Lindee Morgan

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.

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.

Designing Studies to Evaluate Parent-Mediated Interventions for Toddlers With Autism Spectrum Disorder

Given recent advances in science, policy, and practice of early identification in autism spectrum disorder (ASD), questions about the effectiveness of early intervention have far-reaching service and policy implications. However, rigorous research evaluating the efficacy and effectiveness of intervention programs for toddlers with ASD faces a multitude of novel scientific challenges. The Autism Speaks Toddler Treatment Network (ASTTN) was formed in 2007 to provide an infrastructure for ongoing communication between the investigators of eight research projects evaluating parent-mediated interventions for toddlers with ASD. The present article describes and compares the research studies of the ASTTN; highlights specific challenges with regard to research design, participants, recruitment, eligibility criteria, enrollment, and intervention approach; and outlines practical considerations that may guide the next generation of parent-mediated intervention studies involving toddlers with ASD.

Impact of Social Communication Interventions on Infants and Toddlers With or At-Risk for Autism: A Systematic Review

This is a systematic review of the impact of communication interventions on the social communication skills of infants and toddlers with or at-risk for autism spectrum disorder (ASD). A priori clinical questions accompanied by specific inclusion and exclusion criteria informed the extensive literature search that was conducted in multiple databases (e.g., PubMed). Twenty-six studies were accepted for this review. Outcomes were reported by social communication category (i.e., joint attention, social reciprocity, and language and related cognitive skills) and communication developmental stage (i.e., prelinguistic, emerging language). Primarily positive treatment effects were revealed in the majority of outcome categories for which social communication data were available. However, the presence of intervention and outcome measure heterogeneity precluded a clear determination of intervention effects. Future research should address these issues while also evaluating multiple outcomes and adding a strong family component designed to enhance child active engagement.

Promoting Early Identification of Autism in the Primary Care Setting: Bridging the Gap Between What We Know and What We Do

During the last decade, research on Autism Spectrum Disorder (ASD) has made tremendous progress with regard to early identification and diagnosis. These advances were made possible by a growing number of rigorous research studies with large sample sizes that utilized a combination of: (1) retrospective parent report and home video studies [1], (2) prospective studies of infant siblings of children with ASD [2], (3) population-wide studies of ASD screening tools [3], and (4) studies on the early stability of diagnostic classifications [4]. Advances in best practices related to early identification are reflected in a 2006 policy statement published by the American Academy of Pediatrics [5], and a corresponding set of clinical practice guidelines [6]. According to these guidelines, it is recommended that Primary Care Providers (PCPs; e.g., family physicians, pediatricians) administer formal screening tests during every well-child visit scheduled at 18 and 24 months, independent of known risk factors or reported concerns. Moreover, PCPs are urged to promptly refer children for Early Inter‐ vention1 services as soon as ASD is seriously considered.

Cluster randomized trial of the classroom SCERTS intervention for elementary students with autism spectrum disorder.

Objective: This cluster randomized trial (CRT) evaluated the efficacy of the Classroom Social, Communication, Emotional Regulation, and Transactional Support (SCERTS) Intervention (CSI) compared with usual school-based education with autism training modules (ATM). Method: Sixty schools with 197 students with autism spectrum disorder (ASD) in 129 classrooms were randomly assigned to CSI or ATM. Mean student age was 6.79 years (SD 1.05) and 81.2% were male. CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation. A CRT, with students nested within general and special education classrooms nested within schools, was used to evaluate student outcomes. Results: The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction. The CSI group also had significantly better outcomes on measures of adaptive communication, social skills, and executive functioning with Cohen’s d effect sizes ranging from 0.31 to 0.45. Conclusion: These findings support the preliminary efficacy of CSI, a classroom-based, teacher-implemented intervention for improving active engagement, adaptive communication, social skills, executive functioning, and problem behavior within a heterogeneous sample of students with ASD. This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures.