Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi.

There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.

Neural correlates of enhancing question asking and initiations in children with autism spectrum disorders: A Randomized Clinical Trial.

Children diagnosed with autism spectrum disorder (ASD) demonstrate challenges in various areas of social communication. The aim of this study was to examine the effect of Pivotal Response Treatment (PRT) targeting question-asking on brain activity in twenty 6-12-year-old autistic boys, using a Randomized Clinical Trial (RCT) design. Verbal children, diagnosed with autism, who lacked question asking in their communication were matched based on age and mean length utterance (MLU) and were randomly placed in either PRT intervention or treatment as usual (TAU) groups. Sessions were individually administered, lasting for 60 minutes 3 days a week for a two-month period. All children were tested before and after intervention to assess behavioral areas (questions, general communicative skills, and MLU) and both groups underwent electroencephalography for 10 minutes in open and closed eye resting-state conditions to assess neural correlates. Data were analyzed using covariance analysis and post-hoc using Mann-Whitney and Wilcoxon methods. Significant behavioral improvements in the PRT group were observed after intervention that correlated with changes in electroencephalography (EEG) oscillations at several brain regions compared to the TAU group. The results of this study support other studies suggesting collateral neural changes following the PRT.

Using Self-Management and Visual Cues to Improve Responses to Nonverbal Social Cues in Adults With Autism Spectrum Disorder.

Many individuals with Autism Spectrum Disorder (ASD) experience challenges with social communication, including recognizing and responding to non-verbal cues. The purpose of this study was to assess the efficacy of self-management combined with textual cues to teach adults with ASD to recognize and respond to nonverbal expressions of boredom and confusion during social conversation. A multiple baseline across participants design was used to assess the efficacy of this intervention for three participants. Results showed substantial gains across all participants in their recognition and responsiveness to the targeted nonverbal cues. Moreover, this skill maintained after the completion of intervention and generalized to novel conversation partners and settings with large effect sizes. The findings add to the literature base on interventions for adults with ASD, and further support the use of self-management and textual cues as effective intervention strategies for improving nonverbal communication.

The Effect of Teaching Initiations on the Communication of Children with Autism Spectrum Disorder: A Randomized Clinical Trial.

This study examined the effect of Pivotal response treatment (PRT) to improve verbal initiations in children with Autism Spectrum Disorder, age 6-12 years old, using a Randomized Clinical Trial design. Intervention was conducted three times a week for 2 months, for a total of 24 one-hour sessions. The PRT intervention taught a variety of questions and attention/assistance-seeking initiations. The treatment as usual (TAU) group received standard language intervention. Results showed that the PRT group made significant improvements in their number of verbal initiations as well as collateral gains in general communicative skills and mean length of utterance (MLU) compared to the TAU group. Theoretical implications of including motivational approaches to develop social initiations are reviewed.

Using a Question Bank Intervention to Improve Socially Initiated Questions in Adolescents and Adults With Autism.

Purpose Individuals with autism spectrum disorder (ASD) often have difficulty asking questions during social conversation, which can negatively impact their interactions with peers. The purpose of this study was to assess whether a question bank intervention would be effective in improving question asking during social conversation. Method In the context of a multiple-baseline experimental design, we implemented an intervention using prepractice with question banks designed to increase the number and diversity of questions asked by adolescents and adults with ASD during social conversations with their peers. Results Following intervention, all participants improved their use of questions in natural settings with their neurotypical peers. Generalization to novel questions occurred, and gains were maintained at follow-up. Finally, supplemental measures of social validity showed that similarly aged neurotypical peers who were naïve to the experimental hypothesis rated two of the three participants with higher social desirability following intervention. Conclusion Individuals with ASD can improve their appropriate question asking during social conversation using a brief question bank intervention with generalization to their peers in natural settings.

Parent Education in Studies With Nonverbal and Minimally Verbal Participants With Autism Spectrum Disorder: A Systematic Review.

