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Bailey KM, Rodgers ME, Quinn ED, Thompson S, Nietfeld J, Kaiser AP. Just-in-Time: A Caregiver-Mediated Intervention for Toddlers With Autism. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1209-1225. [PMID: 38346135 DOI: 10.1044/2023_ajslp-23-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE We investigated effects of an adaptive telehealth coaching model on caregiver implementation of enhanced milieu teaching (EMT) with newly diagnosed toddlers with autism. METHOD Three caregiver-child dyads participated in a multiple-baseline-across-behaviors, single-case design. Caregivers were taught EMT via telehealth using the teach-model-coach-review approach. EMT strategies were taught sequentially in four components corresponding to design tiers. Caregivers reported their needs for support and adaptation via weekly surveys. Primary outcomes were measures of caregiver's implementation, including (a) a fidelity checklist for wholistic use of EMT and (b) a percentage of correct use of a subset of key EMT strategies (e.g., matched turns, target talk, expansions, play actions, milieu episodes). Generalization and maintenance of caregiver strategy use in uncoached home activities were measured. The number of different words used by children was measured as a secondary, descriptive outcome. Social validity data were collected through ratings and interviews at the end of the study. RESULTS There was a functional relation between the intervention and caregiver's implementation of EMT for all dyads. Caregiver's use of EMT strategies often generalized and maintained post-intervention. Child response to intervention was variable. Social validity data indicated that the model was beneficial to caregivers and children. CONCLUSIONS An adaptive telehealth coaching model is effective for teaching caregivers of toddlers with autism to implement EMT and potentially helps to bridge the gap between diagnosis and comprehensive intervention. Further exploration of the relation between caregiver fidelity and dosage of active ingredients and child spoken language outcomes is needed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25156223.
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Affiliation(s)
- Kathryn M Bailey
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Mary E Rodgers
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Emily D Quinn
- Department of Pediatrics, Oregon Health & Science University, Portland
| | - Suzanne Thompson
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Jennifer Nietfeld
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Ann P Kaiser
- Department of Special Education, Vanderbilt University, Nashville, TN
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Delehanty A, Lorio CM, Romano M, Brown JA, Woods JJ, Wetherby AM. Social Communication and Parent Verbal Responsiveness Across Interaction Contexts in Toddlers on the Autism Spectrum. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1266-1282. [PMID: 38407116 PMCID: PMC11081527 DOI: 10.1044/2024_ajslp-23-00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/24/2023] [Accepted: 01/02/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Interactions with caregivers during the ordinary activities that occur as families go about their everyday lives are critical to supporting children's acquisition of social communication and language skills. The purpose of this study was to examine child communication and parent verbal responsiveness across interaction contexts in 211 children (Mage = 20 months) on the autism spectrum (n = 121), with developmental delay (n = 46), or with typical development (n = 44). METHOD Families participated in up to eight activities during an hour-long, video-recorded home observation. We tested differences in the strength of associations between diagnostic group and interaction context using linear mixed-effects models, with child rate per minute of communication and proportions of parent follow-in comments and directives as outcome variables. Child communicative functions expressed across contexts were also examined. RESULTS Children across groups communicated at significantly higher rates per minute during book sharing and play with people compared to other interaction contexts. Most child communication was for the function of joint attention during book sharing, for social interaction during play with people, and for behavior regulation during necessary activities such as family chores and meals. On average, parents of children responded using proportionally more follow-in comments during book sharing and play compared to necessary activities, during which parents used more follow-in directives. CONCLUSION Results provide a glimpse into the dyadic communication that may occur within everyday activities at home, which supports the need for future intervention research and may aid clinicians seeking to identify activities that serve as important contexts for intervention.
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Affiliation(s)
- Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Ciera M. Lorio
- Communication Sciences and Disorders, Illinois State University, Normal
| | - Mollie Romano
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Jennifer A. Brown
- Mary Frances Early College of Education, University of Georgia, Athens
| | - Juliann J. Woods
- Emeritus Professor, School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Amy M. Wetherby
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee
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Ouyang Y, Feng J, Wang T, Xue Y, Mohamed ZA, Jia F. Comparison of the efficacy of parent-mediated NDBIs on developmental skills in children with ASD and fidelity in parents: a systematic review and network meta-analysis. BMC Pediatr 2024; 24:270. [PMID: 38664754 PMCID: PMC11044316 DOI: 10.1186/s12887-024-04752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Recently, studies on behavioral interventions for autism have gained popularity. Naturalistic Developmental Behavior Interventions (NDBIs) are among the most effective, evidence-based, and widely used behavior interventions for autism. However, no research has been conducted on which of the several NDBI methods is most effective for parents and children with autism spectrum disorders. Therefore, we conducted a network meta-analysis to compare the specific effects of each type of parental-mediated NDBI on children's developmental skills and parent fidelity. METHODS PubMed, Embase, Cochrane Library, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), CINAHL, and Wanfang databases were searched from inception to August 30, 2023. A total of 32 randomized controlled trial studies that examined the efficacy of different NDBIs were included. RESULTS Parents of children with ASD who received Pivotal Response Treatment (PRT) reported significant improvements in their children's social skills (SUCRA, 74.1%), language skills (SUCRA, 88.3%), and parenting fidelity (SUCRA, 99.5%). Moreover, parents who received Early Start Denver Model (ESDM) reported significant improvements in their children's language (SMD = 0.41, 95% CI: 0.04, 0.79) and motor skills (SMD = 0.44, 95% CI: 0.09, 0.79). In terms of the efficacy of improving parent fidelity, the results showed that the Improving Parents as Communication Teachers (ImPACT) intervention significantly improved parent fidelity when compared with the treatment-as-usual group (TAU) (SMD = 0.90, 95% CI: 0.39, 1.42) and the parental education intervention (PEI) (SMD = 1.10, 95% CI:0.28, 1.91).There was a difference in parent fidelity among parents who received PRT(SMD = 3.53, 95% CI: 2.26, 4.79) or ESDM(SMD = 1.42, 95% CI: 0.76, 2.09) training compared with PEI. CONCLUSION In conclusion, this study revealed that parents can achieve high fidelity with the ImPACT intervention, and it can serve as an early first step for children newly diagnosed with ASD. It also showed that parent-mediated ESDM is effective in improving language and motor skills for children with ASD and can be used as part of the second stage of parent training. Parent-mediated PRT can also be used as a third stage of parent training with sufficient training intensity to further improve language, social, and motor skills.
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Affiliation(s)
- Yuling Ouyang
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
- School of Nursing, Jilin University, Changchun, 130021, China
| | - Junyan Feng
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Tiantian Wang
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Yang Xue
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Zakaria Ahmed Mohamed
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Feiyong Jia
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China.
