Cross-Cultural Validation of the York Measure of Quality of Intensive Behavioral Intervention

Predictors of Picture Exchange Communication System (PECS) outcomes

Background & aims

Although the Picture Exchange Communication System (PECS) has been demonstrated to be an effective intervention to teach people diagnosed with autism spectrum disorder a functional communication system, the research indicates variability in PECS outcomes across people and studies. Therefore, the purpose of the current study was to explore child characteristics and treatment variables that may explain the variation in, and potentially predict, PECS outcomes.

Method

A total of 22 children and youth diagnosed with autism or a related developmental disorder, all of whom scored substantially below average on standardized measures of cognitive and adaptive abilities, participated in a PECS intervention.

Results

Participants who achieved high phases of PECS (≥PECS phase IIIb) differed significantly from those who mastered lower PECS phases (≤PECS phase IIIa) in terms of overall, verbal, and nonverbal mental age, matching abilities, and adaptive behavior level. Stimulus generalization was also associated with significant variation in PECS outcome. PECS outcomes could be predicted with good accuracy using a combination of these child characteristics and treatment variables.

Conclusions

The findings from the current study suggest that children with relatively higher cognitive and adaptive skill levels are more likely to achieve higher phases of PECS; further, approaches to generalization training also play a role. Factors such as autism symptom severity and parental ratings of maladaptive behavior were not associated with significant differences in PECS outcomes. However, more research is needed.

Implications

Gaining a better understanding of predictors of PECS outcomes is important to inform intervention, provide more accurate outcome expectations for families, and guide PECS teaching procedures. Although participants were more likely to achieve higher phases of PECS if they had a higher mental age, adaptive skill level, and matching skills, the average scores for these measures were well below those expected for same age peers. These results indicate that PECS is appropriate for use with children with clinically significant deficits in cognitive and/or adaptive abilities. Further, results suggest that even children who demonstrate more severe symptoms of autism and exhibit more challenging behavior can achieve higher phases of PECS.

Behavior analytic interventions for children with autism: Policy and practice in the United Kingdom and China

LAY ABSTRACT

The prevalence of autism is increasing, and the development of these children and the lived experience of their families have become a global concern. Applied behavioral analytic intervention is proved to be effective in improving their cognitive abilities, language skills, and social and emotional skills, but the service delivery between developed and developing countries is different. A qualitative study was conducted to explore personal experiences with actual practice fidelity of behavior analytic services for children with autism in a Western developed country (United Kingdom) and an Eastern developing country (China). The study found: (1) a lack of support for autism and behavioral analytic services in both countries; (2) applied behavioral analytic intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular aspect of behavioral analytic interventions was similar and increased with ongoing training. This study emphasizes the need to support children with autism, and to consider regional adaptations of evidence-based practice of behavior analytic interventions for the affected population.

Quality of Early Intensive Behavioral Intervention as a Predictor of Children's Outcome

Research has directed surprisingly little attention to the quality of Early Intensive Behavioral Intervention (EIBI) in autism spectrum disorder (ASD) as a potential predictor of outcome. Therefore, using a preschool delivery model within a sample of 30 children, we examined the predictive power of EIBI quality on treatment outcome. EIBI quality was assessed at baseline by the York Measure of Quality of Intensive Behavioral Intervention (YMQI) and treatment outcome was evaluated after a period of 4 to 6 months using a battery of behavioral tests and scales to evaluate treatment success. Multinomial logistic regressions demonstrated that general EIBI quality predicted clinically significant change at follow-up. Particularly improvements in basic language and learning skills and global clinical impression were observed. Specific quality indicators that influenced overall treatment success were treatment organization, teaching level and differential reinforcement. In addition to previously examined predictors of EIBI treatment effects, such as child characteristics and intervention quantity, our findings highlight the importance of adequate EIBI quality assurance.