Effects of Serial Multiple Exemplar Training on Bidirectional Naming in Children with Autism.

This study examined the effect of a serial multiple exemplar training (S-MET) procedure on bidirectional naming (BiN) in four preschool children diagnosed with autism spectrum disorder (ASD). A non-concurrent multiple baseline design was used to evaluate the effects of training listener and speaker behavior for one stimulus at a time until BiN occurred. When BiN occurred, probes were conducted to measure whether generalization occurred across settings and people. Three out of four participants' responding met the mastery criterion for BiN, while the fourth participant improved her performance. The results of this study suggest that S-MET may be a promising intervention and contribute to our knowledge about learning histories required for BiN.

Experimental assessment of seizure-like behaviors in a girl with Rett syndrome.

Contextual events are recognized to affect seizure-like behaviors, yet there is limited research on procedures assessing contextual control. This study aimed to examine the utilization of a brief experimental precursor functional analysis within a clinical team assessment. Furthermore, the study explored if telehealth supervision could guide a parent administered replication of the functional analysis. The participants were a young female with Rett syndrome and a history of epilepsy as well as non-epileptic seizures and her mother. The functional analysis procedures consisted of the systematic alternations of contextual conditions that were hypothesized to either prevent or evoke seizure-like behaviors. The primary outcome measure was the occurrence of behavioral precursors that were identified to consequently signal subsequent seizure-like behaviors. In addition, procedure fidelity and interobserver agreement data were obtained alongside parent rating of the procedure's social validity. The clinical functional analysis clearly suggested that the seizure-like behaviors served the function of access to attention and preferred activities. A parent administered functional analysis replicated clinical functional analysis findings. The parent's fidelity to procedures was high and scores in social validity were excellent. The results show that functional analysis procedures could provide essential information in assessment of non-epileptic seizures. Strengths and limitations are discussed.

Emergent Intraverbal and Reverse Intraverbal Behavior Following Listener Training in Children with Autism Spectrum Disorder.

We evaluated whether intraverbal and reverse intraverbal behavior emerged following listener training in children with autism spectrum disorder (ASD). Six participants were each taught three sets of three "when?" questions in listener training. A multiple baseline design across behaviors (stimulus sets) was used to assess the effects of listener training. Results showed that intraverbal behavior emerged following listener training for five out of six participants. One participant received additional listener training and intraverbal training before intraverbal behavior emerged. Furthermore, reverse intraverbal responding occurred across all three sets of questions for three of the six participants. Establishing listener behavior may be a pathway for emergent intraverbal and reverse intraverbal responding in children with ASD. Future research could examine what skill repertoire may facilitate such transfer.

Intensive behavioural interventions based on applied behaviour analysis for young children with autism: An international collaborative individual participant data meta-analysis.

LAY ABSTRACT: Early intensive applied behaviour analysis-based interventions are designed to support young autistic children's learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis-based interventions might lead to some changes in children's cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.

Moderate Effects of Low-Intensity Behavioral Intervention.

We compared clinical outcomes in a treatment group of 98 individuals who received between 8 and 15 weekly hours (M = 10.6; SD = 1.7) of applied behavior analysis (ABA) intervention with a comparison group of 73 individuals who received another provision, including some ABA, (between 1.4-8 weekly hours, M = 5.7; SD = 1.6). After 2 years, the treatment group made greater gains than the comparison group on language and social skills, and other areas assessed by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). We evaluated the outcome on adaptive skills for a smaller sample of participants using the Vineland Adaptive Behavior Scales II (VABS), but found no significant differences between the treatment (n = 17) and comparison groups (n = 11). Although the treatment group made important and clinically meaningful gains, the gains were moderate. These findings underline the importance of intervention intensity and provide further support for a dose-response relationship between ABA intervention hours and outcomes.

Effects of Functional Discrimination Training on Initial Receptive Language in Individuals With Autism Spectrum Disorder.

