SCIENCE IN AUTISM TREATMENT, P Halliday, Z Houston, E BCBA, MS Kinney

Tags: Autism Treatment, autism, intervention, children with autism, Myers & Johnson, social skills, ASAT, communication, families, Picture Exchange Communication System, Autism Spectrum Disorders, skills, development, PECS, scientific evidence, Augenstein, Gonzalez-Heydrick, treatment goals, Carr & LeBlanc, Science, scientific literature, behavioral approaches, social intervention, toddlers with autism, treatments, Pediatric Annals, Board Member Daniel W. Mruzek, autism spectrum, CAM therapies, social communication, treatment group, Caldwell College, family physicians, controlled studies, David Celiberti, BCBA, Treatment Summary, medical professionals, Kerry Ann Conde, Scott M. Myers, Autism Awareness, ASDs, High-Functioning Autism Spectrum Disorders Lopata, social development, autism spectrum disorder, Daniel W. Mruzek
Content: Page 1 SCIENCE IN AUTISM TREATMENT
Vol. 9 No. 2
Newsletter of the Association for Science in Autism Treatment
Spring 2012
Table of Contents Autism Treatment Reviews for Physicians ............. 1 Science in Autism Treatment Team ....................... 1 Shout Outs, Accolades, and Appreciations ............ 5 Letter from the Editor.............................................. 8 ASAT Conference..................................................... 8 Review: RCT of DIR/Floortime Therapy ................. 9 Focus on Science: Pitfalls of Testimonials........... 12 ASAT Advisory Board ............................................. 12 Treatment Summary: Son-Rise............................. 13 New CDC Autism Numbers Highlights .................. 13 Annual Rock'n 4 Autism Awareness Concert....... 14 ASAT 2011 Sponsors ............................................ 15 Clinical Corner: Expanding Interest ...................... 16 ASAT Advertising Policy ......................................... 18 ASAT Sponsorship ................................................. 19 2011 ASAT Donor Wall ......................................... 20 ASAT Board of Directors........................................ 21 Media Watch Update ............................................ 21 Research Review: RCT of Manualized Tx ............. 22 Research Review: Effectiveness of PECS ............ 23 Research Review: Synchronous Engagement .... 24 International News ................................................ 25 ASAT Committee Members ................................... 25 ASAT's Facebook Update ...................................... 25
Autism Treatment Reviews for Physicians: The Take-home Messages By Peggy Halliday, MEd, BCBA, Zachary Houston, MS, BCBA, Elisabeth Kinney, MS, BCBA & Scott M. Myers, MD Although screening and early recognition of autism spectrum disorders (ASDs) are important, the role of the primary healthcare provider does not end with diagnosis. Management responsibilities after the diagnosis of ASDs include providing high quality medical care and guiding families to effective interventions and accurate information sources. Primary healthcare providers, such as pediatricians, family physicians, nurse practitioners, and physician assistants, may take part in any or all of these duties in addition to making referrals to subspecialists and coordinating services. In a national survey conducted in 2007, pediatricians and family physicians reported low self-perceived competency in providing care for children with ASDs and a desire for education (Golnik, Ireland, & Borowsky, 2009). Fortunately, in recent years, literature reviews and guidelines have been published which summarize the evidence and help medical professionals to manage their patients with ASDs. In this article, we summarize the treatment recommendations of five reviews that have been published in the medical literature in the last four years, including the American Academy of Pediatrics (AAP) guidelines (Carr & LeBlanc, 2007; Myers & Johnson, 2007; Golnik, Ireland, & Borowsky, 2009; Myers, 2009; Carbone, Farley & Davis, 2010; Munshi, Gonzalez-Heydrick, Augenstein, & D'Angelo, 2011).
General Management Issues Broad treatment goals include improving quality of life by: (1) correcting or minimizing the core deficits (social impairment, communication impairment, and restricted, repetitive behaviors and interests) and associated deficits, (2) maximizing functional independence by facilitating learning and academic achievement, acquisition of self-care and daily living skills, and development of play and leisure skills, and (3) eliminating or minimizing problem behaviors that interfere with functioning (Myers & Johnson, 2007; Myers, 2009). Most interventions that are helpful for achieving these goals are carried out by parents and professionals such as teachers, therapists, and behavior specialists- not by physicians. However, efforts to optimize health are likely to have a positive impact on educational progress and quality of life.
