The influence of child-preferred activities on autistic children's social behavior

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.

Increasing social time allocation and concomitant effects on mands, item engagement, and rigid or repetitive behavior

Recent research has developed methods of assessing the function of generic, nonindividualized social interactions. The purpose of this type of assessment is to provide a measure of how an individual may respond to the types of interactions readily available in the natural environment. To date, no research has evaluated how the social time allocation of individuals for whom generic interactions are neutral or aversive could be improved. Moreover, no research has included additional dependent variables that may be functionally related to social time allocation. In the current study, we evaluated the effects of initiating preferred, individualized social interactions on the social time allocation of 3 participants for whom generic interactions functioned as neutral or aversive stimuli. The intervention increased social time allocation for all 3 participants. Next, we evaluated the relation between social time allocation and the occurrence of mands, item engagement, and rigid or repetitive behavior using the intervention data as well as secondary analyses of previously published datasets. The occurrence of mands and rigid or repetitive behaviors changed with improvements in social time allocation and were strongly correlated with social time allocation across participants. Implications for future research on, and the clinical use of, this type of assessment and intervention are discussed.

Improvement of Autism Symptoms After Comprehensive Intensive Early Interventions in Community Settings

BACKGROUND

Preschool children with autism in southern Sweden participated in a comprehensive Naturalistic Developmental Behavioral Intervention (NDBI) program.

AIMS

To evaluate the ongoing NDBI program by comparing the pre- and postintervention outcomes in terms of improved autism symptom severity.

METHOD

The improvement of Autism Diagnostic Observation Schedule (ADOS-R) test results between baseline and evaluation among children participating in the NDBI program (n = 67) was compared with the results among children receiving community treatment as usual (n = 27) using analysis of covariance.

RESULTS

The study showed that children in the NDBI group improved their ADOS-R total scores between baseline and evaluation (-0.8 scores per year; 95% CI [-1.2, -0.4]), whereas no improvement was detected in the comparison group (+0.1 scores per year; 95% CI [-0.7, +0.9]). The change in the NDBI group versus the change in the comparison group was statistically significant after adjusting for possible confounders as well. Children in the NDBI group also significantly improved their ADOS severity scores, but the scores were not significantly different from those of the comparison group.

CONCLUSIONS

The results from the current naturalistic study must be interpreted cautiously, but they do support earlier studies reporting on improvement of autism symptoms after early intensive interventions. Results from observational studies are difficult to interpret, but it is nevertheless of uttermost importance to evaluate costly autism intervention programs. The results do indicate that children with autism benefit from participating in early comprehensive intensive programs.

The functional neural architecture of dysfunctional reward processing in autism

Functional imaging studies have found differential neural activation patterns during reward-paradigms in patients with autism spectrum disorder (ASD) compared to neurotypical controls. However, publications report conflicting results on the directionality and location of these aberrant activations. We here quantitatively summarized relevant fMRI papers in the field using the anatomical likelihood estimation (ALE) algorithm. Patients with ASD consistently showed hypoactivations in the striatum across studies, mainly in the right putamen and accumbens. These regions are functionally involved in the processing of rewards and are enrolled in extensive neural networks involving limbic, cortical, thalamic and mesencephalic regions. The striatal hypo-activations found in our ALE meta-analysis, which pooled over contrasts derived from the included studies on reward-processing in ASD, highlight the role of the striatum as a key neural correlate of impaired reward processing in autism. These changes were present for studies using social and non-social stimuli alike. The involvement of these regions in extensive networks associated with the processing of both positive and negative emotion alike might hint at broader impairments of emotion processing in the disorder.

The Son-Rise Programme: an intervention to improve social interaction in children with autism spectrum disorder

Background/aims

Communication problems are a core feature of autism spectrum disorder. These problems usually lead to challenges in social interactions. The aim of this study was to assess the effectiveness of the Son-Rise Programme on improving social interaction and communication in children with autism spectrum disorder.

Methods

Thirty children with autism spectrum disorder (aged 4–6) were involved in this study. The children were assigned randomly to one two groups, either the 1-week intensive Son-Rise Programme or the control group. They were evaluated using the Gilliam Autism Rating Scale before and after the study.

