Unrealized Cross-System Opportunities to Improve Employment and Employment-Related Services Among Autistic Individuals.

Policy Points Employment is a key social determinant of health and well-being for the estimated 5.4 million autistic adults in the United States-just as it is for citizens without disabilities. Evaluation and monitoring of publicly funded employment services is paramount given the dramatic increases in adults with autism who need job supports. Vocational Rehabilitation agencies appeared to be absorbing short-term employment needs of autistic people, but Medicaid was severely lacking-and losing ground-in serving those who need longer-term employment services. Across both Vocational Rehabilitation and Medicaid, we estimated that only 1.1% of working-age autistic adults who potentially need employment services are actually receiving them-leaving an estimated 1.98 million autistic individuals without the employment services that are associated with achievement of well-being. CONTEXT: Employment is a key social determinant of health. As such, high rates of unemployment, underemployment, and poverty across the rapidly growing autistic population are concerning. A web of publicly funded services exists to support the employment, and associated health and well-being, of United States citizens with autism and other intellectual and developmental disabilities, namely through Vocational Rehabilitation (VR) and Medicaid home- and community-based services (HCBS) waivers. Given an absence of overarching surveillance of employment services, this study aimed to characterize the distribution of autistic service users across Medicaid versus VR, understand the types of employment services utilized within these programs and expenditures, and assess overall capacity to provide employment services as needs continue to increase. METHODS: This study examined the distribution of employment services among autistic people compared with those with intellectual disability using 2008-2016 data from the Centers for Medicare & Medicaid Services and the Rehabilitation Services Administration. Estimated need for employment services among autistic individuals was compared with capacity derived from VR service counts and a review of HCBS waivers. FINDINGS: The number of autistic people served through VR tripled during the study years, whereas those served through Medicaid only increased slightly. VR spending increased by 384% over the study years, whereas Medicaid costs decreased by 29%. Across VR and Medicaid, we estimated that only 1.1% of working-age autistic adults who needed employment services received them. CONCLUSIONS: Although VR appeared to be absorbing short-term employment needs of autistic individuals, Medicaid was severely lacking-and losing ground-in serving those who needed longer-term employment services. VR far outpaced Medicaid in both the number of autistic people served and total expenditures across the study years. However, an estimated 1.98 million autistic adults did not receive employment services that could be critical to improving their health and well-being.

Literacy instruction for autistic children who speak languages other than English.

LAY ABSTRACT: Many autistic children across the globe speak languages other than English. However, much of the research about teaching children with autism to read and write is derived from studies including people who speak English and no other languages. Here, we review the research on teaching children with autism to read and write in languages other than English. We did this because the world's languages, and the ways they are represented in written form, vary greatly. A broader overview that encompasses languages other than English can help us better understand how learning to read and write can be supported for autistic children around the world. The studies included in our review highlight some potential differences in effective literacy teaching for autistic children learning to read and write using different writing systems. The studies we reviewed tended to include relatively small samples of autistic children, among other limitations. We hope that our review will increase awareness and research efforts in the area of autism and global literacy.

Improvement of the health of people with autism spectrum disorder by exercise / Melhoria da saúde de pessoas com transtorno do espectro do autismo por meio de exercícios físicos / Mejora de la salud de las personas con trastorno del espectro autista mediante el ejercicio físico

