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Waddington H, Jordan P, Hammond M, Tupou J, Patrick L, Macaskill E, Davies G, Pillar S, van der Meer L, Whitehouse AJO. Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 51:101173. [PMID: 39253066 PMCID: PMC11381806 DOI: 10.1016/j.lanwpc.2024.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/11/2024]
Abstract
Background Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children. Methods This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2-3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1-4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529. Findings From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, ηp 2 = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support. Interpretation A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited. Funding Emerging Researcher First Grant from the Health Research Council of New Zealand.
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Affiliation(s)
- Hannah Waddington
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Phoebe Jordan
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Matthew Hammond
- School of Psychology, Faculty of Science, Victoria University of Wellington, Wellington, New Zealand
| | - Jessica Tupou
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | | | - Ella Macaskill
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Georgia Davies
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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2
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Hou Y, Song Z, Deng J, Song X. The impact of exercise intervention on social interaction in children with autism: a network meta-analysis. Front Public Health 2024; 12:1399642. [PMID: 39206007 PMCID: PMC11349572 DOI: 10.3389/fpubh.2024.1399642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Background Extensive research has documented the positive impacts of physical activity on children and adolescents with Autism Spectrum Disorders (ASD). However, the specific benefits of various sports on the social functioning of children with ASD remain ambiguous. This study aims to employ a network meta-analysis to investigate the effects of different sports on the social functioning of children and adolescents with ASD and to establish a ranking of their effectiveness. Methods This study conducted a comprehensive online search across Web of Science, PubMed, Cochrane, and Embase databases for randomized controlled trials and quasi-experimental studies focusing on social functioning outcomes. Data were synthesized using a Bayesian framework. Results Sixteen relevant studies encompassing 560 participants were included. According to Cohen's classification, mini-basketball (SMD = 0.84, 95% CI: 0.46, 1.20), SPARK (SMD = 0.88, 95% CI: 0.06, 1.70), and Karate (SMD = 1.10, 95% CI: 0.27, 2.00) demonstrated high effect sizes, with Karate identified as the most effective intervention. Conversely, Combined Exercise and Nei Yang Gong interventions exhibited the least significant effects, falling below small effect sizes. Conclusion Physical activity interventions have been shown to enhance social functioning in children and adolescents with ASD to varying extents, with Karate emerging as the most efficacious.
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Affiliation(s)
| | | | | | - Xiangqin Song
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
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3
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Minjarez MB, Gengoux GW, Paszek K, Liang JA, Ardel CM, Hardan AY, Frazier T. Adherence and Opportunity Frequency as Predictors of Communication Outcomes from Pivotal Response Parent Training. J Autism Dev Disord 2024:10.1007/s10803-024-06447-7. [PMID: 38976103 DOI: 10.1007/s10803-024-06447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Access to intervention is a barrier for children with autism. As parent-mediated interventions have emerged to address this need, understanding implementation components contributing to child gains is critically important. Existing literature documents relationships between parent treatment adherence and child progress; however, less is understood about components, such as frequency of learning opportunities, which could also affect child outcomes. METHODS This study is a secondary analysis of data from a randomized controlled trial evaluating Pivotal Response Treatment group parent training (PRTG) compared to psychoeducation. Linear regression and mediational models were employed to identify potential predictors and mediators of outcome. RESULTS PRTG produced large increases in adherence and learning opportunities. In general, greater frequency of learning opportunities and adherence predicted better child outcomes. The best-fitting cross-sectional mediational models indicated at least partial mediational effects, whereby increased learning opportunities mediated the relationship between greater adherence and improved child outcomes. CONCLUSIONS This study provides preliminary evidence of how early gains in adherence may support parents to provide more frequent learning opportunities, which, in turn, yield positive effects on child social communication. Future large-scale research, with greater granularity of measurement, is needed to further understand the temporal relationships between these variables.
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Affiliation(s)
| | - Grace W Gengoux
- Stanford University School of Medicine, Stanford, United States.
