Stephanny F. N. Freeman

Language outcome in autism: randomized comparison of joint attention and play interventions

This study reports results of a randomized controlled trial aimed at joint attention (JA) and symbolic play (SP) in preschool children with autism, with prediction to language outcome 12 months later. Participants were 58 children (46 boys) with autism between 3 and 4 years of age. Children were randomized to a JA intervention, an SP intervention, or control group. Interventions were conducted 30 min daily for 5-6 weeks. Assessments of JA skills, SP skills, mother-child interactions, and language development were collected at 4 time points: pre- and postintervention and 6 and 12 months postintervention by independent testers. Results indicate that expressive language gains were greater for both treatment groups compared with the control group, and results could not be explained by differences in other interventions in which children participated. For children beginning treatment with the lowest language levels, the JA intervention improved language outcome significantly more than did the SP or control interventions. These findings suggest clinically significant benefits of actively treating JA and SP skills in young children with autism.

Behavior Problems, Academic Skill Delays and School Failure Among School-Aged Children in Foster Care: Their Relationship to Placement Characteristics

We describe the level of behavior problems, academic skill delays, and school failure among school-aged children in foster care. We also examine how behavior problems are associated with academic problems, and explore how these outcomes are related to childrens placement characteristics. Foster parent and child home interviews, as well as teacher telephone interviews were conducted from a randomly selected sample of 302 children aged 6 through 12 years living in out-of-home placement. Interviews included standardized screening measures. Results showed that 27% of the children scored in the clinical range for a behavior problem, and 34% were rated as having at least one behavior problem in the classroom. Twenty-three percent of the children had severe delays in reading or math, 13% had repeated a grade, and 14% had a history of school suspension and/or expulsion. Behavior problems by foster parent report were related to child suspension and/or expulsion from school, but were not associated with severe academic delays or grade retention. Placement characteristics were only sometimes related to these outcomes. Future studies examining the mental health and educational needs of this population should take into account the childs sociodemographic and placement characteristics.

Academic and Social Attainments of Children with Mental Retardation in General Education and Special Education Settings

Parents, professionals, and researchers have been concerned about the most appropriate placement for children with mental retardation. To shed light on the efficacy of integration, 36 studies were reviewed on the academic and social attainments of school-age children with mental retardation. Results show that children in general education classes do not attain social acceptance ratings at as high a level as do their typically developing peers. When comparing children with mental retardation in general education and special education classrooms, integrated students perform better than their comparable segregated students on measures of academic achievement and social competence. Other variables are discussed that might affect child outcomes, and related recommendations are given for future research.

Parental perspectives on inclusion: effects of autism and Down syndrome.

This study examined the effects of the childs diagnosis (autism vs. Down syndrome), age, and current educational placement on parental perceptions toward inclusion for their child with disabilities. Parents of children with autism and with Down syndrome completed surveys regarding their opinions on their childs current educational placement, their desire for changing the current placement, and their views on inclusive education. Results indicated that diagnosis, age, and current placement influenced parental opinion on the ideal educational placement for their child. Parents of children with Down syndrome were significantly more likely to endorse inclusion (full-time placement in general education) as the ideal educational program for their child whereas parents of children with autism were more likely to endorse mainstreaming (consistent part-time placement with general education students). Parents of younger children and parents whose children were already placed in general education programs were more positive towards inclusion than parents of older children or students currently in special education. Findings are discussed in terms of child characteristics and prevailing educational practices.

Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play.

OBJECTIVE This study examines the cognitive and language outcomes of children with an autism spectrum disorder (ASD) over a 5-year period after receiving targeted early interventions that focused on joint attention and play skills. METHOD Forty children from the original study (n = 58) had complete data at the 5-year follow-up. RESULTS In all, 80% of children had achieved functional use of spoken language with baseline play level predicting spoken language at the 5-year follow-up. Of children who were using spoken language at age 8 years, several baseline behaviors predicted their later ability, including earlier age of entry into the study, initiating joint attention skill, play level, and assignment to either the joint attention or symbolic play intervention group. Only baseline play diversity predicted cognitive scores at age 8 years. CONCLUSIONS This study is one of the only long-term follow-up studies of children who participated in preschool early interventions aimed at targeting core developmental difficulties. The study findings suggest that focusing on joint attention and play skills in comprehensive treatment models is important for long-term spoken language outcomes.

