|Current Trends in the Assessment of Treatment Outcomes of Behavioral Services for Autism and Other Developmental Disabilities
|Sunday, May 24, 2020
|8:00 AM–9:50 AM
|Walter E. Washington Convention Center, Level 2, Room 202B
|Area: AUT; Domain: Translational
|Chair: Aida Tarifa Rodriguez (ABA España, Universidad Autónoma de Madrid)
|Discussant: Brian Reichow (University of Florida)
|CE Instructor: Javier Virues Ortega, Ph.D.
The evaluation of treatment outcomes is key to a wider adoption of behavioral treatments by key players in health and education including health insurance providers, advocacy groups, and government agencies. As part of this symposium we will present a series of pioneering studies in the area of treatment evaluation and outcome research in behavioral services for people with autism and fragile X syndrome. Study 1 from Scott Hall's group at Standford University presents a randomized controlled trial of function-driven interventions for problem behavior provided via telehealth. Study 2 from Svein Eldevik's group at Oslo Metropolitan University presents a 10-year follow up of treatment outcomes for adolescents and adults that have received early intensive behavioral intervention (EIBI) during childhood. Study 3 by Bill Ahearn's group at the New England Center for Children presents an evaluation of an early detection and treatment protocol. The study hopes to demonstrate that early detection followed by early treatment can result in optimal outcomes for young children with autism. Finally, Study 4 by Javier Virues-Ortega's group at The University of Auckland and Universidad Autónoma de Madrid presents the results of a case-control study aimed at identifying neural biomarkers of treatment outcomes. The study compared a range of neural pathways in two groups of children with autism who had or had not received parent-managed behavioral intervention. Together these studies feature a variety of emerging approaches to evaluate behavioral services. Dr. Brian Reichow author of several high-impact Cochrane reviews of EIBI will discuss the session.
|Instruction Level: Advanced
|Keyword(s): biomarkers, EIBI autism, fragile X, outcome research
Practitioners, researchers, advocates and policy decision-makers.
|Learning Objectives: Understand the key characteristics of several approaches to outcome research in ABA including: 1. Randomized controlled trials and randomized clinical trials 2. Early detection studies 3. Extended follow-up and longitudinal analyses 4. Case-control studies
Delivering Early Interventions for Children With Fragile X Syndrome via Telehealth: Outcomes of a Randomized Controlled Trial
|SCOTT S. HALL (Stanford University), Katerina Monlux (Stanford University/Oslo Met), Arlette Bujanda (Behavior Change Institute and Stanford University), Joy Pollard (Behavior Change Institute)
Introduction:Early Interventions for children with developmental disabilities are increasingly being delivered via telehealth to reduce health access disparities. In this paper, we describe the outcomes of a study designed to evaluate behavior analytic treatments for problem behaviors exhibited by young children with fragile X syndrome (FXS), the most common known inherited cause of Autism Spectrum Disorder. Methods:Participants were 61 boys with FXS, aged 3 to 10 years, who exhibited problem behavior on a daily basis. Following a functional analysis, participants were randomized to receive function-based behavioral treatment over 12 weeks (n=26) or treatment as usual (n= 25). The primary outcome measures were scores obtained on the Aberrant Behavior Checklist- Community (ABC-C) and the Treatment Acceptability Rating Form - Revised (TARF-R). Results:Children who received function-based behavioral treatment via telehealth evidenced significant decreases in problem behavior compared to those who received treatment as usual (Cohen’s d = 0.65, p<.001). Scores obtained on the TARF-R indicated that treatment acceptability remained high at 4-week follow-up. Discussion:These data provide initial evidence to support the efficacy of delivering function-based behavioral treatments via telehealth for this population. The advantages and disadvantages of using RCT designs to evaluate treatment effects will be discussed.
Treatment Gains from Early Intensive Behavioral Interventionare Maintained in Adolescents and Adulthood
|SVEIN EIKESETH (Oslo Metropolitan University ), Dean Smith (UK Young Autism Project), Diane W. Hayward (UK Young Autism Project), Catherine M. Gale (UK Behaviour Analysis and Research Group CIC), Lars Klintwall (Stockholm University)
This presentation reports the current outcomes of adolescents and adults with autism who received Early Intensive Behavioral Intervention (EIBI) in their childhood. Nineteen children (16 boys and three girls) who had received two years of EIBI starting at a mean age of 2.9 years took part in an extended follow up 12 years later. Results showed that participants had significantly increased their cognitive and adaptive standardized scores during the two years of EIBI, and that these gains were maintained 10 years after EIBI had ended. Participants also showed a significant reduction in autism symptoms between intake and follow-up. Participants had not received any additional psychiatric diagnoses and were not taking psychotropic medication at the 10-year follow up. Results indicate that treatment gains achieved in EIBI are maintained into adolescence. Treatment outcomes during adulthood are reported for eight children from Eikeseth, Smith, Jahr and Eldevik (2002, 2007) who received either three years of EIBI (n = 4) or three years of eclectic special education (n = 4). Preliminary results suggest that children who had received EIBI made larger gains and maintained their progress to a greater extent than those who received eclectic treatment. Overall, our results indicate that gains made after EIBI may persist into adolescence and adulthood.
|Early Identification and Treatment of Autism Symptomatology in Infant Siblings
|KATHRYN COUGER (New England Center for Children), Rebecca P. F. MacDonald (New England Center for Children), William H. Ahearn (New England Center for Children)
|Abstract: Infant siblings of children diagnosed with ASD have a 19% recurrence risk at 3 years old (Ozonoff et al., 2011). The point at which symptoms emerge is documented in the literature as occurring within 6-12 months. Treatment protocols that have roots in ABA have shown best outcomes. Graupner and Sallows (2017), in a sample of 55 infant siblings, reported symptoms in children under 3 months old. They were able to remediate symptoms in 13 of 14 siblings. The purpose of this study was to replicate their findings. Currently 41 siblings under 6 months of age have been recruited and are receiving bi- weekly screenings focusing on identifying symptoms. Seven of those babies have shown some symptoms and ABA therapy and/or parent coaching has been provided. All babies receive standardized assessment at 3-month intervals. Data to date reveal that earlier age and greater intensity of treatment results in best outcomes. Interobserver agreement averaged 94%. These findings have implications for service delivery and long term financial obligations.
|A Callosal Biomarker of Behavioral Intervention in Autism: A Case-Control Study
|JAVIER VIRUES ORTEGA (Universidad Autónoma de Madrid
The University of Auckland), Nerea Lopez (Universidad Española de Educación a Distancia), Nicole McKay (The University of Auckland), Jessica Catherine McCormack (The University of Auckland), Rosalie Liu (The University of Auckland), Ian Kirk (The University of Auckland)
|Abstract: The current study used MRI-derived diffusion imaging data (TBSS and seed-based tractography) to investigate whether there was a relationship between the type of intervention people diagnosed with ASD had previously received and their current brain connectivity. Twenty-five children and adolescents with ASD, with and without a history of parent-managed behavioral intervention, underwent an MRI scan with a diffusion data acquisition sequence. We conducted a region of interest analysis and tract-based spatial statistics. Significantly different fractional anisotropy values (believed to indicate white matter integrity) were found in the posterior corpus callosum of those exposed to parent-managed behavioral intervention relative to those who were not. The corpus callosum is the largest interhemispheric white matter bundle and callosal abnormalities have been previously found in people diagnosed with autism. The current case-control study paves the way for larger longitudinal randomized controlled trials. This area of research is critical to explore the possible clinical application of neuroimaging in measuring treatment efficacy in people diagnosed with autism spectrum disorder and to establish the biological plausibility of behavioral interventions.