- Department of Psychiatry & Behavioral Sciences, Division of Child & Adolescent Psychiatry, 401 Quarry Road, Stanford, CA, 94305-5719, USA.
| | | | | | | | | | - Thomas Frazier
- John Carroll University and SUNY Upstate Medical University, OH, United States
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4
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Swain D, Li Y, Brown HR, Petkova E, Lord C, Rogers SJ, Estes A, Kasari C, Kim SH. Implementing a Uniform Outcome Measurement Approach for Early Interventions of Autism Spectrum Disorders. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00351-4. [PMID: 38964630 DOI: 10.1016/j.jaac.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/22/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Naturalistic developmental behavioral interventions for children with autism spectrum disorder show evidence for effectiveness for specific social communication targets such as joint attention or engagement. However, combining evidence from different studies and comparing intervention effects across those studies have not been feasible due to lack of a standardized outcome measure of broader social communication skills that can be applied uniformly across trials. This investigation examined the usefulness of the Brief Observation of Social Communication Change (BOSCC) as a common outcome measure of general social communication skills based on secondary analyses of data obtained from previously conducted randomized controlled trials of 3 intervention models, Early Social Intervention (ESI), Early Start Denver Model (ESDM) and Joint Attention Symbolic Play Engagement and Regulation (JASPER). METHOD The subset of datasets from the 3 randomized controlled trials was created to examine differences in the BOSCC scores between intervention and control groups over the course of the interventions. RESULTS Based on 582 videos from 207 caregiver-child dyads, the BOSCC noted significant differences between intervention vs control groups in broad social communication skills within 2 of the 3 intervention models, which were longer in duration and focused on a broad range of developmental skills. CONCLUSION The BOSCC offers the potential to take a uniform measurement approach across different intervention models to capture the effect of intervention on general social communication skills but may not pick up the effects of some brief interventions targeting proximal outcomes. CLINICAL TRIAL REGISTRATION INFORMATION Comparing Parent-Implemented Interventions for Toddlers With Autism Spectrum Disorders; https://www. CLINICALTRIALS gov/; NCT00760812. Intensive Intervention for Toddlers With Autism (EARLY STEPS); https://www. CLINICALTRIALS gov/; NCT00698997. Social and Communication Outcomes for Young Children With Autism; https://www. CLINICALTRIALS gov/; NCT00953095.
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Affiliation(s)
| | - Yi Li
- New York University Langone Health, New York, New York
| | | | - Eva Petkova
- New York University Langone Health, New York, New York
| | - Catherine Lord
- University of California Los Angeles, Los Angeles, California
| | - Sally J Rogers
- University of California Davis Medical Center, Sacramento, California
| | | | - Connie Kasari
- University of California Los Angeles, Los Angeles, California
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5
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Shire S. The devil is in the details: Advancing our collective understanding of naturalistic developmental behavioral interventions. Autism Res 2024; 17:10-16. [PMID: 37943121 DOI: 10.1002/aur.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
Given the growing body of randomized trials examining various Naturalistic Developmental Behavioral Intervention (NDBI) approaches, a dialog has emerged exploring the overlap in strategies across NDBIs to create single measures that propose to capture core strategies across the interventions. This commentary will ask readers to consider the current state of the science, the potential value of looking not only for similarities but also for differences across approaches, and present five scientific next steps to advance our collective understanding of the NDBIs including: (a) operationalizing intervention strategies and outcomes, (b) expansion of the effectiveness evidence base and begin testing implementation strategies for individual NDBIs, (c) rigorous testing of core intervention components and the mechanism of each intervention, (d) personalization, and (e) supporting transparency with a priori trial registration.
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Affiliation(s)
- Stephanie Shire
- Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, Oregon, USA
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6
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D’Agostino SR, Dueñas AD, Bravo A, Tyson K, Straiton D, Salvatore GL, Pacia C, Pellecchia M. Toward deeper understanding and wide-scale implementation of naturalistic developmental behavioral interventions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:253-258. [PMID: 36056601 PMCID: PMC9797432 DOI: 10.1177/13623613221121427] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Naturalistic Developmental Behavioral Interventions (NDBIs) are a group of early interventions that use a variety of strategies from applied behavioral and developmental sciences. Although Naturalistic Developmental Behavioral Interventions have been demonstrated effective, Naturalistic Developmental Behavioral Interventions are not implemented on a wide scale within early intervention programs for children on the autism spectrum. Potential reasons likely stem from differing theoretical orientations of developmental and behavioral sciences and practitioners' lack training, knowledge, and support for implementing Naturalistic Developmental Behavioral Interventions. In support of efforts to promote wide-scale implementation of Naturalistic Developmental Behavioral Interventions, we (1) clarify their common features, (2) discuss possible misconceptions, and (3) offer reasons why Naturalistic Developmental Behavioral Interventions should be widely implemented. We also provide recommendations to the autism service community, intervention developers, and researchers.
