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Patten KK, Murthi K, Onwumere DD, Skaletski EC, Little LM, Tomchek SD. Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan. Am J Occup Ther 2024; 78:7803397010. [PMID: 38758762 DOI: 10.5014/ajot.2024.078301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. OBJECTIVE These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. METHOD These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. RESULTS A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.
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Affiliation(s)
- Kristie K Patten
- Kristie K. Patten, PhD, OT/L, FAOTA, is Counselor to the President and Professor, Department of Occupational Therapy, New York University, New York, NY
| | - Kavitha Murthi
- Kavitha Murthi, MSc(OT), FHEA(UK), OTR, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Dora D Onwumere
- Dora D. Onwumere, MS, OTR/L, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Emily C Skaletski
- Emily C. Skaletski, MOT, OTR/L, is PhD Candidate, Department of Kinesiology, University of Wisconsin-Madison
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, FAOTA, is Associate Dean of Research, College of Health Sciences, and Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, School of Medicine, University of Louisville, Louisville, KY
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Siller M, Morgan L, Fuhrmeister S, Wedderburn Q, Schirmer B, Chatson E, Gillespie S. Feasibility and acceptability of a low-resource-intensive, transdiagnostic intervention for children with social-communication challenges in early childhood education settings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:587-599. [PMID: 37291971 PMCID: PMC10703997 DOI: 10.1177/13623613231179289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT Preschool classrooms provide a unique context for supporting the development of children with social-communication challenges. This study is an uncontrolled clinical trial of an adapted professional development intervention for preschool teachers (Social Emotional Engagement-Knowledge & Skills-Early Childhood). Social Emotional Engagement-Knowledge & Skills-Early Childhood is a low-resource-intensive, transdiagnostic intervention to address the learning needs of children with social-communication challenges and consists of four asynchronous online modules and three synchronous coaching sessions. The current research evaluated the feasibility and acceptability of intervention and research procedures, implemented in authentic early childhood education settings. Participants included one teacher and one target child with social-communication challenges from 25 preschool classrooms, sampled to maximize variability. Overall, the current research revealed high levels of feasibility, with 9 out of 10 benchmarks met: (a) procedures for participant recruitment reliably identified a neurodiverse sample of children with teacher-reported social-communication challenges; (b) teachers showed high levels of program engagement and Social Emotional Engagement-Knowledge & Skills-Early Childhood completion (76%); and (c) results revealed a robust pattern of gains in Social Emotional Engagement-Knowledge & Skills-Early Childhood classrooms and associations among key outcome measures (including active engagement, student teacher relationship, social-communication competencies). Implications for the design of a subsequent, larger effectiveness-implementation hybrid trial (Type 1) are discussed.
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Affiliation(s)
- Michael Siller
- Emory University School of Medicine, USA
- Children's Healthcare of Atlanta, USA
| | - Lindee Morgan
- Emory University School of Medicine, USA
- Children's Healthcare of Atlanta, USA
| | | | - Quentin Wedderburn
- Emory University School of Medicine, USA
- Children's Healthcare of Atlanta, USA
- University of South Carolina, USA
| | - Brooke Schirmer
- Emory University School of Medicine, USA
- Children's Healthcare of Atlanta, USA
| | - Emma Chatson
- Emory University School of Medicine, USA
- Children's Healthcare of Atlanta, USA
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Van Breukelen GJP. Cluster Randomized Trials with a Pretest and Posttest: Equivalence of Three-, Two- and One-Level Analyses, and Sample Size Calculation. MULTIVARIATE BEHAVIORAL RESEARCH 2024; 59:206-228. [PMID: 37590444 DOI: 10.1080/00273171.2023.2240779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In a cluster randomized trial clusters of persons, for instance, schools or health centers, are assigned to treatments, and all persons in the same cluster get the same treatment. Although less powerful than individual randomization, cluster randomization is a good alternative if individual randomization is impossible or leads to severe treatment contamination (carry-over). Focusing on cluster randomized trials with a pretest and post-test of a quantitative outcome, this paper shows the equivalence of four methods of analysis: a three-level mixed (multilevel) regression for repeated measures with as levels cluster, person, and time, and allowing for unstructured between-cluster and within-cluster covariance matrices; a two-level mixed regression with as levels cluster and person, using change from baseline as outcome; a two-level mixed regression with as levels cluster and time, using cluster means as data; a one-level analysis of cluster means of change from baseline. Subsequently, similar equivalences are shown between a constrained mixed model and methods using the pretest as covariate. All methods are also compared on a cluster randomized trial on mental health in children. From these equivalences follows a simple method to calculate the sample size for a cluster randomized trial with baseline measurement, which is demonstrated step-by-step.
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Shire S. The devil is in the details: Advancing our collective understanding of naturalistic developmental behavioral interventions. Autism Res 2024; 17:10-16. [PMID: 37943121 DOI: 10.1002/aur.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
Given the growing body of randomized trials examining various Naturalistic Developmental Behavioral Intervention (NDBI) approaches, a dialog has emerged exploring the overlap in strategies across NDBIs to create single measures that propose to capture core strategies across the interventions. This commentary will ask readers to consider the current state of the science, the potential value of looking not only for similarities but also for differences across approaches, and present five scientific next steps to advance our collective understanding of the NDBIs including: (a) operationalizing intervention strategies and outcomes, (b) expansion of the effectiveness evidence base and begin testing implementation strategies for individual NDBIs, (c) rigorous testing of core intervention components and the mechanism of each intervention, (d) personalization, and (e) supporting transparency with a priori trial registration.
