Placebo‐like response in absence of treatment in children with Autism

Jones, Rebecca M.; Carberry, Caroline; Hamo, Amarelle; Lord, Catherine

doi:10.1002/aur.1798

Cited by 51 publications

(48 citation statements)

References 29 publications

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“…Many systems used for tracking treatment outcomes are based on parent report via interviews or questionnaires or expert clinical assessment. However, recent research has highlighted the presence of a striking placebo effect in ASD populations: even when outcome evaluators are masked to treatment condition, significant improvements are still reported in a surprisingly substantial number of participants assigned to control conditions [Bradshaw et al, ; Jones, Carberry, Hamo, & Lord, ; Masi, Lampit, Glozier, Hickie, & Guastella, ]. This, in addition to the cost of training and maintaining fidelity on clinically based measures, leads us to believe that neither questionnaires nor clinical phenotyping are optimal outcome measures.…”

Section: Introductionmentioning

confidence: 99%

The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism

et al. 2019

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There is a pressing need for objective, quantifiable outcome measures in intervention trials for children with autism spectrum disorder (ASD). The current study investigated the use of eye tracking as a biomarker of treatment response in the context of a pilot randomized clinical trial of treatment for young children with ASD. Participants included 28 children with ASD, aged 18-48 months, who were randomized to one of two conditions: Pivotal Response Intervention for Social Motivation (PRISM) or community treatment as usual (TAU). Eye-tracking and behavioral assessment of developmental functioning were administered at Time 1 (prior to randomization) and at Time 2 (after 6 months of intervention). Two well-established eye-tracking paradigms were used to measure social attention: social preference and face scanning. As a context for understanding relationships between social attention and developmental ability, we first examined how scanning patterns at Time 1 were associated with concurrent developmental functioning and compared to those of 23 agematched typically developing (TD) children. Changes in scanning patterns from Time 1 to Time 2 were then compared between PRISM and TAU groups and associated with behavioral change over time. Results showed that the social preference paradigm differentiated children with ASD from TD children. In addition, attention during face scanning was associated with language and adaptive communication skills at Time 1 and change in language skills from Time 1 to Time 2. These findings highlight the importance of examining targeted biomarkers that measure unique aspects of child functioning and that are well-matched to proposed mechanisms of change. Autism Res 2019, 12: 779-793.Lay Summary: Biomarkers have the potential to provide important information about how and why early interventions effect positive change for young children with ASD. The current study suggests that eye-tracking measures of social attention can be used to track change in specific areas of development, such as language, and points to the need for targeted eye-tracking paradigms designed to measure specific behavioral changes. Such biomarkers could inform the development of optimal, individualized, and adaptive interventions for young children with ASD.

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Section: Introductionmentioning

confidence: 99%

The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism

et al. 2019

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“…Language difficulties are a hallmark of neurodevelopmental disorders with the majority of behavioral interventions targeting spoken language [Abbeduto, McDuffie, Thurman, & Kover, 2016]. Changes in social communication are commonly assessed through caregiver or clinician report [Budimirovic et al, 2017;McConachie et al, 2015], yet these measurements can be biased by expectations [Guastella et al, 2015;Jones, Carberry, Hamo, & Lord, 2017;Jones et al, 2015;King et al, 2013;Jones, Tarpey, Hamo, Carberry, & Lord, 2018], warranting the need for objective, direct measures from the child. Speech from the child is typically assessed through human, manual transcriptions [Berry-Kravis et al, 2013;Sheinkopf, Mundy, Oller, & Steffens, 2000]; however, these procedures are costly and time intensive.…”

Section: Introductionmentioning

confidence: 99%

How effective is LENA in detecting speech vocalizations and language produced by children and adolescents with ASD in different contexts?

