Rose Nevill

Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder

A number of studies of parent-mediated interventions in autism spectrum disorder have been published in the last 15 years. We reviewed 19 randomized clinical trials of parent-mediated interventions for children with autism spectrum disorder between the ages of 1 and 6 years and conducted a meta-analysis on their efficacy. Meta-analysis outcomes were autism spectrum disorder symptom severity, socialization, communication-language, and cognition. Quality of evidence was rated as moderate for autism spectrum disorder symptom severity, communication-language, and cognition, and very low for socialization. Weighted Hedges’ g varied from 0.18 (communication-language) to 0.27 (socialization) and averaged 0.23 across domains. We also examined the relationship between outcome and dose of parent training, type of control group, and type of informant (parent and clinician). Outcomes were not significantly different based on dose of treatment. Comparing parent training to treatment-as-usual did not result in significantly different treatment effects than when parent training was compared to an active comparison group. Based on parent report only, treatment effects were significant for communication-language and non-significant for socialization, yet the opposite was found based on clinician-rated tools. This meta-analysis suggests that while most outcome domains of parent-delivered intervention are associated with small effects, the quality of research is improving.

Language profiles in young children with autism spectrum disorder: A community sample using multiple assessment instruments:

This study investigated language profiles in a community-based sample of 104 children aged 1–3 years who had been diagnosed with autism spectrum disorder using Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic criteria. Language was assessed with the Mullen scales, Preschool Language Scale, fifth edition, and Vineland-II parent-report. The study aimed to determine whether the receptive-to-expressive language profile is independent from the assessment instrument used, and whether nonverbal cognition, early communicative behaviors, and autism spectrum disorder symptoms predict language scores. Receptive-to-expressive language profiles differed between assessment instruments and reporters, and Preschool Language Scale, fifth edition profiles were also dependent on developmental level. Nonverbal cognition and joint attention significantly predicted receptive language scores, and nonverbal cognition and frequency of vocalizations predicted expressive language scores. These findings support the administration of multiple direct assessment and parent-report instruments when evaluating language in young children with autism spectrum disorder, for both research and in clinical settings. Results also support that joint attention is a useful intervention target for improving receptive language skills in young children with autism spectrum disorder. Future research comparing language profiles of young children with autism spectrum disorder to children with non-autism spectrum disorder developmental delays and typical development will add to our knowledge of early language development in children with autism spectrum disorder.

Brief report: Poor self-regulation as a predictor of individual differences in adaptive functioning in young children with autism spectrum disorder: Self-regulation and adaptive functioning in ASD

The present study examined the link between poor self‐regulation (measured by the child behavior checklist dysregulated profile [DP]) and core autism symptoms, as well as with developmental level, in a sample of 107 children with autism spectrum disorder (ASD) aged 19–46 months. We further examined the utility of DP in predicting individual differences in adaptive functioning, relative to the influence of ASD severity, chronological age (CA), and developmental level. Poor self‐regulation was unrelated to CA, developmental level, and severity of ADOS‐2 restricted and repetitive behaviors, but was associated with lower ADOS‐2 social affect severity. Hierarchical regression identified poor self‐regulation as a unique independent predictor of adaptive behavior, with more severe dysregulation predicting poorer adaptive functioning. Results highlight the importance of early identification of deficits in self‐regulation, and more specifically, of the utility of DP, when designing individually tailored treatments for young children with ASD. Autism Res 2018, 11: 1157–1165.

Health Research in Intellectual and Developmental Disabilities

Information on the health and wellness of people with intellectual and developmental disability (IDD) has been furthered by direct clinical assessments, community surveys, and health service research. Each of these presents with limitations, particularly in the area of generalization. Population based surveillance methods address this limitation and provide a representative look at the lives of people with IDD. National surveillance datasets are successful in presenting rich, nationally-representative information on health issues, however, they also present with limitations that do not apply to other methods of health research. For example, this methodology is unable to confirm diagnoses of health conditions endorsed by respondents, and information may not be as in-depth as smaller-scale studies such as direct assessment, community-based surveys, and health record reviews. Despite these limitations, we will in this chapter share examples of research findings that have been published using national surveillance data. Surveillance data has led to many discoveries in terms health status, care, and quality that can help health care providers anticipate the needs of patients with IDD and their families, and ultimately provide better care.