Joint attention is considered one of the fundamental deficits in children with autism spectrum disorders, and in the recent years there has been published several studies based on applied behavior analysis providing joint attention interventions.
For some years there has been conducted a large rendomized controlled study in Norway on joint attention intervention for children with autism. This study ins not solely based on behavior analysis, but on the works of Kasari and collegaues. Read more…
The effect of behavior interventions for children with autism has been showed to be effective through research and the professional literature. And all involved in behavior interventions agree that staff training and staff competency are important factors, to provide qualitative good and effective interventions.
There exists several research reports on the importance of staff competency, and staff training, and Weinkauf, Zaug, Anderson and Ala’i-Rosales have published a new study on a comprehensive staff training package in Research in Autism Spectrum Disorders. This study showed effect on the training package that included verbal descriptions and modeling of 125 skills determined to be important in implementing behavior intervention. And that the teachers required between 20 and 32.5 hours to reach the criteria of mastering at least 120 skills.
The need for research using randomized groups have been great in the field of autism intervention. And in volume 52:1 of Journal of child psychology and psychiatry Landa, Holman, O’Niell and Stuart have published a randomized study on socially synchronous engagement in toddlers with autism spectrum disorder.
In their study their randomized fifty two years old children with autism spectrum disorders. The two groups received identical treatment based on established teaching strategies such as discrete trial teaching and pivotal response treatment, but one group (interpersonal synchrony) received a supplementary curriculum on engaged imitation, joint attention and affect sharing.
The study showed a significant effect for the interpersonal synchrony group on engaged imitation (including eye contact). The study also showed positive results on joint attention and affect sharing, but not statistically significant.
It´s important that the number of randomized controlled trials in autism interventions is raised, and recently a new randomized controlled trial reached publication. Carter et al published a randomized trial of Hanen´s More Than words in the Journal of Child Psychology and Psychiatry.
Hanen´s More Than Words (HMTW) is described as a parent training program to teach parents with young children with ADS practical strategies to use during everyday situations and routines to increase communication. The program includes eight group sessions with parents, and three individualized sessions with parents and child. HMTW focuses on helping children with ASD to reach the following four goals: (1) improved two-way interaction, (2) more mature and conventional ways of communicating, (3) better skills in communicating for social purposes, and (4) improved understanding of language.
In this study including 62 children found differential effects on child communication. They found no main effects of the HMTW on either parental responsively or children´s communication. But they showed effects on residualized gains in parent responsively from the time before randomization to 5 and 9 months later. They also found that children with low object interest before interventions exhibited facilitated growth in communication 9 months later.
The concept of evidence-based and scientifically based has received much attention within the psychological and educational areas for some time, and also in the field of autism interventions. But in autism interventions there have existed an exists some debate on the application of the term to autism interventions, and how to interpret these concepts to the field of autism intervention.
In the recent issue of Autism, vole 15 (2011) Mesibov and Shea has published their view on evidence-based practices and autism. The authors of this article claims that there is no agreement within the file about what constitutes effective, evidence-based treatment for the entire range of people with autism. But admits that there is some consensus about some aspects of interventions for some sub-groups of individuals with autism, particularly young children.
The continue by describing some of the benefits of an evidence-based approach and some of the challenges the field of autism interventions meets regarding evidence-based. Then the authors list some suggestions for defining and applying the concept of evidence-based to autism interventions. The article describes from my point of view several suggestions that may strengthen the field, but also some that are more problematic and may reduce the objectivity of research on autism interventions. Their proposal of reducing the rigidity of manualization may contribute to difficulties in replication, a fundamental part of science and research and may greatly reduce validity of the research. Even if I agree in their notion of a greater variety of outcome measures, research should concentrate on obtaining objective data to support the findings in studies. I finally find their suggestion of defining and rely on professional recognition in deterring evidence-base problematic as it most likely would be a daunting task to make this measure objective.
A lot of studies and reviews has established the effectiveness of Applied Behavior Analysis (ABA) for children with autism, but it is not available free to all children with autism, especially across Europe. This has lead to among other issues a commercialization of the ABA or EIBI services for children with autism. Creating a service for the wealthy, and created other issues that are problematic. Keenan, Dillenburger, Moderato and Röttgers has elaborated on these issues from examining the current state of ABA for autism in three European countries. The article point out real and important issues for service providers, families and governments and these issues need to be addressed.
Link to the article.
Based on Hayward, Gale and Eikeseht´s (2009) identification of four key variables that are common in those studies showing best effect of EIBI, there is a definitive need for effective assessment tool in developing an prod a unique, comprehensive curriculum that is tailored to the individual child’s needs across all areas of functioning. Gould, Dixon, Najdowski, Smith and Tarbox has an article in press for Research in Autism Spectrum Disorders available online addressing this issue. Their review is labeled “A review of assessments for determining the content of early intensive behavioral intervention programs for autism spectrum disorders.”
First the authors states the critical components for an assessment that may be used in determining curricula in EIBI, these are (1) the assessment should be comprehensive, (2) it should target early childhood development, (3) the assessment should consider behavior function, not just topography, and (4) it should be a direct link from assessment items to specific curricula targets. Based on these criteria hay identified the following four assessment instruments; Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), Brigance Diagnostic Inventory of Early Development-II, Vineland Adaptive Behavior Scales-II, and the Brigance diagnostic Comprehensive Inventory of Basic Skills-Revised.
Even if the authors identify these assessment tools they also That no single assessment tool is comprehensive enough to develop a fully comprehensive EIBI curriculum, and they give descriptions of the strengths and challenges by using the fours identified assessment tools.
This article highlights a central issue for providers of EIBI, and hopefully there will be conducted much more research on assessment tools and curricula design within EIBI. This article is a must read for all providing EIBI.
Mary Jane Weiss, Nicole Pearson, Kristin Foley, and Sara Pahl has published an article describing the importance of fluency outcomes for children with autism in this issue of The Behavior Analyst Today.
As the authors points out several children with autism display fluency deficits, that may affect learning and social outcomes. The level of evidence of providing fluency intervention is not established, and more research on fluency interventions for children autism is needed.
The article discusses to issues that may be especially relevant for children with autism: teaching of motor component skills and the evaluation of the outcomes of fluency building.
As this paper points out fluent performance in motor component skills may be potentially important for children with autism in a wide area of skills and possibilities and enhance further learning.
The outcome of fluency building is described in the acronym RESA – retention, endurance, stability and application. This outcomes is of course relevant for all children and learner, but may be especially relevant for children with autism and the common challenges in generalization and maintenance.