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Bordini D, Moya AC, Asevedo GRDC, Paula CS, Brunoni D, Brentani H, Caetano SC, Mari JDJ, Bagaiolo L. Exploring the Acquisition of Social Communication Skills in Children with Autism: Preliminary Findings from Applied Behavior Analysis (ABA), Parent Training, and Video Modeling. Brain Sci 2024; 14:172. [PMID: 38391746 PMCID: PMC10886593 DOI: 10.3390/brainsci14020172] [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] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Social communication skills, especially eye contact and joint attention, are frequently impaired in autism spectrum disorder (ASD) and predict functional outcomes. Applied behavior analysis is one of the most common evidence-based treatments for ASD, but it is not accessible to most families in low- and middle-income countries (LMICs) as it is an expensive and intensive treatment and needs to be delivered by highly specialized professionals. Parental training has emerged as an effective alternative. This is an exploratory study to assess a parental intervention group via video modeling to acquire eye contact and joint attention. Four graded measures of eye contact and joint attention (full physical prompt, partial physical prompt, gestural prompt, and independent) were assessed in 34 children with ASD and intellectual disability (ID). There was a progressive reduction in the level of prompting required over time to acquire eye contact and joint attention, as well as a positive correlation between the time of exposure to the intervention and the acquisition of abilities. This kind of parent training using video modeling to teach eye contact and joint attention skills to children with ASD and ID is a low-cost intervention that can be applied in low-resource settings.
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Affiliation(s)
- Daniela Bordini
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Ana Cláudia Moya
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | | | - Cristiane Silvestre Paula
- Human Development Sciences Program, Mackenzie Presbyterian University (UPM), Sao Paulo 01302-907, SP, Brazil
| | - Décio Brunoni
- Human Development Sciences Program, Mackenzie Presbyterian University (UPM), Sao Paulo 01302-907, SP, Brazil
| | - Helena Brentani
- Psychiatry Institute, University of São Paulo (USP), Sao Paulo 01246-904, SP, Brazil
| | - Sheila Cavalcante Caetano
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Leila Bagaiolo
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
- Gradual-Behavioral Intervention Group, Sao Paulo 05458-000, SP, Brazil
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Chambers N, de Vries PJ, Wetherby AM. Feasibility of the Autism Navigator ® JumpStart to Coaching in Everyday Activities course in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231223784. [PMID: 38332664 DOI: 10.1177/13623613231223784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
LAY ABSTRACT In low-resource settings, non-profit organisations play an essential role in providing services and support for families with young children with autism, including in Africa. However, non-profit organisation service providers may not have access to quality training in proven intervention methods. Web-based or online courses may help to meet this need. In this study, we invited a group of specialist (10) and non-specialist (16) non-profit organisation providers in South Africa to complete a web-based course, Autism Navigator® JumpStart to Coaching in Everyday Activities, a 20-h self-paced course that provides training in an evidence-based parent coaching intervention called Early Social Interaction. We evaluated acceptability, appropriateness, and feasibility of the training. Of the 26 who enrolled, 16 completed the course (7 specialists and 9 non-specialists). All providers found it difficult to find time to do the course until the lockdown restrictions due to COVID-19, when most completed the course. Those whose first language was not English experienced more difficulties with two of six learner assessments and those who were not clinical specialists had more difficulty with the coaching strategies learner assessment. Most providers rated the course highly feasible, acceptable, and appropriate stating that the course content was very valuable and helpful in equipping them to serve their families. They felt the extensive video clips and regular meetings with a local trainer helped them engage with and understand the material. They suggested that including South African video clips would make the course more relatable. The fact that the course was web-based was identified as a strong benefit, especially during COVID-19 restrictions.
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Peterson-Katz K, Piccone C, Tuzi N, Kulkarni C, Reynolds JN. Barriers and facilitators to implementation of developmental screening and early intervention in Canadian organizations following completion of a training and coaching model: a thematic analysis. FRONTIERS IN HEALTH SERVICES 2023; 3:1160217. [PMID: 37425993 PMCID: PMC10326629 DOI: 10.3389/frhs.2023.1160217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
Introduction Developmental delay affects approximately 1 in 4 children under 6 years old. Developmental delay can be detected using validated developmental screening tools, such as the Ages and Stages Questionnaires. Following developmental screening, early intervention can occur to address and support any developmental areas of concern. Frontline practitioners and supervisors must be trained and coached to organizationally implement developmental screening tools and early intervention practice. No prior work has qualitatively investigated the barriers and facilitators to implementing developmental screening and early intervention in Canadian organizations from the perspectives of practitioners and supervisors who have completed a specialized training and coaching model. Methods and Results Following semi-structured interviews with frontline practitioners and supervisors, thematic analysis identified four themes: cohesive networks support implementation efforts, implementation success is dependent on shared perspectives, established organizational policies increase implementation opportunities, and COVID-19 guidelines create organizational challenges. Each theme encompasses sub-themes that describe implementation facilitators: strong implementation context, multi-level multi-sectoral collaborative partnerships, adequate and collective awareness, knowledge, and confidence, consistent and critical conversations, clear protocols and procedures, and accessibility to information, tools, and best practice guidelines. Discussion The outlined barriers and facilitators fill a gap in implementation literature by informing a framework for organization-level implementation of developmental screening and early intervention following training and coaching.
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Affiliation(s)
| | - Caitlin Piccone
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Nicole Tuzi
- Infant and Early Mental Health Promotion, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chaya Kulkarni
- Infant and Early Mental Health Promotion, The Hospital for Sick Children, Toronto, ON, Canada
| | - James N. Reynolds
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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Delehanty A, Hooker JL, Wetherby AM. Verbal Responsiveness in Parents of Toddlers With and Without Autism During a Home Observation. J Autism Dev Disord 2023:10.1007/s10803-023-05935-6. [PMID: 37171767 DOI: 10.1007/s10803-023-05935-6] [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: 02/13/2023] [Indexed: 05/13/2023]
Abstract
This study examined patterns of verbal responsiveness in parents of toddlers (Mage = 20 months) later identified with autism (n = 121), developmental delay (n = 46), or typical development (n = 44) during an hourlong home observation. Parent verbal responsiveness (PVR) was compared using MANOVA across groups and by child expressive language phase. Multiple regression analyses controlling for child age and maternal education were employed to examine the extent to which PVR predicted variance in concurrent child social communication and prospective language skills. Parents provided synchronous responses approximately 90% of the time. Parents of children with autism and developmental delay used smaller proportions of responses that added linguistic information (i.e., expansions and follow-in directives for language) than those of children with typical development. Parents of children in the preverbal phase were more likely, on average, to affirm their children's acts of intentional communication or provide a follow-in directive for action that did not necessitate a verbal response than to expand or elicit language. Regression results indicated that parental use of expansions and follow-in directives for language made significant contributions to child language outcomes. The patterns we observed may reflect parents' attunement to their child's developmental level. Responsiveness to a child's focus of attention is vital in the earlier stages of language learning; however, results point to the potential importance of parental expansions and follow-in directives for promoting language development across groups in this sample. Directions for intervention research targeting PVR and language skills in toddlers with autism and developmental delays are discussed.
