Early communication development and intervention for children with autism

Autism is a neurodevelopmental disorder defined by impairments in social and communication development, accompanied by stereotyped patterns of behavior and interest. The focus of this paper is on the early development of communication in autism, and early intervention for impairments in communication associated with this disorder. An overview of components of communication is provided. Communication characteristics that are diagnostic of autism are summarized, with consideration of the overlap between social and communication impairment, particularly for children with autism functioning at the prelinguistic level. Early communication development and predictors of communication functioning in autism are examined, based on a review of prospective and retrospective studies. The focus of the discussion then turns to intervention. Consideration is given to the rationale for beginning intervention as early in life as possible for children with autism. Implications of motor, imitation, and play deficits for communication-based intervention are examined. Finally, issues related to the design and delivery of intervention for young children with autism are presented, along with a review of the major early intervention approaches for autism.     

A Social Stories intervention package for students with autism in inclusive classroom settings

A Social Stories intervention package was used to teach 2 students with autism to read Social Stories, answer comprehension questions, and engage in role plays. Appropriate social behaviors increased and inappropriate behaviors decreased for both participants, and the effects were maintained for up to 10 months. This intervention package appears to be useful in inclusive classroom environments and does not require intensive supervision of the child's behavior.     

Shaping approach responses as intervention for specific phobia in a child with autism

We evaluated contact desensitization (reinforcing approach responses) as intervention for specific phobia with a child diagnosed with autism. During hospital-based intervention, the boy was able to encounter previously avoided stimuli. Parental report suggested that results were maintained postdischarge.     

Parent voices: difficulty in accessing behavioral intervention for autism; working toward solutions

The history of autism treatment has been dominated by a series of failed treatments, passing fads, and misinformed theories of etiology. With the advances in teaching methods derived from the science of Applied Behavior Analysis however, significant remediation of the disorder is now possible. Yet at present parents or caregivers still face serious challenges in identifying scientifically‐validated treatment models, and in securing competent and well‐trained therapists. Four parents report on these challenges, on the steps they have taken to mitigate these difficulties in their own families, and on the long‐term solutions they are attempting to implement in the wider community. Copyright © 2001 John Wiley & Sons, Ltd.     

Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism

This study tested the effects of a parent-mediated intervention on parental responsiveness with their toddlers at high risk for an autism spectrum disorder (ASD).Participants included caregivers and their 66 toddlers at high risk for ASD. Caregivers were randomized to 12 sessions of an individualized parent education intervention aimed at improving parental responsiveness or to a monitoring control group involving 4 sessions of behavioral support. Parental responsiveness and child outcomes were measured at three time points: at beginning and end of the 3-month treatment and at 12-months post-study entry. Parental responsiveness improved significantly in the treatment group but not the control group. However, parental responsiveness was not fully maintained at follow up. There were no treatment effects on child outcomes of joint attention or language. Children in both groups made significant developmental gains in cognition and language skills over one year. These results support parental responsiveness as an important intervention target given its general association with child outcomes in the extant literature; however, additional supports are likely needed to fully maintain the treatment effect and to affect child outcomes.     

Pretend play: an application of an intervention program in autism

Methodologically and theoretically based on metarrepresentational deficit hypothesis, we design an intervention to teach the mental state of pretense to an autistic boy. The production and comprehension of symbolic play by means of the use of two specific strategies founded on pictorial analogy of the mental representation and process, was the focus of the learning. The efficiency and efectiveness of the program is reflected in the results that indicated the subject's competence to generate and comprehend the pretense as well as to generalize the acquired knowledge into other areas of mentalistic functioning. We discuss the possibility to develop a metarrepresentational knowledge based on the internalizing of the strategies of conceptual support.     