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Affiliation(s)
- Stephanie Shire
- Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, Oregon, USA
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Yousef BM, Bhaskar Raj N, Nadiah WA, Dhas BN, Mansour AM, Abd Alhadi SA, Rosal FV, Dizon MM. Integrated Life Skills Training and Executive Function Strategies in Children With Autism Spectrum Disorder in Qatar: A Pilot Study of a Randomized Controlled Trial. Cureus 2024; 16:e52809. [PMID: 38264179 PMCID: PMC10805505 DOI: 10.7759/cureus.52809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 01/25/2024] Open
Abstract
Background and aim Executive function (EF) impairment is common in children with autism spectrum disorder (ASD). EF strategies are considered effective in improving the therapeutic outcomes of children with ASD. This study primarily aimed to explore whether integrating EF strategies combined with regular occupational therapy intervention is more effective in improving daily life skills (DLS) and sensory integration/processing (SI/SP) skills than regular occupational therapy alone in children with ASD and secondarily aims to assess treatment outcomes on improving visual motor integration (VMI) skills. Methods A total of 17 participants (13 males, mean age 4.29 years, standard deviation 0.66) completed the study. Following the baseline assessments, the participants were randomly assigned to the treatment group (45-minute once-weekly individual occupational therapy plus EF strategies) or control group (45-minute once-weekly individual therapy sessions alone). All participants received one intervention per week for 14 weeks. All children were systematically evaluated using a pediatric functional independent measure (WeeFIM) and the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) to assess DLS, the Short Sensory Profile 2 (SSP2) to assess SP/SI, and the Beery VMI test (Beery VMI) to assess VMI. Assessments were conducted at baseline, seven weeks, and 14 weeks of treatment. Results The analysis of the results between the treatment and control groups revealed that the treatment group had greater gains and significant differences in the mean values of both the WeeFIM and SSP2. In addition, notable distinctions were observed in the VB-MAPP transition subscale; although these differences did not reach statistical significance, they were clinically significant. Minimal differences were noted in the VMI between the two groups. Nevertheless, both groups showed statistically significant improvements across all outcome measures. Conclusions Our study provides preliminary evidence of the efficacy of EF strategies combined with regular occupational therapy for DLS, SP/SI, and VMI in children with ASD. The differences between the groups support further evaluation of the effectiveness of EF strategies for the next stage of a larger randomized clinical trial.
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Affiliation(s)
- Bara M Yousef
- Rehabilitation, Hamad Medical Corporation, Doha, QAT
- Faculty of Health Sciences, University Sultan Zainal Abidin, Kuala Nerus, MYS
| | - Naresh Bhaskar Raj
- Faculty of Health Sciences, University Sultan Zainal Abidin, Kuala Nerus, MYS
| | - Wan-Arfah Nadiah
- Faculty of Health Sciences, University Sultan Zainal Abidin, Kuala Nerus, MYS
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Wright B, Kingsley E, Cooper C, Biggs K, Bursnall M, Wang HI, Chater T, Coates E, Teare MD, McKendrick K, Gomez de la Cuesta G, Barr A, Solaiman K, Packham A, Marshall D, Varley D, Nekooi R, Parrott S, Ali S, Gilbody S, Le Couteur A. Play brick therapy to aid the social skills of children and young people with autism spectrum disorder: the I-SOCIALISE cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-137. [PMID: 38095124 DOI: 10.3310/vgtr7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background Social skills interventions are commonly recommended to help children and young people with autism spectrum disorder develop social skills, but some struggle to engage in these interventions. LEGO® (LEGO System A/S, Billund, Denmark) based therapy, a group social skills intervention, aims to be more interesting and engaging. Objective To evaluate the clinical effectiveness of LEGO® based therapy on the social and emotional skills of children and young people with autism spectrum disorder in school settings compared with usual support. Secondary objectives included evaluations of cost-effectiveness, acceptability and treatment fidelity. Design A cluster randomised controlled trial randomly allocating participating schools to either LEGO® based therapy and usual support or usual support only. Setting Mainstream schools in the north of England. Participants Children and young people (aged 7-15 years) with autism spectrum disorder, their parent/guardian, an associated teacher/teaching assistant and a facilitator teacher/teaching assistant (intervention schools only). Intervention Schools randomised to the intervention arm delivered 12 weekly sessions of LEGO® based therapy, which promotes collaborative play and encourages social problem-solving in groups of three children and young people with a facilitator (trained teacher or teaching assistant). Participants received usual support from school and community services. Participants in the control arm received usual support only. Research assistants and statisticians were blind to treatment allocation. Main outcome measure The social skills subscale of the Social Skills Improvement System (SSIS), completed by the children and young people's unblinded teacher pre randomisation and 20 weeks post randomisation. The SSIS social skills subscale measures social skills including social communication, co-operation, empathy, assertion, responsibility and self-control. Participants completed a number of other pre- and post-randomisation measures of emotional health, quality of life, loneliness, problem behaviours, academic competence, service resource utilisation and adverse events. Results A total of 250 children and young people from 98 schools were randomised: 127 to the intervention arm and 123 to the control arm. Intention-to-treat analysis of the main outcome measure showed a modest positive difference of 3.74 points (95% confidence interval -0.16 to 7.63 points, standardised effect size 0.18; p = 0.06) in favour of the intervention arm. Statistical significance increased in per-protocol analysis, with a modest positive difference (standardised effect size 0.21; p = 0.036). Cost-effectiveness of the intervention was found in reduced service use costs and a small increase in quality-adjusted life-years. Intervention fidelity and acceptability were positive. No intervention-related adverse events or effects were reported. Conclusions The primary and pre-planned sensitivity analysis of the primary outcome consistently showed a positive clinical difference, with modest standardised effect sizes of between 0.15 and 0.21. There were positive health economics and qualitative findings, corroborated by the difference between arms for the majority of secondary outcomes, which were not statistically significant but favoured the intervention arm. Post hoc additional analysis was exploratory and was not used in drawing this conclusion. Given the small positive change, LEGO® based therapy for children and young people with autism spectrum disorder in schools should be considered. Limitations The primary outcome measure was completed by an unblinded teacher (rather than by the facilitator). Future work The study team recommends future research into LEGO® based therapy, particularly in school environments. Trial registration This trial is registered as ISRCTN64852382. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/49/32) and is published in full in Public Health Research; Vol. 11, No. 12. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
