Delay to Early Intensive Behavioral Intervention and Educational Outcomes for a Medicaid-Enrolled Cohort of Children with Autism.

Increased prevalence of autism spectrum disorder (ASD) has underscored the need for early intervention services. Early Intensive Behavioral Intervention (EIBI) is among the most common evidence-based approaches, however, stakeholders report significant waitlists. The effects of these delays to intervention are unknown. The purpose of this study was to evaluate the effects of delay to EIBI for preschool aged children with ASD on later educational outcomes. Medicaid records from Minnesota (2008-2010) were used to evaluate a cohort diagnosed with ASD and their later educational outcomes from 2010 to 2014 (n = 667) using generalized estimating equations. Approximately 70% of children experienced a delay to EIBI and children that experienced less delay and started EIBI at a younger age had better educational outcomes.

Early Intervention Protocols: Proposing a Default Bimodal Bilingual Approach for Deaf Children.

Despite advances in hearing technology, a growing body of research, as well as early intervention protocols, deaf children largely fail to meet age-based language milestones. This gap in language acquisition points to the inconsistencies that exist between research and practice. Current research suggests that bimodal bilingual early interventions at deaf identification provide children language foundations that can lead to more effective outcomes. Recommendations that support implementing bimodal bilingualism at deaf identification include early intervention protocols, language foundations, and the development of appropriate bimodal bilingual environments. All recommendations serve as multifaceted tools in a deaf child's repertoire as language and modality preferences develop and solidify. This versatile approach allows for children to determine their own language and communication preferences.

Exploring the Influence of Early Childhood Education and Care on the Etiology of Achievement.

The present study used a genetically-sensitive quantile regression approach to examine the relation between participation in early childhood education and care (ECEC) and subsequent school performance in literacy and numeracy at grades 3, 5, 7, and 9. The sample consisted of 1255 twin pairs (596 MZ; 659 DZ) with information on both ECEC and the National Assessment Program-Literacy and Numeracy (NAPLAN) scores from the Twin Study of NAPLAN. Results indicated variation in heritability estimates across the distributions of achievement, suggesting that different patterns of etiological influences may exist among children of different ability levels. Additionally, the results provided no evidence that ECEC significantly influenced achievement, and in the genetically-sensitive analyses, no evidence that ECEC moderated the influences of heritability of achievement for typically advantaged children. These results suggest that ECEC may not provide the levels of environmental support for later achievement that advocates claim, although we acknowledge that ECEC quality, which was not measured in the current study, may make a difference in whether or not ECEC influences achievement.

Adherence to screening and referral guidelines for autism spectrum disorder in toddlers in pediatric primary care.

OBJECTIVES: Although the American Academy of Pediatrics recommends screening for autism spectrum disorder (ASD) for all young children, disparities in ASD diagnosis and intervention in minority children persist. One potential contributor to disparities could be whether physicians take different actions after an initial positive screen based on patient demographics. This study estimated factors associated with physicians completing the follow-up interview for the Modified Checklist for Autism in Toddlers with Follow-up (M-CHAT-F), and referring children to diagnostic services, audiology, and Early Intervention (EI) immediately after a positive screen. METHODS: Children seen in a large primary care network that has implemented universal ASD screening were included if they screened positive on the M-CHAT parent questionnaire during a 16-30 month well child visit (N = 2882). Demographics, screening results, and referrals were extracted from the electronic health record. RESULTS: Children from lower-income families or on public insurance were more likely to have been administered the follow-up interview. Among children who screened positive, 26% were already in EI, 31% were newly referred to EI, 11% were referred each to audiology and for comprehensive ASD evaluation. 40.2% received at least one recommended referral; 3.7% received all recommended referrals. In adjusted multivariable models, male sex, white versus black race, living in an English-speaking household, and having public insurance were associated with new EI referral. Male sex, black versus white race, and lower household income were associated with referral to audiology. Being from an English-speaking family, white versus Asian race, and lower household income were associated with referral for ASD evaluation. A concurrent positive screen for general developmental concerns was associated with each referral. CONCLUSIONS: We found low rates of follow-up interview completion and referral after positive ASD screen, with variations in referral by sex, language, socio-economic status, and race. Understanding pediatrician decision-making about ASD screening is critical to improving care and reducing disparities.

Predictors of referral to the North Carolina Infant-Toddler Program among infants with birth defects and infants born extremely preterm or low birthweight.

