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Schuck RK, Tagavi DM, Baiden KMP, Dwyer P, Williams ZJ, Osuna A, Ferguson EF, Jimenez Muñoz M, Poyser SK, Johnson JF, Vernon TW. Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. J Autism Dev Disord 2022; 52:4625-4645. [PMID: 34643863 PMCID: PMC9508016 DOI: 10.1007/s10803-021-05316-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/25/2022]
Abstract
Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA.
| | - Daina M Tagavi
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, CA, USA
- Center for Mind and Brain, University of California, Davis, Davis, CA, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Anthony Osuna
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily F Ferguson
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Maria Jimenez Muñoz
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Samantha K Poyser
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Ty W Vernon
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
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Abstract
The COVID-19 pandemic has created unprecedented challenges and disruptions for autistic individuals receiving specialized treatment services. This caregiver-report survey study (n = 339) explored predictors of satisfaction with autism services during COVID-19 to improve perceived support for these families. Specifically, we investigated whether service delivery medium (telehealth vs. in person), child’s emotional functioning, and caregiver stress would predict satisfaction with the most highly utilized services. Satisfaction ratings for ABA/behavioral, speech/language, and occupational therapy were lower when delivered via telehealth as compared to in person. Caregivers who reported higher emotional dysregulation in their children were less satisfied with behavioral therapy services. These results provide a critical caregiver-informed perspective on factors influencing satisfaction with specialized autism services during COVID-19.
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Affiliation(s)
- Emily F Ferguson
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, 93117, USA.
| | - Maria Jimenez-Muñoz
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, 93117, USA
| | - Harrison Feerst
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, 93117, USA
| | - Ty W Vernon
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, 93117, USA
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Ferguson EF, Drapalik KN, Liang J, Hua K, Feerst H, Mallory AB, Vernon TW. Social Interaction Skill Intervention for Autistic Adults with Intellectual Disability and Limited Language: A Pilot of the SKILL Program. J Autism Dev Disord 2020; 51:1641-1657. [PMID: 32812191 DOI: 10.1007/s10803-020-04659-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a dearth of research that focuses on social intervention efforts for adults on the autism spectrum with intellectual disability and limited conversational language. Using a multiple baseline experimental design, this pilot investigation of the Socialization Knowledge for Individuals with Limited Language (SKILL) program evaluated a novel peer-facilitated group program specifically designed to target social interaction skills for this population. Findings from five pilot participants yielded evidence of social improvements across specific verbal skills (on-topic conversational contributions and responses) and nonverbal behaviors (eye-contact, active listening), as evidenced by coded social conversation probes and parent-report measures. These findings demonstrate the promise of a socialization intervention for a population that has historically been neglected in the social intervention research literature.
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Affiliation(s)
- Emily F Ferguson
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA.
| | - Krista N Drapalik
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
- Yale Child Study Center, New Haven, CT, USA
| | - Jeffrey Liang
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Klaire Hua
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Harrison Feerst
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Alice B Mallory
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Ty W Vernon
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
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Bradshaw J, Shic F, Holden AN, Horowitz EJ, Barrett AC, German TC, Vernon TW. The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism. Autism Res 2019; 12:779-793. [PMID: 30891960 DOI: 10.1002/aur.2093] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Abstract
There is a pressing need for objective, quantifiable outcome measures in intervention trials for children with autism spectrum disorder (ASD). The current study investigated the use of eye tracking as a biomarker of treatment response in the context of a pilot randomized clinical trial of treatment for young children with ASD. Participants included 28 children with ASD, aged 18-48 months, who were randomized to one of two conditions: Pivotal Response Intervention for Social Motivation (PRISM) or community treatment as usual (TAU). Eye-tracking and behavioral assessment of developmental functioning were administered at Time 1 (prior to randomization) and at Time 2 (after 6 months of intervention). Two well-established eye-tracking paradigms were used to measure social attention: social preference and face scanning. As a context for understanding relationships between social attention and developmental ability, we first examined how scanning patterns at Time 1 were associated with concurrent developmental functioning and compared to those of 23 age-matched typically developing (TD) children. Changes in scanning patterns from Time 1 to Time 2 were then compared between PRISM and TAU groups and associated with behavioral change over time. Results showed that the social preference paradigm differentiated children with ASD from TD children. In addition, attention during face scanning was associated with language and adaptive communication skills at Time 1 and change in language skills from Time 1 to Time 2. These findings highlight the importance of examining targeted biomarkers that measure unique aspects of child functioning and that are well-matched to proposed mechanisms of change. Autism Research 2019, 12: 779-793. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Biomarkers have the potential to provide important information about how and why early interventions effect positive change for young children with ASD. The current study suggests that eye-tracking measures of social attention can be used to track change in specific areas of development, such as language, and points to the need for targeted eye-tracking paradigms designed to measure specific behavioral changes. Such biomarkers could inform the development of optimal, individualized, and adaptive interventions for young children with ASD.