The medical home model of care, which is advocated for children with ASDs and other special healthcare needs, includes provision of care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, (Continued on page 2)
Science in Autism Treatment (SIAT) Team
Co-Editors David Celiberti, PhD, BCBA-D Joshua K. Pritchard, PhD, BCBA Focus On Science Daniel W. Mruzek, PhD, BCBA-D International Updates Daniela Fazzio, PhD, BCBA-D
Research Synopses Sharon Reeve, PhD, BCBA-D Clinical Corner Nicole Pearson, PsyD Consumer Corner Kate Fiske, PhD, BCBA-D Media Watch Barbara Jamison, BA
Treatment Summaries Tristram Smith, PhD Events Denise Grosberg, MA, BCBA Shout Outs Kerry Ann Conde, MS, BCBA From The Archives Sara Jane Gershfeld, MA, BCBA
ASAT, P.O. Box 188, CrossAwSicAkTs, New Jersey 08515-0188 Providing Accurate, Science-BasewdwInwfo.ramsaattioonn-liPnreo.moorgting Access to Effective Treatment
Page 2
Science in Autism Treatment
Volume 9,2 Spring 2012
Pediatric Guide continued...
and culturally effective (Myers,
guidelines to guide families toward childhood educational programs
2009). Reviewers point out that in evidence-based educational
most often used, and which differ
the case of patients with ASDs, treatments. There is general
in basic philosophy, are behavior
office visits and physical
agreement among well-researched analytic, developmental, and
examinations may be challenging guidelines that educational
structured teaching.
and require extra time and effort. treatment should begin early and
treatment goals should be
There are five decades of
In addition to issues specific to comprehensive. Treatments should controlled studies in university and
their neurodevelopmental disorder, strive to minimize core social,
community settings showing the
individuals with ASDs have the
communication, and behavioral effectiveness of applied behavior
same basic healthcare needs as deficits, and to maximize self-care, analysis (ABA) based interventions
other children and they benefit academic independence, and
in helping remediate social and
from routine health promotion and leisure skills, while at the same language impairments as well as
disease prevention efforts,
time decreasing aberrant
helping children make sustained
including immunizations. In some behaviors that interfere with
gains in IQ, academic performance,
cases, medical therapy may play functioning (Myers & Johnson,
and adaptive skills, compared to
an important role in treating
2007; Myers, 2009). Early
children in control groups (Carr &
problem behaviors such as
diagnosis and early intervention LeBlanc, 2007; Myers & Johnson,
aggression and self-injury, either by are associated with best outcomes 2007; Munshi, Gonzalez-Heydrick,
treating a coexisting psychiatric or for children with ASDs. However, in Augenstein, & D'Angelo, 2011).
neurologic condition or addressing the United States the average age Early and intensive behavioral
an underlying medical problem of identification is still older than interventions (or EIBI) are skills-
(such as an ear infection or
constipation) to alleviate pain
or discomfort (Myers &
Johnson, 2007; Myers, 2009;
Carbone, Farley, & Davis,
2010; Munshi, Gonzalez-
Heydrick, Augenstein, &
D'Angelo, 2011). Currently,
four despite the ability to identify based treatment approaches
medical therapies are directed at ASDs as early as two years of age based on the science of applied
specific symptoms or coexisting (Carr & LeBlanc, 2007).
behavior analysis. EIBI program
conditions rather than the ASD
models differ but share a
itself. For example, children with The role of the physician should philosophy of starting when
ASDs who have seizures or
include guiding families to
children are very young, intensity of
gastrointestinal problems (such as empirically supported educational treatment (25-40 hours per week),
chronic diarrhea or constipation) and habilitative practices and
a focus on communication, social,
should be evaluated and treated helping them evaluate the
and pre-academic repertoires, and
the same way as any other child appropriateness of educational the use of teaching methods
with these symptoms would be services being offered (Myers & derived from the principles of
evaluated and treated.
Johnson, 2007). Of the many
operant conditioning (Carr &
educational methods available for LeBlanc, 2007).
Educational/Habilitative/
the treatment of ASDs, some
Behavioral Interventions
methods, such as facilitated
Such programs should be
Easy access to the Internet has communication, have been proven individualized and based on
resulted in widespread
to be ineffective. Others, like
assessment (Carr & LeBlanc,
dissemination of both information auditory integration training,
2007). Behavioral therapy can be
and misinformation about
dolphin-assisted therapy, holding provided by an early intervention
treatments for ASDs. Fortunately, therapy, vision therapy, or
program, a special education
medical professionals can help therapeutic touch lack evidence to program through a school, or by
manage the care of their patients show efficacy in treating individuals therapists in private practice.
with ASDs by drawing upon
with ASDs (Myers, 2009). The three Caregivers who are interested in
published literature reviews and general categories of early
(Continued on page 3)
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 3
Pediatric Guide continued...
pursuing this treatment approach should be referred to eclectic educational methods.
the Behavior Analyst Certification Board to locate a
There is a growing agreement that effective early
professional qualified to oversee such a program.
childhood intervention for children with ASDs should
Programs based on developmental theory include the include the following components (Myers & Johnson,
relationship development intervention (RDI) and
2007):
developmental, individual-difference, relationship-based
model (DIR, also known as "floor-time"). Social deficits Starting early, even before a definitive diagnosis has
are the primary focus of both interventions, and both are been made;
popular and relatively widespread in their dissemination; Intensive teaching for at least 25 hours a week, all
however, no well-controlled studies documenting their
year long;
effects have been published. Furthermore, the basic
One-on-one and small group instruction, with low
developmental theories upon which RDI and DIR are
student-to-teacher ratios;
based have not been tested. When considering these Parent or caregiver training;
interventions, the lack of empirical support should be Ongoing measurement and Data Analysis in order to
considered.