The success of behavior-analytic procedures to teach language to individuals with autism spectrum disorder (ASD) has been well established in the literature. Nevertheless, some individuals may not learn any receptive or expressive language following extensive teaching efforts. We examined the effects of two reinforcement contingencies, functional and arbitrary, on increasing the level of auditory-visual conditional discriminations in children with ASD with a history of having difficulty learning discriminations. We evaluated the effects of the reinforcement contingencies by comparing the number of trials needed to establish discriminations in an adapted alternating treatment design. We found that five out of eight participants showed more rapid acquisition and demonstrated discrimination between more items in the functional reinforcement condition. The remaining three participants did not exhibit any discrimination in either condition within the allotted 500 trials/20 days. These findings suggest that using functional reinforcement procedures may be a helpful alternative for individuals who do not learn discriminations through traditional procedures.

Brief Report: Modest but Clinically Meaningful Effects of Early Behavioral Intervention in Twins with Rett Syndrome-A Case Study.

A growing evidence base supports early intensive behavioral intervention (EIBI) for young children with autism spectrum disorder. We have found only one study exploring the outcome of EIBI for children with Rett syndrome, which reported little effect. It suggested that future studies should employ more fine-grained outcome measures. We provided EIBI for twin 3-year-old girls with Rett syndrome for a period of 3 years. We analyzed raw scores and standard scores from a measure of adaptive behavior and a detailed assessment of skills across 25 areas. We detected moderate but clinically meaningful gains in areas such as communication and self-help. Gains are discussed from a quality of life perspective and whether the moderate effects can justify the resources required in EIBI.

Experimental Analysis of Behavior Readings Assigned by Accredited Master's Degree Programs in Behavior Analysis.

Although a foundation in the basic science of behavior represents a common goal of practitioners and educators of behavior analysis, the content covered in master's degree-level courses on the experimental analysis of behavior (EAB) can vary widely across university programs. The purpose of our study was to analyze the syllabi of master's degree programs accredited by the Association for Behavior Analysis International to develop a list of common readings and topics in EAB coursework that might be useful for curricular development. We identified the most frequently cited references, journals, and participant characteristics. We found commonalities among the syllabi with regard to the types of readings assigned and the topics covered. We discussed our findings in terms of current trends in EAB and quality graduate training in behavior analysis.

[Behavioral intervention for preschool children with autism ­ outcome of parent-based Intervention]. / Verhaltenstherapeutische Intervention für Vorschulkinder mit Autismus.

Objective: Early intensive behavioral intervention (EIBI) has proved to be an effective intervention for children with autism spectrum disorder (ASD). In this exploratory study, we evaluated the effects of a community-based service model with parents as active therapists. Method: 13 children with ASD between 2 and 5 years of age at intake participated in the study. A waiting-list control design was employed. The children received 1 year of home-based EIBI for approximately 20 hours a week, their parents functioning as primary therapists. The waiting-list control group consisted of seven children who were tested 6 months before the intervention commenced. The intervention was based on the University of California at Los Angeles Young Autism Project model (UCLA YAP; Lovaas, 1981, 1987, 2003). The Psychoeducational Profile (3rd ed., PEP-3), the Parenting Stress Index (PSI), and the Childhood Autism Rating Scale (2nd ed., CARS 2) were used to measure outcome. In addition, a mental developmental index (MDI) was calculated on the basis of the Cognitive Verbal/Preverbal subscale of the PEP-3. Results: After 1 year of EIBI, we found a significant increase in the PEP-3 scores and MDI scores as well as a significant reduction in the CARS 2 scores. No significant changes were seen when participants were on the waiting list. The stress level of the parents did not change significantly and in fact showed overall a slight decrease. Conclusion: This model of providing EIBI appears to hold some promise. Comprehensive parental involvement did not affect their stress level. The study need to be replicated with a larger sample and an improved design.

Narrowing the gap: effects of intervention on developmental trajectories in autism.