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Affiliation(s)
- Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Anahita N Holden
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
| | - Erin J Horowitz
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Amy C Barrett
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
| | - Tamsin C German
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Ty W Vernon
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
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Ko JA, Miller AR, Vernon TW. Social conversation skill improvements associated with the Social Tools And Rules for Teens program for adolescents with autism spectrum disorder: Results of a randomized controlled trial. Autism 2018; 23:1224-1235. [DOI: 10.1177/1362361318808781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jordan A Ko
- University of California, Santa Barbara, USA
| | | | - Ty W Vernon
- University of California, Santa Barbara, USA
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Vernon TW. Fostering a social child with autism: a moment-by-moment sequential analysis of an early social engagement intervention. J Autism Dev Disord 2015; 44:3072-82. [PMID: 24974256 DOI: 10.1007/s10803-014-2173-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Young children with autism often experience limited social motivation and responsiveness that restricts establishment of crucial social momentum. These characteristics can lead to decreased opportunities for parental engagement and the social learning associated with these moments. Early social interventions that capitalize on pre-existing interests may be able to re-establish this developmentally critical feedback loop, in which both child and parent social behaviors simultaneously increase and influence one another. This investigation examined the moment-by-moment, micro-transactional relationship between parent and child social behavior gains observed in an early intervention study. Time-window sequential analyses revealed the presence of clinically and statistically significant sequential associations between parent and child social behaviors during an embedded social interaction intervention, but not in a comparable motivational intervention that utilized highly preferred toys and objects. Specifically, the onset of parent eye contact, directed positive affect, or offer of a reinforcing incentive predicted the immediate occurrence of child eye contact and positive affect in the experimental social intervention condition. Additionally, child verbal initiations, positive affect, and eye contact immediately predicted the onset of parent positive affect during this social intervention paradigm. Theoretical implications for the social developmental trajectory of autism are discussed.
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Affiliation(s)
- Ty W Vernon
- Department of Counseling, Clinical, and School Psychology, Koegel Autism Center, Gevirtz Graduate School of Education, University of California Santa Barbara, Santa Barbara, CA, 93106-9490, USA,
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Vernon TW, Koegel RL, Dauterman H, Stolen K. An early social engagement intervention for young children with autism and their parents. J Autism Dev Disord 2013; 42:2702-17. [PMID: 22527708 DOI: 10.1007/s10803-012-1535-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The social vulnerabilities associated with young children with autism are recognized as important intervention targets due to their influence on subsequent development. Current research suggests that interventions that combine motivational and social components can create meaningful changes in social functioning. Simultaneously, it is hypothesized that parent delivery of such strategies can invoke increases in these core social behaviors and parent engagement. This study examined the effects of teaching parents to implement a social engagement intervention with their children. The results indicated that the use of this parent-delivered social intervention led to (a) increases in their children's use of eye contact, directed positive affect, and verbal initiations, (b) increases in parent positive affect and synchronous engagement, and (c) generalized increases in parent and child behaviors.
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Affiliation(s)
- Ty W Vernon
- Koegel Autism Center, Gervitz Graduate School of Education, University of California, Santa Barbara, CA 93106-9490, USA.
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Koegel RL, Vernon TW, Koegel LK. Improving social initiations in young children with autism using reinforcers with embedded social interactions. J Autism Dev Disord 2009; 39:1240-51. [PMID: 19357942 PMCID: PMC2727363 DOI: 10.1007/s10803-009-0732-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 03/22/2009] [Indexed: 11/30/2022]
Abstract
Children with autism often exhibit low levels of social engagement, decreased levels of eye contact, and low social affect. However, both the literature and our direct clinical observations suggest that some components of intervention procedures may result in improvement in child-initiated social areas. Using an ABAB research design with three children with autism, this study systematically assessed whether embedding social interactions into reinforcers, delivered during language intervention, would lead to increased levels of child-initiated social behaviors. We compared this condition with a language intervention condition that did not embed social interactions into the reinforcers. Results indicated that embedding social interactions into the reinforcers resulted in increases in child-initiated social engagement during communication, improved nonverbal dyadic orienting, and improvements in general child affect. Theoretical and applied implications are discussed.
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Affiliation(s)
- Robert L. Koegel
- Department of Counseling, Clinical, School Psychology, Gevirtz Graduate School of Education, Koegel Autism Center, University of California, Santa Barbara, CA 93106-9490 USA
| | - Ty W. Vernon
- Department of Counseling, Clinical, School Psychology, Gevirtz Graduate School of Education, Koegel Autism Center, University of California, Santa Barbara, CA 93106-9490 USA
| | - Lynn K. Koegel
- Department of Counseling, Clinical, School Psychology, Gevirtz Graduate School of Education, Koegel Autism Center, University of California, Santa Barbara, CA 93106-9490 USA
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