Treatment of social behavior in autism through the modification of pivotal social skills

Perceptive Recommendation Robot: Enhancing Receptivity of Product Suggestions Based on Customers' Nonverbal Cues

Service robots that coexist with humans in everyday life have become more common, and they have provided customer service in physical shops around the world in recent years. However, their potential in effective sales strategies has not been fully realized due to their low social presence. This study aims to clarify what kind of robot behavior enhances the social presence of service robots and how it affects human-robot interaction and purchasing behavior. We conducted two experiments with a sales robot, Pepper, at a retail shop in Kyoto. In Experiment 1, we showed that the robot's social presence increased and that customers looked at the robot longer when the robot understood human gaze information and was capable of shared attention. In Experiment 2, we showed that the probability of customers picking up products increased when the robot suggested products based on the humans' degree of attention from gaze and posture information. These results indicate that the robot's ability to understand and make utterances about a customer's orientation and attention effectively enhances human-robot communication and purchasing motivation.

A Scoping Review of Behavioral Interventions for Promoting Social Gaze in Individuals with Autism Spectrum Disorder and Other Developmental Disabilities

Background

Individuals diagnosed with autism spectrum disorder (ASD) commonly experience difficulties maintaining social gaze with others during interactions. Although behavioral interventions targeted to promote social gaze in ASD are evident in the literature, to our knowledge, no review of the literature has been conducted to summarize and evaluate the evidence for these interventions.

Methods

We reviewed and summarized behavioral intervention studies designed to promote social gaze in individuals diagnosed with ASD and other developmental disabilities published in English between 1977 and January 2022 using PsychINFO and PubMed databases.

Results

41 studies met the inclusion criteria describing interventions conducted on 608 individuals. A variety of intervention strategies were employed to promote social gaze in these individuals including discrete trial instruction, prompting, modeling, and imitation. Most studies employed single-case research designs and reported successful outcomes, but limited data were available concerning the generalization, maintenance and social validity of these interventions. An increasing number of studies utilized technology-based procedures including computer application gameplay, gaze-contingent eye tracking devices and humanoid robots.

Conclusions

The present review indicates that behavioral interventions can be successfully employed to promote social gaze in individuals with ASD and other developmental disabilities. However, future research is needed to establish the generalization, maintenance and social validity of these interventions. There are also important ethical issues to be addressed given the increasing divide between treatment advocates and proponents of the neurodiversity movement.

Integrative Review of Developmental Behavior-Analytic Concepts

We reviewed five behavior-analytic concepts related to development: behavioral trap, cumulative-hierarchical learning (CHL), basic behavioral repertoire (BBR), pivotal behavior, and behavioral cusp. We searched for terminological variations of the concepts in the CAPES Journals Portal and selected for analysis 31 peer-reviewed articles written in English or Portuguese, published between 1967 and 2021, that contained the search terms in the title, abstract, or keywords and contextualized in the main text. We analysed the conventional usage of the concepts, their conceptual limitations, and the relationships among them, declared or implied, and proposed a conceptual integration of the concepts under a CHL framework, following a path indicated by other authors. We considered BBR, pivotal behavior, and behavioral cusp nonsynonymous concepts of the same logical category, referring to prerequisites for important developmental outcomes and targets of CHL-inspired interventions but defined by different effects on subsequent behavioral development. The three concepts can be conflated in a superset-subset fashion, based on the specificity of their effects: BBR consists of a broad class of behaviors that may affect subsequent learning; the subclass of BBRs characterized by far-reaching collateral effects are classified as pivotal behavior, and the subclass of pivotal behaviors whose potential effects include contact with unprecedented environmental contingencies are classified as behavioral cusps. We propose that behavioral traps be explicitly incorporated in the CHL framework, to emphasize the environmental component of the cumulative-hierarchical learning process. Our formulation seems to organize the conceptual field in a way that respects the conventional use of concepts, preserving their strengths. Regardless of the specific formulation, we believe that integrating the various development-related concepts within a cumulative-hierarchical learning framework can encourage a more proactive integration of findings, questions, and practices informed by each concept, which could lead to the mutual refinement of the corresponding conceptual and methodological frameworks, as well as new research questions and practical applications. In particular, we expect that explicitly incorporating behavioral traps within the CHL framework will provide a useful heuristic model to guide research on how natural environmental contingencies influence the systematic transformation of behavior across the lifespan.

