Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements

The long-lasting benefits of pre-kindergarten education on autistic children's working memory development

LAY ABSTRACT

Working memory is an important skill for school success, and it involves holding information in our memory while using it to solve complex problems. However, autistic children often have difficulties with working memory tasks. Also, kindergarteners on the autism spectrum tend to be less school-ready compared with their peers. In addition, children from disadvantaged backgrounds tend to struggle more with working memory and school readiness skills. All preschool-age children on the autism spectrum in the United States are entitled to pre-kindergarten (pre-K) education. However, it is unclear whether attending pre-K helps with children's working memory development in the long run. This study tested whether attending pre-K benefits children's working memory development in the long run. It also tested whether pre-K is especially helpful for autistic children's working memory development. It was found that children who attended pre-K outperformed their peers who did not attend pre-K during the first 2 years of elementary school. However, after first grade, such benefits diminished. Importantly, autistic children who attended pre-K did not demonstrate advanced working memory immediately in kindergarten, but they started to outperform their autistic peers who did not attend pre-K during first grade to third grade. This finding highlights the importance of pre-K education for autistic children in particular. It is also important for educators and parents to understand autistic children's unique learning paths that may be different from non-autistic children. This article discusses specific ways for educators to take full advantage of the long-lasting benefits of pre-K education in autistic children's working memory development.

The importance and challenges of observing social interactions in autistic preschoolers during inclusive educational settings: A scoping review

Background and aims

A growing number of autistic children have access to inclusive education programs as early as kindergarten. However, little is known about how they actually participate in social interactions and develop their communicative skills according to the parameters of this environment. The aim of this article is to review observational studies on this topic and critically analyze their methodological choices by arguing on the aspects of communication skills noted in the observation grids. Disparities in the information collected depending on the method used have implications for understanding and supporting autistic children in an inclusive school environment.

Methods

Observational studies on social interactions of autistic preschoolers within inclusive preschool settings were scoped. The studies were analyzed according to the following parameters: aims of observation, method used for coding, communication partners considered (adults and peers), type of children's social engagement (initiatives and responses), diversity of communicative forms and communication functions, distinction and comparison of interactional contexts related to the activities, and whether changes linked to developmental variables are studied on an interindividual or longitudinal basis.

Results

Seventeen studies using the observation method in inclusive preschool settings were identified. Recordingmethods are mostly based on video recording. The coding grids mainly focus on autistic children while partners' behaviors (adults, peers) are often coded in less detail, thus providing littleinformation on their dynamic role in the interactions. Overall, autistic children were found to initiate interactions much less often than they respond to it. The data generally distinguish thecommunicative forms used by children and indicate a predominance of nonverbal means at preschool level. However, a few studies coded communicative functions, whether they areaddressed to children or produced by them. In addition, very few studies compare interactions across activity contexts. In addition, very few studies compare interactions across activity contexts.Results of some studies showed that children initiated interaction more frequently during free play than during work activity, but results are heterogeneous. Developmental trajectories in socialskills seem to be associated with the severity of autism and language skills, but longitudinal designs are still rare.

Conclusions and implications

Direct and fine-grained observation in the classroom is a key source of information about how communication takes place in preschool-inclusive settings. The data, despite some methodological challenges, offer opportunities for better adjustment based on professional objectives. Our review highlights the importance of offering occasions for initiatives to autistic children and training of neurotypical peers to better interact with autistic children and promote verbal communication. Further observational studies are needed to use more microanalytic measures of the functional quality of social interactions in autistic children, including joint comparisons between partners (adults vs. peers) and across contexts (e.g., play vs. structured development) so that appropriate strategies can be proposed in inclusive preschool settings.

Mathematics performance, response time, and enjoyment of eighth-grade autistic students and their general education peers

For autistic students receiving special education services, little is known about their relative strengths, weaknesses, and enjoyment across different math content areas; their overall math interest and persistence are also not well-studied. Using the 2017 eighth-grade National Assessment of Education Progress data, this study finds, relative to general education peers with the same math proficiency level, autistic students scored higher and exhibited faster speed in solving visuospatial problems (e.g. identifying figures), but scored lower on math word problems with complex language or social context. Autistic students reported a higher level of enjoyment in solving math problems related to finding areas of shapes or figures but a lower level of persistence than their non-autistic, general education peers. Our work points out the need to help autistic students overcome their weaknesses in word problems and develop their mathematical persistence.