Results

The participants in the group of the Son-Rise Programme showed a significant improvement in their social interaction skills compared to the control group (P=0.001).

Conclusions

The Son-Rise Programme could improve social interaction in children with autism spectrum disorder.

Gaze to faces across interactive contexts in infants at heightened risk for autism

Infant social-communicative behavior, such as gaze to the face of an interactive partner, is an important early developmental skill. Children with autism spectrum disorder exhibit atypicalities in social-communicative behavior, including gaze and eye contact. Behavioral differences in infancy may serve as early markers of autism spectrum disorder and help identify individuals at highest risk for developing the disorder. Researchers often assess social-communicative behavior in a single interactive context, such as during assessment with an unfamiliar examiner or play with a parent. Understanding whether infant behavior is consistent across such contexts is important for evaluating the validity of experimental paradigms and the generalizability of findings from one interactive context/partner to another. We examined infant gaze to the face of a social partner at 6, 9, and 12 months of age in infants who were later diagnosed with autism spectrum disorder, as well as low- and high-risk infants without autism spectrum disorder outcomes, across two interactive contexts: structured testing with an unfamiliar examiner and semi-structured play with a parent. By 9 months, infant gaze behavior was significantly associated between the two contexts. By 12 months, infants without autism spectrum disorder outcomes exhibited higher mean rates of gaze to faces during parent-child play than Mullen testing, while the gaze behavior of the autism spectrum disorder group did not differ by context-suggesting that infants developing autism spectrum disorder may be less sensitive to context or interactive partner. Findings support the validity of assessing infant social-communicative behavior during structured laboratory settings and suggest that infant behavior exhibits consistency across settings and interactive partners.

Promoting Social Learning at Recess for Children with ASD and Related Social Challenges

The school playground provides an ideal opportunity for social inclusion; however, children with autism spectrum disorder (ASD) often struggle to engage in appropriate social interactions in this unstructured environment. Thus, they may spend recess time alone. The FRIEND Playground Program is a structured, play-based intervention aimed at improving social interactions of children with ASD and other social challenges during recess. The current research study employed a multiple baseline across participant design to systematically evaluate whether this intervention yields increased social engagement and initiations with peers during recess. Seven participants with ASD or other social challenges received 20 min of direct intervention from trained playground facilitators during school recess each day. Results suggest that the FRIEND Playground Program produced meaningful increases in social engagement and social initiations from baseline among participants with ASD and other social challenges.

Circumscribed interests in adolescents with Autism Spectrum Disorder: A look beyond trains, planes, and clocks

Adolescence is a unique developmental period, characterized by physical and emotional growth and significant maturation of cognitive and social skills. For individuals with Autism Spectrum Disorder (ASD), it is also a vulnerable period as cognitive and social skills can deteriorate. Circumscribed interests (CIs), idiosyncratic areas of intense interest and focus, are a core symptom of ASD that may be associated with social development. Yet, relatively little is known about the expression of CIs in adolescents with ASD. Many studies investigating CIs have used images depicting items of special interest; however, it is not clear how images should be customized for adolescent studies. The goal of this study was to gain insight into the types of images that may be appropriate for studies of CIs in adolescents with ASD. To this end, we used a mixed methods design that included, 1) one-on-one interviews with 10 adolescents (4 with ASD and 6 TD), to identify categories of images that were High Autism Interest (‘HAI’) or High Typically Developing Interest (‘HTD’), and 2) an online survey taken by fifty-three adolescents with ASD (42 male) and 135 typically developing (TD) adolescents (55 male) who rated how much they liked 105 ‘HAI’ and ‘HTD’ images. Although we found a significant interaction between ‘HAI’ and ‘HTD’ categories and diagnosis, neither group significantly preferred one category over the other, and only one individual category ('Celebrities') showed a significant group effect, favored by TD adolescents. Males significantly preferred ‘HAI’ images relative to females, and TD adolescents significantly preferred images with social content relative to adolescents with ASD. Our findings suggest that studies investigating affective or neural responses to CI-related stimuli in adolescents should consider that stereotypical ASD interests (e.g. trains, gadgets) may not accurately represent individual adolescents with ASD, many of whom show interests that overlap with TD adolescents (e.g. video games).

