Parental Experiences with Early Identification and Initial Care for their Child with Autism: Tailored Improvement Strategies.

Whereas it is well documented how parents experience the diagnostic process of their child with autism spectrum disorder (ASD), less is known about parental experiences with the course of the early identification process and first steps in receiving care for their child with ASD symptoms. This mixed-method study investigated these experiences as well as barriers and improvement strategies regarding early detection in the Netherlands. A parental survey (N = 45) showed that, on average, initial concerns started at 22 months. A focus group (N = 10) revealed multiple barriers and proposed strategies of improvement in three domains: "Knowledge and Expertise", "Attention to Parental Needs" and "System and Organization". Strategies to improve early identification will be discussed based on parental perspectives and professional perspectives.

Training Teachers to Implement Classroom Pivotal Response Teaching during Small-group Instruction: A Pilot Study.

Background: Providing effective education to students with autism spectrum disorder (ASD) poses a significant challenge to educators. Although several evidence-based practices (EBPs) have been developed, few have been systematically implemented in educational settings. Pivotal response treatment (PRT) is a naturalistic behavioral intervention that has been adapted for implementation in the school context. Methods: This pilot study used a concurrent multiple baseline design across seven teachers and students with ASD to examine the effectiveness of teacher training in classroom pivotal response teaching (CPRT) on teacher fidelity of implementation during small-group instruction and students' communication skills and maladaptive behaviors in schools for special education in the Netherlands. Results: Results indicated no replicated effect of CPRT training on teachers' fidelity of implementation or children's communications skills and maladaptive behavior, although teachers reported high satisfaction with the CPRT training. Discussion: Implications for clinical practice and directions for future research are discussed.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation.

LAY ABSTRACT: Pivotal response treatment is a naturalistic behavioral intervention that teaches pivotal skills to children with autism spectrum disorder to produce widespread gains in other skills. Although most children with autism spectrum disorder benefit from pivotal response treatment, intervention outcomes vary considerably among children. Fidelity of intervention implementation (i.e. the extent to which an intervention is implemented as intended) may affect intervention outcomes. In this study, we studied the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist-child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether a child's age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 pivotal response treatment therapists who videotaped three pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. This study found that therapists' openness to innovation and their experience with pivotal response treatment predicted fidelity of implementation. Therapist personality, therapist-child relationship, and child characteristics were not related to pivotal response treatment fidelity. The results of this study emphasize that it is important (1) to target therapists' attitudes toward innovation prior to or during training in pivotal response treatment and (2) to provide therapists with ongoing supervision and feedback after training to increase fidelity of implementation and thus to improve intervention outcomes for children with autism spectrum disorder.

Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses.

In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed.

Increasing Opportunities for Question-Asking in School-Aged Children with Autism Spectrum Disorder: Effectiveness of Staff Training in Pivotal Response Treatment.

Deficits in question-asking are common in children with autism spectrum disorder (ASD). Furthermore, their opportunities to self-initiate questions are often hindered by directive behavior of their conversation partners. This study assessed the effectiveness of staff training in pivotal response treatment (PRT) on staff member-created opportunities and self-initiated questions of school-aged children with ASD. Generalization and maintenance were also assessed. Participants were 14 staff members and children with ASD attending an inpatient treatment facility. Data showed that PRT resulted in significant increases in both staff member-created opportunities and child-initiated questions. Generalization to group situations and collateral changes in children's language, pragmatic, and adaptive skills, and maladaptive behaviors did not occur. Implications for clinical practice and directions for future research are discussed.

Promoting question-asking in school-aged children with autism spectrum disorders: effectiveness of a robot intervention compared to a human-trainer intervention.

OBJECTIVE: The purpose of the present study was to investigate the effectiveness of an applied behaviour analysis (ABA)-based intervention conducted by a robot compared to an ABA-based intervention conducted by a human trainer in promoting self-initiated questions in children with autism spectrum disorder (ASD). METHODS: Data were collected in a combined crossover multiple baseline design across participants. Six children were randomly assigned to two experimental groups. RESULTS: Results revealed that the number of self-initiated questions for both experimental groups increased between baseline and the first intervention and was maintained during follow-up. The high number of self-initiated questions during follow-up indicates that both groups maintained this skill. CONCLUSIONS: The interventions conducted by a robot and a human trainer were both effective in promoting self-initiated questions in children with ASD. No conclusion with regard to the differential effectiveness of both interventions could be drawn. Implications of the results and directions for future research are discussed.

Investigating the validity of a structured interview protocol for assessing the preferences of children with autism spectrum disorders.

PURPOSE: To investigate the congruent validity of a structured interview protocol for assessing the preferences of seven children with autism spectrum disorder (ASD). METHOD: Using the structured interview protocol described by Green et al., parents were asked to provide a rank ordering of their child's preferred foods, drinks, toys and sensory stimuli. The resulting rank order was then compared to the results of a multiple-stimulus without replacement preference assessment by calculating the Spearman rank order correlation coefficients. RESULTS: The results revealed a high level of correspondence between the rank orderings of both assessments for four of the six participants for food and drink items and four of the seven participants for play items and sensory stimuli. CONCLUSION: Results support the use of the structured interview protocol to determine the preferences of children with ASD. Practical implications and directions for future research are discussed.