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Affiliation(s)
- Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, 600 Forbes Ave., Pittsburgh, PA, 15282, USA.
| | - Jessica L Hooker
- Florida State University Autism Institute, 2312 Killearn Center Blvd., Building A, Tallahassee, FL, 32309, USA
| | - Amy M Wetherby
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL, 32306-4300, USA
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Rollins PR, Rangel-Uribe C, Rojas R, Brantley S. Examining Cultural and Linguistic Sensitivity of Pathways Early Autism Intervention with Hispanic Families. J Autism Dev Disord 2023:10.1007/s10803-023-06003-9. [PMID: 37142911 PMCID: PMC10159226 DOI: 10.1007/s10803-023-06003-9] [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: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE This research aimed to evaluate evidence of Pathways parent-mediated early autism intervention as a culturally and linguistically sensitive intervention (CLSI) for Hispanic families with autistic children. METHODS We used Bernal et al.'s ecologically valid (EV) framework to evaluate current practice and Hispanic parents' perceptions of Pathways 1 ½ years after completing the intervention. Both quantitative and qualitative methods were used. Nineteen parents were contacted, of which 11 completed a semi-structured interview about their experience with Pathways. RESULTS On average, the group that completed the interview was less educated, had more monolingual Spanish speakers, and rated their general experience with the intervention slightly more positively than those who did not agree to complete the interview. A review of Pathways's current practices through the lens of the EV framework suggested that Pathways was a CLSI for Hispanic participants in the domains of context, methods, language, and persons. Parental interviews echoed these strengths. However, Pathways did less well balancing evidence-based intervention strategies for autistic children with the heritage value of respeto. CONCLUSION Pathways demonstrated strengths regarding cultural and linguistic sensitivity for Hispanic families with young autistic children. Future work with our community stakeholder group will integrate heritage and majority culture perspectives to strengthen Pathways as a CLSI.
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Affiliation(s)
- Pamela Rosenthal Rollins
- Department of Speech, Language and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas-Richardson, 1966 Inwood Road, Dallas, TX, 75235, USA.
| | - Cristina Rangel-Uribe
- Department of Speech, Language and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas-Richardson, 1966 Inwood Road, Dallas, TX, 75235, USA
| | - Raúl Rojas
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, 66045, USA
| | - Sara Brantley
- Department of Speech, Language and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas-Richardson, 1966 Inwood Road, Dallas, TX, 75235, USA
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Bertamini G, Perzolli S, Bentenuto A, Paolizzi E, Furlanello C, Venuti P. Child-therapist interaction features impact Autism treatment response trajectories. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104452. [PMID: 36796270 DOI: 10.1016/j.ridd.2023.104452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Identifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated. AIMS The longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling. METHODS AND PROCEDURES N = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features. OUTCOMES AND RESULTS Baseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist's efficacy in child engagement, respecting children's timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment. CONCLUSIONS AND IMPLICATIONS Clinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.
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Affiliation(s)
- Giulio Bertamini
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; Department of Child and Adolescent Psychiatry, Pitie-Salpetriere University Hospital, Sorbonne University, 75013 Paris, France; Data Science for Health (DSH), Bruno Kessler Foundation, 38123 Trento, Italy; Institute for Ingelligent Systems and Robotics (ISIR), Sorbonne University, 75005 Paris, France.
| | - Silvia Perzolli
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Eleonora Paolizzi
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Cesare Furlanello
- Orobix Life Sciences, 24121 Bergamo, Italy; HK3Lab, 38068 Rovereto, Italy
| | - Paola Venuti
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
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Bilgili-Karabacak I, Dueñas AD, Settanni E, Bauer K. A Quantitative Systematic Review of Sibling-Mediated Interventions for Young Children with Autism: Effects on Sibling Outcomes. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Guthrie W, Wetherby AM, Woods J, Schatschneider C, Holland RD, Morgan L, Lord CE. The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231159153. [PMID: 36922406 PMCID: PMC10502186 DOI: 10.1177/13623613231159153] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
LAY ABSTRACT Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.
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Affiliation(s)
- Whitney Guthrie
- Children’s Hospital of Philadelphia, USA
- University of Pennsylvania, USA
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12
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Rollins PR, De Froy AM. Reexamining Pathways Early Autism Intervention in Children Before and After the Third Birthday: A Randomized Control Trial. J Autism Dev Disord 2023; 53:1189-1201. [PMID: 35596830 PMCID: PMC9123830 DOI: 10.1007/s10803-022-05599-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
We reexamined the efficacy of Pathways early autism intervention using generalized measures of social communication and language skills administered by an unfamiliar adult in a novel environment. Generalized measures improve on sources of measurement bias. Sixty-seven autistic children blocked on age (under versus over 3 years) were randomly assigned to 15 weeks of Pathways or services-as-usual. Age moderated the effects of Pathways for social communication. Specifically, Pathways had a significantly large effect for children under 3 and a small effect that approached significance for children over 3. Pathways also had a small effect on expressive speech/language skills. Results replicate previous findings of the efficacy of Pathways on proximal and distal skills and support the importance of early intervention.
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Affiliation(s)
- Pamela Rosenthal Rollins
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1966 Inwood Road, Dallas, TX, 75235, USA.