Brief report: Reduced anxiety following Pivotal Response Treatment in young children with Autism Spectrum Disorder

Up to 40% of children with Autism Spectrum Disorder (ASD) exhibit co-occurring anxiety symptoms. Despite recent success in mitigating anxiety symptoms in school-aged children with ASD (mean age >9 years) using adapted versions of Cognitive Behavioural Therapy, little is known about potential treatment outcomes for younger children. To address the gap in the literature, this open-label study evaluated change in anxiety following a 16-week open-label trial of Pivotal Response Treatment (PRT) in children with ASD aged 4-8 years. PRT is a behavioural treatment based on the principles of Applied Behaviour Analysis and has a primary aim of increasing social communication skills in children with ASD through natural reinforcements. To minimise conflation of anxiety and other co-occurring symptoms such as disruptive behaviour and attention-deficit hyperactivity disorder, we measured anxiety using the autism anxiety subscale of the Child and Adolescent Symptom Inventory (CASI) devised by Sukhodolsky et al. (2008). We observed significant anxiety reduction over 16-weeks of PRT. Furthermore, anxiety reduction was independent of changes in autism symptom severity. This study shows promising results for PRT as an intervention for reducing anxiety in young children with ASD.

Increased Eye Contact During Conversation Compared to Play in Children With Autism

Children with autism have atypical gaze behavior but it is unknown whether gaze differs during distinct types of reciprocal interactions. Typically developing children (N = 20) and children with autism (N = 20) (4-13 years) made similar amounts of eye contact with an examiner during a conversation. Surprisingly, there was minimal eye contact during interactive play in both groups. Gaze behavior was stable across 8 weeks in children with autism (N = 15). Lastly, gaze behavior during conversation but not play was associated with autism social affect severity scores (ADOS CSS SA) and the Social Responsiveness Scale (SRS-2). Together findings suggests that eye contact in typical and atypical development is influenced by subtle changes in context, which has implications for optimizing assessments of social communication skills.

Pivotal response treatment for autism spectrum disorder: current perspectives

Pivotal response treatment (PRT) is an evidence-based behavioral intervention based on applied behavior analysis principles aimed to improve social communication skills in individuals with autism spectrum disorder (ASD). PRT adopts a more naturalistic approach and focuses on using a number of strategies to help increase children's motivation during intervention. Since its conceptualization, PRT has received much empirical support for eliciting therapeutic gains in greater use of functional social communication skills in individuals with ASD. Building upon the empirical evidence supporting PRT, recent advancements have increasingly turned to using interdisciplinary research integrating neuroimaging techniques and behavioral measures to help identify objective biomarkers of treatment, which have two primary purposes. First, neuroimaging results can help characterize how PRT may elicit change, and facilitate partitioning of the heterogeneous profiles of neural mechanisms underlying similar profile of behavioral changes observed over PRT. Second, neuroimaging provides an objective means to both map and track how biomarkers may serve as reliable and sensitive predictors of responder profiles to PRT, assisting clinicians to identify who will most likely benefit from PRT. Together, a better understanding of both mechanisms of change and predictors of responder profile will help PRT to serve as a more precise and targeted intervention for individuals with ASD, thus moving towards the goal of precision medicine and improving quality of care. This review focuses on the recent emerging neuroimaging evidences supporting PRT, offering current perspectives on the importance of interdisciplinary research to help clinicians better understand how PRT works and predict who will respond to PRT.

Effects of a Least-to-Most Prompting Procedure on Multisymbol Message Production in Children With Autism Spectrum Disorder Who Use Augmentative and Alternative Communication

PURPOSE

In this study, we investigated the efficacy of a least-to-most (LTM) prompting procedure (Ault & Griffen, 2013; MacDuff, Krantz, & McClannahan, 2001; Neitzel & Wolery, 2009) for increasing use of multisymbol messages in school-age children with autism spectrum disorder (ASD) who use augmentative and alternative communication (AAC) during a storybook reading activity.

METHOD

In the study, we used a single-subject, multiple-probe research design across participants (Kazdin, 1982) with 6 children (ages 8-12) with ASD and who used AAC systems for communication. There were 4 phases in this investigation: (a) baseline, (b) intervention, (c) generalization, and (d) maintenance.

RESULTS

All participants exhibited a positive increase in multisymbol message production almost immediately upon introduction of the LTM prompting procedure.

