A review of the quality of primary caregiver-implemented communication intervention research for children with ASD

BackgroundMost children with autism spectrum disorder (ASD) spend most of their waking hours at home with their caregivers; thus, involving caregivers in interventions may increase communication interaction opportunities across time and settings.MethodIn this review, an analysis of the quality of the research on communication interventions implemented or mediated by caregivers of children with ASD was conducted based on the What Works Clearinghouse guidelines (Kratochwill et al., 2010) and adapted by Maggin et al. (2013).ResultsAbout one-third of studies included in this review were found to meet the design standards, indicating that those studies utilized a high quality of research design. The studies that failed to meet the design standards were primarily those that lacked sufficient interobserver agreement data collected in each condition, thus, not meeting the minimum quality thresholds. To evaluate an overall effectiveness, a total of 31 single-case experiments were evaluated with the evidence standards. As a result, about half of the experiments were found to have either strong or moderate evidence of an effect.ConclusionsThe findings in this review suggest issues that need to be addressed in the field related to quality of designs in single-case research on primary caregiver-implemented communication interventions for children with ASD. Limitations and implications for future research and for practitioners are discussed.     

Interventions for toddlers with autism spectrum disorder: A meta-analysis of single-subject experimental studies

BackgroundProgress in diagnostic assessment made it possible to diagnose ASD at a young age. Concurrently, intervention research for toddlers with ASD has increased since the past decade.MethodIn this study, we report on a five-level meta-analysis of 34 single-subject experimental studies, intended to offer a better insight into what types of interventions are effective for toddlers under the age of three with or at risk for ASD.ResultsThe analysis revealed a significant positive overall effect size. We found that interventions at home were significantly more effective compared to those in other settings. Other significant moderators regarding intervention characteristics were the agent of intervention and duration in weeks. No moderator effects of study and child characteristics were found.ConclusionsOn average, interventions for toddlers with or at risk for ASD are successful.     

Toilet training interventions for children with autism spectrum disorder: A systematic review

BackgroundChildren on the autism spectrum can often reach independence in toileting at a later age than nonautistic children, which impacts their health outcomes, independence and social participation. This study aimed to systematically review evidence-based toilet training interventions for children on the autism spectrum, and assess the quality of existing evidence.MethodGuided by the PRISMA statement, a search of scholarly databases was conducted and the study characteristics, methodological quality and intervention components of included studies were examined.ResultsThis systematic review identified 26 studies that evaluated toilet training interventions for children on the autism spectrum. Results identified that while Azrin and Foxx’s (1971) Rapid Toilet Training approach is most widely researched for children on the autism spectrum, investigating the effects of current toilet training approaches is limited by small sample sizes, low-level study designs and variable methods of reporting outcomes.ConclusionGreater consideration of parent-child communication, children’s developmental and toileting skill level may facilitate development of toileting approaches that better meet the needs of children on the autism spectrum and their families.     

Picture of Autism Spectrum Disorder (ASD) Research in West Africa—A Scoping Review

Research evidence is required to guide health policy and capacity development on specific health condition. Despite the high prevalence of autism spectrum disorders (ASD) worldwide, there is dearth of data in the West African sub-region to inform evidence-based policy and practice. This review aimed to describe the volume and scope of existing research evidence on ASD across countries in the West African sub-region. This is with the view of identifying gaps in research and capacity development.MethodsLiterature search was done for all original peer-reviewed research articles on ASD in each of the West African Countries using PubMed, Google Scholar, Google search, African Index Medicus and a direct search of reference list of pertinent journal articles. Publications included were peer-reviewed original articles, irrespective of their quality, carried out within the West African countries and which were available in English or translated to English. Case reports, dissertations, abstracts, publications whose primary focus was not ASD, and studies on ASD among West African populations living outside the sub-region were excluded. The methodological framework described by Arksey and O’Malley (2005) was used to synthesize and present the results.ResultsA total of 41 studies that met the inclusion criteria across 5 countries in the sub-region were identified. Five thematic areas emerged from the literature, namely; prevalence/associated factors, professional knowledge and attitude, family and social aspects of ASD, screening/diagnosis and interventions/treatment. Only 6 out of the 16 countries in the sub-region had at least one study with the bulk of the research coming from Nigeria. Research articles on the prevalence/associated factors and professional knowledge of ASD appear modest in the sub-region. A huge gap still exists in the area of epidemiology, aetiology, diagnosis and treatments/intervention.ConclusionFurther research is needed in the identified gaps in the sub-region and this cannot be done without addressing deficit in human capacity development. The results of this study will be useful in comprehensive policies and action plan development for addressing the problems of persons with ASD and capacity development in the sub-region.     