ABSTRACT Introduction Autism Spectrum Disorder (ASD) is a typical neurological development disorder of the brain, exhibiting social communication and communication disorders, narrow interests, and repetitive, stereotyped behaviors. Movement development is an important evaluation index for the development of early motor function in children, so exercise intervention in children with ASD is of great significance. Objective This article conducts exercise intervention on children with ASD to stimulate their exercise ability and improve their self-care ability. Methods The article randomly grouped 24 children with an autism spectrum disorder. The experimental group received exercise intervention, and the control group had regular classes. After the experiment is completed, the influence of exercise intervention on children with autism is analyzed. Results The motor skills of the two groups of children were different after the intervention. The motor skills of the experimental group improved more significantly. Conclusion Exercise intervention can significantly improve the motor skills of children with an autism spectrum disorder. To evaluate whether the large-muscle motor skill learning of children with ASD and its influence on basic motor skills can be transferred to provide a reference for related motor intervention. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução O transtorno do espectro do autismo (TEA) é um transtorno do neurodesenvolvimento típico do cérebro, que apresenta transtornos de comunicação e comunicação social, interesses estreitos e comportamentos repetitivos e estereotipados. O desenvolvimento do movimento é um índice de avaliação importante para o desenvolvimento da função motora precoce em crianças, portanto, a intervenção com exercícios em crianças com TEA é de grande importância. Objetivo Este artigo realiza uma intervenção de exercícios em crianças com TEA para estimular sua capacidade de exercício e melhorar sua capacidade de autocuidado. Métodos O artigo agrupou aleatoriamente 24 crianças com transtorno do espectro do autismo. O grupo experimental recebeu intervenção de exercícios e o grupo controle teve aulas regulares. Após a conclusão do experimento, a influência da intervenção do exercício em crianças com autismo é analisada. Resultados As habilidades motoras dos dois grupos de crianças foram diferentes após a intervenção. As habilidades motoras do grupo experimental melhoraram mais significativamente. Conclusão A intervenção com exercícios pode melhorar significativamente as habilidades motoras de crianças com transtorno do espectro do autismo. Avaliar se a aprendizagem de grandes habilidades motoras musculares de crianças com TEA e sua influência nas habilidades motoras básicas podem ser transferidos para fornecer uma referência para a intervenção motora relacionada. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción El trastorno del espectro autista (TEA) es un trastorno del desarrollo neurológico típico del cerebro, que presenta trastornos de comunicación y comunicación social, intereses estrechos y comportamientos repetitivos y estereotipados. El desarrollo del movimiento es un índice de evaluación importante para el desarrollo de la función motora temprana en los niños, por lo que la intervención con ejercicios en niños con TEA es de gran importancia. Objetivo Este artículo realiza una intervención de ejercicio en niños con TEA para estimular su capacidad de ejercicio y mejorar su capacidad de autocuidado. Métodos El artículo agrupó aleatoriamente a 24 niños con un trastorno del espectro autista. El grupo experimental recibió intervención con ejercicios y el grupo de control tuvo clases regulares. Una vez completado el experimento, se analiza la influencia de la intervención del ejercicio en los niños con autismo. Resultados Las habilidades motoras de los dos grupos de niños fueron diferentes después de la intervención. Las habilidades motoras del grupo experimental mejoraron de manera más significativa. Conclusión La intervención con ejercicios puede mejorar significativamente las habilidades motoras de los niños con un trastorno del espectro autista. Evaluar si el aprendizaje de las habilidades motoras de los músculos grandes de los niños con TEA y su influencia en las habilidades motoras básicas se puede transferir para proporcionar una referencia para la intervención motora relacionada. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Service Use and Unmet Needs Among Adults with Autism Awaiting Home- and Community-Based Medicaid Services.

Autistic adults in need of long-term services and supports spend months on waiting lists before receiving such services through Medicaid. Data from a state-wide survey of adults and their caregivers on a waiting list for autism waivers suggest that the majority have unmet needs for functional skills services (63.6%), employment or vocation services (62.1%), and mental and behavioral health services (52.8%). Almost a third require case management services (28.3%). Predictors of greater service need are African American race and the number of physical and behavioral health diagnoses. Predictors of greater service receipt were employment status, housing type, and school enrollment; there was lower service receipt for African American race, Hispanic ethnicity, over age 21 years, and college completion.

An Exploratory Study of Executive Function Development in Children with Autism, after Receiving Early Intensive Behavioral Training.

Objective: To examine the development of executive functions, in preschool children with autism spectrum disorders (ASD), receiving early intensive behavioral training (EIBI). Method: Executive functions (EF) were assessed with The Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P), by parents and preschool teachers at the time of diagnostic assessment and after 15 months of EIBI intervention. Ten children with ASD (M = 2.9 years, nine males) participated in the study. Reliable Change Index scores were computed for each of the participants in order to investigate any significant change in BRIEF-P T-scores. Results: Three children showed a significant improvement in EF, based on parent ratings. Four children showed a significant improvement in EF based on preschool teacher ratings. Conclusion: Findings indicating a reliable improvement in one third of preschool children with ASD receiving EIBI are encouraging but need to be replicated in larger scale controlled studies.

