A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism

Effect of social skills training on interpersonal interactions of children with autism: an interventional research

Autism is a neuro-developmental disorder typically appears prior to the age of three years, and seriously limits the normal development of children. However, there is a wide variety of effective intervention programs and strategies designed to help children with autism. Hence, this research aimed to see the effect of social skills training on interpersonal interaction of children with autism. Using pre-post equivalent experimental and control group design, data were collected from a sample of eight children using Autism Social Skills Profile Rating Scale before and after the implementation of social skills training. Data were analyzed through frequency, percentage, mean, standard deviation, and independent samples t-test. The pre-intervention assessment revealed that participants of the experimental and the control groups did not significantly differ but both groups scored below half on the total scale point and almost one-third of the maximum score on social reciprocity and social participation sub-scales. The result of the intervention also indicated that children in both groups demonstrated positive changes in their overall social skills including the sub-scales. However, it was found out that the experimental group has greater mean scores as compared to the control group on total scale, social participation and social reciprocity subscales. But the increment on detrimental social behaviors subscale in the experimental group was with a decreasing rate. Based on this finding, it can be concluded that social skills training intervention improves social skills of children with autism. Therefore, it is recommended that further intensive and comprehensive intervention is very critical to more improve the social skills of children with autism.

Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review

OBJECTIVE

Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high.

METHODS

A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data.

OUTCOMES MEASURES

The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review.

RESULTS

A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children.

CONCLUSION

This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.

The categorisation of resistance: interpreting failure to follow a proposed line of action in the diagnosis of autism amongst young adults

Many characteristics typical of autism, a neurodevelopmental condition characterised by socio-communicative impairments, are most evident during social interaction. Accordingly, procedures such as the Autism Diagnosis Observation Schedule (ADOS) are interactive and intended to elicit interactional impairments: a diagnosis of autism is given if interactional difficulties are attributed as a persistent quality of the individual undergoing diagnosis. This task is difficult, first, because behaviours can be interpreted in various ways and, second, because conversation breakdown may indicate a disengagement with, or resistance to, a line of conversation. Drawing upon conversation analysis, we examine seven ADOS diagnosis sessions and ask how diagnosticians distinguish between interactional resistance as, on the one hand, a diagnostic indicator and, on the other, as a reasonable choice from a range of possible responses. We find evidence of various forms of resistance during ADOS sessions, but it is a resistance to a line of conversational action that is often determined to be indicative of autism. However, and as we show, this attribution of resistance can be ambiguous. We conclude by arguing for reflexive practice during any diagnosis where talk is the problem, and for a commitment to acknowledge the potential impact of diagnostic procedures themselves upon results.

Effectiveness of Interventions to Improve Social Participation, Play, Leisure, and Restricted and Repetitive Behaviors in People With Autism Spectrum Disorder: A Systematic Review

People with autism spectrum disorder (ASD) commonly experience difficulties with social participation, play, and leisure along with restricted and repetitive behaviors that can interfere with occupational performance. The objective of this systematic review was to evaluate current evidence for interventions within the occupational therapy scope of practice that address these difficulties. Strong evidence was found that social skills groups, the Picture Exchange Communication System, joint attention interventions, and parent-mediated strategies can improve social participation. The findings were less conclusive for interventions to improve play and leisure performance and to decrease restricted and repetitive behaviors, but several strategies showed promise with moderately strong supporting evidence. Occupational therapists should be guided by evidence when considering interventions to improve social participation, play, leisure, and restricted and repetitive behaviors in people with ASD. Additional research using more robust scientific methods is needed for many of the currently available strategies.

Parents' strategies to elicit autobiographical memories in autism spectrum disorders, developmental language disorders and typically developing children

Conversations about the past support the development of autobiographical memory. Parents' strategies to elicit child's participation and recall during past event conversations were compared across three school-age diagnostic groups: autism spectrum disorder (ASD, n = 11), developmental language disorders (n = 11) and typically developing (TD, n = 11). We focused on the prevalence of directives versus enrichment of events. Groups did not differ in number of events, length, and total turns. However, parents of children with ASD produced more direct questions, corrections, and unrelated turns than parents of TD children. Results highlight how parents adjusted their conversational style to their child's communication difficulties to maximize interactions and how these strategies may affect the development of personal conversations.

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

BACKGROUND

The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact.

OBJECTIVES

To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents.

METHODS

The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers.

RESULTS

The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents).

CONCLUSIONS

This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research.

FUTURE WORK

Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012002223.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

“Bill is now singing”: Joint engagement and the emergence of social communication of three young children with autism

Young children with autism spectrum disorder meet significant challenges in joint attention skills and in social communication. A child-centered, improvisational, music therapy intervention model was implemented to promote engagement in three young children with autism in a kindergarten classroom. A multiple baseline design compared the children’s performance through three phases of intervention: focus on faces, response to joint attention, and initiation of joint attention. A complimentary qualitative analysis of teacher and parent experiences allowed for an in-depth understanding of the role of social environment in supporting emerging social communication skills among three children. As all children showed improvement in joint attention and actions of social engagement, this study bears evidence on the potential of music therapy as a promising intervention for promoting social skills of young children with autism spectrum disorder.

A systematic review of early intensive intervention for autism spectrum disorders

CONTEXT

Early intensive behavioral and developmental interventions for young children with autism spectrum disorders (ASDs) may enhance developmental outcomes.

OBJECTIVE

To systematically review evidence regarding such interventions for children aged 12 and younger with ASDs.

METHODS

We searched Medline, PsycINFO, and ERIC (Education Resources Information Center) from 2000 to May 2010. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings using predetermined criteria.

