The effects of age and treatment intensity on behavioral intervention outcomes for children with autism spectrum disorders

Early intensive behavioral intervention (EIBI) has been shown to effectively remediate some cases of autism. However, few studies have evaluated the importance of various factors, such as the effect of treatment intensity on treatment outcomes, and how these outcomes vary by age.The objective of this study was to evaluate the relationship of treatment hours and participant age with the rate of learning within an early intensive behavioral intervention program. The present study evaluated treatment progress for 245 children receiving EIBI services. Regression analyses were conducted to predict treatment progress based upon the number of monthly treatment hours received and the participant's age. Each of these variables were significant predictors and accounted for considerable portions of the observed variance. Further, the younger participants showed a greater benefit from increased treatment hours when compared to older participants.These data indicate that for children between 2 and 7 years of age, there was a significant increase in new skill acquisition with increased treatment hours. Further, there was not a point of diminishing-returns.     

Effectiveness of early behavioral intervention in public and mainstream settings: The case of preschool-age children with autism spectrum disorders

Despite the demonstrated positive outcomes of early intensive behavioral intervention (EIBI) among children with autism spectrum disorders (ASD), several challenges to its implementation on a large scale and in community settings remain. In order to maximize the accessibility and cost-effectiveness of its services, a regional public agency serving children with ASD implemented two consecutive programs: a 1 year pre-program for parents (intensive sessions followed by 1 hour per week of individual coaching) and an early behavioral intervention (EBI) program with less than optimal weekly intensity (16–20 hours) delivered in mainstream day care settings. The outcomes of these programs were assessed among 93 children. Their IQ, adaptive behavior, and socioaffective competencies were found to have improved after 12 months in the EBI program. Their autism symptoms had also decreased marginally. Although the pre-program did not have observable effects on children's outcomes, their parents reported positive impact on their well-being and family life. These results demonstrate the feasibility and sustainability of offering EBI to large, unselected populations. However, the pre-program may need to be offered more intensively in order to yield positive outcomes for children. Delivering EBI services in mainstream settings may foster the development of skills linked to social integration.     

以VB-MAPP为基础的家庭密集行为干预对孤独症谱系障碍患儿语言能力的影响

背景 家庭干预是对孤独症谱系障碍（ASD）患儿进行干预的重要组成部分,既往关于以家庭为主导的密集行为干预对ASD患儿语言能力影响的研究不足。目的 研究以语言行为里程碑评估及安置程序（VB-MAPP）为基础的家庭密集行为干预对ASD患儿语言能力的影响,为制定ASD患儿的家庭干预策略提供参考。方法 选取2020年9月-2021年12月在汕头大学医学院第二附属医院儿童康复科就诊、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）ASD诊断标准的2~3岁患儿为研究对象。采用同期非随机对照试验,将ASD患儿分为研究组（n=24）和对照组（n=14）,研究组接受以VB-MAPP为基础的家庭密集行为干预,对照组接受其他特殊机构或早教机构培训,两组干预均持续6个月。干预前后,对两组患儿进行VB-MAPP里程碑评估,选取VB-MAPP里程碑总评分、提要求、命名和听者反应作为研究指标。比较两组干预效果的差异,采用多元线性回归考查干预效果的影响因素。结果 干预后,研究组VB-MAPP里程碑总评分、提要求、命名和听者反应评分均高于对照组,差异均有统计学意义（Z=-4.339~-2.195,P<0.05或0.01）。多元线性回归分析结果显示,前三个月平均每周家庭训练时长对听者反应能力有影响（β=1.029,P<0.05）。结论 以VB-MAPP为基础的早期家庭密集行为干预可能有助于ASD患儿提要求、命名、听者反应等语言能力的改善。     

Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism

Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. Although several studies have identified behaviors that are possible indicators of best outcome, changes in performance are typically measured using norm-referenced standardized scores referencing overall functioning level rather than via repeated observational measures of autism-specific deficits (i.e., social behavior). In the current study, 83 children with autism (CWA), aged 1, 2 and 3 years, and 58 same-aged typically developing children (TDC) were directly observed in the areas of cognitive skills, joint attention (JA), play, and stereotypic behavior using a measure called the Early Skills Assessment Tool (ESAT; MacDonald et al., 2006). CWA were assessed at entry into an EIBI program and again after 1 year of treatment. Changes in performance were compared pre- and post-treatment as well as to the normative data by age. Results indicate significant gains on the ESAT across all age groups with the greatest gains seen in the children who entered treatment prior to their second birthday. Increases were seen on direct measures of JA, play, imitation and language while decreases were seen in stereotypy regardless of level of performance at entry into EIBI. The ESAT, a direct measurement tool, served as a sensitive tool to measure changes in autism symptomatology following EIBI treatment.     