CONCLUSIONS

The results of the investigation contribute important information on the efficacy of the LTM prompting procedure for teaching use of multisymbol messages to school-age children with ASD who use AAC.

Promoting Social Interaction through Teaching Generalized Play Initiation Responses to Preschool Children with Autism

Two experiments were conducted to investigate the effects of play initiation training on subsequent social interactions between students with severe disabilities and their nonhandicapped peers within play contexts. In both studies, five nonhandicapped peers were used as training confederates, and generalization probes were conducted within unstructured free-play situations with a larger number of peers who did not participate in training. In Experiment 1, a preschool student with autistic behaviors was integrated into a regular preschool The effects of two treatment conditions were compared: (a) providing an awareness activity plus rewards for the nonhandicapped peers who initiated interactions and (b) teaching initiations and play behaviors to the student with severe disabilities. The results indicated that although the awareness activity plus reward condition increased the frequency of peer initiations, peer responsivity to the initiations by the student with severe disabilities remained low. When the student with severe disabilities was taught to initiate interactions and play appropriately, the level of initiation by the student increased and the level of responsivity by the peers toward his initiations also increased. In Experiment 2, we replicated this effect with two students who were integrated into a kindergarten class. The effects of competent social interaction skills on shaping environments that are responsive to the social initiations of students with severe disabilities are discussed.

The Effects of Preference on Spontaneous Verbal Requests in Individuals with Autism

Children with autism are characterized by the absence of functional spontaneous speech. This study assessed whether the type of stimulus materials (preferred versus nonpreferred) would affect the frequency of spontaneous verbal requests in these children. The results of the repeated reversals analysis revealed that the frequency of spontaneous verbal requests was higher in the preferred materials condition than in the nonpreferred materials condition. The results are discussed in relation to issues involving motivation and the development of naturalistic, context-appropriate speech training procedures.

Reinforcer Assessment I: Using Problem Behavior to Select Reinforcers

We tested the hypothesis that knowledge of the variables controlling problem behavior could be used to select reinforcers. Students with severe developmental disabilities who exhibited frequent aggression, self-injury, and/or tantrums participated in the study. One group (N = 7) was assessed to engage in problem behavior maintained by social attention, and the second group (N = 7) was assessed to engage in problem behavior maintained by escape from unpleasant situations. A combined multiple baseline and alternating treatments design demonstrated that (a) praise was a reinforcer for the group with attention-maintained behavior and appeared to serve as a punisher for the students with escape-maintained behavior, (b) a procedural “time-out” was a reinforcer for the latter group, and (c) problem behavior was lowest when students with attention-maintained problem behavior were praised and students with escape-maintained problem behavior received the procedural time-out. This study suggests that stimuli that are functionally related to problem behavior (e.g., social attention, escape from tasks) can be used effectively as reinforcers. These findings further emphasize the need to individually select reinforcers because, for some individuals, a presumably positive consequence such as social praise can serve as a punisher.

Honoring Activity Preferences in Individualized Plan Development: A Descriptive Analysis

The activity preferences of 15 adults with intellectual disabilities from eight community-based residential programs were assessed by the participants themselves, residential program staff, and advocates. The study provides descriptive information concerning the degree to which participants' perceived activity preferences were subsequently included in their Individualized Habilitation Plans (IHPs). Results indicate that 78% of participants' IHP objectives were preferred activities. Further analyses revealed that preferred activities requiring a greater degree of staff support were included on the IHP as training objectives, and preferred activities that participants performed infrequently were included as participation objectives. The study indicates a need for more information about how to assess and honor the preferences of people with severe disabilities.

Guidelines for Conducting Socially Valid Systematic Preference Assessments

Systematic preference assessment is the process of presenting sampling trials and observing the person's response. The response to those items is then interpreted as an indicator of preference. The empirical research on systematic preference assessment has greatly advanced the field's understanding of how to identify the preferences of individuals with nonsymbolic and limited symbolic communication skills. The purpose of this paper is to translate this research into guidelines for planning systematic preference assessments that strive to reduce the risk of missing or misinterpreting the person's preferences, as well as increase the social validity of the process and outcomes. We present four guiding questions for practitioners to plan preference assessments: (a) What will be offered? (b) When and where will sampling opportunities take place? (c) Who will present the sampling options? and (d) How will sampling options be presented?

