analyses pertaining to participant characteristics, interventions, and study quality were conducted. Thinning procedures were most effective for children who had stronger communication repertoire. Implications for future research and practice are discussed.

Special Education Service Use by Children with Autism Spectrum Disorder

In the last decade, the prevalence of children with autism spectrum disorder (ASD) without intellectual disability (ID) in schools has increased. However, there is a paucity of information on special education placement, service use, and relationships between service use and demographic variables for children with ASD without ID. This study aimed to describe and explore variation in type and amount of special education services provided to (N = 89) children with ASD. Results indicated that the largest percentage of children received services under the Autism classification (56.2%) and were in partial-inclusion settings (40.4%). The main services received were speech (70.8%) and occupational (56.2%) therapies, while few children received behavior plans (15.7%) or social skills instruction (16.9%). Correlates with service use are described.

Theory of mind development in school environment: A case of children with mild intellectual disability learning in inclusive and special education classrooms

BACKGROUND

This longitudinal study examines the extent to which a school classroom (inclusive vs. special education) is meaningful for theory of mind (ToM) development among children with mild intellectual disability.

MATERIALS AND METHODS

The participant group consisted of 166 primary school-aged children (M = 8.1, SD = 0.99), 79 of whom attended inclusive classrooms; the remaining 87 were in special education classrooms.

RESULTS

Although all children developed ToM over time, children's learning of ToM in inclusive classrooms was significantly greater than that seen in special classrooms. The difference remained significant after controlling for age. The present authors have compared children's individual and family characteristics, but there were almost no differences between groups.

CONCLUSIONS

The present authors discuss the results in the light of their importance for children's cognitive and social development. The implications for children's education are also considered.

The Effects of Social Skills Interventions for Students With EBD and ASD: A Single-Case Meta-Analysis

Social skills interventions are critical for promoting social, emotional, and behavioral competence for students with or at risk of emotional and behavioral disorders (EBD) and autism spectrum disorders (ASD). This single-case meta-analysis examined the effects of social skills interventions (SSIs) for students with EBD and ASD. Effect sizes were calculated for 78 cases across 25 included studies using a nonparametric effect size, Baseline Corrected Tau. The overall weighted mean effect size of 0.54 suggested a moderate effect across the 25 studies. The overall weighted mean effects for studies reporting maintenance and generalization data were 0.68 and 0.37, respectively. Potential moderators examined (disability, intervention design, intervention delivery, methodological quality) were not significant. As such, they did not moderate the outcomes for participants. We conducted a post hoc analysis and hypothesized that between-study differences may be more meaningful than the similarities shared by participants in the same moderator groups. Implications are discussed on using SSIs to address the social, emotional, and behavioral challenges of students with or at risk of EBD and ASD.

Parent Support of Preschool Peer Relationships in Younger Siblings of Children with Autism Spectrum Disorder

Preschool-aged siblings of children with ASD are at high-risk (HR) for ASD and related challenges, but little is known about their emerging peer competence and friendships. Parents are the main providers of peer-relationship opportunities during preschool. Understanding parental challenges supporting early peer relationships is needed for optimal peer competence and friendships in children with ASD. We describe differences in peer relationships among three groups of preschool-aged children (15 HR-ASD, 53 HR-NonASD, 40 low-risk, LR), and examine parent support activities at home and arranging community-based peer activities. Children with ASD demonstrated precursors to poor peer competence and friendship outcomes. Parents in the HR group showed resilience in many areas, but providing peer opportunities for preschool-age children with ASD demanded significant adaptations.