A callosal biomarker of behavioral intervention outcomes for autism spectrum disorder? A case-control feasibility study with diffusion tensor imaging

Tentative results from feasibility analyses are critical for planning future randomized control trials (RCTs) in the emerging field of neural biomarkers of behavioral interventions. The current feasibility study used MRI-derived diffusion imaging data to investigate whether it would be possible to identify neural biomarkers of a behavioral intervention among people diagnosed with autism spectrum disorder (ASD). The corpus callosum has been linked to cognitive processing and callosal abnormalities have been previously found in people diagnosed with ASD. We used a case-control design to evaluate the association between the type of intervention people diagnosed with ASD had previously received and their current white matter integrity in the corpus callosum. Twenty-six children and adolescents with ASD, with and without a history of parent-managed behavioral intervention, underwent an MRI scan with a diffusion data acquisition sequence. We conducted tract-based spatial statistics and a region of interest analysis. The fractional anisotropy values (believed to indicate white matter integrity) in the posterior corpus callosum was significantly different across cases (exposed to parent-managed behavioral intervention) and controls (not exposed to parent-managed behavioral intervention). The effect was modulated by the intensity of the behavioral intervention according to a dose-response relationship. The current feasibility case-control study provides the basis for estimating the statistical power required for future RCTs in this field. In addition, the study demonstrated the effectiveness of purposely-developed motion control protocols and helped to identify regions of interest candidates. Potential clinical applications of diffusion tensor imaging in the evaluation of treatment outcomes in ASD are discussed.

Assessment and Treatment of Prosody Behavior in Individuals with Level 1 Autism: A Review and Call for Research

Differences in prosody behavior between individuals with autism spectrum disorder (ASD) and their typically developing peers have been considered a central feature of ASD since the earliest clinical descriptions of the disorder (e.g., Kanner, 1943/1973). Prosody includes pitch and volume among other dimensions of vocal-verbal behavior that discriminate responses of the listener; thus, people with ASD whose prosody has confusing or off-putting effects may have fewer social opportunities at work, at school, or in the community. The purpose of this review is to examine the state of the literature intervening on prosody with individuals with ASD and to provide recommendations for researchers who are interested in contributing to the scientific understanding of prosody.

Descriptive assessment of conversational skills: Towards benchmarks for young adults with social deficits

Descriptive assessments are necessary to identify social norms and establish a foundation for experimental analysis. Much of the social skills intervention literature involves goals that have been selected through interviews and direct observation of behavior without a reference to desired outcomes. The purpose of the current study was to extend research on descriptive assessments of conversations by including additional measures and examining conversational behavior across contexts. We conducted a descriptive assessment of social skills exhibited by 16 neurotypical young adults. Participants had 10-min conversations in groups and 1-on-1 with friends and novel individuals. We then assessed variability within and across participants on a wide array of relevant measures. Throughout the conversations, participants shared the conversation time equally, spent most of the conversation time making on-topic comments, and gazed at their conversation partner more frequently while listening than while speaking. These descriptive data extend current research, inform future experimental analyses, and may guide clinical decisions.