Integrating Choice-Making Opportunities within Teacher-Assigned Academic Tasks to Facilitate the Performance of Children with Autism

Providing opportunities to make choices has received increasing support as an antecedent intervention to improve the performance of students with disabilities. Additional research in this area is needed to determine under what circumstances the application of choice making as a curricular intervention is appropriate and produces meaningful outcomes. The present study extended this line of research and investigated how providing choice opportunities to children with autism impacted their performance during teacher-assigned homework activities. An ABAB design was utilized to evaluate the effects of choice making (student vs. tutor) on the academic performance of four children with autism. Results showed that providing students with opportunities to make choices regarding the order of task completion and use of stimulus materials improved participants' accuracy, productivity, affect, and reduced their disruptive behaviors. These findings support the use of child choice as a teaching strategy to improve the academic performance of children with autism during curricular activities. The functional properties of choice making and considerations for its use as a curricular-based antecedent intervention are discussed.

Modifying Activities to Produce Functional Outcomes: Effects on the Problem Behaviors of Students with Disabilities

This article presents three empirical demonstrations of desirable effects that accrued from modifying curricular activities in accordance with individual students' interests. Participants were three elementary students with disabilities and diverse labels including autism, mental retardation, and emotional and behavioral disorder. In each case, the instructional objective was held constant; whereas, the context of the activity was modified so that it produced an outcome that was judged to be meaningful and reinforcing to the student. Reversal designs showed that each student exhibited less problem behavior and more on-task responding when the modified activity was presented. These results are discussed in relation to the applied and conceptual literatures on curricular design, student preference, and the expanding enterprise of positive behavioral support.

Increasing the Social Behavior of Young Children with Autism Using Their Obsessive Behaviors

This study systematically asked whether individual topics or themes on which children with autism perseverated across a variety of settings (often called obsessions) could be used to create the theme for a socially appropriate game. Data collected within the context of a multiple baseline design revealed very low levels of social interaction during play periods in the baseline condition. In contrast, when the children with autism were taught a socially appropriate game (e.g., one child who perseverated on maps was taught a tag game played on a giant outline of a US map), the percent of social interactions increased dramatically and continued to be high during follow-up measures. Generalization measures indicated that following intervention, the children also demonstrated increases in social interaction during other play activities. The results are discussed in terms of incorporating obsession themes into common games to create intrinsically reinforcing appropriate activities for increasing social interactions, and in relation to developing activities that capitalize on the child with autism's interests, so that the child is a valued member of the peer group.

Reduction of Severe Problem Behavior in Community Employment Using an Hypothesis-Driven Multicomponent Intervention Approach

Individuals with severe problem behavior typically are excluded from integration efforts involving community employment. This study examined one strategy for reducing severe problem behavior in an employment situation. The strategy involved three factors: (a) interventions were chosen based on hypotheses about the maintaining variables for the problem behavior (hypothesis-driven model); (b) a multicomponent intervention package was used that included some combination of functional communication training, building rapport, making choices, embedding demands, and building tolerance for delay of reinforcement; and (c) measures of latency to problem behavior and percentage of work steps completed were used instead of the more traditional measure of frequency. The results demonstrated both an increase in the time spent in the employment situation without problem behavior and increases in completion of work steps to maximum. Social validation of these results was provided by employment site management. The value of this strategy for addressing the obstacles to assessment, measurement, and intervention for severe problem behavior in community employment situations was discussed.

Embedding Choice in the Context of Daily Routines: An Experimental Case Study

In this study, we evaluated the effect of individualized, embedded choice opportunities in daily routines on the task initiations and protests by one man with severe disabilities. An initial functional analysis conducted during Phase 1 revealed that low rates of participation and high rates of protests in household activities were related to prompts that offered no control. Subsequently in Phase 2, we modified prompts within three different routines to provide greater control through choice. Within the context of an A-B-A-B design, the effects of a “traditional” no-choice versus choice task analysis were evaluated in each routine across three staff. The results demonstrated that when routines included opportunities for choice, task initiations were high, whereas protests, including severe aggression, were virtually eliminated. These results are discussed in relation to their implications for participant control, individualizing choice opportunities, embedding choice in daily routines, and the prevention of problem behaviors.