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Balancing Fidelity and Flexibility: Usual Care for Young Children With an Increased Likelihood of Having Autism Spectrum Disorder Within an Early Intervention System. J Autism Dev Disord 2023; 53:656-668. [PMID: 33484371 PMCID: PMC7825383 DOI: 10.1007/s10803-021-04882-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 02/07/2023]
Abstract
Naturalistic developmental behavioral interventions (NDBIs) are evidence-based interventions for young children with autism spectrum disorder. There has been growing interest in implementing manualized NDBIs within the early intervention (EI) system without a clear understanding of how these programs and the broader strategies encompassed within them are already used by EI providers. This study examined the use of manualized NDBI programs and broader NDBI strategies within an EI system and factors that impacted their use. Eighty-eight EI providers completed a measure of NDBI program and strategy use. Thirty-three providers participated in a supplemental focus group or interview. Overall, providers described using broader NDBI strategies and the need to adapt manualized NDBI programs. Provider-, intervention-, and organization-level factors impacted their use of NDBI programs and strategies.
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8
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Weitlauf AS, Broderick N, Alacia Stainbrook J, Slaughter JC, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dorris K, Garrett LJ, Hopton M, Kinsman A, Morton M, Vogel A, Dykens EM, Pablo Juárez A, Warren ZE. A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes. J Autism Dev Disord 2022; 52:5403-5413. [PMID: 35040001 PMCID: PMC9289080 DOI: 10.1007/s10803-021-05399-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Neill Broderick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy G Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madeline Santulli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Dorris
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michelle Hopton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Kinsman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Morton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley Vogel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Dykens
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - A Pablo Juárez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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9
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Yamane N, Snow AD, Fein D, Naigles L, Goldman S. Brief report: Parent-guided movements during play with children with autism spectrum disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 94:101968. [PMID: 36329719 PMCID: PMC9629284 DOI: 10.1016/j.rasd.2022.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Children with autism spectrum disorder (ASD) demonstrate social and communication impairments from an early age. While researchers have long investigated parenting behaviors in relation to children's social and communication development, fewer studies have examined the relevance of movement-based parenting behaviors to facilitating communication and social engagement with young children. The present study aimed to investigate: (1) parent-guided movements (PGMs) within dyads of parents and typically developing (TD) children and children with ASD; and (2) children's ASD diagnostic and receptive language scores as predictors of PGM frequency. Method Video-recorded play interactions of 33 TD dyads (mean age: 20.4 months) and 31 dyads with ASD (mean age: 32.6 months) were matched on child's expressive language. Data were obtained from a longitudinal study on developmental language trajectories in ASD and coded for PGMs. Results Overall, parents of children with ASD initiated PGMs more frequently than parents of TD children during play (U = 269.00, z = - 3.58, p < 0.001). PGM frequency was predicted by children's ADOS scores (X 2 = 5.46, p = 0.02, OR = 1.26, 95% CI [1.04, 1.54]) and receptive language (X 2 = 4.15, p = 0.04, OR = 5.43, 95% CI [1.10, 27.67]). Conclusions Findings suggest that parents of children with ASD and low receptive language may utilize more movement-based strategies to compensate for their children's impaired social engagement and verbal comprehension. This study offers insight on a particular movement-based modality characterizing ASD dyads that can be used as a measure in parent-mediated interventions.
