Aubyn C. Stahmer

Stress Levels and Adaptability in Parents of Toddlers with and without Autism Spectrum Disorders

The toddler years can be a particularly stressful time for all parents, however, parents of children with disabilities may experience additional sources of stress. Recent literature on early education for children with disabilities promotes inclusion with typical peers with increases in the availability of inclusive programs. However, little is known about early intervention inclusion programs and parental factors such as stress and adaptability. The current study expands the research for children with disabilities by investigating the associations of having a young child with an Autism Spectrum Disorder (ASD) on multiple dimensions of parental stress for mothers and fathers and how participation in an inclusive toddler program may be related to these stress levels. Results for this community sample are consistent with previous research indicating that that both mothers and fathers of children with ASD report significantly elevated levels of both child and parent related stress in comparison with parents of typically developing toddlers. Following their childs participation in the inclusion program, mothers of children with ASD report significant reductions in child-related stress but no reductions in the parent-related stress domain. No changes were seen with either child or parent domain for fathers. Lastly, a childs level of social skills was a significant predictor of child-related maternal stress for children with autism. This pattern was not seen in fathers of these children. Implications for early intervention program modifications, such as increasing family support and incorporating adjunctive parent interventions for parents with elevated levels of stress are discussed.

Teaching symbolic play skills to children with autism using pivotal response training.

Used Pivotal Response Training (PRT) to teach 7 children with autism to engage in symbolic play behaviors. Symbolic play, complexity of play behavior, and creativity of play were assessed. In addition, generalization measures were obtained across settings, toys, and play partners. Interaction with the play partners and comparison with typical controls were also examined. Results indicated that children with autism rarely exhibited symbolic play before training or after a control condition. After specific symbolic play training using PRT, all of the children learned to perform complex and creative symbolic play actions at levels similar to that of language-matched typical controls. In most cases the children generalized their play to new toys, environments, and play partners and continued to engage in symbolic play behavior after a 3-month follow-up period. In addition, interaction skills improved after training. Treatment implications for these findings are discussed.

Developmental and behavioral needs and service use for young children in child welfare.

Objective. To determine the level of developmental and behavioral need in young children entering child welfare (CW), estimate early intervention services use, and examine variation in need and service use based on age and level of involvement with CW by using a national probability sample in the United States. Methods. As part of the National Survey of Child and Adolescent Well-Being, data were collected on 2813 children <6 years old for whom possible abuse or neglect was investigated by CW agencies. Analyses used descriptive statistics to determine developmental and behavioral needs across 5 domains (cognition, behavior, communication, social, and adaptive functioning) and service use. Logistic regression was used to examine the relationship between independent variables (age, gender, race-ethnicity, maltreatment history, level of CW involvement, and developmental or behavior problems) and service use. Results. Results indicate that age and level of CW involvement predict service use when controlling for need. Both toddlers (41.8%) and preschoolers (68.1%) in CW have high developmental and behavioral needs; however, few children are receiving services for these issues (22.7% overall). Children that remain with their biological parents have similar needs to those in out-of-home care but are less likely to use services. Children <3 years of age are least likely to use services. Conclusions. Children referred to CW have high developmental and behavioral need regardless of the level of CW involvement. Both age and level of involvement influence service use when controlling for need. Mechanisms need to be developed to address disparities in access to intervention.

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.

Early Intervention Practices for Children With Autism: Descriptions From Community Providers:

Across the country, states are reporting increases in the number of children With autism enrolled in the education system. Although a feW specific treatment methods have been established as efficacious for some children With autism in controlled settings, research examining the translation of these treatments into early intervention programs has been minimal. The current study examined provider self-reports of the use of interventions in community settings through focus groups. Providers report the use of both evidence-based and non—evidence-based techniques and indicate that they often combine and modify these techniques based on child, personal, and external factors. FeW providers had a clear understanding of evidence-based practice, and all providers reported concerns about adequate training. Implications for early intervention research are discussed.

The Use of Video Priming to Reduce Disruptive Transition Behavior in Children with Autism

This study investigated the use of video priming, or exposure, as a means for reducing or eliminating the disruptive behavior of children with autism in transition situations. Specifically, it was hypothesized that such disruptive behavior would be reduced if the children received prior priming to upcoming transitions. Three children with autism who demonstrated severely disruptive behavior during transitions viewed short videos of specific transition situations in which parents reported behavioral difficulties. A multiple-baseline design across participants showed that the implementation of the video priming procedure led to a reduction or elimination of the disruptive behavior. Further, behavior reductions generalized to new transition situations. The results are discussed in terms of the possible mechanisms responsible for treatment effects and the potential advantages of using video interventions with this population.

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

OBJECTIVE. The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use. METHODS. This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. RESULTS. Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications. CONCLUSIONS. Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. Given the limited evidence base, there is an urgent need to assess the risks, benefits, and costs of medication use and understand the local and national policies that affect medication use.

Effects of sociodramatic play training on children with autism.

We assessed the effects of teaching sociodramatic play to three children with autism. The training was conducted using a variation of Pivotal Response Training (PRT), a program traditionally used to teach language to children with autism. Measures of play skills, social behavior, and language skills were obtained before treatment, after treatment, and at a followup period. The correlation between language and pretend play was explored, as was the relationship between sociodramatic play and social competence. Positive changes were observed in play, language, and social skills. These changes generalized across toys and settings, although little generalization to other play partners occurred. Effects of play training with children with autism and maintenance of behavior change is discussed.

Effectiveness of Training Parents to Teach Joint Attention in Children With Autism

Young children with autism have deficits in initiating and responding to joint attention bids. This study was designed to examine a parent-implemented intervention targeting joint attention responding in children with autism. Parents were trained to increase their joint attention bids using behavior analytic techniques to facilitate appropriate responding. Parents effectively employed joint attention intervention techniques. As parent joint attention bids increased, childrens responses increased. Childrens joint attention initiations also increased, even though they were not direct targets of intervention. Findings suggest that parent behaviors during and after intervention impact generalization and maintenance of behavior changes. Implications for practice and future investigations are discussed.

Inclusive Programming for Toddlers with Autism Spectrum Disorders Outcomes From the Children's Toddler School

The passage of the Individuals with Disabilities Education Act of 1990 mandated the provision of interventions for young children with autism spectrum disorders (ASD) under the age of 3 years. Although Strain, McGee, and Kohler (2001) suggested that children with autism benefit from inclusive programming, inclusive early intervention programs are rare. In the current study, the authors used a quasi-experimental design to analyze the outcomes for 20 young children with ASD in an inclusive program for children under age 3. Both outcomes on standardized assessments and functional outcomes were compared at program entry and exit. Significant increases in standard scores were found for the standardized assessments from intake to exit, with 37% of the children functioning in the typical range at exit, compared to 11% at entry. Significant improvements in performance on functional measures were also seen. At intake, 50% of the study participants had no functional communication skills, whereas at exit, 90% used a functional communication system. Social and play behaviors also increased substantially. Use of augmentative communication systems and a combination of research-based programming are discussed.