Increasing Early Social-Communicative Skills of Preverbal Preschool Children with Autism through Social Interactive Training

We evaluated the effects of a social interactive training program on early social-communicative skills (i.e., eye contact, joint attention, motor imitation) of three preverbal preschool children with autism. Training was conducted in the children's classroom during naturally occurring daily activities. Findings indicated that implementation of social interactive training components (i.e., contingent imitation, use of naturally occurring reinforcement, expectant look, environmental arrangement) was associated with increases in target behaviors across participants. In addition, generalization of eye contact and motor imitation behavior were found across an additional setting and different interactive partners, although joint attention rarely generalized. Social validation measures provided by 30 raters indicated that perceived positive changes in performance had occurred in child behaviors and that training procedures were considered acceptable. Results are discussed in terms of implications for research and practice.

Analyzing the Communication Environment to Increase Functional Communication

Many students with severe and multiple disabilities demonstrate severe communication impairments. Efforts to improve communication in these students often embrace a “natural environment” or “milieu” approach, embedding opportunities to communicate within natural, functional activities across the entire schedule of daily activities. In reality, functional activities differ greatly in the degree to which they foster communication. This article describes an environmental inventory designed to allow a teacher or speech-language pathologist to analyze the extent to which a specific activity encourages functional communication for a particular student. The inventory may be used to compare different activities across the student's day or to track the improvement of specific activities that initially may show little communicative value for the student. Reliability and validity data for the inventory are presented along with a case study of its use to monitor and guide improvements in a functional activity to increase communication by a young child with multiple disabilities.

Leisure Activity Enjoyment of Children with Autism Spectrum Disorders

Enjoyment is a fundamental component of activity participation. This study compared leisure activity enjoyment experienced by typically developing children (TD; n = 64) and those with autism spectrum disorders (ASD; n = 67) from age 6 to 13. The TD children enjoyed formal and physical activities significantly more than the children with ASD. Symptom severity was negatively related to enjoyment of overall, formal, physical and social activities. Older children with ASD enjoyed overall, informal, recreational, and self-improvement activities significantly less than younger children, but no differences were seen across TD age groups. Children with ASD enjoyed swimming significantly more than TD children. Understanding patterns of activity enjoyment is useful for being better able to address a child's motivation to participate in various life activities.

Comment on Technology-Based Intervention Research for Individuals on the Autism Spectrum

The purpose of this letter to the editor is to comment on several review papers recently published in the current Journal of Autism and Developmental Disorders, Special Issue on Technology: Software, Robotics, and Translational Science. These reviews address a variety of aspects relating to technology-aided intervention and instruction for individuals with Autism Spectrum Disorders (ASDs). Here, I comment on and evaluate the overall status of research and development in this area, including reflection on current challenges in this area in the context of previous challenges and resolutions in behavioral intervention research. From these reviews and the current evaluation, I further discuss important next steps for the field which may be critical for guiding progress toward meaningful impacts upon individuals with ASD.

The River Street Autism Program

An urgent demand from Connecticut parents for behavioral intervention resulted in the development of the River Street Autism Program (RSAP). This research-to-practice program implements intervention service based on empirical research findings conducted with children diagnosed with autism and pervasive developmental disorders. RSAP is provided through a regional service center and provides services for children entering the program at 2 to 5 years old. Because of the diverse nature of the districts served by RSAP, the delivered services varied according to the needs of the districts, available funding, and family preferences. Program evaluation data were therefore examined with regard to outcomes for children who received programs with differing numbers of treatment components. Treatment components that varied across children were treatment intensity, duration, extent of family participation, staff training, and supervision. Outcome data revealed that families reported greater gains in child functioning and quality of life when children received programs with more treatment components.

Pivotal Response Treatment: Case Reports

The current paper provides an overview of an evidence-based treatment, Pivotal Response Treatment (PRT), for autism spectrum disorder (ASD). The paper describes PRT principles and then illustrates the approach using two case reports. The children are preschool-aged children with high-functioning ASD. They were participating in a four-month clinical trial of PRT. At the start of treatment, they presented with significant social communication impairments, including a minimal understanding of reciprocity, limited play skills, and repetitive behaviors and speech. The paper outlines how behavioral treatment goals were identified and then how activities were designed, using principles of PRT, to target skill acquisition. Following the treatment course, both children made substantial and meaningful gains in social communication skill development.