Children with autism exhibit similar longitudinal changes in core symptoms when placed in special or mainstream education settings

LAY ABSTRACT

Today, children with autism spectrum disorder (ASD) are placed in mainstream or special education settings somewhat arbitrarily with no clear clinical recommendations. Here, we compared changes in core ASD symptoms, as measured by the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) clinical assessment, across ASD preschool children placed in special or mainstream education. Longitudinal changes in ADOS-2 scores did not differ significantly across settings over a 1- to 2-year period. While some children improved in core ASD symptoms, others deteriorated in both settings. This highlights the need to identify specific criteria for establishing meaningful placement recommendations.

Supporting peer engagement for low-income preschool students with autism spectrum disorder during academic instruction: A pilot randomized trial

Schools are the portal through which many children with autism spectrum disorder access early intervention. Collaborating with teachers can be an effective way to implement evidence-based practices. In this study, teachers learned to embed strategies from the Joint Attention, Symbolic Play, Engagement, and Regulation intervention into the standard preschool curriculum. Twelve schools with special education preschool classrooms for students with moderate to severe disabilities from under-resourced neighborhoods were randomized to augment their curriculum with Joint Attention, Symbolic Play, Engagement, and Regulation strategies or continue the standard curriculum. Teachers’ strategy implementation, children’s time on task, and social communication were examined before and after completing the intervention phase. Teachers in the Joint Attention, Symbolic Play, Engagement, and Regulation group implemented more Joint Attention, Symbolic Play, Engagement, and Regulation strategies than the control group after the intervention phase. Children in both groups increased time on task during teacher-led small group instruction. Children in the Joint Attention, Symbolic Play, Engagement, and Regulation group were more likely to be engaged with peers during small group instruction at the end of the intervention phase. Children from both groups improved in standardized measures of joint attention, requesting, expressive language, and receptive language. Training teachers to embed Joint Attention, Symbolic Play, Engagement, and Regulation strategies into small group instruction can help facilitate peer engagement, providing children more opportunities for peer socialization.

Feasibility of delivering parent-implemented NDBI interventions in low-resource regions: a pilot randomized controlled study

BACKGROUND

This implementation feasibility study was conducted to determine whether an evidence-based parent-implemented distance-learning intervention model for young children at high likelihood of having ASD could be implemented at fidelity by Part C community providers and by parents in low-resource communities.

METHODS

The study used a community-academic partnership model to adapt an evidence-based intervention tested in the current pilot trial involving randomization by agency in four states and enrollment of 35 coaches and 34 parent-family dyads. After baseline data were gathered, providers in the experimental group received 12-15 h of training while control providers received six webinars on early development. Providers delivered 6 months of intervention with children-families, concluding with data collection. Regression analyses were used to model outcomes of the coach behaviors, the parent fidelity ratings, and child outcomes.

RESULTS

A block design model-building approach was used to test the null model followed by the inclusion of group as a predictor, and finally the inclusion of the planned covariates. Model fit was examined using changes in R² and F-statistic. As hypothesized, results demonstrated significant gains in (1) experimental provider fidelity of coaching implementation compared to the control group; and (2) experimental parent fidelity of implementation compared to the control group. There were no significant differences between groups on child developmental scores.

CONCLUSIONS

Even though the experimental parent group averaged less than 30 min of intervention weekly with providers in the 6 months, both providers and parents demonstrated statistically significant gains on the fidelity of implementation scores with moderate effect sizes compared to control groups. Since child changes in parent-mediated models are dependent upon the parents' ability to deliver the intervention, and since parent delivery is dependent upon providers who are coaching the parents, these results demonstrated that two of these three links of the chain were positively affected by the experimental implementation model. However, a lack of significant differences in child group gains suggests that further work is needed on this model. Factors to consider include the amount of contact with the provider, the amount of practice children experience, the amount of contact both providers and parents spend on training materials, and motivational strategies for parents, among others.

TRIAL REGISTRATION

Registry of Efficacy and Effectiveness Studies: #4360, registered 1xx, October, 2020 - Retrospectively registered, https://sreereg.icpsr.umich.edu/sreereg/.

