Amy L. Donaldson

Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model

OBJECTIVE: To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). METHODS: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. RESULTS: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. CONCLUSIONS: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.

Investigating requests for information in children with autism spectrum disorders: Static versus dynamic assessment

This study investigated the use of static assessment (SA) and dynamic assessment (DA) methodologies for examining the production of requests for information (RI) by children with autism spectrum disorders (ASD) and typically developing peers (TDP) within their school environment. Following an initial SA observation session, the effects of manipulating contextual and linguistic variables to facilitate the production of RI were systematically investigated across three DA sessions. The contextual variables included object/activity choice and physical setting (e.g., treatment room versus classroom). The linguistic variables included prompting of RI production in an attempt to enhance performance. Independent and paired t-test comparisons revealed statistically significant differences in production of RI between the TDP group and children with ASD. The environmental variables of object/activity choice and linguistic prompting appeared to influence performance for a subgroup of children with ASD. Clinical implications related to the importance of assessing performance using both static and dynamic methodologies are discussed.

Team Collaboration: The Use of Behavior Principles for Serving Students With ASD

PURPOSE Speech-language pathologists (SLPs) and behavior analysts are key members of school-based teams that serve children with autism spectrum disorders (ASD). Behavior analysts approach assessment and intervention through the lens of applied behavior analysis (ABA). ABA-based interventions have been found effective for targeting skills across multiple domains for children with ASD. However, some SLPs may be unfamiliar with the breadth of ABA-based interventions. The intent of this tutorial is to briefly introduce key ABA principles, provide examples of ABA-based interventions used within schools, and identify strategies for successful collaboration between behavior analysts and SLPs. METHOD This tutorial draws from empirical studies of ABA-based interventions for children with ASD within school settings, as well as discussions in the extant literature about the use of behavior principles by SLPs and strategies for interdisciplinary collaboration. CONCLUSION Given the prevalence of ASD at 1 in 68 children (Centers for Disease Control and Prevention, 2014) and the high cost of serving these children within schools (an average cost of 286% over regular education; Chambers, Shkolnik, & Perez, 2003), the need for effective, comprehensive service provision and efficiency within interdisciplinary teams is paramount. Communication, mutual understanding, and recognition of common ground between SLPs and behavior analysts can lead to successful collaboration.

Pre-Professional Training for Serving Children with ASD: An Apprenticeship Model of Supervision.

Children with autism spectrum disorder (ASD) often present with varied skill profiles and levels of severity making development and implementation of specialized school services challenging. Research indicates that school professionals require and desire additional ASD-specific professional development, both at the pre- and in-service levels. Speech–language pathologists (SLPs) are one member of a school-based team who frequently serve children with ASD. Due to broad graduate training requirements (across the life span), SLPs receive limited ASD-specific clinical education, which may affect their contributions on school-based intervention teams. Given these issues, this article aims to briefly describe an apprenticeship model of clinical supervision, which may be well suited to preparing SLPs to significantly contribute to school teams serving children with ASD; present a case illustration of the use of this model within university graduate program; and briefly discuss implications for pre- and post-professional education and development.

Relationships, Friendships, and Successful Social Communication: Addressing Disability

&NA; Children with autism may perceive friendship in a qualitatively different manner than their neurotypical peers. Yet, these friendships have been reported as satisfying to the child with autism spectrum disorder (ASD). Although many studies have identified lower quality of friendship in ASD, reduced reciprocity, and increased loneliness and depression, perhaps it is time to take a closer look at the perspective of autistic individuals and to identify how the broader community influences development of relationships and friendship. The World Health Organizations International Classification of Functioning framework aligns well with a social model of disability lens, which states that although individuals may be challenged by their health impairment, disability is created by barriers to access, agency, and independence in society. This article discusses how clinicians might examine ways to address disability within the home, school, and community to create opportunities for relationship and friendship development, while considering the definition of friendship from multiple perspectives.

Efficacy of the ASAP Intervention for Preschoolers with ASD: A Cluster Randomized Controlled Trial

The advancing social-communication and play (ASAP) intervention was designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum disorder are trained to implement the intervention in order to improve these children’s social-communication and play skills. In this 4-year, multi-site efficacy trial, classrooms were randomly assigned to ASAP or a business-as-usual control condition. A total of 78 classrooms, including 161 children, enrolled in this study. No significant group differences were found for the primary outcomes of children’s social-communication and play. However, children in the ASAP group showed increased classroom engagement. Additionally, participation in ASAP seemed to have a protective effect for one indicator of teacher burnout. Implications for future research are discussed.

Functional status scale

OBJECTIVE: The goal was to create a functional status outcome measure for large outcome studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable to hospitalized pediatric patients across a wide range of ages and inpatient environments. METHODS: Functional Status Scale (FSS) domains of functioning included mental status, sensory functioning, communication, motor functioning, feeding, and respiratory status, categorized from normal (score = 1) to very severe dysfunction (score = 5). The Adaptive Behavior Assessment System II (ABAS II) established construct validity and calibration within domains. Seven institutions provided PICU patients within 24 hours before or after PICU discharge, high-risk non-PICU patients within 24 hours after admission, and technology-dependent children. Primary care nurses completed the ABAS II. Statistical analyses were performed. RESULTS: A total of 836 children, with a mean FSS score of 10.3 (SD: 4.4), were studied. Eighteen percent had the minimal possible FSS score of 6, 44% had FSS scores of ≥10, 14% had FSS scores of ≥15, and 6% had FSS scores of ≥20. Each FSS domain was associated with mean ABAS II scores (P < .0001). Cells in each domain were collapsed and reweighted, which improved correlations with ABAS II scores (P < .001 for improvements). Discrimination was very good for moderate and severe dysfunction (ABAS II categories) and improved with FSS weighting. Intraclass correlations of original and weighted total FSS scores were 0.95 and 0.94, respectively. CONCLUSIONS: The FSS met our objectives and is well suited for large outcome studies.