Speech Prosody Interventions for Persons With Autism Spectrum Disorders: A Systematic Review

Purpose Persons with autism spectrum disorder (ASD) may demonstrate abnormal prosodic patterns in conversational speech, which can negatively affect social interactions. The purpose of this systematic review was to identify interventions measuring the improvement of expressive speech prosody in persons with ASD in order to support clinician's evidence-based decision making. Method We used 13 electronic databases to search for relevant articles using terms related to autism, intervention, and speech prosody. The databases identified a total of nine articles for the title, abstract, and full-text reviews. Five more articles were included after performing descendant and reference searches. One peer-reviewed article was excluded due to insufficient data received from the authors. We coded the resulting 13 articles for report, setting, intervention, outcome, and results characteristics and methodological quality. Results Results showed that interventions specifically targeting speech prosody using established and emerging evidence-based practices across more than 1 treatment day resulted in moderate to large improvements in speech prosody in persons with ASD. Interventions that indirectly targeted prosody or were very short resulted in small or nonsignificant effects. Discussion The results of this literature review suggest that interventions that directly target speech prosody using established evidence-based practices for ASD may be most effective for increasing typical prosodic patterns during speech for persons with ASD. Further research is needed to establish which interventions are most effective for each age range and context. Supplemental Material https://doi.org/10.23641/asha.12735926.

Outcomes of a practical approach for improving conversation skills in adults with autism

Many individuals with autism spectrum disorder (ASD) have deficits in conversation skills that can interfere with the development of personal and professional relationships. Further research is needed on efficient interventions for targeting conversation skills in adults with ASD and for evaluating the social validity of the outcomes. In this study, 2 practitioners implemented a 4-week training program for 5 adults with ASD that combined individualized computer-based instruction (CBI) and practice with peers to promote the acquisition, maintenance, and generalization of conversation skills. Training was associated with improvements in 12 of 13 skills across participants. These findings, along with peer ratings of the participants' conversation skills, suggest that this model is a promising, socially valid approach for improving conversation skills in adults with ASD.

Descriptive Analyses of Behaviors during Social Interactions

BACKGROUND

Individuals with neurodevelopmental disorders demonstrate difficulty initiating and maintaining eye contact from early infancy into adulthood. However, interventions aimed at improving eye contact lack normative eye contact data to guide treatment.

METHODS

The current study quantified behaviors (e.g., eye contact, vocalizations, head/shoulder, and hand movement) exhibited by college students during social encounters to gather normative data regarding the duration of targeted behaviors. A latent profile analysis was also used to identify participants' patterns of responding.

RESULTS AND DISCUSSION

Participants engaged in high levels of eye contact (M =89.3% of time) and head/shoulder movement (M= 85.0% of time), moderate levels of vocalizations (M= 65.0% of time), and low levels of hand movement (M =35% of time). Results highlight the need for social skills training procedures to target multiple behaviors in conjunction with eye contact and vocalizations. In addition, studies evaluating treatment packages or assessing the relationship between eye contact and other variables (e.g., physiological responses) may use these normative data to inform decisions.

Implementing Aided Augmentative Communication Systems With Persons Having Complex Communicative Needs

Augmentative and alternative communication (AAC) systems can support communication skills for people with significant developmental disabilities who experience complex communication needs (CCNs). There is a need to tailor best practices in AAC assessment and intervention to create individualized communication systems with this population. In this article, we outline the important components of AAC systems that can be implemented in authentic settings. However, given the limited evidence on AAC interventions specific to people with CCNs, we also identify some priority areas for future inquiry. Among these involve strategies to enhance decision making regarding (a) matching communication mode(s) to learner skills and contextual demands, (b) identifying communicative opportunities and obligations, (c) individualizing aided communication display features, (d) selection of vocabulary specificity, and (e) considering dosage parameters needed to acquire and maintain a communicative repertoire. In addition, we briefly discuss the use of telehealth to enhance intervention capability.

Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder

Naturalistic developmental behavioral intervention is an emerging class of interventions for young children with autism spectrum disorder. The present article is a meta-analysis of outcomes of group-design studies ( n = 27) testing interventions using naturalistic developmental behavioral intervention strategies. Small, significant positive effects of naturalistic developmental behavioral intervention were found for expressive language ( g = 0.32), reduction in symptoms of autism spectrum disorder ( g = −0.38), and play skills ( g = 0.23). Larger effects were found for social engagement ( g = 0.65) and overall cognitive development ( g = 0.48). A marginal effect was found for joint attention ( g = 0.14) and receptive language ( g = 0.28). For joint attention, improvement was moderated by hours of professional involvement. Evidence of publication and reporting bias was present for language outcomes. This meta-analysis grows the evidence base for naturalistic developmental behavioral interventions, particularly in the key areas of social engagement and cognition.

Efficiency Is Everything: Promoting Efficient Practice by Harnessing Derived Stimulus Relations

A pivotal skill of practice involves engineering emergent learning. Toward this end, graduate training in applied behavior analysis must emphasize concepts of and research on stimulus relations in order for practitioners to develop these skills.

Moderate Effects of Low-Intensity Behavioral Intervention

We compared clinical outcomes in a treatment group of 98 individuals who received between 8 and 15 weekly hours (M = 10.6; SD = 1.7) of applied behavior analysis (ABA) intervention with a comparison group of 73 individuals who received another provision, including some ABA, (between 1.4-8 weekly hours, M = 5.7; SD = 1.6). After 2 years, the treatment group made greater gains than the comparison group on language and social skills, and other areas assessed by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). We evaluated the outcome on adaptive skills for a smaller sample of participants using the Vineland Adaptive Behavior Scales II (VABS), but found no significant differences between the treatment (n = 17) and comparison groups (n = 11). Although the treatment group made important and clinically meaningful gains, the gains were moderate. These findings underline the importance of intervention intensity and provide further support for a dose-response relationship between ABA intervention hours and outcomes.

Improved analyses of single cases: Dynamic multilevel analysis

This project identifies some difficulties when analyzing single-case data and showcases a new method, dynamic multilevel analysis (DMA). We re-analyze a published, meta-analysis of single-case interventions for participants with autism. Analytic difficulties include missing data, nested data, baseline trends, time periods, recency effects, many hypotheses' false positives, interactions among explanatory variables, indirect effects (including false negatives), and sampling errors. Furthermore, non-overlapping analyses can yield contested results, overvalue data near overlap boundaries, lose statistical power, and lack estimates of explained variance or unexplained residuals. To address these difficulties, DMA integrates several methods, including multilevel and time-series analyses. DMA re-analysis not only showed robust intervention effects, but also time-, outcome-, and intervention component-specific effects. Moreover, DMA informs the suitability of time hypotheses or meta-analysis, and DMA's components can be used separately, notably its time-series analyses for small samples (e.g., one participant). Hence, DMA can help researchers analyze single-case data more accurately.

Social Thinking®, Pseudoscientific, Not Empirically Supported, and Non-Evidence Based: a Reply to Crooke and Winner

J. B. Leaf et al. (Behavior Analysis in Practice, 9, 152-157, 2016) wrote a commentary on social thinking (ST), an intervention commonly implemented for individuals diagnosed with autism spectrum disorder (ASD). The authors described what constitutes scientific, pseudoscientific, and antiscientific evidence and contended that ST aligns with the definition of pseudoscience and, to date, is not empirically supported or evidence based. Crooke and Winner (Behavior Analysis in Practice, 9, 403-408, 2016) responded, arguing that ST meets their definition of an evidence-based practice and identifying purported misconceptions and inaccuracies described by J. B. Leaf et al. In the current article, the authors clarify the original arguments, critically evaluate Crooke and Winner's definition of what constitutes evidence-based practice, further evaluate the research on ST, discuss issues regarding how ST is conceptualized, and express concerns about the endorsement and use of an eclectic approach to treating ASD. As this response was written by behavior analysts, it specifically addresses the conceptual consistency of this approach from a behavior-analytic worldview.

Speak Up: Increasing Conversational Volume in a Child with Autism Spectrum Disorder

Deficits in social interactions are a hallmark of autism spectrum disorder. This study examined one relatively uncommon aspect of social interactions that has not received much attention from the literature: appropriate conversational volume. Conversational speech volume was measured using a commercially available application, and a package intervention was developed that consisted of feedback from the voice measuring application, signaling from a wrist bracelet, and differential reinforcement. The intervention was evaluated in an ABAB design and speaking at conversational volume was significantly increased when the intervention was in place and in probe conditions.

Evidence-Based Social Communication Interventions for Children with Autism Spectrum Disorder

Impairments in social communication skills are a core feature of autism spectrum disorder (ASD) and include deficits in social-emotional reciprocity, non-verbal communicative behaviors used for social interaction, and developing, maintaining, and understanding relationships. In order to improve outcomes for children with ASD, much research has been focused on developing effective interventions to treat these social communication deficits. The purpose of this paper is to highlight the evidence-based practices found within the intervention literature that specifically targets social communication impairments and provide an overview of these strategies. Four relevant themes regarding evidence-based social communication interventions are considered and discussed: (a) social communication outcomes and practices relevant to different stages of development, (b) practices that both reduce interfering behaviors and improve social communication skills,

Using the Teaching Interactions Procedure to Teach Social Skills to Children With Autism and Intellectual Disability

This study implemented a modified teaching interaction procedure to teach social skills to 4 children diagnosed with autism spectrum disorder with an intellectual disability. A multiple baseline design across social skills and replicated across participants was utilized to evaluate the effects of the modified teaching interaction procedure. The results demonstrated that the teaching interaction procedure resulted in all participants acquiring targeted social skills, maintaining the targeted social skills, and generalizing the targeted social skills.

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.

An Alternative Method for Quantitative Synthesis of Single-Subject Researches

The purpose of the present study is twofold: (a) to compare the validation of percentage of nonoverlapping data approach and percentage of data points exceeding the median of baseline phase (PEM) approach, and (b) to demonstrate application of the PEM approach in conducting a quantitative synthesis of single-subject research investigating the effectiveness of self-control. The results show that the PEM had higher Spearman correlation with original authors’judgment than PND did. The results of applying the PEM approach to synthesize the effect of self-control training on academic and social behavior showed that the treatment was highly or at least moderately effective.

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.

Heterogeneity of neural mechanisms of response to pivotal response treatment

We investigated the mechanisms by which Pivotal Response Treatment (PRT) improves social communication in a case series of 10 preschool-aged children with Autism Spectrum Disorder (ASD). Functional magnetic resonance imaging (fMRI) identified brain responses during a biological motion perception task conducted prior to and following 16 weeks of PRT treatment. Overall, the neural systems supporting social perception in these 10 children were malleable through implementation of PRT; following treatment, neural responses were more similar to those of typically developing children (TD). However, at baseline, half of the children exhibited hypoactivation, relative to a group of TD children, in the right posterior superior temporal sulcus (pSTS), and half exhibited hyperactivation in this region. Strikingly, the groups exhibited differential neural responses to treatment: The five children who exhibited hypoactivation at baseline evidenced increased activation in components of the reward system including the ventral striatum and putamen. The five children who exhibited hyperactivation at baseline evidenced decreased activation in subcortical regions critical for regulating the flow of stimulation and conveying signals of salience to the cortex-the thalamus, amygdala, and hippocampus. Our results support further investigation into the differential effects of particular treatment strategies relative to specific neural targets. Identification of treatment strategies that address the patterns of neural vulnerability unique to each patient is consistent with the priority of creating individually tailored interventions customized to the behavioral and neural characteristics of a given person.

Social Thinking®: Science, Pseudoscience, or Antiscience?