Comparison of community-based verbal behavior and pivotal response treatment programs for young children with autism spectrum disorder

This research compared the outcomes of a community-based group program based on the verbal behavior approach to early intervention (Sautter and LeBlanc, 2006, Sundberg and Michael, 2001) to the outcomes of a program based on Pivotal Response Treatment (Bryson et al., 2007, Koegel and Koegel, 2006). Fourteen preschool children with autism spectrum disorder in each program were matched by baseline chronological age and cognitive score. Assessments were conducted at the initiation of treatment and 12 months later to measure cognitive, receptive and expressive language, and adaptive behavior skills, as well as problem behavior and parenting stress. Results for both groups showed statistically significant changes in cognitive scores, receptive and expressive language age equivalents, and problem behavior scores. Significant results were not found for either adaptive behavior or parenting stress scores. Changes in cognitive and adaptive behavior scores were similar to those reported in published studies of applied behavior analytic programs of similar intensity. Study limitations and recommendations for future research are provided. Although additional research is needed to examine the long-term effectiveness of the programs examined in this study, it appears that both hold promise as effective early intervention approaches that are also relatively cost-effective.     

Contextualized behavioral support in early intervention for children with autism and their families

Parent education programs have become an effective mode of treatment delivery for teaching families effective behavioral strategies to manage challenging behavior in young children with autism. Functional assessment and functional communication training (FCT) are empirically validated procedures that have recently been introduced into parent education programming to help resolve challenging behaviors. The success of these procedures, however, is contingent on family members' ability to integrate them into the specific contexts in which challenging behaviors occur. Consequently, the application of these procedures in home settings necessitates consideration of the family context in the assessment and treatment planning process. A study is presented that investigated the use of information on family context (i.e., caregiving demands, family support, patterns of social interaction) to direct the assessment and intervention planning process. More specifically, information on family context was used to individualize behavioral support plans designed to support family use of functional communication training within important family routines. Through parent-investigator collaboration we individualized the manner in which functional communication training procedures were taught and implemented so they were contextually relevant. Utilizing a multiple baseline design, the challenging behaviors and functional communication of three children with autism were monitored across baseline, intervention (i.e., FCT, and contextulized FCT), and follow-up phases. Multiple routines for each participant were selected and monitored across all phases to evaluate changes in the dependent measures within training and generalization routines. A self-report questionnaire was administered intermittently to parents to determine if consideration of family context improved the goodness of fit of the functional communication training treatment packages across FCT and contextualized FCT intervention phases. Results from the study indicate that consideration of family context in the assessment and intervention planning process does not jeopardize and may contribute to the stability and durability of reductions in challenging behavior achieved with functional assessment and functional communication training procedures.     

Emotional prosody perception and its association with pragmatic language in school-aged children with high-function autism

Emotional prosody perception is essential for social communication, but it is still an open issue whether children with high-function autism (HFA) exhibit any prosodic perception deficits or experience selective impairments in recognizing the prosody of positive emotions. Moreover, the associations between prosody perception, pragmatic language, and social adaptation in children with HFA have not been fully explored. This study investigated whether emotional prosody perception for words and sentences in children with HFA (n = 25, 6–11 years of age) differed from age-matched, typically developing children (TD, n = 25) when presented with an emotional prosody identification task. The Children's Communication Checklist and Vineland Adaptive Behavior Scale were used to assess pragmatic and social adaption abilities. Results show that children with HFA performed poorer than TD children in identifying happy prosody in both emotionally neutral and relevant utterances. In contrast, children with HFA did not exhibit any deficits in identifying sad and angry prosody. Results of correlation analyses revealed a positive association between happy prosody identification and pragmatic function. The findings indicate that school-aged children with HFA experience difficulties in recognizing happy prosody, and that this limitation in prosody perception is associated with their pragmatic and social adaption performances.     

Diagnosing young children with autism

The starting point for any research on Autism Spectrum Disorder (ASD) involves the identification of people who evince the condition. From this point follows research on symptom presentation, genetics, epidemiology, animal models, treatment efficacy, and many other important topics. Major advances have been made in differential diagnosis, particularly with young children. This fact is particularly important since ASD is a life long condition. This review documents recent advances and the current state of research on this topic.     

Stress in UK families conducting intensive home-based behavioral intervention for their young child with autism

There is increasing international interest in intensive home-based behavioral intervention for children with autism. In the present study, 141 UK parents conducting such interventions completed a questionnaire addressing issues of stress, coping, and support. Regression analyses showed that parents' stress levels were predicted mainly by psychological rather than demographic variables. In particular, adaptive coping strategies, informal social support sources, and beliefs about the efficacy of the intervention were associated with lower reported stress and higher levels of autism symptomatology were associated with higher reported stress. There was also evidence that the use of Passive Appraisal coping and beliefs about the efficacy of the interventions moderated the effects of autism symptomatology on parents' pessimism. Implications of these findings for future research and for the support of families engaged in intensive home-based behavioral intervention are discussed.     

