Lisa A. Ruble

An Alternative View of Outcome in Autism

Parents often rely on the knowledge and experience of others to explain the longitudinal outcomes in autism. Unfortunately, limitations keep parents from obtaining accurate and relevant information. First, professionals with limited experiences are not likely to understand the range of outcomes for persons with autism. Second, previous studies have used narrow explanations to define outcomes. Past researchers have generally defined good outcome as the development of a normal social life and independence by adulthood; and they have defined the best predictors as verbal and IQ levels. Because most individuals with autism continue to struggle with social relationships and need individualized supports, this outcome is rare. Parents, educators, and researchers need other frameworks now to characterize and conceptualize “good outcome.” Data on 46 individuals with autism will be used to present an alternative view of outcome. Some who would have been predicted to do poorly as adults because of their relatively low verbal, cognitive, and adaptive behavior levels were found to be leading satisfactory lives. To illustrate the multitude of variables that have an impact on outcome and to propose the claim that competency and quality of life are the best criteria for judging outcomes, we present four case studies.

Goal Attainment Scaling as an Outcome Measure in Randomized Controlled Trials of Psychosocial Interventions in Autism.

Goal attainment scaling (GAS) holds promise as an idiographic approach for measuring outcomes of psychosocial interventions in community settings. GAS has been criticized for untested assumptions of scaling level (i.e., interval or ordinal), inter-individual equivalence and comparability, and reliability of coding across different behavioral observation methods. We tested assumptions of equality between GAS descriptions for outcome measurement in a randomized trial (i.e., measurability, equidistance, level of difficulty, comparability of behavior samples collected from teachers vs. researchers and live vs. videotape). Results suggest GAS descriptions can be evaluated for equivalency, that teacher collected behavior samples are representative, and that varied sources of behavior samples can be reliably coded. GAS is a promising measurement approach. Recommendations are provided to ensure methodological quality.

Toilet Training and Behaviors of People with Autism: Parent Views.

Individuals with autism often present with toileting problems, yet there is little information about the nature of these problems. This investigation surveyed 100 parents of people with autism of a mean age of 19.5 years. Results indicated that lower cognition and lower verbal levels were significantly correlated with age of accomplishment of bowel and urine training; some subjects were not trained at the time of the study. The average duration of urine training was 1.6 years, bowel training 2.1 years. On the average, training started more than 21/2 years before the average age of diagnosis of autism. Fifty-six percent of the sample had to be taught to self-initiate, 42% were taught to ask to use the toilet, and 49% were taught using a schedule. Reinforcement was used by 78% of the parents of males and by 100% of the parents of females. Punishment, primarily scolding was used by 37% of the parents. The most common problems reported were urinating in places other than the toilet, constipation, stuffing up toilets, continually flushing, or smearing feces. More fears related to toileting were noted for verbal subjects.

Preliminary Investigation of the Sources of Self-Efficacy Among Teachers of Students with Autism

Teacher self-efficacy refers to the beliefs teachers hold regarding their capability to bring about desired instructional outcomes and may be helpful for understanding and addressing critical issues such as teacher attrition and teacher use of research-supported practices. Educating students with autism likely presents teachers with some of the most significant instructional challenges. The self-efficacy of 35 special education teachers of students with autism between the ages of 3 to 9 years was evaluated. Teachers completed rating scales that represented self-efficacy and aspects of the following 3 of Bandura’s 4 sources of self-efficacy: (1) sense of mastery, (2) social persuasions, and (3) physiological/affective states. Significant associations were observed between physiological/affective states and self-efficacy, but no associations were observed for the other sources.

The Effects of Consultation on Individualized Education Program Outcomes for Young Children With Autism: The Collaborative Model for Promoting Competence and Success.

The effects of a teacher consultation intervention were examined—namely, the collaborative model for promoting competence and success (COMPASS), which was designed to improve objectives of individualized education programs for children with autism. The intervention consists of an initial parent—teacher consultation, followed by four teacher consultations across the school year. Thirty-five teachers and a randomly selected child with autism (M age = 6.1 years) from each classroom participated. Compared to the nonintervention teacher—child dyads, the intervention teacher—child dyads showed improvements in individualized education program objectives, with a large effect size ( d = 1.51).

A Comparative Study of Rurality and Urbanicity on Access to and Satisfaction with Services for Children with Autism Spectrum Disorders.

