PLATE A–PLATE B: USE OF SEQUENTIAL PRESENTATION IN THE TREATMENT OF FOOD SELECTIVITY

This study examined the effects of sequential presentation of foods on increasing acceptance of novel foods in a 16‐year‐old boy with autism spectrum disorder residing in a short‐term behavioral stabilization unit. The participant ate only 10 foods and one beverage prior to treatment. The intervention involved presenting a plate containing pea‐sized bites of novel foods (Plate A) and a plate containing spoonful‐sized bites of highly preferred foods (Plate B). After the participant consumed a bite from Plate A, he chose a bite from Plate B and was given a preferred beverage. The intervention, involving sequential presentation and establishing operations without the use of escape extinction, was successful in increasing the number of foods eaten from 10 to 24 while not increasing his maladaptive behaviors. Copyright © 2012 John Wiley & Sons, Ltd.     

PROMOTING RECIPROCAL INTERACTIONS VIA PEER INCIDENTAL TEACHING

This study evaluated peer incidental teaching as a strategy for increasing reciprocal peer interactions by children with autism. Three typical preschoolers were trained as peer tutors for 3 young children with autism. During a classroom free-play session, peer tutors used incidental teaching to obtain verbal labels of preferred toys by children with autism. A multiple baseline across the 3 target children showed replicated positive effects of the intervention. Adult supervision and assistance were then faded systematically, with resulting maintenance of increased reciprocal interactions. Multiple measures of the extent and limits of generalization suggested that 1 child increased interactions in free-play periods throughout the day, but none of the children showed increases at lunch. Teacher and peer ratings supported the social validity of positive findings.     

Family Experience of Safe: A New Intervention for Families of Children with a Diagnosis of Autism Spectrum Disorder

Systemic Autism-related Family Enabling (SAFE) is a new intervention for families of children with a diagnosis of Autism Spectrum Disorder (ASD). SAFE responds to international and national recommendations for improved care and the reported needs of families. SAFE draws from Family Therapy techniques, Attachment Narrative Therapy and known preferences of individuals with autism. Twenty two families of a child with a diagnosis of ASD severity level 1 or 2 were recruited. The families attended five 3-hour sessions. Family members completed the Helpful Aspects of Therapy Questionnaire (HAT) after each session. Analysis of the HAT data revealed that adults and children experienced SAFE to be helpful which was elaborated in terms of the following themes: therapist as helping reflection, increased understanding, feeling closer, more confident to reflect and problem solve, improved communication and feeling less alone and isolated. The findings are discussed to consider how SAFE can be improved and implemented to offer support for families. SAFE is a good candidate to fill a gap in autism related care.

     

Promoting healthy food consumption among young children: Evaluation of a multi-component nutrition education program

This study was an outcome evaluation of a multi-component nutrition education program for African American kindergarten and first grade students attending an under-resourced urban school. The program focused on increasing fruit and vegetable knowledge and vegetable consumption during school lunch. It included a classroom-based knowledge change component, a lunchtime-based behavior-change component, and a home component. This program was unique in that natural helpers in the school (i.e., paraprofessionals) were enlisted as agents of behavior change. Findings indicated that the program was considered socially valid from the perspectives of students, teachers, and paraprofessional community assistants. Implementation integrity was acceptable for the classroom intervention, but highly variable for the lunchtime intervention. Program outcomes demonstrated that knowledge change was high, but behavior change was variable. Inconsistent behavioral effects appeared to be related in part to the variable level of intervention integrity. The challenges of promoting intervention integrity with paraprofessionals were discussed, and strategies for improving integrity were outlined.     

Liquid rescheduling for the treatment of rumination

A pre‐intervention assessment was conducted to determine the conditions under which rumination by a 19‐year‐old man with autism was most and least likely to occur. The results of the assessment suggested that rumination was least likely when the participant did not consume liquids with meals and when he consumed peanut butter during meals. Based upon the results of the assessment, an intervention consisting of rescheduling access to liquids (i.e., no liquids during meals) was evaluated across both breakfast and lunch at the participant's school placement. Results suggest that the intervention was effective in reducing rumination. Copyright © 2003 John Wiley & Sons, Ltd.     

