OBJECTIVE To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). METHODS Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. RESULTS Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD:15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of grow thin adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. CONCLUSIONS This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.
The advancing social-communication and play (ASAP) intervention was designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum disorder are trained to implement the intervention in order to improve these children's social-communication and play skills. In this 4-year, multi-site efficacy trial, classrooms were randomly assigned to ASAP or a business-as-usual control condition. A total of 78 classrooms, including 161 children, enrolled in this study. No significant group differences were found for the primary outcomes of children's social-communication and play. However, children in the ASAP group showed increased classroom engagement. Additionally, participation in ASAP seemed to have a protective effect for one indicator of teacher burnout. Implications for future research are discussed.
The autism community represents a broad spectrum of individuals, including those experiencing autism, their parents and/or caregivers, friends and family members, professionals serving these individuals, and other allies and advocates. Beliefs, experiences, and values across the community can be quite varied. As such, it is important for the professionals serving the autism community to be well-informed about current discussions occurring within the community related to neurodiversity, a strengths-based approach to partnering with autism community, identity-first language, and concepts such as presumed competence. Given the frequency with which speech-language pathologists (SLPs) serve the autism community, the aim of this article is to introduce and briefly discuss these topics.
Purpose Speech-language pathologists (SLPs) and behavior analysts are key members of school-based teams that serve children with autism spectrum disorders (ASD). Behavior analysts approach assessment and intervention through the lens of applied behavior analysis (ABA). ABA-based interventions have been found effective for targeting skills across multiple domains for children with ASD. However, some SLPs may be unfamiliar with the breadth of ABA-based interventions. The intent of this tutorial is to briefly introduce key ABA principles, provide examples of ABA-based interventions used within schools, and identify strategies for successful collaboration between behavior analysts and SLPs. Method This tutorial draws from empirical studies of ABA-based interventions for children with ASD within school settings, as well as discussions in the extant literature about the use of behavior principles by SLPs and strategies for interdisciplinary collaboration. Conclusion Given the prevalence of ASD at 1 in 68 children (Centers for Disease Control and Prevention, 2014) and the high cost of serving these children within schools (an average cost of 286% over regular education; Chambers, Shkolnik, & Perez, 2003), the need for effective, comprehensive service provision and efficiency within interdisciplinary teams is paramount. Communication, mutual understanding, and recognition of common ground between SLPs and behavior analysts can lead to successful collaboration.
The data revealed interval sorting and kappa to be a suitable method for examining reliability of occurrence and duration of ongoing social communication behavioral dimensions. Nearly all comparisons yielded medium to large kappa values; interval size and length of observation minimally affected results. Implications The analysis procedure described in this research solves a challenge in reliability: comparing coding by independent observers of both occurrence and duration of behaviors. Results indicate the utility of a new coding taxonomy and technology for application in online observations of social communication in a classroom setting.
This study investigated the use of static assessment (SA) and dynamic assessment (DA) methodologies for examining the production of requests for information (RI) by children with autism spectrum disorders (ASD) and typically developing peers (TDP) within their school environment. Following an initial SA observation session, the effects of manipulating contextual and linguistic variables to facilitate the production of RI were systematically investigated across three DA sessions. The contextual variables included object/activity choice and physical setting (e.g., treatment room versus classroom). The linguistic variables included prompting of RI production in an attempt to enhance performance. Independent and paired t-test comparisons revealed statistically significant differences in production of RI between the TDP group and children with ASD. The environmental variables of object/activity choice and linguistic prompting appeared to influence performance for a subgroup of children with ASD. Clinical implications related to the importance of assessing performance using both static and dynamic methodologies are discussed.
Children with autism spectrum disorder (ASD) often present with varied skill profiles and levels of severity making development and implementation of specialized school services challenging. Research indicates that school professionals require and desire additional ASD-specific professional development, both at the pre- and in-service levels. Speech–language pathologists (SLPs) are one member of a school-based team who frequently serve children with ASD. Due to broad graduate training requirements (across the life span), SLPs receive limited ASD-specific clinical education, which may affect their contributions on school-based intervention teams. Given these issues, this article aims to briefly describe an apprenticeship model of clinical supervision, which may be well suited to preparing SLPs to significantly contribute to school teams serving children with ASD; present a case illustration of the use of this model within university graduate program; and briefly discuss implications for pre- and post-professional education and development.
Purpose Autistic adults use a variety of communication methods, including both speech and augmentative and alternative communication (AAC); however, there has been limited, if any, academic research in this area. The purpose of this study was to examine the experiences of speaking autistic adults who use AAC. Method Using a participatory research method, we completed an online survey that included five demographic questions and 29 open-ended questions related to communication choice, communication access, attitudes, and recommendations. Six autistic adults who use AAC participated. The data were analyzed with thematic analysis using an inductive approach at the semantic level. Results Participants reported identifying AAC as a communication choice as adults, after using speech during childhood. They described how forced communication choices have greatly impacted their lives, both historically and today, and reported on the successes they experience when communication autonomy is promoted within a supportive environment. Participants further described what impacts their in-the-moment decision making related to use of different communication methods. Finally, they discussed the importance of normalizing AAC use and disability in general and provided recommendations for other AAC users, families, and professionals. Conclusions Historically, AAC intervention was considered a “last resort” for children who did not develop functional speech. Speaking autistic adults encourage families, professionals, and society to promote and accept all communication as equal—ensuring opportunities for all children to develop full and rich communication without delay and without stigma.
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