"I don't want to be a patient": Peer mentoring partnership fosters communication for autistic university students.

Background: Despite recognition of the benefits of post-school education in improving life outcomes for autistic adults their university completion rates remain low.Aim: To explore the experiences of undergraduate autistic university students participating in specialist peer mentoring (SPM) to identify active ingredients in the peer mentoring process and to examine the impact of SPM on social communication.Material and method: A total of 30 (8 female; M age = 22.3; SD = 6.7) undergraduate autistic university students engaged in SPM participated in this study. A quantitative pre-test post-test design examined changes in autistic traits. In parallel, the experiences of participating in SPM were explored through semi-structured interviews.Results: Improvements were noted at post-test on the Social Responsiveness Scale-2 total score p = 0.02), and its Social Communication, (p = 0.03) and Social Motivation (p = 0.03) sub-scales. Four themes emerged from the interviews: Developing Partnership and Understanding, Modelling and Practising Communication, Psychological Support and Grading and Planning Skills.Conclusions: These results indicated that the mentor-mentee partnership was a crucial active ingredient of SPM. This partnership appeared to modify social cognition and motivation for autistic university students through modelling and practising communication.Significance: These results demonstrate that SPM can support participation at university for autistic university students.

Teaching Undergraduate Clinicians Empirically Supported Practices for Preschool Vocabulary Instruction.

Purpose To incorporate evidence-based practice into clinical settings, there is a need for efficient, effective ways to share information from research to speech-language pathologists (SLPs) and to students preparing to become SLPs. The purpose of this study was to implement and evaluate a method for teaching undergraduate student clinicians to use empirically supported practices in vocabulary instruction during shared storybook reading with preschoolers. Method Undergraduate students enrolled in a semester-long preschool practicum participated in the study. In Study 1, 11 students participated in a multiple-baseline, single-case design. In Study 2, an additional 10 students were included in a quasi-experimental group design. All students completed prerecorded, online teaching modules that taught empirically supported practices for teaching vocabulary during shared storybook reading. Half of the students received weekly e-mails with performance feedback. Targeted practices included selection of appropriate vocabulary targets, explicit teaching, and use of interactive teaching strategies. Results In Study 1, treatment effects were observed for targeted practices for many of the student clinicians. In Study 2, group comparisons indicated an effect of e-mail performance feedback for 1 of 3 outcomes with a large effect size. Conclusion Prerecorded teaching modules may be an efficient, effective way to teach specific empirically supported practices to undergraduate student clinicians. E-mail feedback might improve use of taught practices for some students or for some practices. Future studies can examine the potential of these types of teaching modules for other outcomes or with groups of practicing SLPs.

Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism.

BACKGROUND: Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. METHODOLOGY: We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. DISCUSSION: Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. TRIAL REGISTRATION: ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019.

Academic Needs in Middle School: Perspectives of Parents and Youth with Autism.

Youth with autism spectrum disorders (ASD) without intellectual disability frequently experience academic problems, in part due to executive functioning (EF) deficits. There are currently no evidence-based interventions targeting academic EF skills for middle school youth with ASD. An intervention is currently in development. This paper reports on a "proof of concept" uncontrolled trial of the intervention, and focus groups with parents and youth to inform tailoring and adaptation of the intervention. Results of the trial suggest high feasibility/satisfaction, but a need for further adaptation to promote uptake by youth with ASD. Results from the focus groups confirmed the need for an intervention targeting academic EF skills, successful strategies in use, and the need to promote increased youth independence.

Blindness and Autism: Parents' Perspectives on Diagnostic Challenges, Support Needs and Support Provision.

Autism spectrum disorder (ASD), with or without intellectual disability (ID), is common in children with congenital blindness. This complex combination of disabilities often involves many challenges for the family. This study explored parents' experiences of having a child with blindness and ASD (with or without ID), their support needs and experiences of the support provided. Interviews with eight parents, representing six families, were performed. The parents emphasized that assessment and diagnostic procedures must be performed by professionals with expertise in blind children's development, and ASD. The support was often perceived as fragmented and did not correspond to the families' needs. The results suggest that national guidelines should be produced, to ensure a more coordinated and tailored support to these families.

Needs of Grandparents of Preschool-Aged Children with ASD in Sweden.