Although still a matter of some debate, there is a growing body of research supporting Early and Intensive Behavioral Intervention as the intervention of choice for children with autism. Learning rate is an alternative to change in standard scores as an outcome measure in studies of early intervention. Learning rates can be displayed graphically as developmental trajectories, which are easy to understand and avoid some of the counter-intuitive properties of changes in standard scores. The data used in this analysis were from 453 children with autism, previously described by Eldevik et al. Children receiving Early and Intensive Behavioral Intervention exhibited significantly steeper developmental trajectories than children in the control group, in both intelligence and adaptive behaviors. However, there was a considerable variability in individual learning rates within the group receiving Early and Intensive Behavioral Intervention. This variability could partly be explained by the intensity of the treatment, partly by children's intake intelligence quotient age-equivalents. Age at intake did not co-vary with learning rate.

Effects of computer simulation training on in vivo discrete trial teaching.

Although Discrete-trial Teaching (DTT) is effective in teaching a many skills to children with autism, its proper implementation requires rigorous staff training. This study used an interactive computer simulation program ("DTkid") to teach staff relevant DTT skills. Participants (N = 12) completed two sets of pre-tests either once (n = 7) or twice (n = 5) before brief DTkid training. These evaluated (a) simulated interactive teaching using DTkid and (b) in vivo teaching of three basic skills (receptive and expressive labeling; verbal imitation) to children with autism. Post-tests showed that DTkid training, rather than repeated testing, was significantly associated with improvements in staff's ability to implement DTT both within the simulation and in vivo, and that the skills acquired showed both stimulus and response generalization.

Outcomes of behavioral intervention for children with autism in mainstream pre-school settings.

We evaluated outcomes for 31 children with autism (2-6 years of age at intake) who received behavioral intervention in mainstream pre-school settings and a comparison group of 12 children receiving treatment as usual. After 2 years, children receiving behavioral intervention had higher IQ scores (Hedges g = 1.03 (95% CI = .34, 1.72) and adaptive behavior composite scores (Hedges g = .73 (95% CI = .05, 1.36). Despite probably fewer intervention hours, these group level outcomes were comparable to studies providing more intensive intervention. Individual child data also showed positive results with 19.4% achieving change at a reliable level for IQ; but a lower percentage than found in recent meta-analysis research. Strengths and weaknesses of the mainstream pre-school delivery model are discussed.

Kiddie-SADS reveals high rates of DSM-IV disorders in children and adolescents with autism spectrum disorders.

Prevalence of current comorbid DSM-IV disorders was assessed in a special school population of children and adolescents with ASD (N = 71, age 6.0-17.9 years), representing all cognitive levels and main ASD subgroups. Symptoms were assessed through parent interview and association to child characteristics was explored. Seventy-two percent was diagnosed with at least one comorbid disorder. Anxiety disorders (41%) and attention deficit/hyperactivity disorder (31%) were most prevalent. Obsessive-compulsive disorder was more common in older children, and oppositional defiant disorder/conduct disorder more prevalent in pervasive developmental disorder, not otherwise specified. Our results show high rates of comorbid DSM-IV disorders and underscore the importance of such evaluation in children ASD. However, diagnostic challenges are present and future research on the diagnostic validity of comorbid psychiatric disorders is needed.

Using participant data to extend the evidence base for intensive behavioral intervention for children with autism.

We gathered individual participant data from 16 group design studies on behavioral intervention for children with autism. In these studies, 309 children received behavioral intervention, 39 received comparison interventions, and 105 were in a control group. More children who underwent behavioral intervention achieved reliable change in IQ (29.8%) compared with 2.6% and 8.7% for comparison and control groups, respectively, and reliable change in adaptive behavior was achieved for 20.6% versus 5.7% and 5.1%, respectively. These results equated to a number needed to treat of 5 for IQ and 7 for adaptive behavior and absolute risk reduction of 23% and 16%, respectively. Within the behavioral intervention sample, IQ and adaptive behavior at intake predicted gains in adaptive behavior. Intensity of intervention predicted gains in both IQ and adaptive behavior.

Cognitive and adaptive behavior outcomes of behavioral intervention for young children with intellectual disability.