Today, there are several interventions that can be implemented with individuals diagnosed with autism spectrum disorder. Most of these interventions have limited to no empirical evidence demonstrating their effectiveness, yet they are widely implemented in home, school, university, and community settings. In 1996, Green wrote a chapter in which she outlined three levels of science: evidence science, pseudoscience, and antiscience; professionals were encouraged to implement and recommend only those procedures that would be considered evidence science. Today, an intervention that is commonly implemented with individuals diagnosed with autism spectrum disorder is Social Thinking®. This intervention has been utilized by behaviorists and non-behaviorists. This commentary will outline Social Thinking® and provide evidence that the procedure, at the current time, qualifies as a pseudoscience and, therefore, should not be implemented with individuals diagnosed with autism spectrum disorder, especially given the availability of alternatives which clearly meet the standard of evidence science.

Language comprehension and brain function in individuals with an optimal outcome from autism

Although Autism Spectrum Disorder (ASD) is generally a lifelong disability, a minority of individuals with ASD overcome their symptoms to such a degree that they are generally indistinguishable from their typically-developing peers. That is, they have achieved an Optimal Outcome (OO). The question addressed by the current study is whether this normalized behavior reflects normalized brain functioning, or alternatively, the action of compensatory systems. Either possibility is plausible, as most participants with OO received years of intensive therapy that could alter brain networks to align with typical function or work around ASD-related neural dysfunction. Individuals ages 8 to 21 years with high-functioning ASD (n = 23), OO (n = 16), or typical development (TD; n = 20) completed a functional MRI scan while performing a sentence comprehension task. Results indicated similar activations in frontal and temporal regions (left middle frontal, left supramarginal, and right superior temporal gyri) and posterior cingulate in OO and ASD groups, where both differed from the TD group. Furthermore, the OO group showed heightened “compensatory” activation in numerous left- and right-lateralized regions (left precentral/postcentral gyri, right precentral gyrus, left inferior parietal lobule, right supramarginal gyrus, left superior temporal/parahippocampal gyrus, left middle occipital gyrus) and cerebellum, relative to both ASD and TD groups. Behaviorally normalized language abilities in OO individuals appear to utilize atypical brain networks, with increased recruitment of language-specific as well as right homologue and other systems. Early intensive learning and experience may normalize behavioral language performance in OO, but some brain regions involved in language processing may continue to display characteristics that are more similar to ASD than typical development, while others show characteristics not like ASD or typical development.

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fMRI study of "optimal outcome" (OO) youth with no symptoms of autism spectrum disorder.

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Results show “compensatory” language activation in some areas in OO.

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OO youth also had some “residual ASD” patterns of activation (OO, ASD > TD).

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There was no evidence of areas of normalized brain function (OO, TD ≠ ASD).

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Early treatment may normalize behavior but not brain in some individuals with ASD.

Early Infant Development and Intervention for Autism Spectrum Disorder

OBJECTIVE

The objective is to overview recent findings on early detection/diagnosis of autism spectrum disorders, as well as clinical trials of early interventions for toddlers at risk for/diagnosed with autism spectrum disorder.

FINDINGS

Prospective studies of infants at high risk of autism spectrum disorder have yielded significant advances in understanding early development in autism spectrum disorder. Findings from prospective studies indicate that abnormalities in social communication and repetitive behaviors emerge during the second year, whereas additional "prodromal features" (motor and sensory abnormalities) emerge in the first year. Subsequently, exciting progress has been made in establishing the efficacy of autism spectrum disorder-specific interventions for toddlers as young as 15 months. Finally, efforts occur to characterize autism spectrum disorder-specific characteristics in genetic syndromes with concurrent autism spectrum disorder symptomatology.

CONCLUSION

Substantial progress in characterizing early developmental trajectories as well as the identification of specific behavioral markers has aided early detection. Work remains to ensure that research findings are translated into clinical practice for uptake in the health care system.