- Child Oriented Mental Health Innovation Collaborative, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - Ellen Kingsley
- Child Oriented Mental Health Innovation Collaborative, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katie Biggs
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew Bursnall
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Han-I Wang
- Hull York Medical School, University of York, York, UK
| | - Tim Chater
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Coates
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty McKendrick
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Amy Barr
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kiera Solaiman
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Packham
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Roshanak Nekooi
- Child Oriented Mental Health Innovation Collaborative, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - Steve Parrott
- Hull York Medical School, University of York, York, UK
| | - Shehzad Ali
- Hull York Medical School, University of York, York, UK
| | - Simon Gilbody
- Hull York Medical School, University of York, York, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Caldani S, Humeau E, Delorme R, Bucci MP. Inhibition functions can be improved in children with autism spectrum disorders: An eye-tracking study. Int J Dev Neurosci 2023; 83:431-441. [PMID: 37218472 DOI: 10.1002/jdn.10276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Cognitive remediation therapy interventions could improve cognitive functioning in subjects with autism. To investigate the benefit of a short cognitive training rehabilitation in children with autism spectrum disorder (ASD) on pursuit and fixation performances. We recruited two groups (G1 and G2) of 30 children with ASD, sex-, IQ- and age-matched (mean 11.6 ± 0.5 years), and pursuit and fixation eye movements were recorded twice at T1 and T2. Between T1 and T2, a 10-min cognitive training was performed by the G1 group only, whereas the G2 group had a 10-min of rest. For all children with ASD enrolled in the study, there was a positive correlation between restricted and repetitive behaviour scores of both Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) and the number of saccades recorded during the fixation task at T1. At T1, oculomotor performances were similar for both groups of ASD children (G1 and G2). At T2, we observed a significant reduction in the number of saccades made during both pursuit and fixation tasks. Our findings underlined the importance to promote cognitive training rehabilitation for children with ASD, leading to a better performance in inhibitory and attention functioning responsible for pursuit and fixation eye movement's performance.
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Affiliation(s)
- Simona Caldani
- MoDyCo, UMR 7114 CNRS, Paris Nanterre University, Nanterre, France
- EFEE-Center for the Functional Exploration of Balance in Children, Robert Debré Hospital, Paris, France
| | - Elise Humeau
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
- High Functioning Autism Expert Centre, Fundamental Fondation, Paris, France
- Paris University, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
- High Functioning Autism Expert Centre, Fundamental Fondation, Paris, France
- Paris University, Paris, France
| | - Maria Pia Bucci
- MoDyCo, UMR 7114 CNRS, Paris Nanterre University, Nanterre, France
- EFEE-Center for the Functional Exploration of Balance in Children, Robert Debré Hospital, Paris, France
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Tomchek SD, Dean E, Baker A, Little LM, Wallisch A. Interventions to Support Participation in Education for Autistic Students (2013-2021). Am J Occup Ther 2023; 77:7710393150. [PMID: 37585656 DOI: 10.5014/ajot.2023.77s10015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on interventions to support autistic1 children and youth (up to 18 yr old) and focuses on participation in education settings.
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Affiliation(s)
- Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Evan Dean
- Evan Dean, PhD, OTR/L, is Associate Director, Beach Center on Disability, University of Kansas, Lawrence, KS
| | - Alissa Baker
- Alissa Baker, MS, OTR/L, is Instructor, Department of Occupational Therapy, Western Michigan University, Kalamazoo, MI
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, is Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Anna Wallisch
- Anna Wallisch, PhD, OTR/L, is Postdoctoral Research Associate, Juniper Gardens Children's Project, University of Kansas, Lawrence, KS
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Stahmer AC, Suhrheinrich J, Rieth SR, Roesch S, Vejnoska S, Chan J, Nahmias A, Wang T. A Waitlist Randomized Implementation Trial of Classroom Pivotal Response Teaching for Students With Autism. FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES 2023; 38:32-44. [PMID: 38605730 PMCID: PMC11008494 DOI: 10.1177/10883576221133486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Classroom Pivotal Response Teaching (CPRT) is a community-partnered adaptation of a naturalistic developmental behavioral intervention identified as an evidence-based practice for autistic children. The current study evaluated student outcomes in a randomized, wait-list controlled implementation trial across classrooms. Participants included teachers (n = 126) and students with autism (n = 308). Teachers participated in 12 hours of didactic, interactive training and additional in-classroom coaching. Generalized Estimating Equations accounted for clustering. Adjusted models evaluated the relative effects of training group, CPRT fidelity, and classroom quality on student outcomes. Results indicate higher CPRT fidelity was associated with greater increases in student learning. Having received CPRT training predicted increased student engagement and greater decreases in reported approach/withdrawal problems. These differences may be linked to the theoretical foundations of CPRT of increasing student motivation and engagement and collaborative adaptation to increase feasibility in schools. Overall, results suggest CPRT may be a beneficial approach for supporting autistic students.