Comparison of visual analysis, non-overlap methods, and effect sizes in the evaluation of parent implemented functional assessment based interventions

We used an existing body of research (i.e., parent implemented functional-assessment based interventions) to examine visual analysis features and processes and evaluate the reliability of two frequently used non-overlap indices (NAP & Tau-U) and a novel effect size index-the between-case standardized mean difference (BC-SMD). Results indicated that visual analysis terms and procedures were inconsistently used across studies. Further, there was limited agreement between the non-overlap indices and independent visual analysis. Results regarding the BC-SMD were inconclusive given only 5 of the 15 studies were eligible for analyses for different dependent variables. Our results suggest that visual analysis standards are needed by which single case researchers analyze and report their results. Further, additional research is needed refining SCR effect sizes, which can be used to describe the magnitude of change within and across SCR studies with functional relations.

The Interrelationship Between Motor Coordination and Adaptive Behavior in Children With Autism Spectrum Disorder

Objective: Children with autism spectrum disorder (ASD) experience significant challenges with their motor coordination. It is not, however, well understood how motor coordination may impact the behavioral functioning of children with ASD. Therefore the purpose of this study was to explore the relationships between motor coordination and adaptive behavior in 7-12-year-old children with ASD. Methods: Motor coordination was assessed using the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and adaptive behavior was assessed by parental report using the Vineland Adaptive Behavior Scales, 2nd Edition (VABS-2) as part of a larger cross-sectional study. Descriptive characteristics were calculated for MABC-2 and VABS-2 scores and Spearman's rank order correlation analyses were used to examine the relationship between motor coordination and adaptive behavior. Results: On average, the participants (n = 26) exhibited significant challenges in regard to their motor coordination with all but two participants classified as having significant motor impairments by scoring at or below the 16th percentile on the MABC-2. Results from the correlation analyses indicated that manual dexterity was positively related to daily living skills (ρ = 0.58, p < 0.003), and overall motor coordination was positively related to daily living skills (ρ = 0.60, p < 0.003) and overall adaptive behavior (ρ = 0.57, p < 0.003). In all instances, better motor coordination was related to more adaptive behaviors. Conclusion: These results highlight the profound motor coordination challenges that children with ASD experience and also suggest that these challenges, particularly with manual dexterity, are related to the daily behavior of children with ASD. The interrelatedness of motor and adaptive behavior suggests the need to further explore the impact of motor-based interventions for this population, as well as conduct longitudinal studies to disentangle these relationships.

Meta-analysis of Tablet-Mediated Interventions for Teaching Academic Skills to Individuals with Autism

Portable touch-screen devices have been the focus of a notable amount of intervention research involving individuals with autism. Additionally, popular media has widely circulated claims that such devices and academic software applications offer tremendous educational benefits. A systematic search identified 19 studies that targeted academic skills for individuals with autism. Most studies used the device's built-in video recording or camera function to create customized teaching materials, rather than commercially-available applications. Analysis of potential moderating variables indicated that participants' age and functioning level did not influence outcomes. However, participant operation of the device, as opposed to operation by an instructor, produced significantly larger effect size estimates. Results are discussed in terms of recommendations for practitioners and future research.

The effect of caregiver-delivered social-communication interventions on skill generalization and maintenance in ASD

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.

A systematic review of school-based interventions targeting social communication behaviors for students with autism

Initiating and responding to peers are social communication behaviors which are challenging for students with autism. We reviewed intervention studies set in mainstream elementary schools, which targeted these behaviors and reported on intervention outcomes as well as the resources required for their implementation. A total of 22 studies met the criteria for inclusion. Findings suggest that school-based interventions can increase the frequency and duration of initiating and responding behaviors in elementary school aged students with autism. These interventions were resource-intensive and usually delivered by researchers or teaching assistants away from the classroom. Future research should build on this emerging evidence base to consider interventions which could be implemented by classroom teachers as part of the classroom program.

Autism Spectrum Disorder in Fragile X Syndrome: Cooccurring Conditions and Current Treatment

BACKGROUND AND OBJECTIVE

Individuals with fragile X syndrome (FXS) are frequently codiagnosed with autism spectrum disorder (ASD). Most of our current knowledge about ASD in FXS comes from family surveys and small studies. The objective of this study was to examine the impact of the ASD diagnosis in a large clinic-based FXS population to better inform the care of people with FXS.