Emotion-Focused Therapy for Autism Spectrum Disorder: A Case Conceptualization Model for Trauma-Related Experiences

People with autism spectrum disorder (ASD) report painful experiences through emotional misunderstandings with typically developing peers. There are limited intervention methodologies for ASD on the impact of emotional injuries and how to work with resulting trauma. This paper presents a rational-empirical model of trauma-related experiences with the first presentation of a new case conceptualization model for emotion-focused therapy for ASD. It describes the transformation of problematic emotion schemes through a sequence of emotional processing steps illustrated with a case example. These steps include: overcoming differentiation of core painful feelings (such as loneliness, shame, and fear); autobiographical memory recall of distanced trauma, using a novel method of video Interpersonal Process Recall; and articulation of the unmet needs contained in core painful feelings. This is followed by the expression of an emotional response to those feelings/needs; typically, self-soothing, protective anger and compassion responses offered interpersonally by group members. These emerging adaptive emotions facilitate mentalization of self and other that strengthens intrapersonal and interpersonal agency. This rational-empirical case conceptualization acts as a hypothesis for testing in subsequent trials.     

Parent–child interaction therapy (PCIT) in young children with autism spectrum disorder

Abstract

Parent–child interaction therapy (PCIT) is an evidence-based treatment for typically developing children with disruptive behavior. We conducted a randomized-controlled trial of PCIT versus wait-list control (WLC) with 23 children with ASD (3–7?years) and disruptive behavior. Over 16 treatment sessions, PCIT significantly predicted reductions in disruptive behavior over WLC and explained a significant variation in scores on the ECBI Intensity subscale. Additionally, parent skills improved significantly compared to WLC. However, no statistically significant group differences were found on child compliance rates, autism severity, or parental stress. Results support PCIT as an evidence-based treatment for disruptive behavior in ASD.

• Highlights

• Parent skills were significantly improved for those receiving PCIT

• Intensity of disruptive behaviors decreased significantly for those receiving PCIT

• Parental stress and autism severity did not significantly decrease with PCIT

     

Increasing Behavioral Variability and Social Skill Accuracy in Children with Autism Spectrum Disorder

Although social skills training for children with autism spectrum disorder (ASD) often addresses deficits in social communication, restricted and repetitive social behaviors are less frequently targeted in the literature. The present study evaluated a manualized social skills training program, modified to incorporate lag schedules of reinforcement, to promote appropriate and variable responding in three children in a school setting. Participants attended social skills once weekly, with probes of social skills taking place daily. A multiple baseline design across target skills was used to determine intervention efficacy. Results of the study indicated that the social skills curriculum incorporating lag schedules of reinforcement resulted in substantial increases in the number of appropriate and variable responses demonstrated by participants during each probe session, as well as the number of appropriate and variable responses demonstrated overall.     

An evaluation of a multi-component intervention for loud speech among children with autism spectrum disorder

Idiosyncratic patterns of speech are common among individuals with autism spectrum disorder (ASD) and can greatly affect their ability to participate successfully in various social and educational settings. We evaluated a treatment package with three children with ASD and a history of loud speech. A multiple baseline across participants design and a decibel meter application were used to evaluate whether the multi-component intervention (i.e., a rule, differential reinforcement, and in vivo feedback) would effectively reduce participants' rates of loud speech. The results showed that the intervention decreased rates of loud speech for all participants. Results are discussed in terms of (a) their extension of the literature regarding speech prosody in ASD by demonstrating an effective intervention for loud speech, (b) clinical implications, and (c) potential future research regarding this nuanced, yet crucial aspect of social communication, including appropriate methods for addressing loud speech in individuals with ASD.     

Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

A PEER-MEDIATED SOCIAL NETWORK INTERVENTION TO ENHANCE THE SOCIAL INTEGRATION OF PERSONS WITH MODERATE AND SEVERE DISABILITIES

Increasingly, parents, teachers, and students with disabilities are advocating for interventions that go beyond skill training to provide support for participation in integrated environments and support for friendships. The present research demonstrated a social network intervention for youths with moderate and severe disabilities. Two groups of nondisabled peers were recruited to participate in weekly discussions with an adult integration facilitator to increase opportunities for social interaction for 2 students (1 with autism and 1 who was moderately mentally retarded). The groups met to discuss social interactions that had occurred with the students with disabilities and to talk about strategies to promote greater inclusion of the students into ongoing social interaction. The nondisabled students participated in the design and implementation of social skills interventions during transition times and lunch. The nondisabled students used self-monitoring data sheets to record the quantity and quality of interactions. The frequency of interaction, number of opportunities for interaction, and appropriateness of social interactions were analyzed with a multiple baseline design. Results indicated that the social network intervention was successful in increasing the quantity and quality of interactions and that the network strategy promoted the development of friendships. The results are discussed in terms of the need for additional research showing the relationships between increases in social competence, peer-mediated intervention, and the development and support of friendship.     

Telehealth parent training for a young child at risk for autism spectrum disorder

The global pandemic has highlighted the importance of telehealth to access behavioral interventions. Face-to-face parent training improves the development and behaviors of young children at risk for autism spectrum disorder (ASD). We evaluated a telehealth parent training intervention for a child at risk for ASD. Two parents identified possible early ASD symptoms in their 30-month-old son (lack of imitation, pointing, and vocal manding). Both parents simultaneously received telehealth behavioral skills training on the Parent Intervention for Children at Risk for Autism program for 1 hour per week over 29 weeks. Multiple baseline designs across parent and child behaviors showed that both parents improved their parent teaching fidelity above 80% and the child improved on all trained behaviors. This study expands the utility of telehealth behavioral parent training to young children at risk for ASD to mitigate early symptoms of ASD.     

The effects of a behavioral skills training and general‐case training package on caregiver implementation of a food selectivity intervention

We used behavioral skills training with general‐case training to teach 3 caregivers to implement a behavioral feeding intervention with their children. The percentage of correctly performed steps of the feeding intervention increased for all 3 caregivers and was maintained at follow‐up. For all 3 children, the number of bites consumed increased and the number of bites with inappropriate mealtime behavior decreased across treatment. Increases in bites consumed and bites without behavior problems were maintained for 2 participants at follow‐up.     

Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder

Food selectivity is a common problem for children with autism spectrum disorder (ASD; Schreck, Williams, & Smith, 2004). Behavior‐analytic interventions have the most empirical support for feeding disorders (Sharp, Jaquess, Morton, & Miles, 2011). However, there are no randomized controlled trials that have evaluated its effects with a well‐defined cohort of children with ASD. In the current investigation, we randomly assigned 6 young children with ASD and food selectivity to either an applied behavior analytic intervention or a wait‐list control. We used a crossover randomized controlled trial to evaluate the effects of a multicomponent applied behavior analytic intervention on independent acceptance and mouth clean of 16 novel foods. We subsequently exposed the wait‐list control group to the intervention. We also evaluated the effects of the intervention on individual participants with single‐case designs. The percentage of independent acceptance and mouth clean increased for the applied behavior analytic intervention group, but not for the wait‐list control group until we implemented the intervention.     