A Case Study on Vocal Loudness With a Young Adult With Autism Spectrum Disorder and Developmental Delay

PURPOSE

This clinical focus article describes an exploratory case study addressing reduction of vocal loudness in a young adult with a history of autism spectrum disorder and developmental delay. The need for a short-term pullout individual intervention arose from his participation in the Advancing Language and Literacy group, a program that provides support for enhancement of speech, language, and literacy skills for young adults with developmental disabilities.

METHOD

The participant attended individual treatment sessions weekly for 9 sessions, all of which were digitally audio-recorded. Client awareness of different loudness levels was first established using nonspeech sounds and speech samples. Loudness in spontaneous speech was monitored with support of verbal and visual feedback in the individual sessions and tracked in individual sessions as well as sessions of the Advancing Language and Literacy group, which served as a generalization context.

RESULTS

In the individual sessions, the participant's spontaneous production of acceptable volume improved from 42% to 92% of utterances. Observation of group participation indicated generalization, with the majority of utterances produced posttreatment at an acceptable volume.

CONCLUSIONS

This clinical focus article emphasizes suprasegmental aspects as a dimension of communicative competence and highlights the need for continued intervention research and services for young adults with developmental disabilities.

Improvements in social and adaptive functioning following short-duration PRT program: a clinical replication

Pivotal Response Treatment (PRT) is an empirically validated behavioral treatment for individuals with autism spectrum disorders (ASD). The purpose of the current study was to assess the efficacy of PRT for ten cognitively-able preschool-aged children with ASD in the context of a short-duration (4-month) treatment model. Most research on PRT used individual behavioral goals as outcome measures, but the current study utilized standardized assessments of broader-based social communication and adaptive skills. The children made substantial gains; however, magnitude and consistency of response across measures were variable. The results provide additional support for the efficacy of PRT as well as evidence for improvements in higher-order social communication and adaptive skill development within the context of a short-duration PRT model.

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.

Toward optimal outcome following pivotal response treatment: a case series

There is a growing literature on children with autism spectrum disorder (ASD) who respond favorably to behavioral treatment, which is often termed "optimal outcome." Rates and definitions of optimal outcome vary widely. The current case series describes an empirically validated behavioral treatment approach called Pivotal Response Treatment (PRT). We present two preschool-aged children who received an intensive course of PRT and seem to be on a trajectory toward potential optimal outcome. Understanding response to treatment and predictors of response is crucial, not necessarily to predict who may succeed, but to individualize medicine and match children with customized treatment programs that will be best tailored to their unique and varied needs.

Effective Behavioural Strategies for the Defining Characteristics of Autism

The following review paper describes the outcomes of data-based behavioural intervention strategies for the defining characteristics of autistic disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). The results of relevant evaluations of behaviour analytic procedures are reviewed for each of the four potential areas of difficulty under each of the main criteria for autistic disorder, which are: (a) impairment in social interaction, (b) impairment in communication, and (c) restrictive, repetitive, and stereotyped patterns of behaviour, interests, and activities (DSM-IV). The current areas of research activity as well as those domains that have received comparatively little attention by behavioural researchers are identified, and suggestions for future research are discussed.

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

PURPOSE

To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome.

METHODS

A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services.

RESULTS

The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person.

CONCLUSIONS

Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].

Neural mechanisms of improvements in social motivation after pivotal response treatment: two case studies

Pivotal response treatment (PRT) is an empirically validated behavioral treatment that has widespread positive effects on communication, behavior, and social skills in young children with autism spectrum disorder (ASD). For the first time, functional magnetic resonance imaging was used to identify the neural correlates of successful response to PRT in two young children with ASD. Baseline measures of social communication, adaptive behavior, eye tracking and neural response to social stimuli were taken prior to treatment and after 4 months of PRT. Both children showed striking gains on behavioral measures and also showed increased activation to social stimuli in brain regions utilized by typically developing children. These results suggest that neural systems supporting social perception are malleable through implementation of PRT.