Little is known about needs of grandparents of young children with autism in family and community settings. This study investigated perceived needs of grandparents of preschool-aged children diagnosed with ASD in the cultural context of Sweden. Participants were 120 grandparents of children enrolled into autism intervention programs provided by the public disability services in Stockholm. The Grandparents' Needs Survey and the SDQ Impact supplement were used to collect data. Grandparents expressed most needs in topic areas of information and childcare. No significant relations were found between grandparents' demographics and perceptions of needs; grandparents' needs were predicted by their perceived burden. The findings provide insight into understanding of grandparents' needs essential for planning and provision of quality family-centered early intervention services.

Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-site Randomized Clinical Trial.

This study reports the results of a multi-site, parallel block randomized clinical trial to expand the previous findings regarding the implementation of Project SEARCH plus ASD Supports (PS + ASD) on employment outcomes upon graduation from high school. Participants were 156 individuals with significant impact from ASD between the ages of 18-21. There was a significant difference between treatment and control groups with 73.4% of the treatment group acquiring competitive employment at or above minimum wage by 1-year after graduation compared to 17% of the control group for whom data was provided. At 1-year, employed treatment group participants worked an average of 21.2 h per week (SD = 9) for a mean hourly wage of $9.61 per hour (SD = $1.55).Clinical Trial Registration: clinicaltrials.gov Identifier: NCT03560453.

Use of Vocational Rehabilitation Supports for Postsecondary Education Among Transition-Age Youth on the Autism Spectrum.

Transition-age youth with autism (TAY-ASD) experience poor employment outcomes and gaps in services that could assist them in securing jobs. Vocational rehabilitation (VR) is a source of public assistance for people with disabilities seeking employment and TAY-ASD are a growing segment of VR service users. Postsecondary education (PSE) is essential for building vocational skills, contributing to employment satisfaction and better wages. VR provides services to support PSE success. Fewer TAY-ASD received PSE training from VR (18%) than TAY with other disabilities (32%), but more than TAY with an intellectual disability (15%). TAY-ASD who received PSE training were more likely to exit VR with a job. The importance of PSE to employment should be considered in TAY-ASD who seek employment supports.

The Effects of Stability Ball Seating on the Behavior of Children with Autism During Instructional Activities.

Children with ASD often display behavior problems that can lead to academic and social disruptions. This has led to the introduction of stability balls as an alternative seating method for children, both on the autism spectrum and with other needs. This study used a multiple baseline design and duration data to evaluate the effects of stability ball seating on attending and in-seat behavior for children with ASD who received ABA therapy in their homes. The intervention replaced their standard seating method with a stability ball. In the final phase participants chose their own seating method before beginning table work to assess preference. Following intervention the stability ball was found to increase both attending and in-seat durations for children with ASD.

High School Experiences and Support Recommendations of Autistic Youth.

We used an online survey to gather perspectives of autistic youth (n = 248) on the impacts of autism, school professionals, family members, and peers on their high school experiences; what each stakeholder group could have done better; and what future high school professionals and autistic youth should know. Two-thirds of participants viewed autism as negatively impacting their school experience, and this was more prevalent in women. The majority viewed impacts of school professionals, family, and peers as positive. Women were more likely to view school professional contributions as positive than men, and LGBT youth were more likely to view school professional and peer contributions as negative than non-LGBT youth. Suggestions for stakeholders included providing more help, care, and quality time.

An analysis of the five year outcomes of a cohort of 46 deaf children with severe (SLD) or profound and multiple learning difficulties (PMLD) and associated complex needs, including autism (ASD), tracked using the Nottingham Early Cognitive and Listening Links (Early CaLL): This framework monitors the relationship between sound processor use and listening, spoken language, cognition and communicative development, following cochlear implantation.