Jones

Skwerer

Pawar³

et al. 2019

Autism Research

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The LENA system was designed and validated to provide information about the language environment in children 0 to 4 years of age and its use has been expanded to populations with a number of communication profiles. Its utility in children 5 years of age and older is not yet known. The present study used acoustic data from two samples of children with autism spectrum disorders (ASD) to evaluate the reliability of LENA automated analyses for detecting speech utterances in older, school age children, and adolescents with ASD, in clinic and home environments. Participants between 5 and 18 years old who were minimally verbal (study 1) or had a range of verbal abilities (study 2) completed standardized assessments in the clinic (study 1 and 2) and in the home (study 2) while speech was recorded from a LENA device. We compared LENA segment labels with manual ground truth coding by human transcribers using two different methods. We found that the automated LENA algorithms were not successful (<50% reliable) in detecting vocalizations from older children and adolescents with ASD, and that the proportion of speaker misclassifications by the automated system increased significantly with the target‐child's age. The findings in children and adolescents with ASD suggest possibly misleading results when expanding the use of LENA beyond the age ranges for which it was developed and highlight the need to develop novel automated methods that are more appropriate for older children. Autism Research 2019, 12: 628–635. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Current commercially available speech detection algorithms (LENA system) were previously validated in toddlers and children up to 48 months of age, and it is not known whether they are reliable in older children and adolescents. Our data suggest that LENA does not adequately capture speech in school age children and adolescents with autism and highlights the need to develop new automated methods for older children.

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“…Recent findings from a simulated 8-week clinical trial protocol for ASD [Jones, Carberry, Hamo, & Lord, 2017] showed placebo-like (positive) responses in caregiver ratings even in absence of treatment, while no significant changes in clinical ratings of ASD symptoms were noted.…”

Section: Discussionmentioning

confidence: 96%

“…Recent findings from a simulated 8‐week clinical trial protocol for ASD [Jones, Carberry, Hamo, & Lord, ] showed placebo‐like (positive) responses in caregiver ratings even in absence of treatment, while no significant changes in clinical ratings of ASD symptoms were noted. This study indicates that a placebo‐like effect is less likely to influence independent expert ratings, whereas therapists and caregivers will tend to overestimate intervention effects because they believe in the intervention they administer and in their therapeutic orientation.…”

Section: Discussionmentioning

confidence: 99%

Process research in early intensive intervention in autism spectrum disorder: Sensitivity to change of the autism behavior coding system

Herbrecht¹,

Lazari²,

Notter³

et al. 2019

Autism Research

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The development of sensitive measures to capture changes in core autism symptoms is crucial in early intervention research. The study examines the sensitivity to change of the Autism Behavior Coding System (ABCS), a video‐based instrument to assess core autism symptoms during therapist‐child interaction. Video sequences of 40 young children treated in the Frühintervention bei Autistischen Störungen center were analyzed with regard to the question of whether short‐term changes during an 18 day period of early intervention could be captured, and whether these results are reflected in an independent clinical assessment (Developmental Disorders‐Child‐Global Assessment Scale [DD‐C‐GAS]). ABCS results showed statistically significant improvements on behavioral domains such as “expression of wishes” and “social cooperative behavior” (P < 0.01), less pronounced on “eye contact.” Improvements on the DD‐C‐GAS were highly significant on all subdomains. Both scales showed high correlations within their subdomains, yet no significant correlations between the changes in both instruments' scores were found. An additional analysis between the DD‐C‐GAS scores at day 18 and the changes in the ABCS scores showed statistically significant associations in the expected direction between the changes in the variable “eye contact” and all DD‐C‐GAS subdomains. The correspondence of the two levels of assessment is low, but the specifics of this relationship deserve further study. The ABCS may prove useful in addition to standard assessment tools, especially in early intervention research settings, as it allows reliable analysis of core behavioral elements in young children with autism. Autism Res 2019, 12: 1817–1828. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.Lay SummaryThe study examined the sensitivity of an autism‐specific video coding system (ABCS) in assessing changes after an 18 day period of intensive early intervention. Video sequences of therapist‐child‐interaction of 40 young children with autism spectrum disorder (ASD) were analyzed. Children's behavior improved in expression of wishes, social cooperativity and eye contact. A therapist‐based global assessment scale also showed important improvement after 18 days, yet both assessment instruments showed weak correlations between their respective changes. We showed that the ABCS may prove useful in capturing short‐term changes in autism‐related behaviors, especially in early intervention research.

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Placebo‐like response in absence of treatment in children with Autism

Cited by 51 publications

References 29 publications

The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism

The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism

How effective is LENA in detecting speech vocalizations and language produced by children and adolescents with ASD in different contexts?

Process research in early intensive intervention in autism spectrum disorder: Sensitivity to change of the autism behavior coding system

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