A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations

The use of Treatment and Education of Autistic and Related Communication Handicapped Children in schools to improve the ability of children with autism to complete tasks independently: A single-case meta-analysis

OBJECTIVE

To investigate the effectiveness of a Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) intervention in schools for improving independent task performance in children with autism spectrum disorders (ASD).

METHODS

We screened relevant studies published up to December 2022 from Web of science, ERIC, PsycINFO and other databases using predefined inclusion/exclusion criteria to identify suitable intervention studies for meta-analysis. Tau-U effect sizes were calculated for each A-B comparison extracted from the included experiments. Moderated analyses were conducted to examine the type of intervention (independent variable), intervention target behaviours (dependent variable), participant characteristics, setting characteristics and intervener characteristics.

RESULTS

A total of 14 studies (38 participants) met the criteria and were included in the meta-analysis. The analysis results showed that TEACCH had a significant intervention effect, and the overall intervention effect size was Tau-U = 0.85[0.77, 0.91]. There were significant differences in the intervention target behaviour variables (p < 0.01), limited variation in the intervention type variables, but no differences in participant characteristics, setting characteristics and intervenor characteristics.

CONCLUSION

The use of TEACCH is effective in improving independent task completion in children with ASD and provides evidence-based recommendations for its extended use in schools.

Examining Conjoint Behavioral Consultation to Support 2e-Autism Spectrum Disorder and Gifted Students in Preschool with Academic and Behavior Concerns

Conjoint behavioral consultation (CBC), as adjusted for 2e children with academic and behavioral difficulties, was the focus of this single-subject design study. Three young children from a preschool participated, together with their parents and teachers. Academic enablers for students-intervention, maintenance, and generalization phases; academic and behavioral competencies-intervention, maintenance, and generalization phases; and teachers', parents', and students' perceptions of the intervention's social validity data were collected among the outcome measures. Findings from multiple participant-related probes pointed to constructive improvements in the phases of intervention, maintenance for listening behavior, and improved on-task skill in intervention, maintenance, and generalization. Additionally, during the consultation, parents and teachers noted improvements in the outcomes of the target behavior such as rhythm keeping, picture-word matching, writing the pictured concept in Turkish, writing the pictured concept in English, short personal story writing, short personal story telling, and verbal math problem solving, and each stakeholder gave the intervention a grade for its social validity. Limitations, potential routes for future study, and implications for preschool CBC intervention are highlighted.

Somatosensory Stimulation Interventions for Children with Autism: Literature Review and Clinical Considerations

Background. There is considerable evidence that children with autism experience sensory dysfunction, which can affect their ability to participate in functional activities. Occupational therapists frequently recommend somatosensory stimulation interventions to mitigate sensory dysfunction and improve a child's ability to function. Purpose. This paper examines the rationale and evidence supporting somatosensory stimulation interventions for children with autism. Method. A comprehensive review of the literature specific to somatosensory stimulation was conducted, resulting in six published studies that addressed interventions feasible within a child's daily routine. Discussion. Although research related to somatosensory stimulation interventions is becoming more rigorous, empirical support remains limited; therefore, when these interventions are implemented, they should be systematically evaluated. Practice Implications. To help occupational therapists recommend interventions with confidence, strategies are provided to (1) utilise best practices to intervene in an area in which evidence is limited, and (2) help expand the evidence base through clinical research.

Predictable enriched environment prevents development of hyper-emotionality in the VPA rat model of autism

Understanding the effects of environmental stimulation in autism can improve therapeutic interventions against debilitating sensory overload, social withdrawal, fear and anxiety. Here, we evaluate the role of environmental predictability on behavior and protein expression, and inter-individual differences, in the valproic acid (VPA) model of autism. Male rats embryonically exposed (E11.5) either to VPA, a known autism risk factor in humans, or to saline, were housed from weaning into adulthood in a standard laboratory environment, an unpredictably enriched environment, or a predictably enriched environment. Animals were tested for sociability, nociception, stereotypy, fear conditioning and anxiety, and for tissue content of glutamate signaling proteins in the primary somatosensory cortex, hippocampus and amygdala, and of corticosterone in plasma, amygdala and hippocampus. Standard group analyses on separate measures were complemented with a composite emotionality score, using Cronbach's Alpha analysis, and with multivariate profiling of individual animals, using Hierarchical Cluster Analysis. We found that predictable environmental enrichment prevented the development of hyper-emotionality in the VPA-exposed group, while unpredictable enrichment did not. Individual variation in the severity of the autistic-like symptoms (fear, anxiety, social withdrawal and sensory abnormalities) correlated with neurochemical profiles, and predicted their responsiveness to predictability in the environment. In controls, the association between socio-affective behaviors, neurochemical profiles and environmental predictability was negligible. This study suggests that rearing in a predictable environment prevents the development of hyper-emotional features in animals exposed to an autism risk factor, and demonstrates that unpredictable environments can lead to negative outcomes, even in the presence of environmental enrichment.