Adults With Special Educational Needs Participating in Interactive Learning Environments in Adult Education: Educational, Social, and Personal Improvements. A Case Study

Previous scientific contributions show that interactive learning environments have contributed to promoting learners' learning and development, as interaction and dialogue are key components of learning. When it comes to students with special needs, increasing evidence has demonstrated learning improvements through interaction and dialogue. However, most research focuses on children's education, and there is less evidence of how these learning environments can promote inclusion in adult learners with SEN. This article is addressed to analyse a case study of an interactive learning environment shared by adults with and without special needs. This case shows several improvements identified by adult learners with special needs participating in this study. Based on a documental analysis and a qualitative study, this study analyses a context of participatory and dialogic adult education. From the analysis undertaken, the main results highlight some improvements identified in the lives of these adult women and men with SEN, covering educational improvements, increased feeling of social inclusion, and enhanced well-being.

Impact of Interactive Learning Environments on Learning and Cognitive Development of Children With Special Educational Needs: A Literature Review

Children with special educational needs (SEN) achieve lower educational levels than their peers without special needs, leading to a higher risk of social exclusion in the future. Inclusive education aims to promote learning and to benefit the cognitive development of these students, and numerous research studies have indicated that interactive environments benefit inclusion. However, it is necessary to know how these inclusive environments can positively impact the academic improvement and development of these students' cognitive skills. This article provides a review of the scientific literature from Web of Science, SCOPUS, ERIC, and PsychINFO to understand the impact of interactive environments on the academic learning and cognitive skill development of children with SEN. A total of 17 studies were selected. Those studies showed the effectiveness of interactive learning environments in promoting instrumental learning, increasing academic involvement, and improving the cognitive development of children with disabilities. Based on these results, it can be concluded that interaction-based interventions with an inclusive approach nurture the learning and cognitive development of students with SEN.

Trajectories in Symptoms of Autism and Cognitive Ability in Autism From Childhood to Adult Life: Findings From a Longitudinal Epidemiological Cohort

OBJECTIVE

For the first time, we use a longitudinal population-based autism cohort to chart the trajectories of cognition and autism symptoms from childhood to early adulthood and identify features that predict the level of function and change with development.

METHOD

Latent growth curve models were fitted to data from the Special Needs and Autism Project cohort at three time points: 12, 16, and 23 years. Outcome measures were IQ and parent-reported Social Responsiveness Scale autism symptoms. Of the 158 participants with an autism spectrum disorder at 12 years, 126 (80%) were reassessed at 23 years. Child, family, and contextual characteristics obtained at 12 years predicted intercept and slope of the trajectories.

RESULTS

Both trajectories showed considerable variability. IQ increased significantly by a mean of 7.48 points from 12 to 23 years, whereas autism symptoms remained unchanged. In multivariate analysis, full-scale IQ was predicted by initial language level and school type (mainstream/specialist). Participants with a history of early language regression showed significantly greater IQ gains. Autism symptoms were predicted by Social Communication Questionnaire scores (lifetime version) and emotional and behavioral problems. Participants attending mainstream schools showed significantly fewer autism disorder symptoms at 23 years than those in specialist settings; this finding was robust to propensity score analysis for confounding.

CONCLUSION

Our findings suggest continued cognitive increments for many people with autism across the adolescent period, but a lack of improvement in autism symptoms. Our finding of school influences on autism symptoms requires replication in other cohorts and settings before drawing any implications for mechanisms or policy.

Editorial: Important First Look at Population-Based Trajectories of Youths With Autism

Few studies have followed young people with autism spectrum disorder (shortened to "autism" herein) over time, and all previous longitudinal studies have used clinical or center-based samples,^1,2 leaving considerable uncertainty about the course of autism in the general population. In this issue, Simonoff and colleagues³ describe the first longitudinal study within a population-based sample, the Special Needs and Autism Project (SNAP) cohort. By assessing adolescents and young adults with autism at 3 time points over 11 years, from approximately 12 to 23 years of age, the authors profiled the trajectories of both cognitive and autism symptoms. Despite little change in caregiver-rated autism symptoms over this time period, they found that full-scale IQ (FSIQ) showed a moderate increase, with some hints of factors that may predict greater improvement.

