Veronica Smith

Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review

Background Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD. Methods and Findings Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration. Conclusions While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.

Systematic reviews of psychosocial interventions for autism: an umbrella review

Aim  A wide range of psychosocial interventions for the treatment of individuals with autism‐spectrum disorders (ASDs) have been evaluated in systematic reviews. We conducted an umbrella review of systematic reviews of the effectiveness of psychosocial interventions for ASD.

Social Stories™ to improve social skills in children with autism spectrum disorder: A systematic review

Over the past 20 years a variety of treatments have been developed to remediate deficits associated with autism. Since the early 1990s, Social Stories™ have been suggested to positively affect the social development of children with autism spectrum disorder (ASD). Despite much research, there remains uncertainty regarding the effectiveness of this modality. We conducted a systematic review of the literature using pre-defined, rigorous methods. Studies were considered eligible if they were controlled trials evaluating Social Stories™ among persons with ASD. Two reviewers independently screened articles for inclusion, applied eligibility criteria, extracted data, and assessed methodological quality. A qualitative analysis was conducted on six eligible controlled trials. Five of the six trials showed statistically significant benefits for a variety of outcomes related to social interaction. This review underscores the need for further rigorous research and highlights some outstanding questions regarding maintenance and generalization of the benefits of Social Stories™.

A systematic review of training programs for parents of children with autism spectrum disorders: Single subject contributions

Aim: The purpose of this systematic review was to examine research utilizing single subject research designs (SSRD) to explore the effectiveness of interventions designed to increase parents’ ability to support communication and social development in children with autism spectrum disorders (ASDs). Method: Included studies were systematically assessed for methodological quality (Logan et al., 2008; Smith et al., 2007) and intervention effects. Data examining participant characteristics, study methodology, outcomes, and analysis were systematically extracted. Results: Eleven SSRD parent-training intervention studies examining 44 participants with ASD were included. Overall, the studies were of moderate quality and reported increases in parent skills and child language and communication outcomes. Interpretation: The results supported by improvement rate difference (IRD) analysis indicated several interventions demonstrated positive effects for both parent and child outcomes. However, limited generalization and follow-up data suggested only one intervention demonstrated parents’ accurate and ongoing intervention implementation beyond training.

Behavioural intervention practices for stereotypic and repetitive behaviour in individuals with autism spectrum disorder: a systematic review

Aim  The purpose of this systematic review was to examine the quality of conduct of experimental studies contributing to our empirical understanding of function‐based behavioural interventions for stereotypic and repetitive behaviours (SRBs) in individuals with autism spectrum disorders (ASDs).

Enabling 2-wheeled cycling for youth with Down syndrome

Purpose: To study the effectiveness of cognitive orientation to daily occupational performance (CO-OP) to teach motor skills to youth with intellectual disabilities. Methods: Six youth aged 12 to 19 years participated in this study. A multiple baseline design was employed to evaluate distance and time cycled, and a pre-post-follow-up design was used to evaluate the effect on cycling skills mastered, cycling performance, and parent satisfaction. Results: At follow-up, 5 of the 6 youth rode their 2-wheeled bicycles over 100 m in their communities (range, 103-1400 m) and demonstrated improved cycling skills and parent satisfaction. Conclusions: The skills acquired by youth with Down syndrome using a CO-OP approach exceeded what has been reported in the literature. CO-OP offers a promising alternative to existing approaches for teaching 2-wheeled cycling to youth with Down syndrome.

Mindfulness Activities and Interventions that Support Special Populations

Over the past decade, a body of literature has emerged examining the role of mindfulness with children, youth, and adults with special learning needs, and with their teachers and professional caregivers. The findings from mindfulness programs that have been offered to special education teachers and professional caregivers are promising. Effects of the programs include reductions in stress and “burnout,” more effective “reappraisal” of situations and high acceptance of the programs by teachers. For children with special needs, mindfulness appears to have positive outcomes, especially in regard to decreased anxiety, improved on task behavior, and decreased depression and rumination. This review reveals that mindfulness is a promising approach for delivering needed supports for students with special needs. While there are promising effects for some targeted developmental issues, more work is needed to specify who will benefit from mindfulness programs and how the positive effects can endure and translate to other settings.

Autism Spectrum Disorders: Information for Pediatricians Supporting Families of Young Children on the Spectrum

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting in US 1 in 110 individuals.(1) As increasingly younger children are receiving ASD diagnoses, many pediatricians are now faced with the unique needs of parents and other caregivers of newly diagnosed toddlers and young children. This chapter provides an overview of ASD designed to offer information and resources to pediatricians that could, in turn, be provided to families of children newly diagnosed with ASD.

Social scripts and visual cues for children with ASD: More evidence for increasing context appropriate conversation and suggested collateral effects

Abstracted from: Ganz, J. B., Kaylor, M., Bourgeois, & Haddon, K. (2008). The impact of social scripts and visual cues on verbal communication in three children with autism spectrum disorders. Focus on Autism and Developmental Disabilities, 23, 79–94. Source of funding: Mini-grant from the College of Education and Human Development at the University of Texas at San Antonio, USA.