A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.

Personality traits associated with occupational 'burnout' in ABA therapists

BACKGROUND

Applied behaviour analysis (ABA) therapists typically work one-to-one with children with autism for extended periods of time, which often leads to high levels of job-related stress, lower levels of job satisfaction, increased frequency of occupational 'burnout' and higher than average job turnover (Journal of Autism Development, 39, 2009 and 42). This is particularly unfortunate, in that these vulnerable clients need stability and consistency in care, both of which are empirically related to clinical outcomes (Journal of Autism Development, 39, 2009 and 42). It is reasonable to assume that some individuals, by virtue of their personal characteristics, are better suited to this type of work than are others.

METHOD

The purpose of the this study was to investigate associations between personality traits, using the five-factor model of personality, and key job-related variables, including burnout and job satisfaction, in a sample of therapists (n = 113) who work one-to-one with individuals diagnosed with autism.

RESULTS

Significant correlations were found between Neuroticism and all three subscales of burnout (Exhaustion, Cynicism and Professional Efficacy). Extraversion and Conscientiousness were significantly negatively correlated with Cynicism and positively correlated with Professional Efficacy. Agreeableness was positively associated with Professional Efficacy. Job satisfaction was correlated positively with Extraversion and negatively with Neuroticism. Level of perceived personal and professional support partially mediated the effect of personality traits on job satisfaction.

CONCLUSIONS

These results may help to identify job applicants who are dispositionally less suited to this type of work, as well as currently employed therapists who are in need of support or intervention.

AutismPro system in supporting treatment of children with autism in Poland

BACKGROUND

The efficacy of early intervention programs for children with autism has been emphasized in many studies. However, access for people with autism to professional services in Poland is very limited and the burden of supporting a child's development often falls on parents, especially in families with low socioeconomic status and families living far away from big cities. Using Internet resources in planning and delivering individualized intervention may be useful. This study examined the effects of a home program of intervention based on the AutismPro system with elements of consultative therapy.

METHODS

Ten families of children with a diagnosis of autism participated in the project; nine of them completed the 6-month program of intervention. Parents were taught to use the AutismPro system and implement the intervention techniques in a home setting. Modification of the intervention program to suit individual children's needs and evaluations of children's progress were performed during consultation meetings with therapists. The pre- and post-treatment measurement of child development was performed using the Psychoeducational Profile - Revised (PEP-R).

RESULTS

Children involved in the study progressed in total PEP-R scores and on the PEP-R subtest of fine motor, gross motor, non-verbal and verbal cognitive skills and eye-hand integration. Parents expressed positive opinions on the program.

CONCLUSIONS

The results suggest that an intervention which combines the use of the Internet support tool and professional consultations may provide benefits to the children with autism. There are, however, methodological limitations of the study to be taken into account when interpreting the results.

BUILDING A RESEARCH-COMMUNITY COLLABORATIVE TO IMPROVE COMMUNITY CARE FOR INFANTS AND TODDLERS AT-RISK FOR AUTISM SPECTRUM DISORDERS

This article describes the formation and initial outcomes of a research-community collaborative group that was developed based on community-based participatory research principles. The group includes a transdisciplinary team of practitioners, funding agency representatives, researchers, and families of children with autism spectrum disorders, who partnered to improve community-based care for infants and toddlers at risk for autism through the implementation of evidence-based practices. Data from this group provide support for the feasibility of developing and sustaining a highly synergistic and productive research-community collaborative group who shares common goals to improve community care.

Credible knowledge: a pilot evaluation of a modified GRADE method using parent-implemented interventions for children with autism

BACKGROUND

Decision-making in child and youth mental health (CYMH) care requires recommendations that are developed through an efficient and effective method and are based on credible knowledge. Credible knowledge is informed by two sources: scientific evidence, and practice-based evidence, that reflects the "real world" experience of service providers. Current approaches to developing these recommendations in relation to CYMH will typically include evidence from one source or the other but do not have an objective method to combine the two. To this end, a modified version of the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach was pilot-tested, a novel method for the CYMH field.

METHODS

GRADE has an explicit methodology that relies on input from scientific evidence as well as a panel of experts. The panel established the quality of evidence and derived detailed recommendations regarding the organization and delivery of mental health care for children and youth or their caregivers. In this study a modified GRADE method was used to provide precise recommendations based on a specific CYMH question (i.e. What is the current credible knowledge concerning the effects of parent-implemented, early intervention with their autistic children?).

RESULTS

Overall, it appeared that early, parent-implemented interventions for autism result in positive effects that outweigh any undesirable effects. However, as opposed to overall recommendations, the heterogeneity of the evidence required that recommendations be specific to particular interventions, based on the questions of whether the benefits of a particular intervention outweighs its harms.