Friendship interventions and measurements in children with ASD: A systematic review

BackgroundFriendships are vital to children's social well-being and overall development, and they can also serve as a protector factor from peer victimization and bullying. For children with ASD, friendship development can be an area of challenge. Friendship interventions may help children and adolescents with ASD in developing the skills for making and keeping friends.MethodThis systematic review examined friendship interventions for children and adolescents with autism spectrum disorder (ASD). It also explored measures of friendship skills in children with ASD. Twenty-seven studies met the inclusion criteria: (a) experimental intervention studies focused on improving friendships of individuals with ASD, (b) the measurement of friendship outcomes, and (c) strong or acceptable methodological ratings.ResultsFifteen unique interventions were tested across the 27 studies. Thirteen interventions included strategies specifically focused on improving (making and maintaining) friendships in the participants with ASD. Friendship interventions were primarily focused on behaviorally based social skills building and varied in implementation settings. Friendship measures included the use of parent reports, child and adolescent surveys and questionnaires, peer nominations, and sociometric ratings.ConclusionThe results highlighted the benefit of including targeted friendship-building strategies in social and friendship interventions and the value of multiple perspectives when measuring friendship. The findings of the study can influence how families and practitioners collaborate to support children and adolescents with ASD in the development and maintenance of their friendships.     

A systematic review of peer-mediated interventions for children with autism spectrum disorder

BackgroundPeer mediated intervention (PMI) is a promising practice used to increase social skills in children with autism spectrum disorder (ASD). PMIs engage typically developing peers as social models to improve social initiations, responses, and interactions.MethodThe current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group designs. Five studies met the pre-specified review inclusion criteria: four randomized controlled trials and one pre- and post-test design.ResultsFour of the studies were conducted in school settings, whereas one study was conducted in a camp setting. The studies all reported that participants improved in social skills (e.g., social initiations, social responses, social communication) post intervention. Additionally, sustainment, generalization, and fidelity of implementation were examined.ConclusionPMI is a promising approach to address social skills in children with ASD, and this approach can be conducted in meaningful real-word contexts, such as schools. Limitations of the studies as well as future directions are discussed.     

Evaluation of the efficacy of Social Stories™ using three single subject metrics

Social Stories? are a popular intervention used with individuals with autism spectrum disorders (ASD) and other disabilities. Most of the research conducted to date has involved small n designs. Previous meta-analyses of this research have involved relatively small numbers of studies and issues such as selection bias and failure to evaluate methodological quality and have confounded the findings. The present article addresses the limitations of the previous meta-analyses and evaluates 62 studies using three small n metrics, focussing on whether Social Stories were effective with individuals with ASD or other disabilities. It was also determined whether efficacy varied systematically across study or participant characteristics. Consistent with previous reviews, while there was considerable variation, on average Social Stories appear to have only a small clinical effect on behaviour. Implications for the selection of interventions strategies by practitioners are discussed.     

A systematic search and appraisal of intervention characteristics used to develop varied communication functions in children with autism who use aided AAC

BackgroundAided augmentative and alternative communication (AAC) interventions have been shown to be effective in teaching children with autism spectrum disorder (ASD) to communicate for a range of communication functions. However, currently little is known about the specific characteristics of interventions that can be used to teach functions other than object request.MethodA systematic search and appraisal was undertaken of extant ASD-AAC research to determine whether outcomes varied according to intervention strategies used, communication functions and behaviours targeted, treatment intensity, and participant characteristics. Eighteen studies were identified and appraised for constituents and outcomes.ResultsIntervention components varied widely, as did behaviours targeted, participant characteristics, dosage, and outcomes. There was evidence that a range of functions and communication behaviours could be taught successfully in structured, context-bound routines, with the teaching strategies of time delay and prompting applied most frequently. A small correlation was found between dosage and effect size.ConclusionsThe current appraisal provides evidence that children with ASD who use aided AAC can learn communication functions beyond making requests for objects. AAC interventions that include time delay and prompting, and that teach skills in specific routines, are more likely to demonstrate a moderate to large effect size. Further research on the range of factors that may potentially influence outcomes, such as participant characteristics and dosage, is needed.     