BACKGROUND: North Carolina's Infant-Toddler Program (NC ITP) provides Early Intervention (EI) services from birth to age three for children at risk for developmental delays. This study examined referral patterns by clinical and sociodemographic characteristics among infants with birth defects and infants born extremely preterm (gestational age < 27 weeks) or extremely low birthweight (<1,000 g). METHODS: A retrospective cohort of North Carolina resident births from 2012 to 2014 was matched to data from the North Carolina Birth Defects Monitoring Program and NC ITP records. A total of 2,463 infants with eligible birth defects and 2,118 extremely preterm or low birthweight infants were identified. Adjusted odds ratios and 95% confidence intervals from multivariable logistic regression models were used to analyze differences in referral by sociodemographic and clinical factors. Referrals resulting in enrollment were also examined. RESULTS: About 70% of infants with eligible birth defects and 85% of extremely premature infants were referred to the NC ITP. Geographic region, maternal race/ethnicity, maternal and infant enrollment in Medicaid, and hospital level of care at delivery were associated with referral among both at-risk groups. Among infants with birth defects, maternal age, education, and marital status were also associated with referral, as well as gestational age, birthweight, and the presence of multiple anomalies. Of the infants with referrals, over 80% in each group were subsequently enrolled. CONCLUSIONS: Many of the sociodemographic and clinical factors examined were associated with EI referral. These findings can be used to address coverage gaps and improve referral and enrollment rates for at-risk infants.

School Readiness.

School readiness includes the readiness of the individual child, the school's readiness for children, and the ability of the family and community to support optimal early child development. It is the responsibility of schools to meet the needs of all children at all levels of readiness. Children's readiness for kindergarten should become an outcome measure for a coordinated system of community-based programs and supports for the healthy development of young children. Our rapidly expanding insights into early brain and child development have revealed that modifiable factors in a child's early experience can greatly affect that child's health and learning trajectories. Many children in the United States enter kindergarten with limitations in their social, emotional, cognitive, and physical development that might have been significantly diminished or eliminated through early identification and attention to child and family needs. A strong correlation between social-emotional development and school and life success, combined with alarming rates of preschool expulsion, point toward the urgency of leveraging opportunities to support social-emotional development and address behavioral concerns early. Pediatric primary care providers have access to the youngest children and their families. Pediatricians can promote and use community supports, such as home visiting programs, quality early care and education programs, family support programs and resources, early intervention services, children's museums, and libraries, which are important for addressing school readiness and are too often underused by populations who can benefit most from them. When these are not available, pediatricians can support the development of such resources. The American Academy of Pediatrics affords pediatricians many opportunities to improve the physical, social-emotional, and educational health of young children, in conjunction with other advocacy groups. This technical report provides an updated version of the previous iteration from the American Academy of Pediatrics published in 2008.

What Drives Detection and Diagnosis of Autism Spectrum Disorder? Looking Under the Hood of a Multi-stage Screening Process in Early Intervention.

U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents' concerns, providers' concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.

Current Practice of Child Grammar Intervention: A Survey of Speech-Language Pathologists.

Purpose: The aim of this study was to better understand current grammatical intervention approaches. Despite grammatical language being a common weakness among children with language impairment, relatively little is known about current grammatical intervention practices of speech-language pathologists (SLPs). Such information is needed to guide the development and evaluation of grammatical interventions and to identify areas in which the current practice is not empirically supported. Method: Participants included 338 SLPs working primarily with children. Participants completed an online survey regarding their implementation of nine different grammatical intervention components, including goals, procedures, dosage, agents, contexts, goal attack strategies, service delivery models, activities, and outcome measurements. Participants also indicated how they would alter the intervention setting and dosage if resources were unlimited. Results: We grouped participants based on the ages of children that represent the largest percentage of their caseload resulting in an early education group (n = 114) and an elementary group (n = 224). We aggregated responses from each question to gain an estimate of current implementation practices associated with each intervention component queried. Conclusions: This study provides general guidelines of current clinical practices to help guide research on grammatical interventions for children and to promote successful translation and implementations of evidence-based treatment approaches. Results may also help clinicians and researchers better understand misalignments between empirically supported intervention approaches and current approaches for treating grammatical weaknesses.

The Chicago School Readiness Project: Examining the long-term impacts of an early childhood intervention.

The current paper reports long-term treatment impact estimates for a randomized evaluation of an early childhood intervention designed to promote children's developmental outcomes and improve the quality of Head Start centers serving high-violence and high-crime areas in inner-city Chicago. Initial evaluations of end-of-preschool data reported that the program led to reductions in child behavioral problems and gains in measures of executive function and academic achievement. For this report, we analyzed adolescent follow-up data taken 10 to 11 years after program completion. We found evidence that the program had positive long-term effects on students' executive function and grades, though effects were somewhat imprecise and dependent on the inclusion of baseline covariates. Results also indicated that treated children had heightened sensitivity to emotional stimuli, and we found no evidence of long-run effects on measures of behavioral problems. These findings raise the possibility that developing programs that improve on the Head Start model could carry long-run benefits for affected children.

