James A. Mulick

Cost–benefit estimates for early intensive behavioral intervention for young children with autism—general model and single state case

Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost‐benefits of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder—not otherwise specified (PDD—NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD—NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost‐benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI eAects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of eAectiveness and in constant dollars, this model estimates that cost savings range from

Medication and Parent Training in Children With Pervasive Developmental Disorders and Serious Behavior Problems: Results From a Randomized Clinical Trial

187,000 to

Parental report of sleep problems in children with autism.

203,000 per child for ages 3‐22 years, and from

A history of facilitated communication: Science, pseudoscience, and antiscience science working group on facilitated communication.

656,000 to

Manual of diagnosis and professional practice in mental retardation

1,082,000 per child for ages 3‐55 years. DiAerences in initial costs of

System and Cost Research Issues in Treatments for People with Autistic Disorders

33,000 and

Positive behavior support and applied behavior analysis.

50,000 per year for EIBI have a modest impact on cost‐benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI. #1998 John Wiley & Sons, Ltd.

Effect of Parent Training vs Parent Education on Behavioral Problems in Children With Autism Spectrum Disorder: A Randomized Clinical Trial

OBJECTIVE Many children with pervasive developmental disorders (PDDs) have serious, functionally impairing behavioral problems. We tested whether combined treatment (COMB) with risperidone and parent training (PT) in behavior management is superior to medication alone (MED) in improving severe behavioral problems in children with PDDs. METHOD This 24-week, three-site, randomized, parallel-groups clinical trial enrolled 124 children, aged 4 through 13 years, with PDDs, accompanied by frequent tantrums, self-injury, and aggression. The children were randomized 3:2 to COMB (n = 75) or MED (n = 49). The participants received risperidone monotherapy from 0.5 to 3.5 mg/day (with switch to aripiprazole if risperidone was ineffective). Parents in the COMB group (n = 75; 60.5%) received a mean of 10.9 PT sessions. The primary measure of compliance was the Home Situations Questionnaire (HSQ) score. RESULTS Primary: intent-to-treat random effects regression showed that COMB was superior to MED on HSQ (p = .006) [effect size at week 24 (d) = 0.34]. The HSQ score declined from 4.31 (± 1.67) to 1.23 (± 1.36) for COMB compared with 4.16 (± 1.47) to 1.68 (± 1.36) for MED. Secondary: groups did not differ on Clinical Global Impressions-Improvement scores at endpoint; compared with MED, COMB showed significant reductions on Aberrant Behavior Checklist Irritability (d = 0.48; p = .01), Stereotypic Behavior (d = 0.23; p = .04), and Hyperactivity/Noncompliance subscales (d = 0.55; p = .04). Final risperidone mean dose for MED was 2.26 mg/day (0.071 mg/kg), compared with 1.98 mg/day for COMB (0.066 mg/kg) (p = .04). CONCLUSIONS Medication plus PT resulted in greater reduction of serious maladaptive behavior than MED in children with PDDs, with a lower risperidone dose.

Handbook of intellectual and developmental disabilities

This research evaluated parent reports of sleep behaviors of four groups of children: those with Autism or Pervasive Developmental Disorders, those with General Mental Retardation alone, those attending Special Education classes (with no MR diagnosis), and a control group of similar aged children without a developmental diagnosis. Diagnostic classification and demographic information were determined through parent report, report of classroom registration, and the Gilliam Autism Rating Scale (Gilliam, 1995). To evaluate sleeping behavior the study used a 28-item, five-factor scale (Behavioral Evaluation of Disorders of Sleep/BEDS; Schreck, 1997/1998) constructed from the diagnostic criteria for childhood sleep disorders found in the International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD, American Sleep Disorders Association, 1990). Findings suggest that reports of parents with children with autistic characteristics exhibit expected quantities of sleep, but parent perception of their sleep difficulties and sleep quality is different for children with autism than for children in all other study groups.

Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders

Facilitated communication (FC) is a method of assisting people with severe developmental disabilities to communicate. Before its adoption as a teaching–treatment technique, the only research evidence in support of its validity consisted of a small number of descriptive reports in the professional li