| | - Adrienne M De Froy
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1966 Inwood Road, Dallas, TX, 75235, USA
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13
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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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14
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Rollins PR, De Froy AM, Gajardo SA, Brantley S. Pragmatic contributions to early vocabulary and social communication in young autistic children with language and cognitive delays. JOURNAL OF COMMUNICATION DISORDERS 2022; 99:106243. [PMID: 35797775 DOI: 10.1016/j.jcomdis.2022.106243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There are limited data on the interrelationships among pragmatic skills and expressive vocabulary and their contribution to later social communication. Understanding these relationships could inform developmental processes and early intervention strategies. This study explored the relationship among pragmatics skills (i.e., communicative intents and responding to parents' preceding utterances) and concurrent expressive vocabulary as well as the predictive nature of these skills on later social communication in young autistic children with language and cognitive delays. METHOD Data from 56 autistic children (age 18-57 months) who participated in a larger randomized control trial of Pathways Early Autism Intervention were used in this secondary analysis. Video recordings of pre-intervention (Time 1) parent-child interactions were analyzed for number of different words (NDW; expressive vocabulary), number of different (ND) communicative intents, and response to parents' preceding utterances. Residual scores from an assessment of social communication were used to measure Time 2 social communication. First-order correlations and hierarchical regression were used for analyses. RESULTS Adjusting for age and receptive language, both ND communicative intents and response to parents' preceding utterances were associated with pre-intervention NDW. Further, adjusting for receptive language age and intervention group, NDW and response to parents' preceding utterances - but not ND communicative intents-was related to Time 2 social communication. NDW, however, was no longer related to Time 2 social communication skills after accounting for response to parents' preceding utterances. CONCLUSIONS This study provides evidence that autistic children with language and cognitive delays use their expressive vocabularies to respond, hence allocating attention to parent speech, a rudimentary form of social orienting. Our results support approaches to intervention that leverage responding as a rudimentary form of social orienting while encouraging more mature forms of social attention (i.e., social orienting to faces and joint attention) within developmentally appropriate activities, such as routines.
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Affiliation(s)
- Pamela Rosenthal Rollins
- University of Texas at Dallas, School of Behavioral and Brain Sciences, Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, United States
| | - Adrienne M De Froy
- University of Texas at Dallas, School of Behavioral and Brain Sciences, Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, United States
| | | | - Sara Brantley
- University of Texas at Dallas, School of Behavioral and Brain Sciences, Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, United States
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15
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Afsah O, El gamily M, Baz H. Early identification of autism in Egyptian children using Arabic version of checklist for autism in toddlers-23 (CHAT-23). INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:507-517. [PMID: 38699506 PMCID: PMC11062263 DOI: 10.1080/20473869.2022.2112541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/09/2022] [Indexed: 05/05/2024]
Abstract
Background: Screening is the first important step in the diagnostic process. There is strong evidence that early diagnosis and management of autism spectrum disorder (ASD) can lead to a better prognosis. The purpose of this study was to develop an Arabic version of the Chinese Checklist for Autism in Toddlers-23 (CHAT-23) to distinguish children with ASD in the Egyptian community. Methods: The Arabic CHAT-23 checklist was applied to 100 Egyptian children with mental age 18-24 months including 30 autistic and 70 typically-developing children. Results and conclusion: Arabic CHAT-23 checklist is a valid and reliable tool for early identification of ASD in Egyptian children with high sensitivity (93.3%) and specificity (97%). Children failing any 15 of all 23 questions of the parental questionnaire should be observed with observational items. Failing any 3 of the 4 observational items would suggest ASD.
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Affiliation(s)
- Omayma Afsah
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Marwa El gamily
- Phoniatric Unit, ORL Department, Mansoura Specialized Hospital, Mansoura, Egypt
| | - Hemmat Baz
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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16
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Yi J, Kim W, Lee J. Effectiveness of the SCERTS Model-Based Interventions for Autistic Children: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2662-2676. [PMID: 35772184 DOI: 10.1044/2022_jslhr-21-00518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This systematic review aimed to examine the effectiveness of the Social Communication, Emotional Regulation, and Transactional Support (SCERTS) Model-based interventions in supporting developmental skills of children who were diagnosed with or at increased likelihood of autism. METHOD We searched six electronic databases, in addition to Google Scholar and the reference lists, using terms related to SCERTS, the Early Social Interaction project, and autism spectrum disorder. Of the 70 articles, six published between 2014 and 2021 (a total of 455 children) were eligible for inclusion and were analyzed in terms of study design, type of publication, participant characteristics, intervention procedures, and major findings. RESULTS Most reviewed studies that were relatively less vulnerable to the given risk of bias suggested that SCERTS may be an effective approach for promoting children's social communication skills, and implementers were able to achieve an adequate level of intervention fidelity through training. Further implications could not be drawn concerning children's language, reduction in restricted repetitive behaviors, emotional regulation, adaptive behavior, play, cognitive skills, academic competence, and motor skills due to contradicting findings within limited evidence. CONCLUSIONS Although SCERTS is a promising intervention with emerging evidence, more methodologically rigorous studies are needed to progress the research base of SCERTS and draw firm conclusions about its effectiveness in improving a wide range of skills for children and implementers. Several areas for future research are discussed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20151842.
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Affiliation(s)
- Juhee Yi
- Department of Speech Pathology, Daegu University, South Korea
| | - Whasoo Kim
- Department of Speech Pathology, Daegu University, South Korea
| | - Jiwoo Lee
- Department of Music and Culture, Dong-A University, Busan, South Korea
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17
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"Going Mobile"-increasing the reach of parent-mediated intervention for toddlers with ASD via group-based and virtual delivery. J Autism Dev Disord 2022; 52:5207-5220. [PMID: 35608785 PMCID: PMC9128315 DOI: 10.1007/s10803-022-05554-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
Evidence supports early intervention for toddlers with ASD, but barriers to access remain, including system costs, workforce constraints, and a range of family socio-demographic factors. An urgent need exists for innovative models that maximize resource efficiency and promote widespread timely access. We examined uptake and outcomes from 82 families participating in a parent-mediated intervention comprising group-based learning and individual coaching, delivered either in-person (n = 45) or virtually (n = 37). Parents from diverse linguistic, ethnic, and educational backgrounds gained intervention skills and toddlers evidenced significant social-communication gains. Few differences emerged across socio-demographic factors or delivery conditions. Findings highlight the feasibility, acceptability, and promise of group-based learning when combined with individual coaching, with added potential to increase program reach via virtual delivery.
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18
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Gunter C, Harris RA, Kovacs-Balint Z, Raveendran M, Michopoulos V, Bachevalier J, Raper J, Sanchez MM, Rogers J. Heritability of social behavioral phenotypes and preliminary associations with autism spectrum disorder risk genes in rhesus macaques: A whole exome sequencing study. Autism Res 2022; 15:447-463. [PMID: 35092647 PMCID: PMC8930433 DOI: 10.1002/aur.2675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
Nonhuman primates and especially rhesus macaques (Macaca mulatta) have been indispensable animal models for studies of various aspects of neurobiology, developmental psychology, and other aspects of neuroscience. While remarkable progress has been made in our understanding of influences on atypical human social behavior, such as that observed in autism spectrum disorders (ASD), many significant questions remain. Improved understanding of the relationships among variation in specific genes and variation in expressed social behavior in a nonhuman primate would benefit efforts to investigate risk factors, developmental mechanisms, and potential therapies for behavioral disorders including ASD. To study genetic influences on key aspects of social behavior and interactions-individual competence and/or motivation for specific aspects of social behavior-we quantified individual variation in social interactions among juvenile rhesus macaques using both a standard macaque ethogram and a macaque-relevant modification of the human Social Responsiveness Scale. Our analyses demonstrate that various aspects of juvenile social behavior exhibit significant genetic heritability, with estimated quantitative genetic effects similar to that described for ASD in human children. We also performed exome sequencing and analyzed variants in 143 genes previously suggested to influence risk for human ASD. We find preliminary evidence for genetic association between specific variants and both individual behaviors and multi-behavioral factor scores. To our knowledge, this is the first demonstration that spontaneous social behaviors performed by free-ranging juvenile rhesus macaques display significant genetic heritability and then to use exome sequencing data to examine potential macaque genetic associations in genes associated with human ASD.
