Amy M. Wetherby

Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. “Naturalistic Developmental Behavioral Interventions (NDBI)” are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.

Ontogeny of communicative functions in autism

Autistic children have been stereotyped as noncommunicative and noninteractive; however, this may be partly attributed to traditional research approaches that do not consider the intentions of the child or the context of the social interaction. This discussion reviews some recent investigations that have used a developmental pragmatics framework to study language and communicative behaviors associated with autism. A working model of the ontogeny of communicative functions in autistic children is proposed. The communicative profile associated with autism is explained by factors related to the childs language-learning environment, as well as factors inherent in the child. Clinical implications for the design of language intervention programs for autistic children are offered.

The SCERTS Model A Transactional, Family-Centered Approach to Enhancing Communication and Socioemotional Abilities of Children With Autism Spectrum Disorder

A range of educational/treatment approaches is currently available for young children with autism spectrum disorders (ASD). A recent comprehensive review by an expert panel on ASD (National Research Council, 2001) concluded that a number of approaches have demonstrated positive outcomes, but nonetheless, not all children benefit equally from any one approach. Efforts to increase communicative and socioemotional abilities are widely regarded as among the most critical priorities, and growth in these areas is closely related to prognosis and long-term positive outcomes. However, some widely disseminated approaches are not based on the most contemporary developmental research on social and communication development in children with and without disabilities, nor do they draw from current understanding of the learning style of children with ASD. This article describes the SCERTS Model, which prioritizes Social Communication, Emotional Regulation, and Transactional Support as the primary developmental dimensions that must be addressed in a comprehensive program designed to support the development of young children with ASD and their families. The SCERTS Model has been derived from a theoretical as well as empirically based foundation and addresses core challenges of children with ASD as they relate to social communication, emotional regulation, and transactional support. The SCERTS Model also is consistent with empirically supported interventions and it reflects current and emerging “recommended practices” (National Research Council, 2001).

Validation of the Infant—Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age

There is an urgent requirement for the improvement of early detection of ASDs. This article provides a brief review of research on the accuracy of screeners for children with ASD that have been administered to general pediatric samples and then present results of a population-based study with a broadband screener to detect children with communication delays including children with ASD.

Communicative, Social/Affective, and Symbolic Profiles of Young Children With Autism and Pervasive Developmental Disorders

Research on children with autism and pervasive developmental disorders (PDD) has identified deficits and differences in social-communicative and related symbolic abilities. This includes a limited ...

Early Social Interaction Project for Children With Autism Spectrum Disorders Beginning in the Second Year of Life: A Preliminary Study

The Early Social Interaction (ESI) Project (Woods & Wetherby, 2003) was designed to apply the recommendations of the National Research Council (2001) to toddlers with autism spectrum disorders (ASD) by using a parent-implemented intervention that (a) embeds naturalistic teaching strategies in everyday routines and (b) is compatible with the mandate of the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, Part C. This quasi-experimental study is a preliminary effort by the authors to evaluate the effects of ESI on the social communication outcomes for a group of 17 children with ASD who entered ESI at age 2 years. The results indicated significant improvement on 11 of 13 social communication measures. The researchers compared the ESI group with a contrast group of 18 children with ASD who entered early intervention at age 3 years. The contrast groups results were comparable to those of the ESI postintervention group on communicative means and play, but the contrast group as a whole demonstrated significantly poorer performance on all other social communication measures. These findings offer promise for the use of parent-implemented interventions in promoting social communication for toddlers with ASD.

Parent-implemented social intervention for toddlers with autism: an RCT.

OBJECTIVES: To compare the effects of two 9-month parent-implemented interventions within the Early Social Interaction (ESI) Project. Both individual-ESI, offered 2 or 3 times per week at home or in the community, and group-ESI, offered once per week in a clinic, taught parents how to embed strategies to support social communication throughout everyday activities. METHODS: Participants in the randomized controlled trial included 82 children diagnosed with autism spectrum disorder at 16 to 20 months. Children were matched on pretreatment nonverbal developmental level and pairs were randomly assigned to treatment condition. Child outcomes included measures of social communication, autism symptoms, adaptive behavior, and developmental level. Child outcomes are reported from baseline to the end of the 9-month interventions. RESULTS: Children in individual-ESI showed differential change on a standardized examiner-administered observational measure of social communication, as they improved at a faster rate than children in group-ESI. Individual-ESI also showed differential efficacy on a parent report measure of communication, daily living, and social skills, as they showed improvement or stability, whereas group-ESI led to worsening or no significant change on these skills. Finally, individual-ESI showed differential change on examiner-administered measures of receptive language skills, as children in individual-ESI improved significantly, whereas group-ESI showed no change. CONCLUSIONS: These findings support the efficacy of individual-ESI compared with group-ESI on child outcomes, suggesting the importance of individualized parent coaching in natural environments. The efficacy of a parent-implemented intervention using little professional time has potential for community viability, which is particularly important in light of the lack of main effects on child outcomes of most other parent-implemented interventions.

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on “teachable moments,” and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.

Repetitive and stereotyped movements in children with autism spectrum disorders late in the second year of life

OBJECTIVES The purpose of this study was to examine group differences and relationships with later developmental level and autism symptoms using a new clinical tool developed to measure repetitive and stereotyped movements (RSM) in young children. METHOD Videotaped behavior samples using the Communication and Symbolic Behavior Scales Developmental Profile (CSBS; Wetherby & Prizant, 2002) were coded for children with autism spectrum disorders (ASD; n = 50), developmental delays without ASD (DD; n = 25), and typical development (TD; n = 50) between 18 and 24 months of age. RESULTS Children with ASD demonstrated significantly higher rate and larger inventory of RSM with objects and body during a systematic behavior sample than both the DD and TD groups. Measures of RSM were related to concurrent measures of social communication and predicted developmental outcomes and autism symptoms in the fourth year for the ASD group. None of the correlations between RSM and autism symptoms remained significant when controlling for CSBS Symbolic level. RSM with objects predicted unique variance in the severity of autism symptoms in the fourth year beyond that predicted by social communication measures alone. CONCLUSIONS This study provides support for the diagnostic significance of RSM in children under 24 months of age and documents the utility of this RSM measurement tool as a companion to the CSBS.

Early Identification of Children with Communication Disorders: Concurrent and Predictive Validity of the CSBS Developmental Profile.

Communication disorders in infants and toddlers are significantly underidentified, prohibiting early intervention for many children and families who might benefit from services. Researchers have sought to identify earlier and more accurate predictors of later language development. This article describes the FIRST WORDS Project evaluation model for identifying children less than 24 months of age who are at risk for communication disorders by using the CSBS Developmental Profile (CSBS DP; A. Wetherby & B. Prizant. Communication and Symbolic Behavior Scales Developmental Profile—First Normed Edition. Baltimore, Md: Brookes Publishing Co; 2002). Children were first screened with a brief parent-report checklist distributed by healthcare and childcare providers and other community agencies serving families of young children. Children were followed up with a more in-depth parent report tool and face-to-face evaluation. This paper presents the results of 2 studies. The first study examined the concurrent validity of the CSBS DP based on screening and evaluation with the CSBS DP for 232 children between 12 and 24 months of age. The second study examined the predictive validity of the CSBS DP based on follow-up testing of receptive and expressive language for 246 children at 2 years of age and 108 children at 3 years of age. These findings support the use of prelinguistic predictors and the important role of the family in screening and evaluation to improve early identification.