Little is known about services for children with autism spectrum disorders (ASD) living in rural areas. The purpose of this study was to examine parent report of access to and satisfaction with services for children with ASD in rural areas and compare results to parents from urban areas. Parents in both groups reported children were diagnosed after the age of 3 and experienced challenges accessing services, trained professionals, and educators. Parents from rural areas reported significantly more difficulty accessing trained physicians and professionals in their areas. The implications of this study and needed future research are discussed.

Compass A Parent—Teacher Collaborative Model for Students With Autism

Educational and psychological consultants have a long history of providing indirect school-based service delivery to students With disabilities. The need for consultants With skills in autism is ne...Educational and psychological consultants have a long history of providing indirect school-based service delivery to students With disabilities. The need for consultants With skills in autism is necessary noW more than ever. Described as one of the most complex developmental disabilities, autism is being identified in children at a rapid rate—more so than any other loW-incidence disability, resulting in the need for trained personnel. To enhance competence of both the student and the teacher, a holistic understanding of the interactions betWeen students and their environments is necessary. A consultation frameWork With strong theoretical and conceptual support is described. The rationale for a specific consultation approach in autism is presented and components of the consultation model provided. Educational and psychological consultants are ideally positioned to act as bridges betWeen parents and school personnel for developing appropriate programs based on parent—teacher collaboration.

A Randomized Controlled Trial of Compass Web-Based and Face-to-Face Teacher Coaching in Autism.

OBJECTIVE Most children with autism rely on schools as their primary source of intervention, yet research has suggested that teachers rarely use evidence-based practices. To address the need for improved educational outcomes, a previously tested consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple, & McGrew, 2010; Ruble, Dalrymple, & McGrew, 2012) was evaluated in a 2nd randomized controlled trial, with the addition of a web-based group. METHOD Forty-nine teacher-child dyads were randomized into 1 of 3 groups: (1) a placebo control (PBO) group, (2) COMPASS followed by face-to-face (FF) coaching sessions, and (3) COMPASS followed by web-based (WEB) coaching sessions. Three individualized goals (social, communication, and independence skills) were selected for intervention for each child. The primary outcome of independent ratings of child goal attainment and several process measures (e.g., consultant and teacher fidelity) were evaluated. RESULTS Using an intent-to-treat approach, findings replicated earlier results with a very large effect size (d = 1.41) for the FF group and a large effect size (d = 1.12) for the WEB group relative to the PBO group. There were no differences in overall change across goal domains between the FF and WEB groups, suggesting the efficacy of videoconferencing technology. CONCLUSIONS COMPASS is effective and results in improved educational outcomes for young children with autism. Videoconferencing technology, as a scalable tool, has promise for facilitating access to autism specialists and bridging the research-to-practice gap.

Teacher and Child Predictors of Achieving IEP Goals of Children with Autism

It is encouraging that children with autism show a strong response to early intervention, yet more research is needed for understanding the variability in responsiveness to specialized programs. Treatment predictor variables from 47 teachers and children who were randomized to receive the COMPASS intervention (Ruble et al. in The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) were analyzed. Predictors evaluated against child IEP goal attainment included child, teacher, intervention practice, and implementation practice variables based on an implementation science framework (Dunst and Trivette in J Soc Sci 8:143–148, 2012). Findings revealed one child (engagement), one teacher (exhaustion), two intervention quality (IEP quality for targeted and not targeted elements), and no implementation quality variables accounted for variance in child outcomes when analyzed separately. When the four significant variables were compared against each other in a single regression analysis, IEP quality accounted for one quarter of the variance in child outcomes.

Executive Functions and the Natural Habitat Behaviors of Children with Autism

Research suggests that impairments in executive functions play a role in the cognitive deficit in autism. Possible autism- specific impairments include an inability to engage in goal-directed behaviors and adjust behaviors given environmental demands. What has been described as executive functions is based largely on observations of performance in the laboratory rather than in natural settings. An ecological method first described by Barker and Wright and adapted by Scott was used to assess the patterns of goal-directed behaviors of eight children with autism and eight chronological and mental age comparable children with Down syndrome. Quantitative and qualitative features of naturalistic behaviors were collected, and coded using previously described categories of children’s behavior. Results indicated that children with autism exhibited shorter and less overlapping goal- directed behaviors. These data suggest a cognitive difference rather than developmental delay, and lend support for impaired executive functions in autism. Practical implications for educators and caregivers are discussed.