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Affiliation(s)
- Chris Gunter
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA,Departments of Pediatrics Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - R. Alan Harris
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Muthuswamy Raveendran
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Vasiliki Michopoulos
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jocelyne Bachevalier
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Department of Psychology, Emory University, Atlanta, GA, USA
| | - Jessica Raper
- Departments of Pediatrics Human Genetics, Emory University School of Medicine, Atlanta, GA, USA,Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Mar M. Sanchez
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Rogers
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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19
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Esler AN, Sample J, Hall-Lande J, Harris B, Rice C, Poynter J, Kirby RS, Wiggins L. Patterns of Special Education Eligibility and Age of First Autism Spectrum Disorder (ASD) Identification Among US Children with ASD. J Autism Dev Disord 2022; 53:1739-1754. [PMID: 35212866 PMCID: PMC9402793 DOI: 10.1007/s10803-022-05475-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/22/2022]
Abstract
The study examined timing of autism spectrum disorder (ASD) identification in education versus health settings for 8-year-old children with ASD identified through records-based surveillance. The study also examined type of ASD symptoms noted within special education evaluations. Results indicated that children with records from only education sources had a median time to identification of ASD over a year later than children with records from health sources. Black children were more likely than White children to have records from only education sources. Restricted and repetitive behaviors were less frequently documented in educational evaluations resulting in developmental delay eligibility compared to specific ASD eligibility among children with ASD. Future research could explore strategies reduce age of identification in educational settings and increase equitable access to health evaluations.
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Affiliation(s)
- Amy N Esler
- Department of Pediatrics, University of Minnesota, 606 24th Ave S, Minneapolis, MN, 55454, USA.
| | - Jeannette Sample
- Department of Pediatrics, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota, 150 Pillsbury Dr SE, Minneapolis, MN, 55455, USA
| | - Bryn Harris
- School of Education and Human Development, Department of Pediatrics (Developmental Pediatrics), University of Colorado Denver, 1380 Lawrence St. #1114, Denver, CO, 80204, USA
| | - Catherine Rice
- National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30333, USA
| | - Jenny Poynter
- Department of Pediatrics, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Russell S Kirby
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL, 33612, USA
| | - Lisa Wiggins
- National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30333, USA
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20
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Pillay S, Duncan M, de Vries PJ. "We are doing the best we can to bridge the gap" - service provider perspectives of educational services for autism spectrum disorder in South Africa. Front Psychiatry 2022; 13:907093. [PMID: 35928780 PMCID: PMC9343733 DOI: 10.3389/fpsyt.2022.907093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The South African education system is increasingly unable to meet the growing needs of children with autism spectrum disorder (ASD). Recent studies in the Western Cape, one of the better resourced provinces in South Africa, showed that the pathway to care for children with ASD was an inconsistent and lengthy process, and that many children with ASD waited for extended periods to get access to an appropriate school placement. It is therefore clear that scalable and sustainable solutions are required to improve access to appropriate education for children with ASD. METHODS Here we performed a qualitative study using thematic analysis of ten multi-sectorial ASD service provider interviews in the Western Cape Province to examine provider perspectives and proposed solutions to meet the educational needs of children with ASD. RESULTS Provider perspectives were grouped in three categories: "bridging the gap across the spectrum and lifespan", "gaps to bridge", and "building bridges". The first category captured provider perspectives of the service-related needs inherent to a diagnosis of ASD. The second category summarized service provider views of the challenges associated with providing services to children with ASD and the third category captured provider perspectives on potential actions to improve ASD education services delivery in the province. The overarching theme that emerged was "We're doing the best we can to bridge the gap". CONCLUSION Participants provided ten key recommendations for service strengthening that may lead to contextually relevant innovations to meet the educational needs of children with ASD in the province. Findings from this study has direct relevance to other South African provinces and may have relevance to improve pathways and reduce service delivery gaps also in other low-and-middle-income countries.
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Affiliation(s)
- Sarosha Pillay
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa.,Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Madeleine Duncan
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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21
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Gaines R, Korneluk Y, Quigley D, Chiasson V, Delehanty A, Jacobson S. Quickstart for toddlers with autism spectrum disorder: A preliminary report of an adapted community-based early intervention program. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221138699. [PMID: 36466042 PMCID: PMC9709185 DOI: 10.1177/23969415221138699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Early intervention (EI) for young children with autism spectrum disorder (ASD) must be resource-efficient while remaining effective; thus, clinicians are challenged to create and implement useful methods. Clinical evidence from community-based interventions that include reliable diagnoses, individual EI programs, along with comprehensive descriptions of participants, procedures, and participant outcomes can inform practice, translational research, and local policy. Parent-mediated EI for toddlers with ASD can promote positive developmental outcomes and lifelong well-being, but evidence of successful community uptake of research-based EIs is somewhat limited. The community-based, parent-mediated, evidence-informed QuickStart EI program aims to encourage toddlers' early social communication, social interactions, and relationship-building, in a community clinic setting.We aim to (1) describe our adaptations to the evidence-based Parent-Delivered Early Start Denver Model and (2) present promising findings for toddlers with or at risk for ASD and their families who received QuickStart. We also intend to motivate a similar study of EI in real-world situations to advance evidence-based practice and create relevant dialogue and questions for research. METHODS Complete data were identified and analyzed for up to 89 toddlers diagnosed with, or at risk of, ASD. Pre- and post-intervention parent- or self-report data were analyzed using descriptive statistics and paired-sample t-tests, as appropriate. Pre-intervention measures included demographic information (n = 89) and the Early Screening of Autism and Communication (ESAC; n = 89). Measures taken pre- and post-intervention included the Adaptive Behavior Assessment System-II (n = 60), MacArthur-Bates Communication Development Inventories (n = 58), and the parental sense of competence scale (n = 62). The Measure of Processes of Care (n = 60) was taken post-intervention. On enrollment, parents signed standard clinical agreements that included statements allowing their anonymous data to be analyzed for research. RESULTS Using standardized parent/self-report measures, toddler gains were noted for social interaction, language, communication skills, and ASD symptoms, but not for parents' feelings of competence. Parents identified QuickStart procedures as family centered (Measure of Processes of Care). CONCLUSIONS The QuickStart EI program, provided to toddlers and their families over 20 weeks in a community clinic, resulted in promising positive behavior and communication changes, as indicated on the parent-response measures, for a moderately large sample of toddlers. IMPLICATIONS This study adds to the literature by describing a new EI program with clear procedures by which clinicians can create, provide, and evaluate a readily accessible, community-based EI for toddlers with or at risk of ASD. Methodological limitations inherent to our study design that precluded a control group and necessitated a reliance on available parent-report data are carefully critiqued and discussed.