A systematic review of psychosocial interventions for children and young people with epilepsy

BackgroundDespite recognition that psychosocial interventions can improve quality of life and mental health, there continues to be a lack of clarity and guidance around effective psychosocial interventions for children and young people with epilepsy. This review utilizes specific quality criteria to systematically identify and appraise the evidence for the effectiveness of psychosocial interventions for children and young people with epilepsy.MethodsA systematic search of six electronic databases was conducted using predefined eligibility criteria. The reference lists of previous review papers were also manually searched. Seventeen studies met the inclusion and exclusion criteria. A quality appraisal checklist, the ‘Crowe Critical Appraisal Tool’ (CCAT) (Crowe, 2013) [1] was applied to the included articles, and effect sizes were calculated when not provided in the papers.ResultsMethodological quality of the majority of studies included was moderate, with only three studies rated as high quality. Meta-analysis was not conducted as the studies used heterogeneous methodologies and lacked consistency in outcome measures. Limited evidence was found for interventions improving epilepsy knowledge, quality of life, and psychological outcomes.ConclusionsPsychosocial interventions may provide clinical benefit although further research is needed to clarify the most effective treatment components, delivery methods, and measurement of intervention outcomes. The existing evidence base for children and young people is limited by methodological issues such as the use of small samples, inadequate power, and a lack of controlled studies.     

Psychopharmacologic intervention for adults with autism spectrum disorder: A systematic literature review

BackgroundThe increased recognition of psychiatric and behavioural disorder in adults with autism spectrum disorder (ASD) has been associated with more frequent use of psychopharmacologic intervention in this population. However, limited evidence supports the effectiveness of these interventions for adults with ASD.ObjectiveTo review and synthesise the evidence regarding the effectiveness of psychotropic medication in reducing behavioural disturbance in adults with ASD.Data sources and study selectionElectronic literature search of PubMed plus manual reference checks of all articles on psychopharmacology in adults with ASD published in the English language between 1985 and 2015.Results and conclusionsA total of 43 studies were included in the analysis. The results indicate that only two medications, fluoxetine and risperidone, can be considered as promising evidence-based practices for adults with ASD. Given the rising prevalence of ASD, along with increased use of psychopharmacologic intervention in this population, there is a clear need for methodologically rigorous research to establish the effectiveness of these interventions. The subsequent establishment of clinical guidelines for medication use in this population is essential.     

The quality of life of parents of children with autism spectrum disorder: A systematic review

BackgroundPrevious research has raised concerns about the quality of life (QoL) of parents of children with autism spectrum disorder (ASD). A better understanding of parental QoL can inform clinicians and policymakers and lead to improved outcomes for both parents and children.AimsThis review aimed to systematically examine studies measuring the QoL among parents of children with ASD (<18 years) and to investigate its parental, child-related and contextual associated factors.MethodologyAn electronic database search was conducted using Medline, Psycinfo, Embase, CINAHL, Biosis, ASSIA, Social Services Abstracts, Sociological Abstracts and Open grey.ResultsThis review indicated poorer QoL among parents of children with ASD compared to parents of typically developing children or to population norms. Variables associated with lower parental QoL within this group included child behavioural difficulties, unemployment, being a mother and lack of social support.ConclusionThis review verified previous reports on lower QoL among parents of children with ASD and highlighted potential areas of support. Implications for future research, policy and practice are discussed.     

The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism

ObjectivePrevious studies have shown that children with autism have sleep disturbances and elevated levels of pro-inflammatory cytokines. This study aimed to evaluate the effect of aquatic exercise on sleep habits and two certain sleep-related cytokines of children with autism spectrum disorders (ASD).MethodsForty boys with ASD (aged 6–14) were recruited and randomly assigned to an aquatic exercise (n = 20) or a control group (n = 20). Participants in aquatic exercise group performed water-based activities for 10 weeks/2 sessions per week/60 min, while control group didn't get any intervention. The serum levels of Interleukin-1 beta (IL-1β) and Tumor necrosis factor-α (TNF-α) and sleep quality were measured before and after the intervention.ResultsResults revealed that aquatic exercise may improve sleep quality and reduce the serum levels of IL-1β and TNF-α in children with ASD compared to control group.ConclusionsOverall, it is recommended that physicians and educators should provide a safe and effective exercise environment for ASD children to alleviate sleep issues and inflammatory biomarkers.     