Special Education Implications of Point and Cumulative Prevalence for Children With Emotional or Behavioral Disorders

Prevalence of children with emotional or behavioral disorders (EBD) is a critical component in the discussion of underidentification of children served in special education. This discussion has previously focused almost exclusively on point prevalence or the number of children with EBD presumably needing services at any single point in time. Cumulative prevalence, on the other hand, is the number of children who have had EBD at some point in their lives before high school graduation. In the authors’ review of both types of prevalence, they found that estimates of the latter far exceed those of the former, significantly highlighting the service gap that exists between prevalence estimates and special education identification. Even when point prevalence is limited just to children with moderate or severe disorder, special education identification in the emotional disturbance category appears restricted to less than the bottom tenth of all children in need. Implications for special education are discussed, including issues around underidentification, misidentification, underservice, and related issues concerning children with EBD.

Task-Related Social Behavior in Children With Down Syndrome

The specificity and stability of task-related social behaviors in children ages 5 to 12 was examined. Social behaviors during solvable and unsolvable puzzles were compared among children with Down syndrome, children with mental retardation, and typically developing children matched on mental age (MA). Compared to children without Down syndrome, those with the disorder looked to an adult and requested help more frequently. They also took longer to complete the tasks. These findings suggest that the overuse of social behaviors observed in young children with Down syndrome remains stable over the early school years and are specific to children with Down syndrome.

Emotion Recognition by Children With Down Syndrome

In three studies, children with Down syndrome were presented with emotion recognition tasks designed to tap their knowledge of simple emotions, their ability to label emotions, and their understanding of emotions from simple, story-based contexts. Results indicate that young children with Down syndrome perform similarly to typical controls matched on MAs of approximately 3 years. However, by developmental age of 4 years, children with Down syndrome performed worse than both MA-matched typical children and children with non-Down syndrome types of mental retardation. Although the MAs of children with Down syndrome increased over 2-years, their emotion recognition abilities did not. Taken together, findings suggest both etiological and developmental differences in the emotion recognition abilities of children with Down syndrome.

Characteristics and Qualities of the Play Dates of Children With Down Syndrome: Emerging or True Friendships?

Although research on typical development suggests that friendship is a social relationship based on interactions with certain criteria, the qualities, definitions, and characteristics of friendship are not well-understood among children with atypical development. In this study, the interactions of 27 dyads of children in a play-date situation were examined; one dyad member had Down syndrome. The peers brought were more often the same gender, age, and ethnicity. Dyads who were similar in gender, CA, and classroom experiences had better quality interactions. Twenty dyads met strict friendship criteria and, thus, could be classified as friends. These friend dyads were more positive in affect, more often involved in turn-taking, and played at higher levels than did children categorized as simply playmates.

Early intervention in autism: Joint attention and symbolic play

Summary In both intervention case examples, substantial gains were made in the targeted goals in a very short period of time, 31 intervention sessions for Child A and 21 intervention sessions for Child B. Therefore, in reference to our first question of whether joint attention and symbolic play skills can be taught, our answer is yes. Evidence exists that—at least in these two cases—children with autism can indeed be successfully taught skills related to their core deficits. Our second question concerned the specificity of our intervention. Although each child improved on his targeted goals over the course of the intervention, neither child improved in the nontargeted skills of joint attention and symbolic play. Moreover, the control child did not change in either play or joint attention skills. Thus, we have some evidence that changes were made only in the targeted developmental skills. When replicated across the 60 children we will have in our intervention project, we will be able to better assess the specificity of our direct teaching approach. Third, both intervention children made some significant language gains over the course of intervention, whereas our control child did not change. Thus, based on these initial two children, there does not appear to be a specific effect on language based on the type of intervention—joint attention or symbolic play, but there are changes in language. A test of the benefit of these gains will be in the longitudinal data that we are currently collecting and the replication of randomized children in each of the interventions. Finally, an important caveat is in order. The cases presented are merely examples and must be replicated over a number of children with similar pretreatment characteristics. Indeed, all three boys had mental ages just over 20 months, some limited joint attention skills, few behavior problems, and a general interest in objects. Thus, our intervention may be most effective with children who share these pretreatment characteristics. Indeed, this is one line of questioning we will be addressing in our continued data collection. Since we are randomizing children to different treatments, we will ultimately include children who function lower and higher than those described here. These data will be critical in determining who benefits most from which treatment and whether there are long-term effects of treatment.