Number and controllability of reinforcers as predictors of individual outcome for children with autism receiving early and intensive behavioral intervention: a preliminary study

Although Early and Intensive Behavioral Intervention (EIBI) is an effective treatment for many children with autism, there is a substantial individual difference in outcome. This study was designed to investigate whether treatment gains were associated with the number and type of stimuli that function as reinforcers for 21 preschool-aged children with autism. Children with a large repertoire of socially mediated reinforcers benefited more from treatment. Children with many stereotypic behaviors, assumed to be an effect of a larger repertoire of automatic reinforcers, exhibited less benefit from treatment. These two dimensions taken together explained 49.9% of the variation in treatment gains for children after one year of EIBI. Due to the retrospective and indirect design of the study, results are to be interpreted with cautio

Ogräs, åkertistlar och taggiga växter

Psykiatriska diagnoser är kontroversiella. Vissa, ofta psykiatriker, menar att psykiska tillstånd går att dela upp i distinkta klasser medan andra, ofta psykologer, menar att all sådan uppdelning gör våld på verkligheten. Dessutom har psykiatrin anklagats för att vara moraliserande: vem kan avgöra vad som är sjukt och friskt? Är autism en sjukdom? Utifrån en pragmatisk begreppsanalys är uppdelningen mellan sjukt och friskt nödvändigtvis godtycklig. Precis som när en trädgårdsmästare avgör vad som är ogräs så beror det på situationen och ens syften. Och precis som växterarter ibland är distinkta arter så kan vissa psykiatriska diagnoser vara distinkta klasser, och andra inte. Kanske är autism en avgränsad diagnos, kanske inte. Men ibland är inte artsuppdelning det mest användbara för en trädgårdsmästare, precis som det inte behöver vara det för psykiatrin. Istället kan man formulera nya kategoriseringar helt baserade på pragmatiska hänsyn. Ibland räcker det med taggiga växter och socialt indifferenta barn

Manglende generalisering av trenerferdigheter på tvers av situasjoner etter Workshop om Incidental Teaching

Incidental Teaching er en prosedyre som benyttes for å øke spontant språk, og har vist seg effektiv i opplæring og generalisering av språkferdigheter hos personer med ulike diagnoser i ulike situasjoner. Det er behov for kostnadseffektive intervensjoner for å sette lærere og andre trenere i stand til å bruke Incidental Teaching; forskning på personalopplæring innen Incidental Teaching er begrenset. Selv om flere studier har konkludert med at Incidental Teaching kan læres gjennom workshops, er det ukjent om trenere generaliserer ferdighetene til situasjoner hvor de ikke har mottatt eksplisitt opplæring. Vi undersøkte effekten av to workshops på antall episoder med Incidental Teaching lærerne lykkes i å implementere. Resultatene viser en signifikant økning hos begge deltakerne i forhold til bruk av Incidental Teaching i de situasjonene hvor de hadde mottatt eksplisitt opplæring gjennom workshop, men ingen av deltagerne generaliserte ferdighetene i Incidental Teaching til en situasjon som ikke ble omhandlet i workshops.Incidental Teaching is a procedure that is used to increase the use of spontaneous language. IT has been shown to be effective in teaching and promoting generalization of language skills in a variety of persons and settings. However, cost-effective interventions to enable teachers and paraprofessionals to implement Incidental Teaching are needed: research on how to do staff training to increase use of Incidental Teaching is limited. Although several studies have concluded that Incidental Teaching can be successfully taught using workshops, the extent to which therapists generalize teaching skills to settings not explicitly taught is unknown. We investigated the effect of two workshops on the number of Incidental Teaching episodes achieved by two teachers. Although results showed that both participating teachers significantly increased their use of Incidental Teaching in the settings that were explicitly taught in the workshops, neither of them generalized these new skills to a setting that was not explicitly discussed in the workshops

Cross-Cultural Content Validity of the Autism Program Environment Rating Scale in Sweden

Increasing rates of autism spectrum disorder (ASD) and younger age at diagnosis pose a challenge to preschool intervention systems. In Sweden, most young autistic children receive intervention service in community-based preschool programs, but no tool is yet available to assess the quality of the preschool learning environment. This study adapted the Autism Program Environment Rating Scale Preschool/Elementary to Swedish community context (APERS-P-SE). Following translation and a multistep modification process, independent experts rated the content validity of the adaptation. Findings indicate high cross-cultural validity of the adapted APERS-P-SE. The cultural adaption process of the APERS-P-SE highlights similarities and differences between the American and Swedish preschool systems and their impact on early ASD intervention