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Affiliation(s)
- Natasha Yamane
- Columbia University Irving Medical Center, Department of Neurology, G.H. Sergievsky Center, New York, NY, USA
| | - Arielle D. Snow
- Columbia University Irving Medical Center, Department of Neurology, G.H. Sergievsky Center, New York, NY, USA
| | - Deborah Fein
- University of Connecticut, Department of Psychological Sciences, Storrs, CT, USA
| | - Letitia Naigles
- University of Connecticut, Department of Psychological Sciences, Storrs, CT, USA
| | - Sylvie Goldman
- Columbia University Irving Medical Center, Department of Neurology, Divisions of Child Neurology and Cognitive Neuroscience, New York, NY, USA
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10
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Clark-Whitney E, Klein CB, Hadley PA, Lord C, Kim SH. Caregiver Language Input Supports Sentence Diversity in Young Children With Autism Spectrum Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1465-1477. [PMID: 35230878 PMCID: PMC9499362 DOI: 10.1044/2021_jslhr-21-00458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/21/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Sentence diversity is a measure of early language development that has yet to be applied to individuals with autism spectrum disorder (ASD). The primary aim of this study was to identify whether children with ASD show change in sentence diversity over 6 months of treatment with Naturalistic Developmental Behavioral Intervention (NDBI). The secondary aim was to examine possible predictors of changes in children's sentence diversity, including caregiver use of NDBI strategies, naturally occurring instances of caregiver Toy Talk, and child characteristics. METHOD Fifty children with ASD (ages 2-4 years) and their caregivers, who were receiving NDBI, engaged in two 10-min video-recorded play interactions, 6 months apart. Child speech was transcribed and coded for sentence diversity. Caregiver input was transcribed and coded for naturally occurring Toy Talk. Zero-inflated negative binomial mixed models were used to explore predictors of change in child sentence diversity. RESULTS Children's sentence diversity improved over time. Changes in caregiver NDBI strategy use and caregiver baseline Toy Talk were significant predictors of changes in sentence diversity, as were baseline age, nonverbal ratio IQ, and child sex. Additionally, a significant interaction of caregiver baseline Toy Talk and change in caregiver NDBI strategies emerged; the effect of caregiver baseline Toy Talk on children's sentence diversity change was stronger when NDBI strategy use improved. CONCLUSIONS Sentence diversity is a developmentally sensitive measure of language development in ASD. NDBI strategies that facilitate reciprocal social communication, combined with input composed of declarative sentences with noun or third-person pronoun subjects, may provide optimal support for children's sentence development.
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Affiliation(s)
- Elysha Clark-Whitney
- Center for Autism and the Developing Brain, Weill Cornell Medicine, New York, NY
| | - Claire Brito Klein
- Center for Autism and the Developing Brain, Weill Cornell Medicine, New York, NY
| | | | - Catherine Lord
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Weill Cornell Medicine, New York, NY
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11
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Davis PH, Elsayed H, Crais ER, Watson LR, Grzadzinski R. Caregiver responsiveness as a mechanism to improve social communication in toddlers: Secondary analysis of a randomized controlled trial. Autism Res 2022; 15:366-378. [PMID: 34799999 PMCID: PMC8821206 DOI: 10.1002/aur.2640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.
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Affiliation(s)
- Paige Huguely Davis
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC
| | - Heba Elsayed
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,Phoniatrics unit, ENT Department, Faculty of Medicine, Alexandria University, Egypt
| | - Elizabeth R. Crais
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Linda R. Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Rebecca Grzadzinski
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC
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12
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 284] [Impact Index Per Article: 142.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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13
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Sone BJ, Kaat AJ, Roberts MY. Measuring parent strategy use in early intervention: Reliability and validity of the Naturalistic Developmental Behavioral Intervention Fidelity Rating Scale across strategy types. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2101-2111. [PMID: 34030519 DOI: 10.1177/13623613211015003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Children with autism spectrum disorder benefit from early intervention to improve social communication, and parent-implemented interventions are a feasible and family-centered way to increase the amount of treatment they receive. For these treatments to be effective, it is important for the parent to implement the strategies as intended. However, measurement of parent strategy use is inconsistent across studies of parent-implemented interventions. This study evaluates the quality of the NDBI-Fi, an efficient measure, compared to a more time-consuming measure that is known to be precise. Videos of parents playing with their children were used to compare these two measurement methods. Results demonstrated that the NDBI-Fi was of good quality: scorers had high levels of agreement, the NDBI-Fi was similar to the more precise measure in rating parents after intervention, it detected changes from before to after intervention, and it detected differences when parents learned different types of intervention strategies. The NDBI-Fi was not as precise as the other measure across all strategies before parents learned intervention. Taken together, the findings of this study support the use of the NDBI-Fi as a high-quality outcome measure.
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14
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Klein CB, Swain DM, Vibert B, Clark-Whitney E, Lemelman AR, Giordano JA, Winter J, Kim SH. Implementation of Video Feedback Within a Community Based Naturalistic Developmental Behavioral Intervention Program for Toddlers With ASD: Pilot Study. Front Psychiatry 2021; 12:763367. [PMID: 34925094 PMCID: PMC8674462 DOI: 10.3389/fpsyt.2021.763367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
Video feedback (VF) is an intervention delivery technique that complements naturalistic developmental behavioral interventions (NDBI) and parent-mediated interventions (PMI) by using caregiver-child interaction videos reviewed with a clinician to facilitate behavioral change in caregivers. Although VF has been implemented in PMI with young children with ASD, examinations of feasibility and acceptability, as well as the potential effectiveness of VF in community settings, have been limited. In this pilot randomized control trial (NCT03397719; https://clinicaltrials.gov/ct2/show/NCT03397719), families were randomized into a state-funded Early Intervention (EI) NDBI program or the NDBI program augmented with VF. Results demonstrated high levels of implementation and acceptability of VF augmenting the community-based EI program in caregivers and clinicians. Both groups showed significant improvements after 6 months in social communication symptoms and some areas of developmental and adaptive skills. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03397719, identifier: NCT03397719.