METHODS

The study employed a data set populated by data from individuals with FXS seen at specialty clinics across the country. The data were collected by clinicians at the patient visit and by parent report for nonclinical and behavioral outcomes from September 7, 2012 through August 31, 2014. Data analyses were performed by using χ² tests for association, t tests, and multiple logistic regression to examine the association between clinical and other factors with ASD status.

RESULTS

Half of the males and nearly 20% of females met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for current ASD. Relative to the FXS-only group, the FXS with ASD (FXS+ASD) group had a higher prevalence of seizures (20.7% vs 7.6%, P < .001), persistence of sleep problems later in childhood, increased behavior problems, especially aggressive/disruptive behavior, and higher use of α-agonists and antipsychotics. Behavioral services, including applied behavior analysis, appeared to be underused in children with FXS+ASD (only 26% and 16% in prekindergarten and school-age periods, respectively) relative to other populations with idiopathic ASD.

CONCLUSIONS

These findings confirm among individuals with FXS an association of an ASD diagnosis with important cooccurring conditions and identify gaps between expected and observed treatments among individuals with FXS+ASD.

Executive Function, Social Emotional Learning, and Social Competence in School-Aged Boys With Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is an aetiologically complex neurodevelopmental disorder characterized by deficits in social functioning. Children with ASD display a wide range of social competence and more variability in social domains as compared with either communication or repetitive behaviour domains. There is limited understanding of factors that contribute to the heterogeneity of social abilities in ASD. A modified version of McKown and colleagues’ social competence model was used to examine social competence in 49 8- to 13-year-old boys with ASD without cognitive disability. The relations between executive function (EF), social emotional learning (SEL), and parent reports of child social competence were examined. Results showed that EF but not SEL predicted parent-reported child social competence. Although many interventions target SEL skills, these findings support specifically targeting EF in both assessment and interventions of school-aged children with ASD.

Peer-Mediated Intervention for the Development of Social Interaction Skills in High-Functioning Autism Spectrum Disorder: A Pilot Study

Autism Spectrum Disorder (ASD) is characterized by difficulties with social interaction and communication, which manifest at school especially in less structured situations such as recess. Recess provides opportunities for relationship with peers in a natural context, for which students with ASD may not be equipped with the necessary skills to use without support. Using a single-case design, we evaluated an intervention applied in recess to improve the social interaction skills of a student with high-functioning ASD mediated by his peers without ASD, in second grade of elementary school. This intervention includes different strategies to initiate the peers without ASD, using direct instruction, modeling, and social reinforcement carried out in the recess setting. After 14 sessions, changes were observed in the rates of initiating and responding to interactions, and a negative trend in the percentage of time that the student maintained low-intensity interactions or was alone. Teachers and family perceived improvements in social skills, more peer acceptance, and increase in the frequency and duration of social interactions. This intervention can help teachers to apply research-based practices to improve some social interaction skills in high-functioning students with autism in inclusive school environments.

Practitioner Review: School-based interventions in child mental health

BACKGROUND

School-based interventions (SBIs) are well-established and effective treatments for improving child mental health. Specific school-based topics include prevention (Tier I-III) and interventions (e.g. cognitive-behavioural programmes and daily report cards).

METHODS

We performed a systematic literature search in five commonly used online databases (ERIC, MEDLINE, PsycARTICLES, PsycINFO and PSYNDEX) for English-language articles published between 1993 and 2015. Additional sources included reference lists of relevant articles and book chapters.

RESULTS

We identified a number of successful behavioural or cognitive-behavioural programmes yielding moderate to strong effects for a range of emotional and behavioural problems. The implementation of these programmes and the collaboration of the involved settings (school and home) and persons are important factors for their effectiveness under real-life conditions.

CONCLUSIONS

Effective SBIs are valuable tools for students with mental health problems if evidence-based cognitive-behavioural interventions are applied and rules of translational algorithms and implementation science are respected.