RESULTS

Thirty-four unique studies met inclusion criteria. Seventeen studies were case series; 2 were randomized controlled trials. We rated 1 study as good quality, 10 as fair quality, and 23 as poor quality. The strength of the evidence overall ranged from insufficient to low. Studies of University of California Los Angeles/Lovaas-based interventions and variants reported clinically significant gains in language and cognitive skills in some children, as did 1 randomized controlled trial of an early intensive developmental intervention approach (the Early Start Denver Model). Specific parent-training approaches yielded gains in short-term language function and some challenging behaviors. Data suggest that subgroups of children displayed more prominent gains across studies, but participant characteristics associated with greater gains are not well understood.

CONCLUSIONS

Studies of Lovaas-based approaches and early intensive behavioral intervention variants and the Early Start Denver Model resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs, although the literature is limited by methodologic concerns.

Psycho-educational Horseback Riding to Facilitate Communication Ability of Children with Pervasive Developmental Disorders

In this study, we applied a novel psycho-educational horseback riding (PEHR) program to the treatment of four Japanese children with pervasive developmental disorders (PDD) in order to facilitate the acquisition of verbal and nonverbal communication skills. The behavioral changes in each child were evaluated using a psychological and behavioral scale. The scale for evaluating the effect of Human-Equips-Interaction on Mental activity (HEIM scale) was designed to assess the behavioral improvement of children based on the following 10 items: Human relationships, Imitation, Emotional expression, Sudden physical movement, Fixative behavior, Adaptation to change, Visual response, Fear or nervousness, and Verbal and nonverbal communication. After taking part in the PEHR program for several months, all subjects showed remarkably improved HEIM scores and marked improvements were observed in eye contact with others (instructors, side walkers, and leaders) in the riding area. A statistical difference was found in items 1, 2, 3, 6, 7, 8, and 9. However, no statistical difference was found in items 4, 5, and 10. As the program progressed, the children showed enhanced verbal and nonverbal communication skills, and became more expressive in their emotional and empathetic interaction with their parents. These observations suggest that the normal functioning of pleasurable emotions and empathy may facilitate further improvements in joint attention, imitation and empathy, and may result in successful verbal expression by PDD children. Therefore, horseback riding can play a very important role in the psycho-educational support required for the communication ability of PDD children.

Brincadeiras de faz-de-conta em crianças autistas: limites e possibilidades numa perspectiva evolucionista

A constatação da presença universal da brincadeira na infância sugere que tal comportamento deva ter grande valor adaptativo para a espécie. Apesar de universal, a brincadeira sofre interferência do estado desenvolvimental do indivíduo. Crianças com autismo, por exemplo, apresentam dificuldades no brincar, o que nos leva a questionamentos sobre a natureza da sua brincadeira simbólica, se todo faz-de-conta necessariamente inclui teoria da mente e porque um fenômeno considerado universal surge de modo tão atípico no autismo. O artigo discute essas questões à luz da psicologia evolucionista, ilustrando relatos de brincadeiras espontâneas de crianças autistas coletados em instituições educacionais na cidade de Salvador (BA). Os resultados sugerem que os episódios de faz-de-conta envolvem freqüentemente a presença de objetos como apoio para o desenvolvimento da brincadeira. Tal fato está em acordo com a descrição de alguns autores sobre o desenvolvimento do faz-de-conta, com seu início mais sustentado por objetos e independente de metarepresentação.

Fonoaudiologia e autismo: resultado de três diferentes modelos de terapia de linguagem

TEMA: as dificuldades de comunicação e linguagem são elementos essenciais dos distúrbios do espectro autista, fazendo parte da tríade de sintomas utilizada para o diagnóstico. OBJETIVO: verificar a existência de diferenças observáveis a partir das características do perfil funcional da comunicação e do desempenho sócio-cognitivo de crianças e adolescentes do espectro autístico, atendidos em três diferentes situações terapêuticas, tanto no que diz respeito a um período experimental pré-determinado de intervenção, quanto na manutenção dos resultados obtidos após um igual período de tempo de atendimento fonoaudiológico regular. MÉTODO: os sujeitos foram crianças e adolescentes com diagnósticos psiquiátricos incluídos no espectro autístico em início de processos de terapia fonoaudiológica. Os participantes foram divididos em três grupos de acordo com o desenho terapêutico oferecido por um período de seis meses. RESULTADOS: não indicaram diferenças estatisticamente significativas, embora observáveis. O grupo com mais indicadores de progresso durante o período específico de intervenção diferenciada, foi o grupo A, em que os sujeitos eram atendidos em duplas. O resultado não previsto foi que não só em nenhum dos grupos foi observada diminuição dos índices obtidos, após um período de seis meses, como em algumas situações o número de sujeitos com progresso aumentou após esse período. CONCLUSÃO: os resultados do presente estudo reiteram a adequação de procedimentos de determinação do perfil individual de habilidades e inabilidades de cada sujeito como fundamentação para definições a respeito do modelo de intervenção adotado.

When asking questions is not enough: an observational study of social communication differences in high functioning children with autism

This investigation examined communication patterns between high functioning children with autism and their families and typically developing children and their families within traditional dinner time conversation. Twenty families with a child with autism (3.5-7 years.) and ten families with typically developing children (3.5-6 years) were video recorded during dinner and their interactions were coded. Results revealed that children with autism initiated fewer bids for interactions, commented less often, continued ongoing interactions through fewer conversational turns, and responded less often to family member communication bids. Results are interpreted with respect to how communication patterns may be indicative of social communication deficits not previously examined in high functioning children with autism. Strategies for social communication interventions within the family and other natural contexts are discussed.