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Affiliation(s)
- Aubyn C. Stahmer
- UC Davis MIND Institute, Sacramento, CA, USA
- Child and Adolescent Services Research Center, CA, USA
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | - Sarah R. Rieth
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | - Scott Roesch
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | - Sarah Vejnoska
- UC Davis MIND Institute, Sacramento, CA, USA
- Child and Adolescent Services Research Center, CA, USA
| | - Janice Chan
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | | | - Tiffany Wang
- Child and Adolescent Services Research Center, CA, USA
- University of California, San Diego, USA
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Yi J, Kim W, Lee J. Effectiveness of the SCERTS Model-Based Interventions for Autistic Children: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2662-2676. [PMID: 35772184 DOI: 10.1044/2022_jslhr-21-00518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This systematic review aimed to examine the effectiveness of the Social Communication, Emotional Regulation, and Transactional Support (SCERTS) Model-based interventions in supporting developmental skills of children who were diagnosed with or at increased likelihood of autism. METHOD We searched six electronic databases, in addition to Google Scholar and the reference lists, using terms related to SCERTS, the Early Social Interaction project, and autism spectrum disorder. Of the 70 articles, six published between 2014 and 2021 (a total of 455 children) were eligible for inclusion and were analyzed in terms of study design, type of publication, participant characteristics, intervention procedures, and major findings. RESULTS Most reviewed studies that were relatively less vulnerable to the given risk of bias suggested that SCERTS may be an effective approach for promoting children's social communication skills, and implementers were able to achieve an adequate level of intervention fidelity through training. Further implications could not be drawn concerning children's language, reduction in restricted repetitive behaviors, emotional regulation, adaptive behavior, play, cognitive skills, academic competence, and motor skills due to contradicting findings within limited evidence. CONCLUSIONS Although SCERTS is a promising intervention with emerging evidence, more methodologically rigorous studies are needed to progress the research base of SCERTS and draw firm conclusions about its effectiveness in improving a wide range of skills for children and implementers. Several areas for future research are discussed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20151842.
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Affiliation(s)
- Juhee Yi
- Department of Speech Pathology, Daegu University, South Korea
| | - Whasoo Kim
- Department of Speech Pathology, Daegu University, South Korea
| | - Jiwoo Lee
- Department of Music and Culture, Dong-A University, Busan, South Korea
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Sparapani N, Reinhardt VP, Hooker JL, Morgan L, Schatschneider C, Wetherby AM. Evaluating Teacher Language Within General and Special Education Classrooms Serving Elementary Students with Autism. J Autism Dev Disord 2022; 52:2284-2299. [PMID: 34106392 PMCID: PMC9021085 DOI: 10.1007/s10803-021-05115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Abstract
This study examined how teachers and paraprofessionals in 126 kindergarten-second grade general and special education classrooms talked with their 194 students with autism, and further, how individual student characteristics in language, autism symptoms, and social abilities influenced this talk. Using systematic observational methods and factor analysis, we identified a unidimensional model of teacher language for general and special education classrooms yet observed differences between the settings, with more language observed in special education classrooms-much of which included directives and close-ended questions. Students' receptive vocabulary explained a significant amount of variance in teacher language beyond its shared covariance with social impairment and problem behavior in general education classrooms but was non-significant within special education classrooms. Research implications are discussed.
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Affiliation(s)
- Nicole Sparapani
- School of Education and the MIND Institute, University of California, Davis, One Shields Ave., Davis, CA, 95616, USA.
- Autism Institute, College of Medicine, Florida State University, 2312 Killearn Center Boulevard, Building A, Tallahassee, FL, 32309-3524, USA.
| | - Vanessa P Reinhardt
- , Ontario, Canada
- Autism Institute, College of Medicine, Florida State University, 2312 Killearn Center Boulevard, Building A, Tallahassee, FL, 32309-3524, USA
| | - Jessica L Hooker
- Autism Institute, College of Medicine, Florida State University, 2312 Killearn Center Boulevard, Building A, Tallahassee, FL, 32309-3524, USA
| | - Lindee Morgan
- Autism Institute, College of Medicine, Florida State University, 2312 Killearn Center Boulevard, Building A, Tallahassee, FL, 32309-3524, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, 1920 Briarcliff Road, Atlanta, GA, 30329-4010, USA
| | - Christopher Schatschneider
- Department of Psychology, Florida Center for Reading Research, Florida State University, 2010 Levy Avenue, Suite 100, Tallahassee, FL, 32320, USA
| | - Amy M Wetherby
- Autism Institute, College of Medicine, Florida State University, 2312 Killearn Center Boulevard, Building A, Tallahassee, FL, 32309-3524, USA
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Green J, Leadbitter K, Ellis C, Taylor L, Moore HL, Carruthers S, James K, Taylor C, Balabanovska M, Langhorne S, Aldred C, Slonims V, Grahame V, Parr J, Humphrey N, Howlin P, McConachie H, Couteur AL, Charman T, Emsley R, Pickles A. Combined social communication therapy at home and in education for young autistic children in England (PACT-G): a parallel, single-blind, randomised controlled trial. Lancet Psychiatry 2022; 9:307-320. [PMID: 35305746 PMCID: PMC9630149 DOI: 10.1016/s2215-0366(22)00029-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autistic children can have difficulty generalising treatment effects beyond the immediate treatment context. Paediatric Autism Communication Therapy (PACT) has been successful when delivered in the clinic. Here we tested the Paediatric Autism Communication Therapy-Generalised (PACT-G) intervention combined between home and education settings for its overall effect and mechanistic transmission of effect across contexts. METHODS In this parallel, single-blind, randomised, controlled trial, we recruited autistic children aged 2-11 years in urban or semi-urban areas in Manchester, Newcastle, and London, England. Children needed to meet core autism criteria on Autism Diagnostic Observation Schedule-second edition (ADOS-2) and parent-rated Social Communication Questionnaire (SCQ-lifetime), and children older than 5 years were included if they had intentional communication but expressive language equivalent of age 4 years or younger. Eligible children were randomly assigned (1:1), using block randomisation (random block sizes of 2 and 4) and stratified for site, age (2-4 years vs 5-11 years), and gender, to either PACT-G plus treatment as usual or treatment as usual alone. Research assessors were masked to treatment allocation. The PACT-G intervention was delivered by a therapist in