|Keeping What Works and Looking to Improve: Early Intervention in Autism Spectrum Disorder|
|Monday, May 28, 2018|
|12:00 PM–12:50 PM |
|Manchester Grand Hyatt, Grand Hall A|
|Area: AUT/PRA; Domain: Service Delivery|
|Chair: Lynne Levato (University of Rochester Medical Center)|
|CE Instructor: Lynne Levato, Ph.D.|
Applied behavior analysis (ABA) interventions, including at least some discrete trial teaching (DTT), are often considered the standard of care for preschoolers with autism spectrum disorder. However, it is unclear whether community agencies can sustain effective early ABA intervention over time. Also, alternatives to DTT, often emphasizing naturalistic child-led interactions, have generated increasing empirical support in recent years, and it is unclear how these approaches should be integrated into ABA interventions. In this symposium, the first presentation documents sustainability of effective services in a quasi-experimental study of 94 participants, age 18-75 months at onset of intervention, seen for three years (48 children in early intensive ABA at a community agency and 46 matched children in early childhood services as usual). The second presentation shows single subject data for eight participants, age 2-5 years, in a Sequential Multiple Assignment Randomized Trial aimed at tailoring DTT and Verbal Behavior techniques to the needs of individual children. The third presentation describes a three-center, randomized clinical trial that compared DTT to an empirically supported naturalistic developmental behavioral intervention, JASPER, in 161 children, age 33-54 months. Although DTT and JASPER differ markedly in intervention content and method, outcomes were mostly similar across interventions.
|Instruction Level: Intermediate|
|Target Audience: |
Providers and researchers who work in early intervention for children with autism spectrum disorder
|Learning Objectives: 1. Summarize outcomes of early intensive behavioral intervention in community settings 2. Define a Sequential Multiple Assignment Randomized Trial 3. List three key features of naturalistic developmental behavioral interventions 4. Summarize findings from studies that compare discrete trial teaching to naturalistic, child-led teaching formats|
Sustainability of Early Intensive Behavioral Intervention for Children With Autism Spectrum Disorder in a Community Setting
|CHANTI FRITZSCHING WATERS (Central Valley Autism Project, Inc.), Mila A. Amerine Dickens (Central Valley Autism Project, Inc.), Sally Thurston (University of Rochester Medical Center), Xiang Lu (University of Rochester Medical Center), Tristram Smith (University of Rochester Medical Center)|
This study examined whether outcomes in early intensive behavioral intervention (EIBI) during a university-led multisite project could be replicated by the same community agency independently of the project. Participants, age 18-75 months at onset of intervention, were 48 children with autism spectrum disorder enrolled in 35 hours per week of publicly-funded, community-based EIBI for three years and 46 children who were matched on baseline characteristics and received early childhood services as usual (SAU) through local early childhood special education providers. Linear mixed models indicated that EIBI participants improved significantly more than SAU participants on standardized tests of IQ, nonverbal IQ, adaptive behavior, and academic achievement, administered by independent evaluators. Although limited by the use of a matched comparison group rather than random assignment, the study provides evidence for the sustainability of effective EIBI in community settings for children with ASD who start intervention at varying ages throughout early childhood.
Preliminary Comparison of Two Models of Low-Intensity Behavior Analytic Intervention for Preschool Children With Autism
|Mary Louise E. Kerwin (Rowan University), Michelle Ennis Soreth (Rowan University), VICTOR CHIN (Rowan University), Vincent Joseph Carbone (Carbone Clinic), Tristram Smith (University of Rochester Medical Center)|
As high as 47-48% of children receiving Early Intensive Behavioral Intervention (EIBI) have been reported to experience optimal outcomes; however, the responses of children who do not respond optimally to EIBI vary widely. One source of variability in treatment response may be the model of EIBI implemented. Preliminary data will be presented from a 16-week treatment outcome study comparing two behavior analytic models of Early Intensive Behavioral Intervention (EIBI) for children ages 2-5 years old diagnosed with autism: 1) the Lovaas/UCLA Model (LM) and 2) the Verbal Behavior Model (VBM). The study used a dynamic experimental design (i.e., Sequential Multiple Assignment Randomized Trial; SMART) developed to inform adaptive treatment strategies. Participants were randomly assigned either to low-intensity LM or VBM conditions and received 90-minute sessions 3 times/week. At the end of the first 8 weeks, it was determined whether the child was responding to the intervention. Participants slow to respond were randomly assigned to receive either an intensified version of the initial intervention or the unassigned intervention for an additional 8 weeks. Preliminary empirical evidence of participants'responses to LM and VBM conditions will be presented and we will discuss how the outcomes of the study inform adaptive treatment decisions.
|Randomized Trial of Early Intervention for Spoken Communication in Autism Spectrum Disorder|
|Tristram Smith (University of Rochester Medical Center), Connie Kasari (University of California, Los Angeles), Rebecca Landa (Kennedy Krieger Institute), DANIEL W. MRUZEK (University of Rochester Medical Center), Stephanie Shire (University of Oregon), Wendy Shih (University of California Los Angeles), Dana Herman (Kennedy Krieger Institute), Damla Senturk (University of California Los Angeles)|
|Abstract: ABA interventions that emphasize discrete trial teaching (DTT) are well-established for preschoolers with autism spectrum disorder (ASD) and limited language. Other approaches apply naturalistic, developmental behavioral interventions (NDBIs), which aim to increase social engagement by providing learning opportunities during back-and-forth interpersonal interaction, often involving child-led play. We compared DTT to an empirically supported NDBI, the Interpersonal Developmental Approach (IDA) consisting primarily of JASPER. Participants were 161 children with ASD, age 33-54 months, with limited language (<30 initiated spoken words), randomized to DTT (n=82) or IDA (n=79) for one-hour intervention sessions 5x/week for six months. Outcome measures (administered at baseline, end-of-treatment, and six-month follow-up) included the Reynell Developmental Language Scales, Mullen Scales of Early Learning, and Early Social Communication Scales (an observation of nonverbal communication, including frequency of initiations of joint attention, IJA). Generalized linear mixed models indicated both groups improved over time. Outcomes did not differ between groups on the Reynell or Mullen. For participants who did not display IJA at baseline, IJA outcomes did not differ between groups; however, participants with IJA at baseline had better IJA outcomes in IDA than DTT, F(1,159)=4.44, p=0.037. Overall, despite differing intervention content and method, DTT and IDA led to mostly similar outcomes.|