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Affiliation(s)
- Robin Gaines
- Robin Gaines, Children’s Hospital of Eastern Ontario, Ottawa, Canada.
| | | | | | | | - Abigail Delehanty
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA, USA
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22
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Devescovi R, Colonna V, Dissegna A, Bresciani G, Carrozzi M, Colombi C. Feasibility and Outcomes of the Early Start Denver Model Delivered within the Public Health System of the Friuli Venezia Giulia Italian Region. Brain Sci 2021; 11:brainsci11091191. [PMID: 34573216 PMCID: PMC8464931 DOI: 10.3390/brainsci11091191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
The Early Start Denver Model (ESDM) is an evidence-based early intervention model for young children with autism spectrum disorder (ASD). It is crucial to investigate the feasibility of the ESDM in community settings in contexts that are culturally different from American universities in which the model was originally developed. The aim was to further evaluate the effectiveness of the ESDM delivered within the Italian community setting at low intensity. We compared a group aged 19 to 43 months receiving the ESDM for 2 h per week over the course of 1 year with a concurrent, comparable, non-randomized control group receiving treatment as usual (TAU). Children were evaluated at baseline (T0) and after 6 months (T1) and 12 months (T2) of intervention. Feasibility was evaluated by parent and therapist questionnaires, retention rate, and therapist treatment fidelity. Both groups made similar gains in cognition and language abilities. The ESDM group made larger improvement in domains measured by the ESDM Curriculum Checklist, including communication, social skills, and maladaptive behaviors. Feasibility seemed well supported by retentions, therapists and parent satisfaction, and treatment fidelity. Our study further supports the feasibility of the ESDM implemented within the Italian public health system and suggests a better response in the ESDM-treated group than in the control group.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
- Correspondence:
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Costanza Colombi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
- IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
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23
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Havdahl A, Farmer C, Schjølberg S, Øyen AS, Surén P, Reichborn-Kjennerud T, Magnus P, Bresnahan M, Hornig M, Susser E, Lipkin WI, Lord C, Stoltenberg C, Thurm A, Bishop S. Age of walking and intellectual ability in autism spectrum disorder and other neurodevelopmental disorders: a population-based study. J Child Psychol Psychiatry 2021; 62:1070-1078. [PMID: 33369747 PMCID: PMC8236490 DOI: 10.1111/jcpp.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delayed walking is common in intellectual disability (ID) but may be less common when ID occurs with autism spectrum disorder (ASD). Previous studies examining this were limited by reliance on clinical samples and exclusion of children with severe motor deficits. OBJECTIVE To examine in a population-based sample if age of walking is differentially related to intellectual ability in children with ASD versus other neurodevelopmental disorders (NDD). METHODS Participants were from the nested Autism Birth Cohort Study of the Norwegian Mother, Father and Child Cohort Study (MoBa). Cox proportional hazards regression assessed if diagnosis (ASD n = 212 vs. NDD n = 354), continuous nonverbal IQ, and their interaction, were associated with continuous age of walking. RESULTS The relationship between nonverbal IQ and age of walking was stronger for NDD than for ASD (Group × nonverbal IQ interaction, χ2 = 13.93, p = .0002). This interaction was characterized by a 21% decrease in the likelihood of walking onset at any given time during the observation period per 10-point decrease in nonverbal IQ (hazard ratio = 0.79, 95% CI: 0.78-0.85) in the NDD group compared to 8% (hazard ratio = 0.92, 95% CI: 0.86-0.98) in the ASD group. CONCLUSIONS The finding that age of walking is less strongly related to low intellectual ability in children with ASD than in children without other NDDs supports the hypothesis that ID in ASD may result from heterogeneous developmental pathways. Late walking may be a useful stratification variable in etiological research focused on ASD and other NDDs.
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Affiliation(s)
- Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Cristan Farmer
- Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, MD, USA
| | | | - Anne-Siri Øyen
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Michaeline Bresnahan
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Mady Hornig
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Ezra Susser
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - W Ian Lipkin
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Center for Infection and Immunity, Mailman School of Public Health and Departments of Neurology and Pathology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Catherine Lord
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Audrey Thurm
- Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Somer Bishop
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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24
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Bullard L, Abbeduto L. Responsive Parenting as a Target for Telehealth Language Interventions in Fragile X Syndrome: Implications for Scalability and Best Practices. Semin Speech Lang 2021; 42:287-300. [PMID: 34311481 DOI: 10.1055/s-0041-1730989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review highlights the ways in which telehealth procedures can be implemented to help bridge the research-to-practice gap in supporting developmental outcomes for youth with fragile X syndrome (FXS). We review how the literature to date has informed potential treatment targets in the areas of speech and language development with a focus on understanding and supporting the dyadic relationship between the child and their biological mother, who is also impacted biologically. Notably, parental responsivity is an area that is strongly related to child language outcomes, both early and into adolescence, and thus, it is an important treatment target for subsequent interventions. To date, several parent-implemented interventions have been done in FXS across a broad age range (2-17-year-olds) all showing support not only that parents are successful in learning responsive strategies but also that there are subsequent impacts to child language development. Moreover, these interventions were successfully implemented at a distance through telehealth procedures including video teleconferencing and shared recordings of parent-child interactions. This review also addresses potential moderators of treatment gains. Implications for scaling such interventions in the future as well as best practices for incorporating telehealth procedures into future research and intervention programs are also discussed.
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Affiliation(s)
- Lauren Bullard
- MIND Institute, UC Davis Health, Sacramento, California.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, California.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
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Frost KM, Russell K, Ingersoll B. Using qualitative content analysis to understand the active ingredients of a parent-mediated naturalistic developmental behavioral intervention. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1935-1945. [PMID: 33840219 DOI: 10.1177/13623613211003747] [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 Although naturalistic developmental behavioral interventions are supported by research for supporting the development of children on the autism spectrum, how they work is not well understood. This study reviewed parent reflection comments in a systematic way to better how one such treatment worked, when delivered by caregivers. Caregivers completed weekly written reflection responses as they learned how to use the treatment techniques. We studied these responses to understand caregiver perspectives on how their children responded to the techniques. The responses were then compared to a theory of how the treatment works. Many responses were consistent with the treatment theory; however, others were not. We found that individual techniques were associated with different child responses, suggesting that general measures of social communication may not measure these specific short-term changes. Our findings point to specific behaviors that may be useful to measure in future research, or useful as indicators of treatment response in clinical practice settings. Overall, qualitative methods may be useful for understanding complex treatment processes.