parallel to the child's parents at home and to learning-support assistants (LSA) at their place of education, using both in-person and remote sessions over a 6 month period, to optimise adult-child social interaction. Treatment as usual included any health support or intervention from education or local community services. The primary outcome was autism symptom severity using the ADOS-2, as measured by researchers, at 12 months versus baseline. Secondary outcomes were Brief Observation of Social Communication Change (BOSCC) and dyadic social interaction between child and adult across contexts, both at 12 months. Other secondary outcome measures were assessed using the following composites: language, anxiety, repetitive behaviour, adaptive behaviour, parental wellbeing, child health-related quality of life, and disruptive behaviour. Assessments were done at baseline, 7 months, and 12 months. We used an intention-to-treat (ITT) analysis of covariance for the efficacy outcome measures. Adverse events were assessed by researchers for all trial families at each contact and by therapists in the PACT-G group at each visit. This study is registered with the ISRCTN Registry, ISRCTN 25378536. FINDINGS Between Jan 18, 2017, and April 19, 2018, 555 children were referred and 249 were eligible, agreed to participate, and were randomly assigned to either PACT-G (n=122) or treatment as usual (n=127). One child in the PACT-G group withdrew and requested their data be removed from the study, giving an ITT population of 248 children. 51 (21%) of 248 children were female, 197 (79%) were male, 149 (60%) were White, and the mean age was 4·0 years (SD 0·6). The groups were well balanced for demographic and clinical characteristics. In the PACT-G group, parents of children received a median of 10 (IQR 8-12) home sessions and LSAs received a median of 8 (IQR 5-10) education sessions over 6 months. We found no treatment effect on the ADOS-2 primary outcome compared with treatment as usual (effect size 0·04 [95% CI -0·19 to 0·26]; p=0·74), or researcher-assessed BOSCC (0·03 [-0·25 to 0·31]), language composite (-0·03 [-0·15 to 0·10]), repetitive behaviour composite (0·00 [-0·35 to 0·35]), adaptive behaviour composite (0·01 [-0·15 to 0·18]), or child wellbeing (0·09 [-0·15 to 0·34]). PACT-G treatment improved synchronous response in both parent (0·50 [0·36 to 0·65]) and LSA (0·33 [0·16 to 0·50]), mediating increased child communication with parent (0·26 [0·12 to 0·40]) and LSA (0·20 [0·06 to 0·34]). Child dyadic communication change mediated outcome symptom alteration on BOSCC at home (indirect effect -0·78 [SE 0·34; 95% CI -1·44 to -0·11]; p=0·022) although not in education (indirect effect -0·67 [SE 0·37; 95% CI -1·40 to 0·06]; p=0·073); such an effect was not seen on ADOS-2. Treatment with PACT-G also improved the parental wellbeing composite (0·44 [0·08 to 0·79]) and the child disruptive behaviour composite in home and education (0·29 [0·01 to 0·57]). Adverse events on child behaviour and wellbeing were recorded in 13 (10%) of 127 children in the treatment as usual group (of whom four [31%] were girls) and 11 (9%) of 122 in the PACT-G group (of whom three [33%] were girls). One serious adverse event on parental mental health was recorded in the PACT-G group and was possibly study related. INTERPRETATION Although we found no effect on the primary outcome compared with treatment as usual, adaptation of the 12-month PACT intervention into briefer multicomponent delivery across home and education preserved the positive proximal outcomes, although smaller in effect size, and the original pattern of treatment mediation seen in clinic-delivered therapy, as well as improving parental wellbeing and child disruptive behaviours across home and school. Reasons for this reduced efficacy might be the reduced dose of each component, the effect of remote delivery, and the challenges of the delivery contexts. Caution is needed in assuming that changing delivery methods and context will preserve an original intervention efficacy for autistic children. FUNDING National Institute for Health Research and Medical Research Council Efficacy and Mechanism Evaluation Award.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester Royal Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Lauren Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Heather L Moore
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Matea Balabanovska
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Grahame
- Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Manchester, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Ma CH, Chen LY, Li MF, Wu D, Wang SS, Zhao YJ, Shi JL, Rydell PJ, Chen JJ, Wang Y. Treatment of Preschool Children With Autism Spectrum Disorder: A Trial to Evaluate a Learning Style Profile Intervention Program in China. Front Pediatr 2022; 10:831621. [PMID: 35372141 PMCID: PMC8966376 DOI: 10.3389/fped.2022.831621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate whether the provision of learning style profile (LSP) training improves development in preschool children with autism spectrum disorder (ASD) in China and to describe the characteristics of children who benefit from the intervention. METHODS Eighty-one children aged 36 to 72 months who were diagnosed with ASD for the first time were recruited for the intervention group. All of them received 24 weeks of LSP training, consisting of hospital- and home-based training. Twenty-one children with ASD of the same age in the control group had never received any intervention after diagnosis but underwent an assessment. Assessments were conducted at baseline and 24 weeks later. Differences in the developmental level and severity of ASD symptoms over time and between groups were analyzed by repeated standardized measures. Secondary analyses examined age effects among the 36- 48-, 48- 60-, and 60-72-month age groups. RESULTS Within-group comparison of the intervention group revealed significant treatment effects after the intervention, according to: language, social and adaptive developmental quotients (DQs) of the China Developmental Scale; total Childhood Autism Rating Scale (CARS) score; and hyperactivity, peer problems, total difficulties, and prosocial behavior scores of the Strengths and Difficulties Questionnaire (SDQ). Similar gains were observed in gross and fine motor DQs of the China Developmental Scale and emotional symptoms and conduct problems scores of the SDQ; however, the differences between these pre- and postintervention scores did not reach statistical significance. Comparisons among the three age groups in the intervention groups demonstrated a significant age effect on adaptive DQs of the China Developmental Scale; total CARS score; hyperactivity, peer problems and total difficulties scores of the SDQ. Comparison between the intervention and control groups revealed significant treatment effects on language, social and adaptive DQs of the China Developmental Scale; total CARS score; and emotional symptoms, conduct problems, hyperactivity, peer problems, total difficulties, and prosocial behavior scores of the SDQ after the intervention. Similar gains were observed in gross and fine motor DQs of the China Developmental Scale, although differences between the two groups did not reach statistical significance. CONCLUSION Our findings suggest that LSP training can effectively improve social behavior and reduce the severity of ASD symptoms in children with ASD. Our data also highlight the importance of early intervention.