Young Autism Spectrum Disorder Children in Special and Mainstream Education Settings Have Similar Behavioral Characteristics

In many countries, parents can place autism spectrum disorder (ASD) children in either mainstream or special education settings, which differ in their ability to provide structured early intervention programs. There are no clear guidelines for how to make initial placement decisions and ongoing debate about the benefits and drawbacks of each educational setting. Previous studies have mostly examined placement of school-age children and reported that those with poorer cognitive abilities and more severe ASD symptoms tend to be placed in special education. The placement of younger children has rarely been studied. Here, we utilized the database at the National Autism Research Center of Israel to examine whether ASD severity, cognitive abilities, and parent education influenced the placement of 242 children. We performed the analyses separately for 1-3-year-old children who were placed in daycare centers and 3-5-year-old children who were placed in pre-school kindergartens. Our analyses revealed surprisingly small differences across special and mainstream education settings, particularly in daycare centers. Cognitive scores and parent education were significantly higher in ASD children placed in mainstream education, but these differences were of moderate effect size and explained a relatively small percentage of the variability in placement choices (<15%). Indeed, we found considerable overlap in the characteristics of ASD children across educational settings, which suggests that initial placement decisions are performed with little regard to the children's abilities. Given the importance of optimal early intervention, further studies are warranted to determine whether children with specific abilities and needs benefit more from placement in either educational setting. LAY SUMMARY: Currently, there are no clear recommendations for placing young children with ASD in special versus mainstream education settings. We examined the influence of ASD severity, cognitive abilities, and parent education on the initial placement of 242 children. While we found significantly higher cognitive scores and parental education in children placed in mainstream education, there was a remarkable overlap in the characteristics of children across both settings, suggesting that initial placement is performed with limited regard to the children's abilities. Autism Res 2021, 14: 699-708. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Fostering the Social Development of Children with Special Educational Needs or Disabilities (SEND) through Dialogue and Interaction: A Literature Review

The United Nations’ Sustainable Development Goal 4 stresses the importance of offering all students an inclusive, quality education, so that they can develop necessary life skills, including academic and social skills. Students with special educational needs and/or disabilities (SEND) not only have greater difficulties in their academic development, but they also have some social development limitations. It is therefore necessary to identify which strategies are effective in helping these students develop social skills. Previous research has noted that dialogical learning environments can contribute to promoting inclusion. This paper provides a literature review of interventions, based on social interaction and their impact on the social skills of students with disabilities. A literature search was performed of scientific databases (Web of Science, SCOPUS, PsycINFO and ERIC) to identify research that used dialogue and interaction to promote the development of the social skills of these students. Twenty-nine studies were selected that yielded improved results in the increase and quality of interactions and the promotion of social behaviours, such as initiations, participation, collaboration, social connection, self-regulation and self-image. Based on these results, it can be concluded that interaction-based interventions with an inclusive approach nurture the social skills of students with disabilities, in line with previous research.

The effect of implementation climate on program fidelity and student outcomes in autism support classrooms

OBJECTIVE

An organization's implementation climate, or the extent to which use of an intervention is expected, supported, and rewarded by colleagues and supervisors, has been identified as critical to successful intervention implementation and outcomes. The effect of implementation climate has not been well studied in special education settings. The present study examines the association between teachers' perceptions of implementation climate, teacher fidelity to a school-based program for students with autism, and student outcomes (measured as changes in IQ) over time.

METHOD

Participants included 158 students from 45 classrooms and their teachers. Teachers provided a measure of implementation climate at the beginning of the academic year; program fidelity was measured monthly throughout the year. The main and interaction effects of perceived implementation climate and fidelity on student outcomes were examined using longitudinal nested linear models with random effects for classroom and student, controlling for important covariates.

RESULTS

On average, IQ scores improved 2.2 points (SD = 8.7). There were no main effects of perceived implementation climate or fidelity on student outcomes; however, the interaction between perceived implementation climate and fidelity was associated with student outcomes (p < .05, d = 0.54). Among classrooms with a strong perceived implementation climate, higher fidelity was associated with better student outcomes.