Translating research into practice in low-resource settings: An Australian case study of early autism service provision in a regional town

ABSTRACT

Background We investigated the context for translating evidence-based early intervention for autism spectrum disorders (ASD) into real world settings through a case study of a regional town characterised as disadvantaged.

Methods Data were from interview surveys of five managers reporting on 15 services, and surveys from 19 practitioners and 15 mothers of young children with ASD.

Results The 15 services were multidisciplinary, offering diagnostic assessments (n?=?2) and interventions delivered in the home and centres. Children were diagnosed at a mean age of 3 years; access to intervention was delayed and mostly limited to one session every two weeks. Some families travelled substantial distances to services, driving on average 50?minutes each way. Practitioners described intervention strategies in broad terms, rather than name interventions.

Conclusions Services available to young children with ASD in this town were far removed from good practice in terms of early diagnosis, and intervention frequency and intensity.     

Language abilities in monolingual- and bilingual- exposed children with autism or other developmental disorders

BackgroundParents and providers are sometimes concerned that exposure to two languages will impair language acquisition in children with autism spectrum disorder (ASD) or other developmental disorders (DD). However, research to date suggests that language milestones and abilities are unaffected by this exposure. The current study explored language abilities in toddlers with ASD or DD exposed to one versus multiple languages, prior to intervention. To our knowledge, this is the largest investigation of language learning in bilingual-exposed (BE) children with ASD.MethodsParticipants were 388 children evaluated as part of a larger study on the early detection of ASD. Parents were asked to list all languages that primary caretakers use to communicate with their child. One hundred six BE children (57 ASD, 49 DD) were compared to 282 monolingual-exposed (ME) children (176 ASD, 106 DD). The Mullen Scales of Early Learning assessed nonverbal and verbal abilities. Multiple regression was used to evaluate the relationship of BE to language abilities, beyond the influence of nonverbal cognitive abilities, diagnosis, and socioeconomic status.ResultsResults showed greater language impairment in ASD than DD, but no main effect for language exposure group nor any interaction of language group by diagnosis. Results remained consistent after controlling for socioeconomic status.ConclusionThis study suggests that bilingual caregivers can communicate with their children in both languages without adverse effects on their children’s language functioning.     

Systematic review of intervention research with adolescents with autism spectrum disorders

A growing body of research provides effective interventions to address the core symptoms of autism spectrum disorders (ASD). However, adolescents with ASDs may face age-specific challenges necessitating the need for contextually relevant and effective interventions. This systematic review examined peer-reviewed intervention research for adolescents (ages 12–21) with ASD. Electronic database searches and ancestral searches were used to identify studies published between 1980 and 2011. 102 studies were identified. A variety of interventions were implemented in these studies to address a wide range of targeted skills and behaviors. Reviewed studies were categorized into seven domains based on the skills and behaviors targeted: (a) social skills; (b) communication skills; (c) challenging behavior; (d) academic skills; (e) vocational skills; (f) independence and self-care; and (g) physical development. Results indicate that effective interventions exist in each category. These results are discussed in relation to participant characteristics, intervention effectiveness, social validity, generalization and maintenance. Generalization, maintenance, and social validity data were gathered in only 34%, 43%, and 31% of the articles, respectively. Additionally, few studies investigated interventions addressing communication, vocational or academic skills. Recommendations for future research are provided.     

Effects of video modeling on communicative social skills of college students with asperger syndrome

Introduction: Empirical support regarding effective interventions for individuals with autism spectrum disorder (ASD) within a postsecondary community is limited. Video modeling, an empirically supported intervention for children and adolescents with ASD, may prove effective in addressing the needs of individuals with ASD in higher education.

Objective: This study evaluated the effects of video modeling without additional treatment components to improve social-communicative skills, specifically, eye contact, facial expression, and conversational turntaking in college students with ASD.

Method: This study utilized a multiple baseline single-case design across behaviors for two post-secondary students with ASD to evaluate the effects of the video modeling intervention.