Purpose The purpose of this systematic review was to identify parent education procedures implemented in intervention studies focused on expressive verbal communication for nonverbal (NV) or minimally verbal (MV) children with autism spectrum disorder (ASD). Parent education has been shown to be an essential component in the habilitation of individuals with ASD. Parents of individuals with ASD who are NV or MV may particularly benefit from parent education in order to provide opportunities for communication and to support their children across the life span. Method ProQuest databases were searched between the years of 1960 and 2018 to identify articles that targeted verbal communication in MV and NV individuals with ASD. A total of 1,231 were evaluated to assess whether parent education was implemented. We found 36 studies that included a parent education component. These were reviewed with regard to (a) the number of participants and participants' ages, (b) the parent education program provided, (c) the format of the parent education, (d) the duration of the parent education, (e) the measurement of parent education, and (f) the parent fidelity of implementation scores. Results The results of this analysis showed that very few studies have included a parent education component, descriptions of the parent education programs are unclear in most studies, and few studies have scored the parents' implementation of the intervention. Conclusions Currently, there is great variability in parent education programs in regard to participant age, hours provided, fidelity of implementation, format of parent education, and type of treatment used. Suggestions are made to provide both a more comprehensive description and consistent measurement of parent education programs.

Definitions of Nonverbal and Minimally Verbal in Research for Autism: A Systematic Review of the Literature.

This systematic review examined definitions of "nonverbal" or "minimally verbal" and assessment measures used to evaluate communication in intervention studies focusing on improving expressive verbal communication in children with autism spectrum disorder (ASD). We reviewed sample size, number of participants, participant age, and male/female representation. Our analysis yielded relatively few studies with non/minimally verbal children with ASD focusing on verbal expressive communication. Further, we found large inconsistencies in measures used, definitions of "nonverbal" and "minimally verbal", and ages targeted. Guidelines are suggested to create a more uniform assessment protocol with systematic descriptions of early communication learners as a foundational step for understanding the heterogeneity in this group and replicating research findings for this subgroup of children with ASD.

Targeting IEP Social Goals for Children with Autism in an Inclusive Summer Camp.

Children with autism spectrum disorder demonstrate challenges in socialization that can interfere with their participation in common childhood activities and can persist or worsen if not addressed. The purpose of this study was to assess whether individualized education program (IEP) social goals could be targeted by a supervised paraprofessional during a short-term inclusive summer camp program. Data were collected using a concurrent multiple baseline design across four children. Results showed that following a 2-week summer camp program all participants made social improvements, reaching their year-long IEP goals, that maintained at follow-up in natural environments. Further, the paraprofessionals reached fidelity of implementation. Findings are discussed in terms of the value and feasibility of providing social interventions in inclusive summer camps.

Improving Functional Language and Social Motivation with a Parent-Mediated Intervention for Toddlers with Autism Spectrum Disorder.

Recent research suggests that children with autism spectrum disorder (ASD) may now be reliably identified in later infancy, highlighting the need for empirically-validated interventions for infants and toddlers with early symptoms of ASD. Using a multiple baseline design across 15- to 21-month-old toddlers, this study implemented a brief, parent-mediated, Pivotal Response Treatment program, focusing on improving expressive communication. The results indicated that verbal communication improved as a consequence of the intervention, with concomitant improvements in untreated areas for all participants. Following the intervention, symptoms of autism decreased and parents reported satisfaction with the program's ease of implementation and observed child gains. The results are discussed in terms of developing very early interventions to improve developmental trajectories for infants and toddlers.

A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism.

Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with an adult-directed ABA approach on disruptive behavior during language intervention in the public schools. A randomized clinical trial design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior.

Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: a systematic review.

Early detection methods for autism spectrum disorder (ASD) in infancy are rapidly advancing, yet the development of interventions for infants under two years with or at-risk for ASD remains limited. In order to guide research and practice, this paper systematically reviewed studies investigating interventions for infants under 24 months with or at-risk for ASD. Nine studies were identified and evaluated for: (a) participants, (b) intervention approach (c) experimental design, and (d) outcomes. Studies that collected parent measures reported positive findings for parent acceptability, satisfaction, and improvement in parent implementation of treatment. Infant gains in social-communicative and developmental skills were observed following intervention in most of the reviewed studies, while comparisons with treatment-as-usual control groups elucidate the need for further research. These studies highlight the feasibility of very early intervention and provide preliminary evidence that intervention for at-risk infants may be beneficial for infants and parents.

A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism.

Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two applied behavior analysis (ABA) intervention procedures, a naturalistic approach, pivotal response treatment (PRT) with a structured ABA approach in a school setting. A randomized clinical trial design using two groups of children, matched according to age, sex and mean length of utterance was used to compare the interventions. The data showed that the PRT approach was significantly more effective in improving targeted and untargeted areas after 3 months of intervention. The results are discussed in terms of variables that produce more rapid improvements in communication for children with ASD.

Training paraprofessionals to improve socialization in students with ASD.