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Affiliation(s)
- Chen-Huan Ma
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ling-Yan Chen
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Meng-Fan Li
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Wu
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Sha-Sha Wang
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Jun Zhao
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Li Shi
- Department of Molecular, Cellular and Developmental Biology, University of Colorado, Denver, CO, United States
| | - Patrick J Rydell
- Department of Communicative Disorders, University of Louisiana at Lafayette, Lafayette, LA, United States
| | - Jin-Jin Chen
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Wang
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Bauer RH, Gilpin AT, Thibodeau-Nielsen RB. Executive functions and imaginative play: Exploring relations with prosocial behaviors using structural equation modeling. Trends Neurosci Educ 2021; 25:100165. [PMID: 34844695 DOI: 10.1016/j.tine.2021.100165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Policy makers have long considered how to best educate children for success. Thus, this research explored whether imaginative play serves as a positive context for developing executive functions (EF) and prosocial behaviors necessary for academic success. Specifically, we hypothesized that EF would explain links between imaginative play and prosocial behaviors. METHOD 284 preschool children and their teachers completed measures of imaginative play, EF, and prosocial behaviors. Structural Equation Modeling examined mediational links between these constructs. RESULTS Imaginative play predicted both hot and cool EF, as well as prosocial behavior, even after controlling for age and vocabulary; furthermore, the relationship between imaginative play and prosocial behavior was fully mediated by hot EF. CONCLUSION Results suggest that imaginative play may serve as a positive context for developing EF and prosocial behaviors. Curricula and teachers should consider encouraging imaginative play to facilitate the development of EF and prosocial behaviors.
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Affiliation(s)
- Rebecca H Bauer
- Center for Youth Development and Intervention, Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Ansley T Gilpin
- Center for Youth Development and Intervention, Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
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15
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Odom SL, Hall LJ, Morin KL, Kraemer BR, Hume KA, McIntyre NS, Nowell SW, Steinbrenner JR, Tomaszewski B, Sam AM, DaWalt L. Educational Interventions for Children and Youth with Autism: A 40-Year Perspective. J Autism Dev Disord 2021; 51:4354-4369. [PMID: 33866461 PMCID: PMC8531076 DOI: 10.1007/s10803-021-04990-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Abstract
Commemorating the 40 th anniversary of the Diagnostic and Statistical Manual (DSM) III, the purpose of this commentary is to describe school-based and school-relevant interventions and instructional approaches for children and youth with autism that have been developed and employed during that time period. The commentary begins with a brief description of foundational research that provides an historical context. Research themes shaped by science, ethics, social policy, and the changes in the DSM provide an organization for describing the evolution of intervention and instructional practices over the four previous decades. The commentary concludes with a discussion of school-contextual variables that influence implementation and the promise of the "iSciences" for closing the research to practice gap in the future.
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Affiliation(s)
- Samuel L Odom
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
- San Diego State University, San Diego, CA, USA.
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, CB 8040, Chapel Hill, NC, 27599-8040, USA.
| | | | | | | | - Kara A Hume
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Sallie W Nowell
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ann M Sam
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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16
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Hampton LH, Sandbank MP. Keeping up with the evidence base: Survey of behavior professionals about Naturalistic Developmental Behavioral Interventions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:875-888. [PMID: 34320872 DOI: 10.1177/13623613211035233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Primary service providers for young children on the autism spectrum and developmentally delayed children use many strategies under the umbrella of applied behavior analysis therapy. The evidence supporting interventions for children on the autism spectrum has changed last decade, and powerful research supports the relative effectiveness of Naturalistic Developmental Behavior Interventions, yet a few professionals serving young children on the autism spectrum receive training in this category of interventions. Board Certified Behavior Analysts and related professionals are the primary service providers for this population. The purpose of this survey study is to describe and understand the knowledge and beliefs that Behavior Analyst Certification Board certificants have around Naturalistic Developmental Behavior Interventions. The survey was completed by 901 respondents. Respondents indicated, on average, little to no knowledge of Naturalistic Developmental Behavior Intervention practices and few believe that these practices are effective or appropriate for the field. Recommendations include increasing training opportunities for related professionals, and changing certification requirements to match the current evidence.
