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Troxel M, Kraper C, Verbalis A, Safer-Lichtenstein J, Seese S, Ratto A, Myrick Y, Armour AC, Pugliese CE, Strang JF, Ba C, Martucci J, Biel MG, Jackson V, Hardy KK, Mandell D, Goode TD, Anthony BJ, Kenworthy L, Anthony LG. Reaching "The Other Half": Teacher Referral Increases Inclusivity in Intervention Research for Neurodivergent School-Age Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-14. [PMID: 38270579 DOI: 10.1080/15374416.2024.2303723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Researchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating requirements for existing diagnoses on recruitment, sample characteristics, and intervention response. METHOD Autistic students and students with ADHD in schools serving underresourced communities were recruited for an executive functioning (EF) intervention trial over 2 years. In Year 1, school staff nominated students with previous diagnoses. In Year 2, school staff nominated students demonstrating EF challenges associated with ADHD or autism; previous diagnosis was not required. Study staff then confirmed diagnoses. RESULTS More students were included in Year 2 (N = 106) than Year 1 (N = 37). In Year 2, 96% of students referred by school staff met diagnostic criteria for ADHD or autism, 53% of whom were not previously diagnosed. Newly identified students were less likely than previously diagnosed students to be receiving services and, for those with ADHD, were more likely to speak primarily Spanish at home. Previously diagnosed and newly identified students did not differ on other demographic variables or intervention response. Caregivers of previously diagnosed students reported more symptoms than caregivers of newly identified students for both diagnostic groups. Previously diagnosed students with ADHD had more researcher-rated symptoms than newly identified students. CONCLUSIONS Recruitment for an intervention study using behavior-based referrals from school staff enhanced enrollment without compromising the sample's diagnostic integrity and engaged children who otherwise would have been excluded.
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Affiliation(s)
- Mary Troxel
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Catherine Kraper
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Jonathan Safer-Lichtenstein
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Sydney Seese
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Allison Ratto
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Yetta Myrick
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - A Chelsea Armour
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Cara E Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - John F Strang
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Caroline Ba
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Jillian Martucci
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Matthew G Biel
- Department of Psychiatry, Georgetown University Medical Center
| | - Vivian Jackson
- Center for Child and Human Development, Georgetown University
| | - Kristina K Hardy
- Center for Autism Spectrum Disorders, Children's National Hospital
- Center for Child and Human Development, Georgetown University
| | - David Mandell
- Center for Mental Health, Department of Psychiatry, University of Pennsylvania, School of Medicine
| | - Tawara D Goode
- Center for Child and Human Development, Georgetown University
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center
| | - Bruno J Anthony
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
- Department of Psychiatry, Georgetown University Medical Center
- Center for Child and Human Development, Georgetown University
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Hospital
| | - Laura Gutermuth Anthony
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital of Colorado
- Center for Autism Spectrum Disorders, Children's National Hospital
- National Center for Cultural Competence, Department of Pediatrics, Georgetown University Medical Center
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Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Roberts J, Silove N, Whitehouse A. Non-pharmacological interventions for autistic children: An umbrella review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:275-295. [PMID: 36081343 DOI: 10.1177/13623613221119368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andrew Whitehouse
- Telethon Kids Institute and The University of Western Australia, Australia
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A Systematic Review of Play-Based Interventions Targeting the Social Communication Skills of Children with Autism Spectrum Disorder in Educational Contexts. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractChildren 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.
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Waddington H, Reynolds JE, Macaskill E, Curtis S, Taylor LJ, Whitehouse AJ. The effects of JASPER intervention for children with autism spectrum disorder: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2370-2385. [PMID: 34348479 DOI: 10.1177/13623613211019162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Naturalistic developmental behavioural interventions are promising approaches for young children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation intervention (JASPER) is a well-researched naturalistic developmental behavioural intervention but, to date, no reviews have specifically evaluated its effects. This systematic literature review examined the effects of JASPER intervention and its components on child, parent and educator outcomes. Of the 96 articles screened, 19 were eligible for inclusion in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills and language skills compared to the comparison group. Implementation outcomes for parents and educators were generally positive. There were no consistent predictors or mediators of treatment effects. None of the studies met all of the quality indicators outlined by the Council of Exceptional Children, and the majority of outcome measures were classified as proximal. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.Lay abstractInterventions which are delivered in natural contexts and use both developmental and behavioural techniques may be helpful for children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation (JASPER) is a type of intervention, which falls under this category. Although several studies have examined the effects of JASPER, this has not yet been summarised in a review. This systematic literature review examined the effects of JASPER intervention, and the techniques that make up JASPER, on child, parent and educator outcomes. We screened 96 articles and, of these, 19 were included in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills, and language skills compared to children who did not receive JASPER intervention. Parents and educators were mostly able to use the JASPER techniques. There were no consistent child, parent, teacher or treatment characteristics that influenced the effects of the JASPER intervention. None of the studies met all of the indicators of being a good quality study outlined by the Council of Exceptional Children. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.
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Affiliation(s)
| | | | | | | | | | - Andrew Jo Whitehouse
- Telethon Kids Institute, Australia.,The University of Western Australia, Australia
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Tupou J, Waddington H, van der Meer L, Sigafoos J. Effects of a low-intensity Early Start Denver Model-based intervention delivered in an inclusive preschool setting. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:107-121. [PMID: 35309698 PMCID: PMC8928834 DOI: 10.1080/20473869.2019.1707434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 06/14/2023]
Abstract
The Early Start Denver Model (ESDM) is a promising early intervention for promoting improved social, cognitive, and communication outcomes for young children with autism spectrum disorder (ASD). However, most studies evaluating group-based delivery of this program have used 15-25 h per week of intervention in specialized ESDM preschools with low child-teacher ratios. Thus, the positive results from such studies might not be obtained when this intervention model is evaluated in more typical inclusive preschool settings. In this study, a low-intensity version of the ESDM was delivered to three young children with ASD in their regular inclusive preschool by a certified therapist who did not typically work at any of the preschools. The intervention procedures were implemented for 3 h per week over an 8- to 10-week period. Data were gathered on children's levels of participation, imitation, and communication from weekly 10-min video recordings. The effects of the intervention were evaluated using a multiple probe across participants design with 3 weekly follow-up probes, 3 weeks after the intervention ended. All participants showed improvement in active participation, imitation and either intentional vocalizations or spontaneous functional utterances. These results were generally maintained at follow-up. This low-intensity version of the ESDM would seem effective for use in real-world preschool environments.
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Affiliation(s)
- Jessica Tupou
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | | | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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