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26
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Bertamini G, Bentenuto A, Perzolli S, Paolizzi E, Furlanello C, Venuti P. Quantifying the Child-Therapist Interaction in ASD Intervention: An Observational Coding System. Brain Sci 2021; 11:366. [PMID: 33805630 PMCID: PMC7998397 DOI: 10.3390/brainsci11030366] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Observational research plays an important part in developmental research due to its noninvasiveness. However, it has been hardly applied to investigate efficacy of the child-therapist interaction in the context of naturalistic developmental behavioral interventions (NDBI). In particular, the characteristics of child-therapist interplay are thought to have a significant impact in NDBIs in children with autism spectrum disorder (ASD). Quantitative approaches may help to identify the key features of interaction during therapy and could be translated as instruments to monitor early interventions. METHODS n = 24 children with autism spectrum disorder (ASD) were monitored from the time of the diagnosis (T0) and after about one year of early intervention (T1). A novel observational coding system was applied to video recorded sessions of intervention to extract quantitative behavioral descriptors. We explored the coding scheme reliability together with its convergent and predictive validity. Further, we applied computational techniques to investigate changes and associations between interaction profiles and developmental outcomes. RESULTS Significant changes in interaction variables emerged with time, suggesting that a favorable outcome is associated with interactions characterized by increased synchrony, better therapist's strategies to successfully engage the child and scaffold longer, more complex and engaging interchanges. Interestingly, data models linked interaction profiles, outcome measures and response trajectories. CONCLUSION Current research stresses the need for process measures to understand the hows and the whys of ASD early intervention. Combining observational techniques with computational approaches may help in explaining interindividual variability. Further, it could disclose successful features of interaction associated with better response trajectories or to different ASD behavioral phenotypes that could require specific dyadic modalities.
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Affiliation(s)
- Giulio Bertamini
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, TN, Italy; (G.B.); (A.B.); (S.P.); (E.P.)
- Data Science for Health (DSH), Bruno Kessler Foundation (FBK), 38123 Povo, TN, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, TN, Italy; (G.B.); (A.B.); (S.P.); (E.P.)
| | - Silvia Perzolli
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, TN, Italy; (G.B.); (A.B.); (S.P.); (E.P.)
| | - Eleonora Paolizzi
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, TN, Italy; (G.B.); (A.B.); (S.P.); (E.P.)
| | - Cesare Furlanello
- Hk3 Lab, 38068 Rovereto, TN, Italy;
- Orobix Life, 24121 Bergamo, BG, Italy
| | - Paola Venuti
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, TN, Italy; (G.B.); (A.B.); (S.P.); (E.P.)
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Waizbard-Bartov E, Ferrer E, Young GS, Heath B, Rogers S, Wu Nordahl C, Solomon M, Amaral DG. Trajectories of Autism Symptom Severity Change During Early Childhood. J Autism Dev Disord 2021; 51:227-242. [PMID: 32410098 PMCID: PMC7810617 DOI: 10.1007/s10803-020-04526-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Autism symptom severity change was evaluated during early childhood in 125 children diagnosed with autism spectrum disorder (ASD). Children were assessed at approximately 3 and 6 years of age for autism symptom severity, IQ and adaptive functioning. Each child was assigned a change score, representing the difference between ADOS Calibrated Severity Scores (CSS) at the two ages. A Decreased Severity Group (28.8%) decreased by 2 or more points; a Stable Severity Group (54.4%) changed by 1 point or less; and an Increased Severity Group (16.8%) increased by 2 or more points. Girls tended to decrease in severity more than boys and increase in severity less than boys. There was no clear relationship between intervention history and membership in the groups.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, CA, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Gregory S Young
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Brianna Heath
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Sally Rogers
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Christine Wu Nordahl
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Marjorie Solomon
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - David G Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.
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Early behavioral profiles elucidating vulnerability and resiliency to later ASD outcomes. Dev Psychopathol 2020; 32:1217-1229. [PMID: 32928316 DOI: 10.1017/s0954579420000814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Infant siblings of children with autism spectrum disorder (ASD) exhibit greater heterogeneity in behavioral presentation and outcomes relative to infants at low familial risk (LR), yet there is limited understanding of the diverse developmental profiles that characterize these infants. We applied a hierarchical agglomerative cluster analysis approach to parse developmental heterogeneity in 420 toddlers with heightened (HR) and low (LR) familial risk for ASD using measures of four dimensions of development: language, social, play, and restricted and repetitive behaviors (RRB). Results revealed a two-cluster solution. Comparisons of clusters revealed significantly lower language, social, and play performance, and higher levels of restricted and repetitive behaviors in Cluster 1 relative to Cluster 2. In Cluster 1, 25% of children were later diagnosed with ASD compared to 8% in Cluster 2. Comparisons within Cluster 1 between subgroups of toddlers having ASD+ versus ASD- 36-month outcomes revealed significantly lower functioning in the ASD+ subgroup across cognitive, motor, social, language, symbolic, and speech dimensions. Findings suggest profiles of early development associated with resiliency and vulnerability to later ASD diagnosis, with multidimensional developmental lags signaling vulnerability to ASD diagnosis.
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Mutual Gaze: An Active Ingredient for Social Development in Toddlers with ASD: A Randomized Control Trial. J Autism Dev Disord 2020; 51:1921-1938. [PMID: 32894382 PMCID: PMC8124047 DOI: 10.1007/s10803-020-04672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We examined the efficacy of an early autism intervention for use in early childhood intervention (ECI) and mutual gaze as a contributor to social development. Seventy-eight families were randomly assigned to one of three 12-week interventions: Pathways (with a mutual gaze component), communication, or services-as-usual (SAU). The Pathways/SAU comparison concerned the efficacy of Pathways for ECI, and the Pathways/communication comparison, mutual gaze. The Pathways group made significantly more change on social measures, communicative synchrony, and adaptive functioning compared with the SAU group and on social measures compared with the communication group. There were no group differences for communicative acts. The results support Pathways as a potential ECI program and mutual gaze as an active ingredient for social and communication development.