Data from Norway were analyzed to evaluate early behavioral intervention for children with intellectual disabilities. The intervention group (n = 11) received approximately 10 hours per week of behavioral intervention; the eclectic comparison group (n = 14) received treatment as usual. After 1 year, changes in intelligence and adaptive behavior scores were statistically significant in favor of the behavioral intervention group (effect sizes of 1.13 for Intelligence quotient (IQ) change and .95 for change in adaptive behavior composite). Approximately 64% of the children in the behavioral intervention group met objective criteria for reliable change in IQ, whereas 14% in the eclectic comparison group did so. These results suggest that children with intellectual disability may profit from behavioral intervention typically provided for children with autism.

Meta-analysis of Early Intensive Behavioral Intervention for children with autism.

A systematic literature search for studies reporting effects of Early Intensive Behavioral Intervention identified 34 studies, 9 of which were controlled designs having either a comparison or a control group. We completed a meta-analysis yielding a standardized mean difference effect size for two available outcome measures: change in full-scale intelligence and/or adaptive behavior composite. Effect sizes were computed using Hedges's g. The average effect size was 1.10 for change in full-scale intelligence (95% confidence interval = .87, 1.34) and .66 (95% confidence interval = .41, .90) for change in adaptive behavior composite. These effect sizes are generally considered to be large and moderate, respectively. Our results support the clinical implication that at present, and in the absence of other interventions with established efficacy, Early Intensive Behavioral Intervention should be an intervention of choice for children with autism.

Frequency and latency of social interaction in an inclusive kindergarten setting: a comparison between typical children and children with autism.

This study investigated the frequency and latency of naturally occurring social interaction with typically developing children and those with autism in inclusive kindergarten settings. The children with autism were also subdivided into two groups according to intellectual functioning in order to analyze frequency and latency of social interaction in relation to degree of disability. The results showed a significant difference in frequency of social interaction between the typical children and those with autism. There was no difference between the groups on latency to initiate interaction. However, shorter latency was associated with higher frequency in the typical group but not in the group of children with autism. Significant differences in IQ and adaptive functioning were found between the children with autism who showed interaction and those who did not. The results for the typical children may be used as benchmark values for the assessment of treatment outcome for children with autism.

Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: a comparison controlled study.

This study extends findings on the effects of intensive applied behavior analytic treatment for children with autism who began treatment at a mean age of 5.5 years. The behavioral treatment group (n = 13, 8 boys) was compared to an eclectic treatment group (n = 12, 11 boys). Assignment to groups was made independently based on the availability of qualified supervisors. Both behavioral and eclectic treatment took place in public kindergartens and elementary schools for typically developing children. At a mean age of 8 years, 2 months, the behavioral treatment group showed larger increases in IQ and adaptive functioning than did the eclectic group. The behavioral treatment group also displayed fewer aberrant behaviors and social problems at follow-up. Results suggest that behavioral treatment was effective for children with autism in the study.

Effects of low-intensity behavioral treatment for children with autism and mental retardation.

We retrospectively compared 2 groups of children receiving either behavioral treatment (n = 13) or eclectic treatment (n = 15) for an average of 12 hours per week. Children were assessed on intelligence, language, adaptive functioning and maladaptive behavior at pretreatment and 2 years into treatment. The groups did not differ significantly at pretreatment. After 2 years of treatment, the behavioral group made larger gains than the eclectic group in most areas. However, gains were more modest than those reported in previous studies with children receiving more intensive behavioral treatment, and it is questionable whether they were clinically significant.

Intensive behavioral treatment at school for 4- to 7-year-old children with autism. A 1-year comparison controlled study.

This study was designed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism. An independent clinician assigned children to either behavioral treatment (n = 13) or eclectic treatment (n = 12). Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference. The two treatment groups received similar amounts of treatment (M = 28.52 hours per week at the child's school). Children in the behavioral treatment group made significantly larger gains on standardized tests than did children in the eclectic treatment group. Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment (not just its intensity) may account for favorable outcomes.