Differential rates of skill acquisition and outcomes of early intensive behavioral intervention for autism

Intensive behavioral intervention for very young children with autism has received increased attention in recent years. Researchers have documented unprecedented success in educating some young children with autism, although not every child makes dramatic developmental gains. It might be useful to identify early in treatment those children who will benefit most from the current methodology and who might require slight variations in instructional format or curricular focus. The present study suggests that initial learning rates are moderately correlated with treatment outcomes after two years. Among 20 children receiving early, intensive behavioral intervention, initial acquisition of skills was correlated with later learning rates, severity of autism symptomatology and adaptive behavior profiles two years into treatment. Implications are discussed, especially in light of the universal need for intensive intervention in this population. Copyright © 1999 John Wiley & Sons, Ltd.     

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.     

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.     

Prediction of treatment outcomes and longitudinal analysis in children with autism undergoing intensive behavioral intervention

Outcome prediction is an important component of treatment planning and prognosis. However, reliable predictors of intensive behavioral intervention (IBI) have not been clearly established. IBI is an evidence-based approach to the systematic teaching of academic, social, verbal, and daily living skills to individuals with autism spectrum disorder. Incorporating longitudinal analysis to IBI outcome studies may help to identify outcome predictors of clinical value. Twenty-four children with autism underwent on average two years of IBI and completed language, daily living skills, cognitive, and motor assessments (Early Learning Accomplishment Profile and the Learning Accomplishment Profile-Diagnostic, 3rd edition) every six months. We used multilevel analysis to identify potential longitudinal predictors including gender, age, intervention intensity, intervention duration, total intervention time, and pre-intervention functioning. Results indicated that total intervention time, pre-intervention functioning, and age caused the greatest increase in goodness-of-fit of the longitudinal multilevel models. Longitudinal analysis is a promising analytical strategy to identify reliable predictors of the clinical outcome of IBI.     

Social competence group intervention (SOCO) for children with autism spectrum disorder: A pilot study

This study aimed to describe concept of social competence as a theoretical background for social skills group intervention for children with autism spectrum disorder (ASD). A model of social competence comprised of three components: social skills, social performance, and social adjustment. We also examined the feasibility and preliminary efficacy of the manualized Social Competence group intervention for children with autism spectrum disorder (SOCO) using a variety of outcome measures. The nine-month intervention included children groups, parental support groups and co-operation with teachers. A pilot study involved 23 children aged 7 to 12 years (n = 16 intervention, n = 7 control) and intervention outcomes were measured with questionnaires for parents and teachers, neuropsychological tests, and observations. The parents of the intervention group reported improvements in social skills and social adjustment, whereas the teachers reported increases in social performance. Findings also indicated that affect recognition skills, social overtures, and reactions to peers were improved in the intervention group. Although the evidence of the pilot study should be considered as preliminary, it gives some indication of the feasibility of the SOCO group intervention and supports the usability of the theoretical background and approach for multiple outcome measures.     

A social competence intervention for young children with high functioning autism and Asperger syndrome: a pilot study

The key features of Asperger Syndrome (AS) and high functioning autism (HFA) include marked and sustained impairment in social interactions. A multi-session, small group program was developed to increase social perception based on the assumption perceptual or interpretive problems underlying these social difficulties. Additionally, the group format espoused a play therapy orientation and the use of sociodramatic play was the primary therapeutic modality used. Qualitative analyses of the data resulted in an explanation of the key changes in social interactions that took place through the course of the intervention. Although each participant's experience in this group was unique, all children in this program demonstrated improvements in their social interactions, as they experienced development both emotionally and behaviorally. Findings suggest that, despite their rigid interests and behavior patterns, the social limitations of these children improved when provided with the necessary environmental resources.     

Functional analysis and intervention of perseverative speech in students with high-functioning autism and related neurodevelopmental disabilities

Although perseverative speech is a common characteristic of individuals with high-functioning neurodevelopmental disabilities, little is known about the operant functions of these verbalizations. We conducted analogue functional analyses of perseverative speech for 2 students using reinforcement contingencies that included alone, attention, control, escape, and tangible conditions. Results showed the following patterns: attention only (Charlotte) or multiply determined including an attention function (Paul). We then tested an intervention for perseverative speech maintained by social positive reinforcement that included differential reinforcement of alternative behavior and extinction of perseverative speech for 1 participant. The intervention reduced perseverative speech, but did not increase appropriate speech until we added a prompting component. We then replicated this three-component intervention with Paul. The results showed moderate to high decreases in levels of perseverative speech and increased appropriate verbalizations in both cases. The results systematically replicated the interventions of previous studies by adding a prompting component to the intervention.     