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17
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Siller M, Morgan L, Wedderburn Q, Fuhrmeister S, Rudrabhatla A. Inclusive Early Childhood Education for Children With and Without Autism: Progress, Barriers, and Future Directions. Front Psychiatry 2021; 12:754648. [PMID: 34777059 PMCID: PMC8585780 DOI: 10.3389/fpsyt.2021.754648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
University-affiliated lab and model schools play an important role in creating educational innovations in inclusive early childhood education (ECE) for young children with Autism Spectrum Disorder (ASD). In the United States, access to inclusive high-quality ECE programs for young children with disabilities has been required by law for over 40 years, has been recommended by leading professional organizations, and has been emphasized in federal public policy initiatives. Yet, improvement in the rates of young children with disabilities experiencing inclusion has been limited. This review article consists of three parts. First, we identify and describe four barriers to wide-scale implementation of inclusive ECE programs for children with ASD in the US. These barriers include (1) the fragmented nature of the ECE system in the United States, (2) the age at which ASD is typically first diagnosed in the community, (3) the diverse presentation/support needs of children with ASD, and (4) the thoughts and feelings of parents of children without disability about inclusion. Second, we used a snowball sampling approach to identify nine leading university-affiliated, inclusive lab and model schools for young children with ASD. By describing these programs, we highlight similarities and differences between programs, and capture the unique ways in which these programs adapt to local conditions, resources, and barriers (e.g., federal and state regulations, funding sources, community resources, institutional structures and priorities, professional orientation and training, access to families and staff). Finally, we propose a roadmap for researchers focused on the development, evaluation, and implementation of community-viable inclusive ECE programs in ASD. This roadmap leverages synergies between inclusive university-affiliated lab and model preschools in ASD, and proposes the formation of a research network that creates an infrastructure for cross-program collaboration.
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Affiliation(s)
- Michael Siller
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Lindee Morgan
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Quentin Wedderburn
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Sally Fuhrmeister
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Asha Rudrabhatla
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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18
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Bauminger-Zviely N, Estrugo Y, Samuel-Magal K, Friedlin A, Heishrik L, Koren D, Bar-Yehuda S. Communicating Without Words: School-Based RCT Social Intervention in Minimally Verbal Peer Dyads with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:837-853. [PMID: 31560567 DOI: 10.1080/15374416.2019.1660985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite their social withdrawal, school-age children with autism spectrum disorder who are minimally verbal (MVASD; i.e., use a limited repertoire of communicative spoken words) have received few interventions supporting peer engagement. This study examined efficacy of a novel ecological randomized controlled trial-school-based peer social intervention-designed to increase social engagement (via available communication channels) in school-age peer dyads with MVASD. Fifty-four children with MVASD (8-16 years) in 9 Israeli special education schools were randomly assigned to conversation intervention, collaboration intervention, or waitlisted treatment-as-usual (control) group (n = 18 per group). Manualized conversation and collaboration interventions each included 60 lessons (15 weeks × 4), implemented by teachers at school and supervised by researchers. Pretest-posttest improvement in spontaneous peer interaction was measured via 3 data sources/methods: teacher-reported social behavior (Vineland: Socialization domain) and direct observations of children's spontaneous free play (Modified-Classroom Observation Schedule to Measure Intentional Communication) and free conversation (Social Conversation Scale). Allocation group was masked from reporters/coders. As secondary outcomes, children's progress was measured in executive functions (BRIEF Inventory), and communication (Vineland). Significant pre-post improvement emerged for both intervention groups' spontaneous free conversation and for the collaboration group's spontaneous free play. Teacher reports, although mixed, indicated that the conversation group's socialization skills improved, but communication did not. Children in the conversation group also improved their metacognitive executive skills (e.g., planning, monitoring, organization). Strengthening this high-risk school-age population's ability to interact more spontaneously with peers through conversation and collaboration intervention holds promise for reducing social withdrawal in MVASD.
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Affiliation(s)
| | | | | | | | | | - Dror Koren
- School of Education, Bar-Ilan University
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19
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Leifler E, Carpelan G, Zakrevska A, Bölte S, Jonsson U. Does the learning environment 'make the grade'? A systematic review of accommodations for children on the autism spectrum in mainstream school. Scand J Occup Ther 2020; 28:582-597. [PMID: 33078981 DOI: 10.1080/11038128.2020.1832145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The 2030 Agenda for Sustainable Development adapted by the United Nations envisions inclusive and equitable quality education. While there is a growing body of research on interventions designed to help children on the autism spectrum adapt to the school environment, accommodations to children needs have been given less attention. OBJECTIVE To synthesize the literature on accommodations in the learning environment for children on the autism spectrum (ages 5-19 years) in mainstream school, with a specific focus on the effects on functioning, educational outcomes and well-being. METHODS A systematic search was conducted. The study selection and data extraction were performed by two independent reviewers. Eligible studies were assessed according to the What Works Clearinghouse (WWC) standards. RESULTS The search yielded 6102 citations. Only 37 eligible studies were identified, of which 14 met the WWC standards. This inconclusive and heterogeneous body of research tentatively suggest that accommodations in the pedagogical and psychosocial leaning environment can improve performance and function in school. CONCLUSION AND SIGNIFICANCE Accommodations in the learning environment is a promising but understudied approach. Creative research and innovation will be needed to support policy makers and school personnel in their quest to ensure inclusive and equitable education.