"Jeg ønsker å lese bedre!" : intensiv leseopplæring for en elev med ADHD

Studien redegjør for et 10 ukers individuelt tilpasset leseopplæringsprogram, med bruk av positiv miljøtilrettelegging og systematisk lydering som metode for en 8 år gammel elev med Attention Deficit/Hyperactivity Disorder (ADHD). Prosedyren innebærer en trinnvis tilnærming fra visuell og auditiv gjenkjenning av bokstaver til selvstendig lesing under optimale motivasjonsbetingelser. Målet var leseferdigheter tilnærmet nivået som forventes på 3. klassetrinn. Resultatene er oppmuntrende og tiltaket illustrerer hvordan det kan jobbes intensivt og systematisk over en kort periode for å gi et ekstra løft i ferdigheter

Self-reported sex differences in high-functioning adults with autism: a meta-analysis

Background: Sex differences in autistic symptomatology are believed to contribute to the mis- and missed diagnosis of many girls and women with an autism spectrum condition (ASC). Whilst recent years have seen the emergence of clinical and empirical reports delineating the profile of young autistic girls, recognition of sex differences in symptomatology in adulthood is far more limited. Methods: We chose here to focus on symptomatology as reported using a screening instrument, the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R). In a meta-analysis, we pooled and analysed RAADS-R data from a number of experimental groups. Analysis of variance (ANOVA) searched for the presence of main effects of Sex and Diagnosis and for interactions between these factors in our sample of autistic and non-autistic adults. Results: In social relatedness and circumscribed interests, main effects of Diagnosis revealed that as expected, autistic adults reported significantly greater lifetime prevalence of symptoms in these domains; an effect of Sex, in circumscribed interests, also suggested that males generally reported more prevalent symptoms than females. An interaction of Sex and Diagnosis in language symptomatology revealed that a normative sex difference in language difficulties was attenuated in autism. An interaction of Sex and Diagnosis in the sensorimotor domain revealed the opposite picture: a lack of sex differences between typically-developing men and women and a greater prevalence of sensorimotor symptoms in autistic women than autistic men. Conclusions: We discuss the literature on childhood sex differences in relation to those which emerged in our adult sample. Where childhood sex differences fail to persist in adulthood, several interpretations exist, and we discuss, for example, an inherent sampling bias that may mean that only autistic women most similar to the male presentation are diagnosed. The finding that sensorimotor symptomatology is more highly reported by autistic women is a finding requiring objective confirmation, given its potential importance in diagnosis

Traduction et adaptation du TEI-SF afin de documenter l’acceptabilité sociale de l’intervention comportementale intensive

L’intervention comportementale intensive est de plus en plus utilisée dans le cadre de services à large échelle destinés aux jeunes enfants ayant un trouble du spectre de l’autisme. Il s’avère pertinent d’évaluer l’acceptabilité sociale de ce programme. La présente étude propose de mesurer l’acceptabilité sociale de cette intervention lorsqu’elle est offerte en service de garde inclusif, ainsi que deux interventions ciblées qui y sont associées. Pour ce faire, le questionnaire d’évaluation Treatment Evaluation Inventory Short-form (TEI-SF) a été traduit et adapté en français. Les résultats présentent les premières preuves de validité de la version francophone du TEI-SF de même que des scores de validité d’intervention et un point de vue favorable relié à l’intervention comportementale intensive, ouvrant la porte à des recherches ultérieures. Early intensive behavioral intervention is more widely used in large-scale community-based services in Autism Spectrum Disorder. There is an increased need to evaluate the social acceptability of these programs. The present study used a measure of social acceptability as part of a social validation procedure to evaluate a community-based EIBI offered in inclusive childcare, as well as two focused interventions associated with this program. To do so, the Treatment Evaluation Inventory Short-form (TEI-SF) questionnaire was adapted and translated to French. The validation results for the TEI-SF, as well as for the social acceptability of the EIBI programs and procedures, are presented. The results are the first evidence of the validity of the TEI-SF (adapted and translated to French), presenting scores of validity of intervention and a favourable perspective related to the early intensive behavioral intervention and opening the door to further research

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

Background: The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness, skills such as social functioning and play, participation outcomes such as social inclusion, and parent and family impact. Objectives: To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. Methods: The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013, systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD, and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. Results: The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184, in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular,there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). Conclusions: This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. Future work: Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. Study registration: This study is registered as PROSPERO CRD42012002223. Funding: The National Institute for Health Research Health Technology Assessment programme