Behavioral Approaches to Promoting Play

A variety of techniques grounded in behavioral psychology, and more specifically in applied behavior analysis, have been established to increase and improve play skills in children with autistic spectrum disorders. This article introduces a set of efficacious methods, which range from highly structured techniques to more naturalistic strategies. It focuses on object play as other authors in the issue discuss social play in greater depth. Behavioral techniques that are reviewed include: discrete trial training, use of stereotyped behaviors to increase play skills, pivotal response training, reciprocal imitation training, differential reinforcement of appropriate behavior, in vivo modeling and play scripts, and video modeling. A discussion of expanding behavior techniques to teach more complex play as well as training in varied environments is also presented. References are provided to allow the reader to obtain more in-depth information about each technique.

A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism

Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with an adult-directed ABA approach on disruptive behavior during language intervention in the public schools. A randomized clinical trial design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior.

Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. “Naturalistic Developmental Behavioral Interventions (NDBI)” are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.

The effect of sung speech on socio-communicative responsiveness in children with autism spectrum disorders

There is emerging evidence to demonstrate the efficacy of music-based interventions for improving social functioning in children with Autism Spectrum Disorders (ASD). While this evidence lends some support in favor of using song over spoken directives in facilitating engagement and receptive intervention in ASD, there has been little research that has investigated the efficacy of such stimuli on socio-communicative responsiveness measures. Here, we present preliminary results from a pilot study which tested whether sung instruction, as compared to spoken directives, could elicit greater number of socio-communicative behaviors in young children with ASD. Using an adapted single-subject design, three children between the ages of 3 and 4 years, participated in a programme consisting of 18 sessions, of which 9 were delivered with spoken directives and 9 with sung. Sessions were counterbalanced and randomized for three play activities-block matching, picture matching and clay play. All sessions were video-recorded for post-hoc observational coding of three behavioral metrics which included performance, frequency of social gesture and eye contact. Analysis of the videos by two independent raters indicated increased socio-communicative responsiveness in terms of frequency of social gesture as well as eye contact during sung compared to spoken conditions, across all participants. Our findings suggest that sung directives may play a useful role in engaging children with ASD and also serve as an effective interventional medium to enhance socio-communicative responsiveness.

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.

Peer-Mediated Pivotal Response Treatment for Young Children With Autism Spectrum Disorders

This review examined the effectiveness of peer-mediated pivotal response treatment (PM-PRT) to increase social-communication skills for children with autism spectrum disorders (ASD). A systematic review was conducted of all published studies examining PM-PRT in school-aged children with ASD, based on an established rubric. Five PM-PRT studies utilizing single-subject research designs were reviewed, involving 29 participants (8 with ASD and 21 peer coaches). Most studies of PM-PRT observed positive outcomes. However, the existing research base did not meet criteria for classification as promising or established evidence-based practice (EBP) for improving social skill deficits in children with ASD. More research is required for PM-PRT to be considered formally as EBP. This review may be used to guide clinical decisions for school psychologists and future research. Our aim was to highlight the rationale for, and core aspects of, this intervention and discuss school-based applications.

A quarter century of progress on the early detection and treatment of autism spectrum disorder

The last 25 years have witnessed tremendous changes in our ability to detect autism very early in life and provide interventions that can significantly influence children's outcomes. It was once questioned whether autism could be recognized before children had developed language and symbolic play skills; now changes in early behaviors, as well as structural brain changes, have been documented in infants 6-12 months of age who later develop autism. Advances in brain imaging and genetics offer the possibility of detecting autism before the syndrome is fully manifest, thereby reducing or preventing symptoms from developing. Whereas the primary mode of behavioral intervention a few decades ago relied on operant conditioning, recent approaches integrate the methods of applied behavioral analysis within a developmental, relationship-focused intervention model that are implemented by both parents and clinicians. These interventions have been found to have positive effects on children's developmental trajectory, as measured by both behavioral and neurophysiological assessments. Future approaches will likely combine both behavioral and pharmacological treatments for children who have less robust responses to behavioral interventions. There has been a paradigm shift in the way that autism is viewed, evolving from a lifelong condition with a very poor prognosis to one in which significant gains and neuroplasticity is expected, especially when the condition is detected early and appropriate interventions are provided. The grand challenge for the future is to bridge the tremendous gap between research and the implementation of evidence-based practices in the broader community, both in the United States and worldwide. Significant disparities in access to appropriate health care for children with autism exist that urgently require advocacy and more resources.

