Tristram Smith

Randomized Trial of Intensive Early Intervention for Children With Pervasive Developmental Disorder

Young children with pervasive developmental disorder were randomly assigned to intensive treatment or parent training. The intensive treatment group (7 with autism, 8 with pervasive developmental disorder not otherwise specified--NOS) averaged 24.52 hours per week of individual treatment for one year, gradually reducing hours over the next 1 to 2 years. The parent training group (7 with autism, 6 with pervasive developmental disorder NOS) received 3 to 9 months of parent training. The groups appeared similar at intake on all measures; however, at follow-up the intensive treatment group outperformed the parent training group on measures of intelligence, visual-spatial skills, language, and academics, though not adaptive functioning or behavior problems. Children with pervasive developmental disorder NOS may have gained more than those with autism.

Randomized trial of intensive early intervention for children with pervasive developmental disorder.

Abstract Young children with pervasive developmental disorder were randomly assigned to intensive treatment or parent training. The intensive treatment group (7 with autism, 8 with pervasive developmental disorder not otherwise specified—NOS) averaged 24.52 hours per week of individual treatment for one year, gradually reducing hours over the next 1 to 2 years. The parent training group (7 with autism, 6 with pervasive developmental disorder NOS) received 3 to 9 months of parent training. The groups appeared similar at intake on all measures; however, at follow-up the intensive treatment group outperformed the parent training group on measures of intelligence, visual-spatial skills, language, and academics, though not adaptive functioning or behavior problems. Children with pervasive developmental disorder NOS may have gained more than those with autism.

Intensive Behavioral Treatment at School for 4- to 7-Year-Old Children With Autism A 1-Year Comparison Controlled Study

This study was designed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism. An independent clinician assigned children to either behavioral treatment (n = 13) or eclectic treatment (n = 12). Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference.The two treatment groups received similar amounts of treatment (M = 28.52 hours per week at the child’s school). Children in the behavioral treatment group made significantly larger gains on standardized tests than did children in the eclectic treatment group. Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment (not just its intensity) may account for favorable outcomes.

Discrete Trial Training in the Treatment of Autism

Discrete trial training (DTT) is a method for individualizing and simplifying instruction to enhance childrens learning. For children with autism, DTT is especially useful for teaching new forms of behavior (e.g., speech sounds or motor movements that the child previously could not make) and new discriminations (e.g., responding correctly to different requests). DTT can also be used to teach more advanced skills and manage disruptive behavior. However, several cautions about DTT are noteworthy: First, the method must be combined with other interventions to enable children to initiate the use of their skills and display these skills across settings. Second, early in treatment, children with autism may require many hours of DTT per week, although controversy exists over precisely how much is appropriate. Third, to implement DTT effectively, teachers must have specialized training. Despite these limitations, DTT is one of the most important instructional methods for children with autism.

Outcome for Children With Autism Who Began Intensive Behavioral Treatment Between Ages 4 and 7 A Comparison Controlled Study

This study extends findings on the effects of intensive applied behavior analytic treatment for children with autism who began treatment at a mean age of 5.5 years. The behavioral treatment group (n = 13, 8 boys) was compared to an eclectic treatment group (n = 12, 11 boys). Assignment to groups was made independently based on the availability of qualified supervisors. Both behavioral and eclectic treatment took place in public kindergartens and elementary schools for typically developing children. At a mean age of 8 years, 2 months, the behavioral treatment group showed larger increases in IQ and adaptive functioning than did the eclectic group. The behavioral treatment group also displayed fewer aberrant behaviors and social problems at follow-up. Results suggest that behavioral treatment was effective for children with autism in the study.

Intensive Behavioral Treatment for Preschoolers with Severe Mental Retardation and Pervasive Developmental Disorder.

From archival records, we assessed outcomes achieved by preschoolers with both severe mental retardation and autistic features: (a) an experimental group (n = 11), which received intensive behavioral treatment, and (b) a comparison group (n = 10), which received minimal treatment. At intake (mean CA = 3.08 years), the groups did not differ significantly on any variable. At follow-up children in the experimental group obtained a higher mean IQ and evinced more expressive speech than did those in the comparison group. Behavior problems diminished in both groups. Results indicate that intensively treated children achieved clinically meaningful gains relative to the comparison group but remained quite delayed.

A comprehensive behavioral theory of autistic children: Paradigm for research and treatment☆

Although behavioral treatment is the most effective intervention currently available for autistic children, there have been no attempts to present a comprehensive behavioral theory of autistic children since Ferster (1961). The present paper is intended to fill this gap. Behavioral work is distinguished from traditional work with autistic children in three ways: (a) it focuses on specific behaviors rather than on the diagnostic entity of autism; (b) it emphasizes the immediate environment rather than etiology or early history; and (c) research is inductive rather than hypothetico-deductive. The behavioral theory derived from such work has four tenets: (a) autistic childrens behaviors are consistent with laws of learning derived from the behavior of other organisms; (b) autistic children have many separate behavioral difficulties best described as a developmental delay; (c) despite their difficulties, many autistic children learn as much as other human beings in certain environments; and (d) their difficulties can be viewed as a mismatch between a deviant nervous system and average or typical environments rather than as a disease. A number of practical and theoretical problems remain that require further research and that would add to the present theory.

A Review of Subtyping in Autism and Proposed Dimensional Classification Model

Autism has been divided into subtypes based on social interaction/communication, developmental level, or both. The validity of subtyping systems and the extent to which they overlap were examined. According to this review, a single subtyping system capable of accounting for the symptom heterogeneity in autism has not yet been proposed; however, evidence supports the presence of a three-factor continuum containing at least four subgroups. Foremost among directions for future research is the need for comprehensive studies in which medical screening, careful selection of measures, and longitudinal data collection are included.

Interventions in schools for children with autism spectrum disorder: Methods and recommendations

Although researchers have identified many promising teaching strategies and intervention programs for children with autism spectrum disorder, research on implementation of these interventions in school settings has lagged. Barriers to implementation include incompletely developed interventions, limited evidence of their utility in promoting long-term and meaningful change, and poor fit with school environments. To overcome these barriers, interventions need to be detailed in manuals that identify key components yet allow for flexibility, and studies need to evaluate long-term, real-life outcomes. Innovative research strategies also may be important, particularly carrying out research on new interventions in school settings from the outset, conducting partial effectiveness trials in which study personnel administer interventions in school settings, using community-partnered participatory research approaches, and redesigning interventions in a modular format.

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

IMPORTANCE Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014. INTERVENTIONS Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. MAIN OUTCOMES AND MEASURES Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. RESULTS At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01233414.