Effects of Lag Schedules and Response Blocking on Variant Food Consumption by a Girl with Autism

Food selectivity by individuals with autism spectrum disorder (ASD) is often viewed in the behavioral literature as a problem with compliance and treated accordingly. However, when viewed as a problem with invariance, it may be appropriate to treat the problem by using procedures that increase variant food consumption. Lag schedules of reinforcement have been shown to increase variability in verbal and play behavior of children with ASD. Therefore, we attempted to evaluate the effects of a lag schedule of positive reinforcement on variant food consumption by a girl with ASD and food selectivity. Ultimately, a lack of baseline variability in consumption precluded an evaluation of the programmed lag schedule but suggested that a discovery research approach may be informative. Thus, additional treatment components were added and evaluated in a component analysis. Response blocking of invariant consumption appeared to establish a lag schedule of reinforcement that increased variability and variety in food consumption, which was maintained across changes in the value of the lag schedule. Some potential behavioral processes responsible for the effects and implications for future research are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

Using concurrent reinforcement schedules and prompts to produce varied manding: A replication of Seaver and Bourret (2020)

Deficits in social communication and restricted, repetitive patterns of behavior or interests are displayed by individuals with autism spectrum disorder (ASD; American Psychiatric Association, 2013). Given this, individuals with ASD may engage with a limited variety of reinforcers. Treatments designed to modify the distribution of manding may allow individuals to contact a broad array of reinforcers that could improve the quality of life for individuals with ASD (Seaver & Bourret, 2020). The purpose of the current study was to replicate the results of Seaver and Bourret (2020) by evaluating the effects of manipulating concurrent schedules of reinforcement, alone and with prompts, on the rates of target manding in three boys with ASD, aged 7–9 years, in the United Arab Emirates. All three participants showed increased target manding following intervention. The findings support the use of concurrent reinforcement schedules and prompts as an effective intervention to produce varied manding.     

Teaching conversational speech to children with autism spectrum disorder using text‐message prompting

The present study was designed to teach conversational speech using text‐message prompts to children with autism spectrum disorder (ASD) in home play settings with siblings and peers. A multiple baseline design across children was used. Children learned conversational speech through the text‐message prompts, and the behavior generalized across peers and settings. Maintenance of treatment gains was seen at 1‐month follow‐up probes. Social validity measures indicated that parents of typically developing children viewed the participants' conversational speech as much improved after the intervention. Results are discussed in terms of the efficacy of text‐message prompts as a promising way to improve conversational speech for children with ASD.     

Restricted interests and teacher presentation of items

Restricted and repetitive behavior (RRB) is more pervasive, prevalent, frequent, and severe in individuals with autism spectrum disorders (ASDs) than in their typical peers. One subtype of RRB is restricted interests in items or activities, which is evident in the manner in which individuals engage with items (e.g., repetitious wheel spinning), the types of items or activities they select (e.g., preoccupation with a phone book), or the range of items or activities they select (i.e., narrow range of items). We sought to describe the relation between restricted interests and teacher presentation of items. Overall, we observed 5 teachers interacting with 2 pairs of students diagnosed with an ASD. Each pair included 1 student with restricted interests. During these observations, teachers were free to present any items from an array of 4 stimuli selected by experimenters. We recorded student responses to teacher presentation of items and analyzed the data to determine the relation between teacher presentation of items and the consequences for presentation provided by the students. Teacher presentation of items corresponded with differential responses provided by students with ASD, and those with restricted preferences experienced a narrower array of items.     

Patterns of language and discourse comprehension skills in school‐aged children with autism spectrum disorders

Åsberg, J. (2010). Patterns of language and discourse comprehension skills in school‐aged children with autism spectrum disorders. Scandinavian Journal of Psychology 51, 534–539. The present study examined patterns of language and discourse comprehension skills in Swedish school‐aged children with autism spectrum disorders (ASD) (n = 16) as compared to a slightly younger group of typically developing children (n = 16) matched for non‐verbal cognitive ability. Results suggested significantly lower abilities in narrative discourse comprehension for the ASD group, but not in oral receptive vocabulary or reception of grammar. This difficulty with discourse‐level comprehension appeared to be of a general nature, as no evidence was found for the hypothesis that participants with ASD would find comprehension of inferential discourse information disproportionally more difficult than stated information, or for the hypothesis that discourse processing in ASD would be characterized by an elevated processing of explicitly stated narrative details. The study has clinical and educational implications, as the findings suggest that children with ASD would benefit from being offered specific support for discourse‐level comprehension.