Memory for actions in autism spectrum disorder

This study explored how memory for actions in children with autism spectrum disorder (ASD) and typically developing children might benefit from self-performance and experimenter demonstration, and whether these groups possess metamemory knowledge of their performance levels in this task. Children with autism were less accurate on the action memory task when they carried out each action themselves during encoding, or when no actions were implemented during this phase, but this difference was abolished when the experimenter demonstrated each action during encoding. Despite clear difficulties in the self-performed condition relative to typical children, the group with ASD also showed a beneficial effect of performing the actions themselves during instruction. Finally, children with autism were as accurate as typical children in judging the accuracy of their own memory performance, indicating an absence of metamemory difficulties for this task.     

Assessment and treatment of response to name for children with autism spectrum disorder: Toward an efficient intervention model

Response to name (RTN) is an early developmental milestone, deficits in which are associated with autism spectrum disorder (ASD). This study extends previous research by evaluating an assessment and treatment model for RTN with 13 children with ASD. For all participants, phase 1 was a naturalistic social baseline. The 9 children who did not meet mastery criteria in phase 1 underwent a series of treatment conditions in phase 2. In phase 3, treatment components were removed, and generalization was assessed. Results indicated that tangible reinforcement procedures can produce rapid increases in discriminated RTN, sometimes without prompts. The total number of trials to mastery were reduced in the current study relative to previous research. Results also provide preliminary evidence to suggest that the phase 1 baseline condition may produce distinct patterns of RTN that could be used to predict treatment effects and further reduce trials to mastery in future work.     

Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism

The current study used an AB crossover design to directly compare the effects of sensory integration therapy (SIT) and behavioral intervention (BI) on the challenging behavior of 10 participants with autism spectrum disorder. During the intervention phase, all participants received both treatments. Follow‐up probes were conducted 1 month following intervention for 4 participants implementing the more effective intervention. The results showed that BI successfully reduced challenging behavior to low‐ or near‐zero levels. In contrast, SIT resulted in higher and more variable rates of challenging behavior. One exception was noted for Participant 4 who engaged in a decreased level of challenging behavior during SIT. The findings are discussed in relation to implication for practice and future research.     

Outcome measures for clinical drug trials in autism

This paper identifies instruments and measures that may be appropriate for randomized clinical trials in participants with autism spectrum disorders (ASDs). The Clinical Global Impressions scale was recommended for all randomized clinical trials. At this point, however, there is no "perfect" choice of outcome measure for core features of autism, although we will discuss five measures of potential utility. Several communication instruments are recommended, based in part on suitability across the age range. In trials where the intention is to alter core features of ASDs, adaptive behavior scales are also worthy of consideration. Several "behavior complexes" common to ASDs are identified, and instruments are recommended for assessment of these. Given the prevalence of cognitive impairment in ASDs, it is important to assess any cognitive effects, although cognitive data from ASD randomized clinical trials, thus far, are minimal. Guidance from trials in related pharmacologic areas and behavioral pharmacology may be helpful. We recommend routine elicitation of side effects, height and weight, vital signs, and (in the case of antipsychotics) extrapyramidal side-effects assessment. It is often appropriate to include laboratory tests and assessments for continence and sleep pattern.     

Evidence for syntactic alignment in children with autism

We report an experiment that examined whether children with Autistic Spectrum Disorder (ASD) spontaneously converge, or align, syntactic structure with a conversational partner. Children with ASD were more likely to produce a passive structure to describe a picture after hearing their interlocutor use a passive structure to describe an unrelated picture when playing a card game. Furthermore, they converged syntactic structure with their interlocutor to the same extent as did both chronological and verbal age-matched controls. These results suggest that the linguistic impairment that is characteristic of children with ASD, and in particular their difficulty with interactive language usage, cannot be explained in terms of a general deficit in linguistic imitation.