Los padres como promotores del desarrollo de lenguaje de bebés prematuros: propuesta de intervención temprana / Parents as Promoters of Language Development in Premature Babies: a Proposal for Early intervention

Resumen Objetivo: Comparar dos sistemas de puntuación para un test de fluidez verbal con el Modelo de Escalas de Calificación. Método: Se analizaron datos de 289 participantes, de los cuales 92 habían sido diagnosticados con Parkinson. Las puntuaciones se calcularon con dos sistemas de categorización: un procedimiento convencional y otro basado en percentiles. Resultados: Las puntuaciones Rasch procedentes de percentiles dan lugar a categorías adecuadas y medidas fiables; la correlación con las puntuaciones del test Minimental es evidencia de validez concurrente. Tras controlar estadísticamente el efecto de la edad, las medidas Rasch procedentes de percentiles discriminan entre ambos grupos, lo que evidencia validez predictiva. Conclusiones: El análisis de los dos procedimientos permite recomendar el uso de las categorías basadas en percentiles.

Abstract Objective: Two scoring systems for a verbal fluency test were compared using the Rasch Rating Scale Model. Method: The analysis was carried out on 289 participants, 92 of whom had had a Parkinson's disease diagnosis. Scores were calculated with two different category systems: a conventional procedure and a percentile-based one. Results: The percentile-based Rasch scores produce adequate categories and reliable measures, while the correlation with the Mini Mental State Examination evinces concurrent validity. After statistically controlling for age, percentile-based Rasch measures discriminated between both groups, demonstrating predictive validity. Conclusions: The analysis of the two procedures allows for the recommendation of the use of percentile-based categories.

The multiple deficit model of dyslexia: what does it mean for identification and intervention?

Research demonstrates that phonological skills provide the basis of reading acquisition and are a primary processing deficit in dyslexia. This consensus has led to the development of effective methods of reading intervention. However, a single phonological deficit is not sufficient to account for the heterogeneity of individuals with dyslexia, and recent research provides evidence that supports a multiple-deficit model of reading disorders. Two studies are presented that investigate (1) the prevalence of phonological and cognitive processing deficit profiles in children with significant reading disability and (2) the effects of those same phonological and cognitive processing skills on reading development in a sample of children that received treatment for dyslexia. The results are discussed in the context of implications for identification and an intervention approach that accommodates multiple deficits within a comprehensive skills-based reading program.

Addressing the Educational Needs of Children with Williams Syndrome: A Rather Neglected Area of Research?

Williams syndrome (WS) is a rare neurodevelopmental disorder associated with physical health problems, limitations in cognitive abilities and increased risk of mental health difficulties. This profile of complex needs may make it challenging to support children with WS in schools. Surprisingly, in the current international move for inclusion, limited research exists on the educational provision and academic achievements of children with WS, including the non-existing literature on their voices and the perspectives of key stakeholders. This letter calls for additional research on the risk and protective factors associated with the educational outcomes of these children, the perspectives of the children themselves and the development of the evidence-base about the effectiveness of education intervention programs.

Meta-analysis of Tablet-Mediated Interventions for Teaching Academic Skills to Individuals with Autism.

Portable touch-screen devices have been the focus of a notable amount of intervention research involving individuals with autism. Additionally, popular media has widely circulated claims that such devices and academic software applications offer tremendous educational benefits. A systematic search identified 19 studies that targeted academic skills for individuals with autism. Most studies used the device's built-in video recording or camera function to create customized teaching materials, rather than commercially-available applications. Analysis of potential moderating variables indicated that participants' age and functioning level did not influence outcomes. However, participant operation of the device, as opposed to operation by an instructor, produced significantly larger effect size estimates. Results are discussed in terms of recommendations for practitioners and future research.

School Age Outcomes of Children Diagnosed Early and Later with Autism Spectrum Disorder.

Early diagnosis of Autism Spectrum Disorder is considered best practice, increasing access to early intervention. Yet, many children are diagnosed after 3-years. The current study investigated the school age outcomes of children who received an early and later diagnosis of ASD. The cognitive and behavioural outcomes of children diagnosed early (n = 48), were compared to children diagnosed after 3-years (n = 37). Children diagnosed early accessed more intervention, demonstrated better verbal and overall cognition at school age, were more likely to attend mainstream school and required less ongoing support than children diagnosed later. Behavioural differences were not found between groups. Earlier diagnosis is important and is likely to promote more positive outcomes at school age due to increased opportunity for EI.