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Affiliation(s)
- Claire B Klein
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY, United States
| | - Deanna M Swain
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY, United States
| | - Bethany Vibert
- Autism Center, Child Mind Institute, New York, NY, United States
| | - Elysha Clark-Whitney
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY, United States
| | - Amy R Lemelman
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY, United States.,NewYork-Presbyterian Hospital, White Plains, NY, United States
| | | | - Jamie Winter
- NewYork-Presbyterian Hospital, White Plains, NY, United States
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY, United States
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15
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Aithal S, Karkou V, Kuppusamy G. Resilience enhancement in parents of children with an autism spectrum disorder through dance movement psychotherapy. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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16
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Vibert BA, Dufek S, Klein CB, Choi YB, Winter J, Lord C, Kim SH. Quantifying Caregiver Change Across Early Autism Interventions Using the Measure of NDBI Strategy Implementation: Caregiver Change (MONSI-CC). J Autism Dev Disord 2020; 50:1364-1379. [PMID: 31925669 PMCID: PMC7103564 DOI: 10.1007/s10803-019-04342-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aimed to provide initial validity and reliability of the Measure of NDBI Strategy Implementation-Caregiver Change (MONSI-CC), a novel measure that captures changes in caregivers' implementation of NDBI strategies during early intervention. The MONSI-CC was applied to 119 observations of 43 caregiver-child dyads of preschoolers with autism spectrum disorders (ASD). The MONSI-CC showed high inter-rater and test-retest reliability and captured significant improvements in caregivers' implementation of NDBI strategies. Significant associations between improvements in caregiver NDBI implementation and improvements in the child's ASD symptoms also emerged. Our work shows promising evidence for the utility of the MONSI-CC to evaluate implementation of NDBI strategies by caregivers as a mediating and moderating factor for treatment effects on children with ASD.
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Affiliation(s)
| | - Sarah Dufek
- University of California, Davis, MIND Institute, Sacramento, CA, USA
| | - Claire B Klein
- Center for Autism and the Developing Brain, Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Rd, White Plains, NY, USA
| | - Yeo Bi Choi
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Jamie Winter
- Center for Autism and the Developing Brain, Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Rd, White Plains, NY, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Rd, White Plains, NY, USA.
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17
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Maye M, Sanchez VE, Stone-MacDonald A, Carter AS. Early Interventionists' Appraisals of Intervention Strategies for Toddlers with Autism Spectrum Disorder and Their Peers in Inclusive Childcare Classrooms. J Autism Dev Disord 2020; 50:4199-4208. [PMID: 32193762 DOI: 10.1007/s10803-020-04456-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Mounting evidence supports several naturalistic developmental behavioral interventions (NDBI) for toddlers and preschoolers within inclusive childcare centers and preschools. However, these interventions pose many barriers to community implementation. As part of a larger project to create an adapted NDBI for early educators in childcare centers, we surveyed 101 early interventionists who had worked with a toddler with autism within the last 12 months. Early interventionists rated 22-of-31 NDBI strategies to be significantly more effective for All Toddlers versus Toddlers with Autism. However, when comparing the top 10 rated strategies between groups, there was a large degree of overlap. Moreover, many of these highly rated NDBI strategies are consistent with best practice accreditation and early education standards within the United States.
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Affiliation(s)
- Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health System, 3A32, 3rd Floor, One Ford Place, Detroit, MI, 48202, USA. .,University of Massachusetts Boston, Boston, USA.
| | - Victoria E Sanchez
- Division of Developmental Medicine, Boston Children's Hospital, Boston, USA.,University of Massachusetts Boston, Boston, USA
| | - Angela Stone-MacDonald
- Department of Curriculum and Instruction, University of Massachusetts Boston, Boston, USA.,University of Massachusetts Boston, Boston, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, USA.,University of Massachusetts Boston, Boston, USA
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