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Affiliation(s)
- Emma Leifler
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden.,Department of Pedagogical, Curricular and Professional Studies, University of Gothenburg, Göteborg, Sweden
| | - Gabriella Carpelan
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden
| | - Anastasiya Zakrevska
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden
| | - Sven Bölte
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
| | - Ulf Jonsson
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Services, Stockholm, Sweden.,Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
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20
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Schottelkorb AA, Swan KL, Ogawa Y. Intensive Child‐Centered Play Therapy for Children on the Autism Spectrum: A Pilot Study. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Yumiko Ogawa
- Department of Counselor Education, New Jersey City University
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21
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Naveed S, Waqas A, Amray AN, Memon RI, Javed N, Tahir MA, Ghozy S, Jahan N, Khan AS, Rahman A. Implementation and effectiveness of non-specialist mediated interventions for children with Autism Spectrum Disorder: A systematic review and meta-analysis. PLoS One 2019; 14:e0224362. [PMID: 31703073 PMCID: PMC6839885 DOI: 10.1371/journal.pone.0224362] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/13/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In recent years, several non-specialist mediated interventions have been developed and tested to address problematic symptoms associated with autism. These can be implemented with a fraction of cost required for specialist delivered interventions. This review represents a robust evidence of clinical effectiveness of these interventions in improving the social, motor and communication deficits among children with autism. METHODS An electronic search was conducted in eight academic databases from their inception to 31st December 2018. A total of 31 randomized controlled trials were published post-2010 while only 2 were published prior to it. Outcomes pertaining to communication, social skills and caregiver-child relationship were meta-analyzed when reported in > 2 studies. RESULTS A significant improvement was noted in child distress (SMD = 0.55), communication (SMD = 0.23), expressive language (SMD = 0.47), joint engagement (SMD = 0.63), motor skills (SMD = 0.25), parental distress (SMD = 0.33) parental self-efficacy (SMD = 0.42) parent-child relationship (SMD = 0.67) repetitive behaviors (SMD = 0.33), self-regulation (SMD = 0.54), social skills (SMD = 0.53) symptom severity (SMD = 0.44) and visual reception (SMD = 0.29). CONCLUSION Non-specialist mediated interventions for autism spectrum disorder demonstrate effectiveness across a range of outcomes for children with autism and their caregivers.
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Affiliation(s)
- Sadiq Naveed
- Kansas University Medical Center, Kansas City, Kansas, United States of America
| | - Ahmed Waqas
- Human Development Research Foundation, Rawalpindi, Pakistan
| | | | | | - Nisma Javed
- Services Institute of medical sciences, Lahore, Pakistan
| | - Muhammad Annas Tahir
- Kingsbrook Jewish Medical Center, New York City, New York, United States of America
| | - Sherief Ghozy
- Neurosurgery Department, El-Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Nusrat Jahan
- Rush University Medical Center, Chicago, IL, United States of America
| | - Anum Saeed Khan
- Westchester Medical Center-New York Medical College, Valhalla, NY, United States of America
| | - Atif Rahman
- University of Liverpool, Liverpool, England, United Kingdom
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Friedman L, Sterling A. A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder. Semin Speech Lang 2019; 40:291-304. [PMID: 31311054 PMCID: PMC7012379 DOI: 10.1055/s-0039-1692964] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Difficulties with both executive functions and language skills are common but variable in autism spectrum disorder (ASD). Executive functions and language skills are related to one another, such that vocabulary, syntax, and pragmatics are related to domains of working memory, shifting, and inhibition in ASD, although the directionality of these relationships remains unclear. Moreover, interventions that target pragmatic ability have been found to improve executive function skills, and conversely, executive function interventions are linked with improvements in social skills in children with ASD. We review the literature on executive functions, language skills, and their relationship in ASD; discuss factors that may be driving inconsistent findings; and explore clinical applications from the research thus far.
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Affiliation(s)
- Laura Friedman
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
| | - Audra Sterling
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
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Hooker JL, Dow D, Morgan L, Schatschneider C, Wetherby AM. Psychometric analysis of the repetitive behavior scale-revised using confirmatory factor analysis in children with autism. Autism Res 2019; 12:1399-1410. [PMID: 31246379 DOI: 10.1002/aur.2159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 06/04/2019] [Indexed: 11/12/2022]
Abstract
Research examining restricted and repetitive patterns of behavior or interests (RRB) in autism spectrum disorder (ASD) has increased our understanding of its contribution to diagnosis and its role in development. Advances in our knowledge of RRB are hindered by the inconsistencies in how RRB is measured. The present study examined the factor structure of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 350 children with ASD ages 2-9. Confirmatory factor analysis designed for items with categorical response types was implemented to examine six proposed structural models. The five-factor model demonstrated the most parsimonious fit based on common overall fit indices that was further supported by examination of local model fit indicators, though, the four- and six-factor models evidenced adequate-to-good fit as well. Examination of RRB factor score approaches indicated only minor differences between summed item subscale scores and extracted factor scores with regard to associations with diagnostic measures. All RRB subtypes demonstrated significant associations with cognitive functioning and adaptive behavior. Implications for future research validating the RBS-R as a more extensive clinical measure of RRB in ASD are discussed. Autism Res 2019, 12: 1399-1410. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Repetitive behaviors are one of the two main symptoms of autism spectrum disorder (ASD). To better understand the role of repetitive behaviors, we must establish effective ways of measuring them. This study assessed the measurement qualities of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 350 children with ASD ages 2-9. We found that the RBS-R measures multiple types of repetitive behaviors and that these behaviors are related to thinking ability and independence.
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Affiliation(s)
- Jessica L Hooker
- School of Communication Science and Disorders, Florida State University, Tallahassee, Florida
| | - Deanna Dow
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Lindee Morgan
- Marcus Autism Center, School of Medicine, Emory University, Atlanta, Georgia
| | - Christopher Schatschneider
- Department of Psychology, Florida Center for Reading Research, Florida State University, Tallahassee, Florida
| | - Amy M Wetherby
- Department of Clinical Sciences, Autism Institute, College of Medicine, Florida State University, Tallahassee, Florida
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