Objectives: In 2018, routine data of the five year outcomes from a cohort of 46 children, (18 PMLD and 28 SLD, including nine SLD children with an additional diagnosis of ASD), was analysed to investigate the type and amount of benefit provided by cochlear implantation and to examine any differences in outcome patterns across the populations.Methods: The level of functional sound processor use achieved over time was reviewed in relation to listening and spoken language outcomes, alongside social engagement, communicative and cognitive development. The extent to which children were able to close the gap between their overall development and their listening abilities was quantified. The outcomes of the children with an additional diagnosis of ASD, was compared to those of the SLD population as a whole.Results: Although equipment management presented long term challenges, after five years, 80% of children were able to attach some meaning to sound. Children with SLD acquired more auditory skills and spoken language than those with PMLD. Most of the children used a mix of augmentative and alternative communication approaches (AAC), with 7%, all SLD children, acquiring some simple spoken language. An additional diagnosis of ASD had a negative effect on outcomes.Discussion: For 80% of the patients, the provision of cochlear implants provided benefits, although changes were slow to develop and required high levels of adult persistence.Conclusion: Outcomes measures which are population specific and acknowledge challenges, alongside providing ways to recognise individual achievements, by matching them against individual capacity, are of great value to families and practitioners.

Language nutrition for language health in children with disorders: a scoping review.

The quantity and quality of child-directed speech-language nutrition-provided to typically-developing children is associated with language outcomes-language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments-preterm birth, intellectual disability, and autism-addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children's language development? We identified 635 potential studies and reviewed 57 meeting study criteria. Child-directed speech to children with all conditions was comparable to speech to language-matched children; caregivers were more directive toward children with disorders. Most associations between child-directed speech and outcomes were positive. However, several interventions had minimal effects on child language. Trials with large samples, intensive interventions, and multiple data sources are needed to evaluate child-directed speech as a means to prevent language impairment. Clinicians should counsel caregivers to use high quality child-directed speech and responsive communication styles with children with these conditions.

A Systematic Review of Linguistic and Verbal Behavior Outcomes of Pivotal Response Treatment.

Pivotal Response Treatment (PRT) is a popular intervention for improving targeted and untargeted communication skills for learners with autism. We systematically reviewed communication outcomes reported in experimental research to determine linguistic forms and verbal behavior functions associated with PRT. We found most researchers aggregated results or did not report sufficient detail to determine linguistic forms and/or verbal behavior functions. Generalization of communication skills to untargeted people, settings, materials, and/or activities was evident. However, only one study clearly indicated untargeted linguistic forms emerged following PRT, and no researchers described results that indicated improved generalized and collateral verbal behavior functions. We suggest PRT researchers more clearly define and report primary, generalized, and collateral communication-specific outcomes in order to advance research and practice.

To See or Not to See: How Does Seeing Spellings Support Vocabulary Learning?

Purpose The aim of this study was to determine when, why, and how the presence of a word's written form during instruction aids vocabulary learning (a process known as orthographic facilitation). Method A systematic review of the research on orthographic facilitation was carried out. PsycInfo, Web of Science, ProQuest, and OpenGrey databases were searched. The search returned 3,529 results, and 23 of these met inclusion criteria. Studies were included in the review if they were written in English, published in a peer-reviewed journal, and compared vocabulary learning outcomes when words were taught with and without their written forms. Conclusions There is strong evidence that the presence of a word's written form leads to improved learning of its spelling and spoken form. There is also some evidence that it may lead to better learning of a word's meaning. A small number of studies have also shown that the presence of a word's written form benefits vocabulary learning in children with developmental language disorder, autism, Down syndrome, and reading difficulties. However, further research into the effects of orthographic facilitation in special populations is needed. In particular, ecologically valid experiments in clinical and educational settings are required in order to better understand how exposure to a word's written form can aid naturalistic vocabulary learning.

The Effects of a Technology-Based Self-monitoring Intervention on On-Task, Disruptive, and Task-Completion Behaviors for Adolescents with Autism.

Individuals with autism spectrum disorders (ASD) often present with difficulty in sustaining engagement, attention, and have disruptive behavior in classroom settings. Without appropriate intervention, these challenging behaviors often persist and negatively impact educational outcomes. Self-monitoring is a well-supported evidence-based practice for addressing challenging behaviors and improving pro-social behaviors for individuals with ASD. Self-monitoring procedures utilizing a handheld computer-based technology is an unobtrusive and innovative way of implementing the intervention. A withdrawal design was employed to assess the effectiveness of a technologically-delivered self-monitoring intervention (I-Connect) in improving on-task and task completion behaviors and decreasing disruptive behavior with four adolescents with ASD. Results demonstrated improvements in on-task and task completion behaviors across all four participants and disruptive behavior improved for two participants.