CONCLUSIONS

While preliminary and requiring replication, these findings suggest that perceived implementation climate and program fidelity each may be important but not sufficient for optimizing outcomes for students with autism. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Outcomes of children receiving Group-Early Start Denver Model in an inclusive versus autism-specific setting: A pilot randomized controlled trial

A major topic of debate is whether children with autism spectrum disorder should be educated in inclusive or specialized settings. We examined the feasibility and preliminary effectiveness of delivering the Group-Early Start Denver Model to children with autism spectrum disorder in inclusive versus specialized classrooms. We randomly assigned 44 preschoolers with autism spectrum disorder to receive the Group-Early Start Denver Model across one school calendar year in classrooms that included only children with autism spectrum disorder or mostly children who were typically developing. Blind-rated indicators of teaching quality showed similar results across settings, which were above the local benchmark. Children showed improvements across blinded proximal measures of spontaneous vocalization, social interaction, and imitation and across distal measures of verbal cognition, adaptive behavior, and autism symptoms irrespective of intervention setting. Mothers of participants experienced a reduction in stress irrespective of child intervention setting. Across both settings, age at intervention start was negatively associated with gains in verbal cognition. Delivery of Group-Early Start Denver Model in an inclusive setting appeared to be feasible, with no significant differences in teaching quality and child improvements when the program was implemented in inclusive versus specialized classrooms.

Social Support, Well-being, and Quality of Life Among Individuals on the Autism Spectrum

Social support plays a critical role in the quality of life (adaptive functioning and subjective well-being) of individuals on the autism spectrum across the lifespan.

Sociodemographic Disparities in Intervention Service Utilization in Families of Children with Autism Spectrum Disorder

This study investigates whether sociodemographic factors are associated with utilization of intervention services for children with autism spectrum disorder (ASD) enrolled in the Childhood Autism Risks from Genetics and the Environment Study. Maternal ethnicity, insurance status, and education for 696 families of children with ASD were available. Children of Black mothers entered intervention earlier compared to White mothers (2 vs. 2.6 years; p = 0.001). Having public insurance was associated with receiving <15 h/week of individual services, while having a Bachelor degree was associated with receiving <15 h/week of classroom-based services. These differences suggest that SES may be a factor in utilization of services. Efforts should be made to ensure that interventions offered are culturally and linguistically accessible.

Team collaboration: the use of behavior principles for serving students with ASD

PURPOSE

Speech-language pathologists (SLPs) and behavior analysts are key members of school-based teams that serve children with autism spectrum disorders (ASD). Behavior analysts approach assessment and intervention through the lens of applied behavior analysis (ABA). ABA-based interventions have been found effective for targeting skills across multiple domains for children with ASD. However, some SLPs may be unfamiliar with the breadth of ABA-based interventions. The intent of this tutorial is to briefly introduce key ABA principles, provide examples of ABA-based interventions used within schools, and identify strategies for successful collaboration between behavior analysts and SLPs.

METHOD

This tutorial draws from empirical studies of ABA-based interventions for children with ASD within school settings, as well as discussions in the extant literature about the use of behavior principles by SLPs and strategies for interdisciplinary collaboration.

CONCLUSION

Given the prevalence of ASD at 1 in 68 children (Centers for Disease Control and Prevention, 2014) and the high cost of serving these children within schools (an average cost of 286% over regular education; Chambers, Shkolnik, & Perez, 2003), the need for effective, comprehensive service provision and efficiency within interdisciplinary teams is paramount. Communication, mutual understanding, and recognition of common ground between SLPs and behavior analysts can lead to successful collaboration.

Motor development and motor resonance difficulties in autism: relevance to early intervention for language and communication skills

Research suggests that a sub-set of children with autism experience notable difficulties and delays in motor skills development, and that a large percentage of children with autism experience deficits in motor resonance. These motor-related deficiencies, which evidence suggests are present from a very early age, are likely to negatively affect social-communicative and language development in this population. Here, we review evidence for delayed, impaired, and atypical motor development in infants and children with autism. We then carefully review and examine the current language and communication-based intervention research that is relevant to motor and motor resonance (i.e., neural "mirroring" mechanisms activated when we observe the actions of others) deficits in children with autism. Finally, we describe research needs and future directions and developments for early interventions aimed at addressing the speech/language and social-communication development difficulties in autism from a motor-related perspective.