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Autism Spectrum Disorders in Greece: Nationwide Prevalence in 10-11 Year-Old Children and Regional Disparities. J Clin Med 2020; 9:jcm9072163. [PMID: 32650567 PMCID: PMC7408756 DOI: 10.3390/jcm9072163] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorders (ASD) constitute a public health concern with increasing prevalence worldwide. We aimed to estimate prevalence and age at diagnosis in Greece, where no large-scale prevalence study has ever been conducted. Aggregate data were collected on ASD diagnoses by gender and calendar year of diagnosis up to 2019, for children born in 2008 and 2009, from the Centers for Educational and Counseling Support, which evaluate children to receive special educational support in school. Coverage was 87.1% of centers and 88.1% of schoolchildren born in 2008–9. ASD prevalence overall was 1.15% (1.83% males, 0.44% females; ratio 4.14:1), ranging from 0.59% to 1.50% in Greece’s 13 regions. In five regions, prevalence differed significantly between centers. Overall, only 3.8% of diagnoses were made before the fourth year after birth and 42.7% before the sixth year, with considerable variation between regions. Approximate mean age at diagnosis was six years and one month, and about three months earlier for girls than for boys. Our results provide evidence-based information to guide service planning and development at national and regional levels. Particular attention should be paid to smoothing out inequalities regarding service accessibility and provision. Emphasis should be given to earlier identification and diagnosis of ASD.
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Bradshaw J, Trumbull A, Stapel-Wax J, Gillespie S, George N, Saulnier C, Klaiman C, Woods J, Call N, Klin A, Wetherby A. Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1874-1884. [PMID: 32594763 DOI: 10.1177/1362361320928829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Early intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
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Affiliation(s)
| | | | - Jennifer Stapel-Wax
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Scott Gillespie
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Nisha George
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Celine Saulnier
- Emory University, USA.,Neurodevelopmental Assessment & Consulting Services, USA
| | - Cheryl Klaiman
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | | | - Nathan Call
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
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Changes in Developmental Trajectories of Preschool Children with Autism Spectrum Disorder during Parental Based Intensive Intervention. Brain Sci 2020; 10:brainsci10050289. [PMID: 32408610 PMCID: PMC7287674 DOI: 10.3390/brainsci10050289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Research highlights the positive effects of early intensive intervention with parent and school involvement for preschool children with Autism Spectrum Disorder (ASD) on general developmental outcomes and social skills in randomized controlled trials. However, given the inter-individual variability in the response to treatment, it is necessary to investigate intervention effects in terms of mediators and moderators in order to explain variability and to highlight mechanisms of change. Methods: 25 children in the experimental group were exposed to early intensive intervention and 14 children in the control group were subjected to “as usual” intervention. The initial assessment was obtained at the time of diagnosis (T1) and the follow-up assessment was conducted after 15 months of intervention (T2) in both groups. Results: Participants in the experimental group achieved more prominent gains in both cognitive and socio-interactive skills. The role of specific factors able to predict general quotient and language quotient after intervention were investigated, pointing out the contribution of personal–social and performance abilities. Conclusions: The findings support the importance of parental involvement in targeting ASD core symptoms. Further, results informed our understanding of early predictors in order to identify specific elements to be targeted in the individualized intervention design.
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Schrader E, Delehanty AD, Casler A, Petrie E, Rivera A, Harrison K, Paterniti T, Sebastiany L, Nottke C, Sohl K, Levy SE, Wetherby AM. Integrating a New Online Autism Screening Tool in Primary Care to Lower the Age of Referral. Clin Pediatr (Phila) 2020; 59:305-309. [PMID: 31976757 DOI: 10.1177/0009922819900947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Alix Casler
- Physician Associates of Orlando Health, Orlando, FL, USA
| | | | | | | | | | | | | | | | - Susan E Levy
- University of Pennsylvania, Philadelphia, PA, USA
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Dow D, Day TN, Kutta TJ, Nottke C, Wetherby AM. Screening for autism spectrum disorder in a naturalistic home setting using the systematic observation of red flags (SORF) at 18-24 months. Autism Res 2020; 13:122-133. [PMID: 31643148 PMCID: PMC6972690 DOI: 10.1002/aur.2226] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/06/2019] [Accepted: 09/26/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to examine the utility of the Systematic Observation of Red Flags (SORF; Dow et al., 2016) as a level 2 screener for autism spectrum disorder (ASD) in toddlers during a naturalistic video-recorded home observation. Psychometric properties of the SORF were examined in a sample of 228 toddlers-84 with ASD, 82 with developmental delay (DD), and 62 with typical development (TD). Trained undergraduate research assistants blind to diagnosis rated 22 red flags (RF) of ASD associated with DSM-5 diagnostic criteria using a 4-point scale. The following scores were computed: a total score summing all items, domain scores summing social communication and restricted, repetitive behavior items, and number of RF counting items with scores of 2 or 3 indicating clear symptom presence. The performance of the total, domain, and RF scores and individual items were examined. A composite score was formed with six items with the best psychometric performance: poor eye gaze directed to faces, limited showing and pointing, limited coordination of nonverbal communication, less interest in people than objects, repetitive use of objects, and excessive interest in particular objects, actions, or activities. The 6-item composite provides a brief measure with optimal performance, while the RF may be instrumental for clinicians who are interested in characterizing the range of observed symptoms. The SORF shows promise as a practical alternative to currently available screening methods for implementation by nonexperts with the potential to increase feasibility and reduce common obstacles to access to care. Autism Res 2020, 13: 122-133. © The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: Research suggests that current autism spectrum disorder (ASD) screening tools are not accurate enough to use in routine screening. The Systematic Observation of Red Flags was developed as a practical option for children at high risk for ASD. It can be used with video-recorded samples of parent-child interactions in the home and by raters who are not experts in ASD. It shows promise in predicting ASD risk in toddlers to determine if a full diagnostic evaluation is necessary.
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Affiliation(s)
- Deanna Dow
- Department of PsychologyFlorida State University, Autism InstituteTallahasseeFlorida
| | - Taylor N. Day
- Department of PsychologyFlorida State University, Autism InstituteTallahasseeFlorida
| | - Timothy J. Kutta
- College of MedicineFlorida State University Autism InstituteTallahasseeFlorida
| | - Charly Nottke
- College of MedicineFlorida State University Autism InstituteTallahasseeFlorida
| | - Amy M. Wetherby
- Department of Clinical Sciences, College of MedicineFlorida State University, Autism InstituteTallahasseeFlorida
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Tager-Flusberg H. Introduction to the Research Symposium Forum. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2613-2614. [PMID: 30418490 PMCID: PMC6693576 DOI: 10.1044/2018_jslhr-l-rsaut-18-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this introduction is to provide an overview of the articles contained within this research forum of JSLHR. Each of these articles is based upon presentations from the 2017 ASHA Research Symposium.
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