An important line of research relates to whether school personnel, such as paraprofessionals, who are present during unstructured social periods, such as lunch-recess, could successfully implement interventions to improve socialization between students with ASD and their typical peers in a group setting. Therefore, within the context of a multiple baseline across participants design, we assessed whether training paraprofessionals to provide social interventions would enhance social development in students with ASD in a group setting. Results showed that paraprofessionals who were not providing any social opportunities during baseline were able to meet fidelity of implementation following a brief training. Consequently, the children with ASD increased their levels of engagement and rates of initiation with typically developing peers following intervention. Implications for training paraprofessionals to implement effective social interventions for students with ASD are discussed.

Improving question-asking initiations in young children with autism using pivotal response treatment.

Social initiations make up a core deficit for children with autism spectrum disorder (ASD). In particular, initiated questions during social interactions are often minimal or absent in this population. In the context of a multiple baseline design, the efficacy of using the motivational procedures of Pivotal Response Treatment to increase social question-asking for three young children with autism was assessed. Results indicated that participants initiated a greater number of targeted questions following intervention. Additionally, all children exhibited increases in initiation of untargeted questions during social interaction in novel settings. Furthermore, post intervention data revealed collateral gains in communication and adaptive behavior. Theoretical implications of incorporating motivational strategies into intervention to improve social initiations in young children with ASD are discussed.

The importance of early identification and intervention for children with or at risk for autism spectrum disorders.

There has been a dramatic rise in the number of children being diagnosed with autism spectrum disorders (ASD), which has led to increased attention paid to assessment and intervention issues. This manuscript agrees with Camarata (2014) that the evidence base for early assessment and intervention should be expanded. However, it disagrees with Warren et al.'s (2011) assumption that there are not empirically validated early interventions. Reliable diagnosis has been documented during infancy and toddlerhood, and evidence suggests that the earlier the onset of intervention, the greater likelihood of an improved developmental trajectory. It is argued that early intervention is more cost and time efficient than a "wait and see" approach. With regard to published studies, the large amount of heterogeneity in the ASD population supports the use of rigorous single case experimental design research. It is an error to limit empirical evidence for treatments to only randomized clinical trials, which have the weakness of masking individual differences. Single case experimental designs examine the effects of intervention beyond typical maturation by allowing for clear estimations of developmental trajectories prior to the onset of intervention, followed by evaluation of the impact of the intervention. This commentary discusses the short- and long-term benefits of early diagnosis and intervention.

Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder.

Individuals with autism spectrum disorders often exhibit difficulties with reciprocal social conversation, engaging in limited verbal exchanges, even when language structures are intact. This study employed a multiple baseline design to examine the effectiveness of a self-management intervention targeting (1) on-topic responsiveness to a conversational partner; (2) expansion of the conversational topic; and (3) on-topic question asking. Results demonstrated improved reciprocal social conversation through elaborated responses and on-topic question asking, which generalized and maintained. Social validity measures by naïve observers indicated that the intervention led to meaningful improvements during conversation, including interest, naturalness, and desirability as a conversational partner.

Acquisition of multiple questions in the context of social conversation in children with autism.

Verbal initiations, such as questions, are essential components of social conversation often lacking in children with autism. Building on research showing that single questions can be taught in isolation, this study used a multiple baseline design to investigate whether a self-management intervention was effective for teaching concurrent acquisition and discrimination of three social questions in the context of conversation. Following intervention, participants rapidly increased their appropriate use of all three questions in a conversational context and maintained these gains over time. The participants also used questions appropriately with partners uninvolved in treatment. Additionally, the occasional presence of appropriate questions during baseline coupled with rapid improvement during intervention support theories that a lack of question-asking may be motivation-based rather than ability-based.

Using individualized reinforcers and hierarchical exposure to increase food flexibility in children with autism spectrum disorders.

Inflexibility is a major characteristic of autism. In the present study we addressed inflexible mealtime behaviors and collected longitudinal data across 48 foods for 3 children, ages 6.4-7.8 years, diagnosed with autism spectrum disorder, for up to 22 weeks. Participants exhibited severe challenges with adherence to an extremely restricted repertoire of foods. We employed clinical replication and multiple baseline designs across participants to assess the effects of individualized reinforcement and hierarchical exposure to increase flexibility. Results showed that following intervention, all participants expanded their food repertoire and spontaneously requested new foods during follow up/generalization. Implications for clinical practice and directions for further research are discussed.