Results: Large effect sizes and statistically significant change across all targeted skills for one participant and eye contact and turntaking for the other participant were obtained.

Conclusion: The use of video modeling without additional intervention may increase the social skills of post-secondary students with ASD. Implications for future research are discussed.     

Au-delà du TED,des compétences parentales à ma portée : évaluation des effets d’un programme de soutien destiné aux parents d’enfants présentant un trouble du spectre de l’autisme

ObjectiveParents of children with autism spectrum disorder (ASD) face many challenges that can impact their sense of competence and their daily stress levels. The aim of this study is to evaluate the effects of a program, implemented in the province of Quebec, for parents of children with ASD. The purpose of this program is to improve parents’ knowledge about ASD and appropriate educational strategies for their children with ASD. The goal of the program is to optimize parenting skills and help them adapt to the particularities of ASD.MethodThe evaluation of the effects of the program was conducted using a quasi-experimental repeated measures design, involving an experimental group and a control group composed of parents of children with ASD. Instruments were administered at three points in time: before the first program workshop, one month after the last workshop, and six months after the program ended.ResultsRepeated measures multivariate analyses of variance did not identify any significant changes for participants in the experimental group. Although statistically significant variations between the three measurement periods were observed for certain variables such as knowledge about ASD, parents’ use of strategies adapted to their child's characteristics, locus of control and parental stress, these variations cannot be interpreted as being specifically related to the effects of the program, since they were observed in both the control group and the experimental group. Discussion Although the analyses revealed a common improvement in scores on certain measures for both groups of parents, we cannot deduce a total absence of program effects. Indeed, factors related to implementation fidelity, the timing of the program exposure to participants, and the fact that the control group was receiving another form of intervention at the same time may have influenced the results.     

Video-based screening for children with suspected autism spectrum disorder – experience during the COVID-19 pandemic in India

BackgroundAssessments for children with autism spectrum disorder (ASD) must adapt to the current COVID-19 pandemic through innovation in screening and assessment strategies using technology. To our knowledge there are no such studies reported from India. We aimed to study the predictive ability of video-based screening tool with definitive diagnosis in children with ASD.MethodThirty-nine children were screened independently by two examiners with a video-based screening tool to start intervention followed by an in-person evaluation by clinical DSM-5 diagnosis three months later.ResultSimilar to studies from developed countries, videos assessments showed a 94.87% correlation with the final diagnosis. Interobserver video agreement had a kappa correlation of 0.803, which was classified as substantial agreement.ConclusionVideo-based evaluations may be used as an interim assessment to initiate early intervention in children with ASD in resource-limited setups in the current pandemic situation. Large, well-designed prospective studies are required to confirm our results.     

The effect of contingent imitation intervention on children with autism spectrum disorder and co-occurring intellectual disabilities

BackgroundImitation plays a crucial role in the development of social communication, and it is a skill that is often missing in children with autism spectrum disorder and co-occurring intellectual disabilities. Contingent imitation (CI) results in increased social eye gaze, an imitation cue for children with ASD. A series of studies on Reciprocal Imitation Training (RIT) intervention that included CI has demonstrated an increase in imitation frequency. However, little is known about CI intervention’s effects on motor, object, and vocal imitation accuracy in children with ASD-ID.MethodThe participants in this study were six 4-year-old children with ASD-ID. A single case experimental design with multiple probes across target behaviors was used to identify CI intervention's efficacy on the motor, object, and vocal imitation. Moreover, pre-and post-assessment analysis evaluated socially engaged imitation and imitation turn-taking.ResultsMost motor, object, and vocal imitation accuracy increased through the CI intervention. However, individual adaptations such as prompting for looking behaviors and motor responses were required to increase specific target behaviors. Moreover, all children increased socially engaged imitation and imitation turn-taking through CI intervention and CI + prompting intervention.ConclusionsCI intervention is an efficacious intervention method for increasing the accuracy of imitation in children with ASD-ID. Furthermore, CI + prompting intervention is effective when CI intervention alone does not improve imitation accuracy. CI + prompting interventions using a decision tree tailored for each child could identify the intervention strategies for improving imitation accuracy during play activities and increase the understanding of ASD-ID children's imitation accuracy difficulties.