Hannah Waddington

Three children with autism spectrum disorder learn to perform a three-step communication sequence using an iPad®-based speech-generating device.

Many children with autism spectrum disorder (ASD) have limited or absent speech and might therefore benefit from learning to use a speech‐generating device (SGD). The purpose of this study was to evaluate a procedure aimed at teaching three children with ASD to use an iPad®‐based SGD to make a general request for access to toys, then make a specific request for one of two toys, and then communicate a thank‐you response after receiving the requested toy.

6 year follow-up supports early autism intervention.

There have been few large randomised controlled trials of early intervention for children with autism spectrum disorder, even fewer with follow-up data, and none with such a lengthy follow-up period as that reported by Andrew Pickles and colleagues 1 in The Lancet. These researchers assessed long-term outcomes for children who had received a parent-mediated intervention versus treatment as usual nearly 6 years earlier. That earlier study from 2010 2 was notable for its rigorous methodology. 3 The present follow-up study is also worthy of note. To appreciate its importance, some background is needed on the 2010 study. That study was a large randomised controlled trial in which young children (aged from 2 years to 4 years and 11 months) were assigned to receive treatment as usual (n=75) or treatment as usual plus the manual-based PreSchool Autism Communication Trial (PACT) programme (n=77). The PACT intervention is grounded in developmental principles and aims to increase parent sensitivity and responsiveness to child communication through various strategies such as improving parent observation, responsiveness, and focused communication. Compared with other early intervention approaches for young children with autism, 4–6 the PACT intervention reported in 2010 was a relatively low-intensity programme. Parents received 2 h clinical sessions every 2 weeks for the fi rst 6 months, followed by monthly booster sessions during the fi nal 6 months. Parents were also asked to implement their newly acquired sensitivity and responsivity skills at home for 20–30 min each day. The treatment eff ect was initially viewed as modest, 2 but the updated analysis reported in this follow-up study 1 reveals greater improvements in the intervention group than in the treatment-as-usual group. The improvements seen from the initial PACT trial are consistent with results from other randomised controlled trials of early autism interventions. 4–6 The follow-up study 1 sought to establish the long-term durability of these initial treatment gains. Follow-up was done at 5·75 years after the trial endpoint and included nearly 80% of the original sample. The resulting data, which were analysed with repeated measures approaches, showed sustained treatment eff ects. Specifi cally, the severity of autism symptoms was signifi cantly lower for children in the intervention group than for children in the treatment-as-usual group. These diff erences were evident at the trial endpoint and at this 5·75 year follow-up. Secondary analyses showed that changes in social communication and restricted and repetitive behaviour, which are the two core …

Intensive toilet training targeting defecation for a child with Autism Spectrum Disorder

ABSTRACTIndependent toileting is a critical functional life skill. Unfortunately, acquisition of this skill is often delayed in children with Autism Spectrum Disorder. Interventions based on behavioural principles are often used to toilet train children. Methods that incorporate behavioural components, including systematic prompting and reinforcement contingencies, have yielded positive results for teaching toileting skills to children with disabilities. The purpose of the present study was to determine whether selected procedures based upon a behavioural model would be effective in teaching an 8-year-old boy with autism independent toileting skills, including in-toilet defecation. A secondary goal of the intervention was to reduce interfering behaviours associated with toileting. In-toilet defecation increased as a result of the intervention.

Teaching mands for actions to children with autism spectrum disorder using systematic instruction, behavior chain interruption, and a speech-generating device

Objective: Evaluate the use of procedures to teach three nonvocal children with autism spectrum disorder to use a speech-generating device to mand for actions. Method: A multiple probe across participants design was used to evaluate the effectiveness systematic instruction and the use of a behavior chain interruption. Results: All three participants acquired the target mand. However, generalization to an untrained item only occurred for one participant. Conclusion: Results suggest that mands for actions expressed with a speech-generating device can be taught to children with autism spectrum disorder using systematic instruction and behavior chain interruption strategies.