School Age Outcomes of Children with Autism Spectrum Disorder Who Received Community-Based Early Interventions.

This study followed children with Autism Spectrum Disorder (ASD) from early intervention into their early schooling years, when they were aged between 6 and 9 years, on autism symptom severity and cognitive functioning. The children, matched at pre-intervention, were compared on type of community provided service: 31 were in receipt of community-based group Early Start Denver Model and 28 had received other community provisions for ASD. Irrespective of groups, cognitive functioning was found to have significantly improved by school age compared to pre-intervention. Autism symptom severity increased during the same developmental period, seemingly driven by an increase in restricted and repetitive behaviours over time. In contrast, both groups displayed improved social affect by school age.

Take Flight: the evolution of an Orton Gillingham-based curriculum.

Thirty years ago in this journal, Aylett Royall Cox reported on the development of Alphabetic Phonics, a revision of the existing Orton Gillingham treatment for children with dyslexia. This paper continues that discussion and reports on the evolution of that curriculum as it is represented in a comprehensive dyslexia treatment program informed by intervention research. The paper describes the curriculum and reports data from a hospital-based learning disabilities clinic that provides qualified support for treatment efficacy and the value of added comprehension instruction. The results are then discussed in the context of current and future issues in dyslexia intervention.

Operation Breakthrough in 2017 Builds on the Past.

Operation Breakthrough (OB) is one of Missouri's largest early Head Start program and provides a variety of other services related to early childhood education and family support to low-income families who live in the poorest neighborhoods of Kansas City. Currently 96% of its preschool children enter kindergarten ready to learn. Current CLASSTM scores for Emotional Support, Organizational Support, and Instructional Support exceed national averages. In this paper, we describe the range of services it provides and give details of its organizational structure and budget.

Changes in household food insecurity are related to changes in BMI and diet quality among Michigan Head Start preschoolers in a sex-specific manner.

Children living in households that have recently become food insecure may be particularly vulnerable to adverse weight and dietary changes, but longitudinal studies examining these associations are lacking. Using data from 501 Head Start preschoolers from Michigan (48% male) who were followed during one school year as a part of a randomized obesity prevention trial, we examined changes in children's adiposity indices and dietary quality according to changes in household food insecurity. Household food insecurity change status was categorized as persistently food secure, became food secure, persistently food insecure, or became food insecure. Linear mixed effects models were used to estimate relative changes in BMI-for-age z scores (BAZ), triceps skinfolds-for-age z scores (TAZ), or diet quality (assessed with the 2010 Healthy Eating Index) over the school year according to food insecurity category. We found that girls from households that became food insecure over the year had a 0.21 unit higher gain in BAZ than girls from households that were persistently food secure, after adjustment for potential confounders (95% CI 0.02 to 0.39, P = 0.03). Girls from households that became food secure had improvements in dietary quality over the year compared to girls from persistently food insecure households (adjusted difference in Healthy Eating Index score change = 9.1 points; 95% CI 3.0 to 15.0; p = 0.003). There were no statistically significant associations with changes in TAZ. Among boys, there were no associations between changes in household food insecurity and changes in BAZ, TAZ, or dietary quality. In summary, we found that BMI and diet quality changes of Head Start preschool girls were correlated with short-term changes in household food insecurity. Continued research efforts should focus on identifying the most effective ways to promote the health of children in food insecure households, especially those who may have recently transitioned or are transitioning into food insecurity.

Deafness and Diversity: Reflections and Directions.

Concluding a two-part American Annals of the Deaf special issue on deafness and diversity (DAD), the editors provide reflections and guidance to the field regarding d/Deaf and hard of hearing (d/Dhh) children with a disability (DWD; e.g., learning or intellectual disability, autism) and d/Dhh children from homes where parents use a language other than English or American Sign Language (d/Dhh Multilingual Learners; DMLs). Contributing authors addressed the application of theory, research, and practice to five topics: (a) early intervention, (b) communication/language, (c) assessment, (d) transition, (e) teacher preparation. An overview of the main recommendations of the contributors and editors is presented in an effort to advance research and pedagogy with these learners. In conclusion, the editors discuss the "Radical Middle" approach (Easterbrooks & Maiorana-Basas, 2015) to working with students who are DAD: providing learners with all options for academic, social, and emotional success.