Using communication to reduce challenging behaviors in individuals with autism spectrum disorders and intellectual disability

This article describes the relationship between expressive communication impairments and common challenging behaviors in individuals with Autism Spectrum Disorder and Intellectual Disability. The communication challenges of individuals with Autism Spectrum Disorder/Intellectual Disability are described and several evidence-based intervention strategies are proposed to support communication so as to decrease challenging behaviors. Recommendations for practice are offered.

Caregiver-mediated approaches to managing challenging behaviors in children with autism spectrum disorder

A significant proportion of children with autism spectrum disorder (ASD) are referred to mental health centers due to the presence of challenging behaviors. Because challenging behaviors in children and adolescents with ASD often result from underlying social and communication difficulties and comorbid anxiety, traditional caregiver-mediated behavior intervention techniques developed for children with disruptive behavior disorders may need to be adapted for this population. Behavioral interventions that target communication skills, social skills, anxiety, and sensory responsiveness in children with ASD may be needed. Notably, while best practice necessitates the involvement of caregivers in treating children and adolescents with ASD, few randomized control studies have examined the effectiveness of caregiver-implemented interventions in reducing challenging behaviors. This review summarizes the current literature with regard to caregiver-mediated behavioral interventions for children with ASD, and suggests areas for intervention development and research.

Beyond behavioural observations: a deeper view through the sensory reactions of children with profound intellectual and multiple disabilities

BACKGROUND

The present study was aimed at assessing the behavioural and physiological responsiveness of three children with profound intellectual and multiple disabilities to a set of sensory stimuli.

METHODS

Eighteen items, 'believed' by clinicians to be appropriate for routine interventions, were presented to the participants and responsiveness was assessed in terms of: (i) consistent behavioural and electrodermal reactions and (ii) biphasic changes in heart rate.

RESULTS

Results were twofold. First, all participants showed frequent consistent physiological reactions but rare consistent behavioural ones. Second, all participants showed biphasic changes in heart rate, pointing to the possibility of different appraisals (novelty and pleasantness) of most of the presented items.

CONCLUSIONS

Data here presented may have implications for the development and the emotional well-being of individuals with profound intellectual and multiple disabilities in that it suggests that reactions to, and potential appraisals of, sensory stimuli may occur despite the lack of consistent observable behaviours.

Brain mechanisms of plasticity in response to treatments for core deficits in autism

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by social communication impairments and repetitive behaviors. Although the prevalence of ASD is estimated at 1 in 88, understanding of the neural mechanisms underlying the disorder is still emerging. Regions including the amygdala, superior temporal sulcus, orbitofrontal cortex, fusiform gyrus, medial prefrontal cortex, and insula have been implicated in social processing. Neuroimaging studies have demonstrated both anatomical and functional differences in these areas of the brain in individuals with ASD when compared to controls; however, research on the neural basis for response to treatment in ASD is limited. Results of the three studies that have examined the neural mechanisms underlying treatment response are promising; following treatment, the brains of individuals with ASD seem to "normalize," responding more similarly to those of typically developing individuals. The research in this area is in its early stages, and thus a focused effort examining the neural basis of treatment response in ASD is crucial.

Measuring change in social interaction skills of young children with autism

Designing effective treatments for improving early social behaviors in autism has been identified as a critical research need. One barrier to drawing conclusions about optimal treatments for children with autism is the use of highly varied dependent measures in the treatment literature. Contributing to this is the absence of "gold standard" assessment batteries. This is particularly true for assessing changes in social interaction impairments in very young children with autism. This paper addresses this issue by reviewing variables important in the development and evaluation of assessment measures, discussing previous studies' choices of socially-related dependent measures, and the strengths, limitations, and research questions pertaining to them. It concludes with recommendations for measurement selection and future directions for research.