Teaching a Child With ASD to Approach Communication Partners and Use a Speech-Generating Device Across Settings: Clinic, School, and Home:

Individuals with autism spectrum disorder (ASD) often have difficulty generalizing newly acquired communication skills to different contexts. In this study, a multiple baseline across settings (clinic, school, and home) design was used to determine whether an 8-year-old boy with ASD could learn to approach communication partners to request preferred items using an iPad®-based speech-generating device (SGD). Results indicated that the participant learned to approach communication partners to request across all settings. Acquisition of this skill was fastest at school and slowest in the clinic. The participant’s learning generalized to a novel room within the same setting, and he was also able to retrieve the SGD prior to approaching the communication partner without additional teaching. Results suggest that individuals with ASD may benefit from being systematically taught to use an SGD across different settings and communication partners.

Teaching two children with autism spectrum disorder to use a speech-generating device

ABSTRACTMany children with autism spectrum disorder have minimal speech and are therefore candidates for learning to use speech-generating devices. Previous research has mainly focused on teaching ...

Training direct-care staff to implement an iPad®-based communication intervention with adults with developmental disability

Objectives: To evaluate the effects of a program for training direct-care staff to implement an iPad®-based communication intervention with adults with developmental disability and severe communication impairment. Methods: Participants were 11 adults with developmental disability and 19 direct-care staff drawn from two day program settings. Direct-care staff completed training on how to implement the iPad®-based intervention. Staff were trained using PowerPoint® and video presentations, role play, practice, and feedback. A nonconcurrent multiple-baseline across settings design was used to evaluate the effects of the training program on fidelity of implementation by direct-care staff and the frequency of functional communicative acts by the adults with developmental disability. Eleven direct-care staff (five from Setting 1 and six from Setting 2) also completed a social validity questionnaire on the acceptability and usefulness of the training program. Results: After the training program, fidelity of implementation and frequency of functional communication increased. These gains were maintained at the follow-up in Setting 1, but not in Setting 2. Direct-care staff in both settings rated the training program as acceptable and useful. Conclusion: Direct-care staff learned to implement an iPad®-based communication intervention to increase functional communication in adults with developmental disability and severe communication impairment. The training program showed promise, but additional research is needed to validate its effectiveness.

Training Direct-Care Staff to Provide Communication Intervention to Adults With Intellectual Disability: A Systematic Review

Purpose The aim of this review was to summarize and evaluate studies on training direct-care staff to provide communication intervention to adults with intellectual disability. Method Systematic searches identified 22 studies. These were summarized and evaluated in terms of (a) participants; (b) settings; (c) training aims and procedures; (d) research designs; (e) reliability, integrity, and social validity; (f) outcomes; (g) generalization and follow-up; and (h) certainty of evidence. Results A total of 437 staff and 254+ adults with intellectual disability participated. Staff training most frequently involved combinations of verbal instruction, role play, modeling, practice, and feedback. Reliability was assessed in 18 studies with acceptable standards for most of these studies. Treatment integrity and social validity were assessed in 1 and 3 studies, respectively, with positive outcomes. Generalization and maintenance were assessed in 5 and 8 studies, respectively, with predominantly positive outcomes. Most studies reported positive outcomes for staff and positive or mixed outcomes for the adults with intellectual disability. Certainty of evidence was rated as conclusive in 1 study, suggestive in 14 studies, and inconclusive in 7 studies. Conclusions There is sufficient evidence to conclude that direct-care staff can be taught to provide effective communication intervention to adults with intellectual disability. Professionals involved in providing training and support to direct-care staff could expect positive outcomes from multicomponent training programs that include opportunities for practice and feedback.

Teaching icon discrimination to a child with autism spectrum disorder using icons with embedded video and audio in an iPad®-based speech-generating device

ABSTRACTSystematic instructional procedures alone have not been effective for teaching some individuals with autism spectrum disorder to discriminate between icons on an iPad®-based speech-generating device in order to request access to preferred items. Altering the quality or type of icon used may facilitate the learning of this kind of discrimination. A sequential withdrawal design was used to evaluate the effects of systematic instructional procedures and icons with embedded video and audio for teaching icon discrimination to a single participant with autism spectrum disorder. The phases of the study were baseline, intervention, follow-up, booster training, withdrawal, and generalisation. The participants percentage of correct requesting improved during the intervention and booster training phases. The video and audio components were able to be withdrawn and discrimination was maintained with eight novel icons. The addition of animation and audio to icons on an iPad®-based speech-generating device may...