The use of the Bilingual Aphasia Test for assessment and transcranial direct current stimulation to modulate language acquisition in minimally verbal children with autism

Minimally verbal children with autism commonly demonstrate language dysfunction, including immature syntax acquisition. We hypothesised that transcranial direct current stimulation (tDCS) should facilitate language acquisition in a cohort (n?=?10) of children with immature syntax. We modified the English version of the Bilingual Aphasia Test (BAT) to test only basic canonical subject–verb–object sentences. We tested syntactic accuracy after teaching then testing all vocabulary from the subsequent syntax test to ensure validity of syntactic scoring. We used scaffolding sentences for syntax training. All procedures were performed both before and after tDCS. Results demonstrated a large effect size of the difference between pre-/post-tDCS groups (p < 0.0005, d?=?2.78), indicating syntax acquisition. Combining a modified BAT with tDCS constitutes effective modalities for assessment and treatment of immature syntax in children with autism. Future studies should explore the BAT for patients with an inability to use or understand language, in particular bilingual children with autism.     

Teaching play skills to young children with autism

Abstract

Background Play is critical for the development of young children and is an important part of their daily routine. However, children with autism often exhibit deficits in play skills and engage in stereotypic behaviour. We reviewed studies to identify effective instructional strategies for teaching play skills to young children with autism.

Method Empirical studies on teaching play skills to young children with autism published from 1990 to 2011 were located. These studies included single subject and group designs.

Results Twenty-six studies were reviewed. The majority of studies on teaching play skills used combined interventions. Children with autism improved their play skills, with direct intervention embedding their interests during play. Improvements in play skills increased positive social interactions and decreased inappropriate behaviour as collateral effects.

Conclusions Further research is needed to develop more effective play skill interventions that assess the functional use of play and are implemented in the natural environment.     

Behavioural problems and autism in children with hydrocephalus

Objective To investigate the prevalence of behavioural problems and autism in a population-based group of children with hydrocephalus and to see whether learning disabilities, cerebral palsy (CP), epilepsy, myelomeningocele (MMC) or preterm birth increase the risk of these problems. Method In the 107 children with hydrocephalus born in western Sweden in 1989–1993, behaviour was assessed using the Conners’ parent rating scales in 66 and the teacher’s rating scales in 57. Autism was investigated using the Childhood Autism Rating Scale. Results Parents rated 67% of the children and teachers 39% of the children as having behavioural problems (>1.5 SD, or T score >65). Learning disabilities increased the risk significantly and almost all the children with CP and/or epilepsy had behavioural problems. Autism was present in nine children (13%), in 20% of those without MMC and in one of 26 with MMC. Autism was significantly more frequent in children with learning disabilities (27% vs. 7%) and in children with CP and/or epilepsy (33% vs. 6%). Conclusion The majority of children with hydrocephalus have behavioural problems and many have autism. It is therefore important to assess and understand all the aspects of cognition and behaviour in these children in order to minimise disability and enhance participation for the child.     

Seasonal changes in sleep and behavioral problems in a pubescent case with autism.

This study reports on the seasonal changes in sleep problems and behavioral problems in a pubescent case with autism. His care diary, kept for 1 year, showed seasonal changes of sleep and behavioral problems, and that his behavioral problems preceded his sleep problems.     

Sequential meta-analysis to determine the sufficiency of cumulative knowledge: The case of early intensive behavioral intervention for children with autism spectrum disorders

Meta-analysis has become a popular tool to statistically integrate results across studies in order to formulate more general conclusions on treatment effectiveness. Unfortunately, traditional meta-analytic applications fail to answer the question whether enough cumulative knowledge is available to draw convincing statistical conclusions. Leaving questions regarding the sufficiency of cumulative knowledge unaddressed may lead to inefficient use of limited resources or to the dissemination of spurious treatment benefit. Sequential meta-analysis or SMA provides a statistical framework to determine the sufficiency of cumulative knowledge in a meta-analysis, but is relatively unknown in mental health or disability fields. In this article, we introduce SMA and demonstrate its application by resynthesizing research findings on the effectiveness of early intensive behavioral intervention (EIBI) for children with autism reported in five published meta-analyses. The results illustrate the additional information that can be gained by including a sequential approach in research synthesis. SMA may serve as a valuable tool to systematically build and interpret a cumulative knowledge base on treatment effectiveness in the field of developmental disabilities.     

Evaluation of neuromotor deficits in children with autism and children with a specific speech and language disorder

Several studies have described problems in motor functions in children with autism and children with a specific speech and language disorder. The purpose of this study was to identify neuromotor deficits in these neurodevelopmentally impaired children. A standardised neurological examination was performed in 11 children with childhood autism, 11 children with an expressive language disorder, 11 children with a receptive language disorder and 11 control children. The children were matched for age and non-verbal IQ, not for gender. All children had a non-verbal IQ above 85. The neurological examination procedure allowed for a qualitative and quantitative assessment of five specific neurological subsystems: fine and gross motor functions, balance, coordination and oral motor functions. The high-functioning children with autism and the children with a specific language disorder (expressive or receptive) had more motor problems than the control children on most neurological subsystems. There were few statistically significant differences between the three groups of developmentally impaired children. The frequent co-occurrence of verbal and non-verbal, in particular neuromotor, deficits in developmentally impaired children put an additional burden on the development of these children and should be diagnosed as early as possible. Accepted: 8 May 2002 The research was funded by grant AM 63/4–2 of the Deutsche Forschungsgemeinschaft. Correspondence to Dr. M. Noterdaeme