CONCLUSIONS

This pilot project provided evidence that a modified GRADE method may be an effective and practical approach to making recommendations in CYMH, based on credible knowledge. Key strengths of the process included separating the assessments of the quality of the evidence and the strength of recommendations, transparency in decision-making, and the objectivity of the methods. Most importantly, this method combined the evidence and clinical experience in a more timely, explicit and simple process as compared to previous approaches. The strengths, limitations and modifications of the approach as they pertain to CYMH, are discussed.

Reauthorization of the Individuals With Disabilities Education Improvement Act (IDEA, 2004): The peer-reviewed research requirement

Due to an insufficient focus on efficacious practices, the reauthorized IDEA requires Individualized Education Program (IEP) teams to base the selection of special education, related services, and supplementary aids and services on peer-reviewed research (PRR), to the extent practicable. This article examines the litigation addressing the PRR requirement, presents the federal policy initiatives to support implementation of PRR and the controversy surrounding an expanded federal influence, and poses several questions pertaining to the implementation of the PRR requirement.

Social validation of evidence-based practices in autism by parents, teachers, and administrators

Relatively little attention has been devoted to the social validation of potentially effective autism interventions. Thus, it is often difficult to identify and implement evidence-based practices, and programming is often inadequate. The authors identified autism intervention components with reported effectiveness for school settings. The results of a social validation survey completed by parents, teachers, and administrators indicate strong, consistent support for program components falling within five functional areas: (a) individualized programming, (b) data collection, (c) the use of empirically-based strategies, (d) active collaboration, and (e) a focus on long-term outcomes. These socially validated interventions can be used to evaluate existing autism curricula and develop training for professionals, parents, and students in order to improve public school autism programs.

Parent implemented early intervention for young children with autism spectrum disorder: a systematic review

BACKGROUND

Recent estimates concerning the prevalence of autism spectrum disorder (ASD) suggest that at least one in 200 children is affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children.

METHODS

This research review focused on interventions for children aged 1-6 years, and was carried out using systematic methodology: a comprehensive search of psychological, educational and biomedical databases, as well as bibliographies and reference lists of key articles, contact with experts in the field, and hand search of key journals. Only studies which involved a concurrent element of control were included.

RESULTS

The review found very few studies that had adequate research design from which to draw conclusions about the effectiveness of parent-implemented early intervention. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression.

CONCLUSION

It seems that parent training can successfully contribute to intervention for young children with ASD. However, the review highlights the need for improved research in this area.

The basic structure of community early intervention programs for children with autism: provider descriptions

Autism researchers have identified a set of common effective practice elements for early intervention (EI) (e.g., intensive programming). The current study examined the reported use of common elements of effective interventions in community EI settings. Eighty EI providers reported about their programs. The majority of participants reported using common effective elements, however, the depth and quality of the use of these elements was highly variable. Taking community program structure into account in future research will facilitate the development of methodologies, which immediately fit into the context of community programming rather than requiring program adaptation for use in the real world. Recommendations for using current community program structure to improve use of evidence-based practices are discussed.

Parent-mediated early intervention for young children with autism spectrum disorder

BACKGROUND

Recent estimates concerning the prevalence of autistic spectrum disorder are much higher than those reported 30 years ago, with at least 1 in 400 children affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children.

OBJECTIVES

The objective of this review was to determine the extent to which parent-mediated early intervention has been shown to be effective in the treatment of children aged 1 year to 6 years 11 months with autistic spectrum disorder. In particular, it aimed to assess the effectiveness of such interventions in terms of the benefits for both children and their parents.

SEARCH STRATEGY

A range of psychological, educational and biomedical databases were searched. Bibliographies and reference lists of key articles were searched, field experts were contacted and key journals were hand searched.

SELECTION CRITERIA

Only randomised or quasi-randomised studies were included. Study interventions had a significant focus on parent-implemented early intervention, compared to a group of children who received no treatment, a waiting list group or a different form of intervention. There was at least one objective, child related outcome measure.

DATA COLLECTION AND ANALYSIS

Appraisal of the methodological quality of included studies was carried out independently by two reviewers. Differences between the included studies in terms of the type of intervention, the comparison groups used and the outcome measures were too great to allow for direct comparison.

MAIN RESULTS

The results of this review are based on data from two studies. Two significant results were found to favour parent training in one study: child language and maternal knowledge of autism. In the other, intensive intervention (involving parents, but primarily delivered by professionals) was associated with better child outcomes on direct measurement than were found for parent-mediated early intervention, but no differences were found in relation to measures of parent and teacher perceptions of skills and behaviours.

REVIEWER'S CONCLUSIONS

This review has little to offer in the way of implications for practice: there were only two studies, the numbers of participants included were small, and the two studies could not be compared directly to one another. In terms of research, randomised controlled trials involving large samples need to be carried out, involving both short and long-term outcome information and full economic evaluations. Research in this area is hampered by barriers to randomisation, such as availability of equivalent services.