individualize instruction as required;
Structured environments, including visual schedules,
Structured teaching is best exemplified by Project
clear physical boundaries and predictable routines;
TEACCH (Treatment and Education of Autistic and
Strategies to promote generalization and
Related Communication-Handicapped Children). The
maintenance of learned skills;
goal of structured teaching is to use strategies like visual Assessment based curricula that includes functional
supports, individual work stations which minimize
communication, social skills, self-management,
distractions, and picture schedules to aid with
cognitive and academic skills and functional
transitions. These strategies cater to the learning styles
adaptive skills to increase independence;
of many individuals with autism. The National Research Reduction of disruptive behavior using strategies
Council considers Project TEACCH a "plausible"
that employ functional assessment.
intervention; however, there are currently no well-
controlled studies of its outcomes.
Psychotropic Medications
Medications that are used to produce behavioral,
Many educational treatments for children and
emotional, or cognitive changes are known as
adolescents with ASDs, despite their popularity, have not psychotropic medications.
been adequately evaluated, and some do not meet
Psychotropic medications have
criteria for "well-established" treatments due to a lack of not been proven to correct the
robust experimental designs, independent replications or core social communication
peer-reviewed published data. This does not necessarily deficits of ASDs, and they
mean that they are ineffective; however, efficacy has not obviously do not teach skills.
been established and replicated in well-designed clinical However, medications are
studies (Carr & LeBlanc, 2007).
sometimes effective for
treating associated problem
In many communities, an "eclectic" treatment approach behaviors or coexisting psychiatric conditions that
is used which combines ABA, structured teaching, and a interfere with educational progress, socialization, health
developmental approach. While there are many
and safety, and quality of life (Myers & Johnson, 2007;
differences between the approaches, there are also
Myers, 2009; Munshi, Gonzalez-Heydrick, Augenstein, &
areas in which they borrow from one another. For
D'Angelo, 2011).
example, behavioral programs address social
interactions like joint attention and imitation, borrowing Examples of problems that might potentially be targeted
from developmental approaches, as well as utilizing
with psychotropic medications include irritability,
visual strategies borrowed from structured teaching;
aggressive or self-injurious behavior, ADHD symptoms
some developmental models and structured teaching (inattention, distractibility, impulsivity, and hyperactivity),
approaches use behavioral techniques to meet their
anxiety, mood disorders, and sleep problems. The best
teaching goals. However, studies which have compared evidence of effectiveness of psychotropic medications
outcomes from the eclectic approach groups to intensive for specific symptoms in people with ASDs comes from
ABA groups have shown more favorable outcomes in the independently replicated studies involving randomized,
ABA groups, raising questions about the efficacy of
(Continued on page 4)
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 4 Pediatric Guide continued... double-blind, placebo-controlled trial designs, with adequate sample sizes and well-characterized study populations. The atypical antipsychotic medications, risperidone and aripiprazole, are currently the only medications with U.S. Food and Drug Administration-approved labeling specific to ASDs [for the symptomatic treatment of irritability, including aggressive behavior, deliberate self-injury, and temper tantrums in children and adolescents with autism] (Myers & Johnson, 2007; Myers, 2009; Munshi, Gonzalez-Heydrick, Augenstein, & D'Angelo, 2011). There is also substantial evidence that these medications and others such as methylphenidate, guanfacine, and atomoxetine are helpful for attention-deficit/hyperactivity disorder (ADHD) symptoms in some individuals with ASDs. Some evidence supports the use of the atypical antipsychotics risperidone and aripiprazole and possibly selective serotonin reuptake inhibitors (SSRIs; such as fluoxetine or fluvoxamine) and the anticonvulsant medication, valproate, for repetitive and rigid behaviors associated with ASDs. However, the largest published controlled trial did not demonstrate that citalopram, a SSRI, was superior to placebo for repetitive behavior associated with autism. Melatonin may be effective for those who have difficulty falling asleep at night. Functional assessment often reveals that problem behaviors in individuals with disabilities, including ASDs, serve as a way to reach an outcome such as attention, access to a preferred object or activity, or escape from a demand or non-preferred activity. In these cases, behavioral interventions are the most effective treatments, and they should be used before medication is considered (Myers & Johnson, 2007; Carr & LeBlanc, 2007; Myers, 2009; Carbone, Farley, & Davis, 2010; Munshi, Gonzalez-Heydrick, Augenstein, & D'Angelo, 2011). Even when medication is used, behavioral strategies are important, and there is growing evidence that the combination of behavioral intervention with medication results in better outcomes, with lower doses of medication required (Munshi, Gonzalez-Heydrick, Augenstein, & D'Angelo, 2011). In the case of rapid onset or intensification of problem behaviors, children with ASDs should be evaluated by their physicians to rule out potential medical causes, such as a hidden source of pain or discomfort. Middle ear infections, dental abscesses, reflux esophagitis, constipation, medication side effects, menstrual periods, or other medical problems may be identified and treated, and resolution of the underlying medical issue may alleviate the behavioral difficulties. All medications can have adverse effects, and it is important for healthcare providers to only prescribe medications with which they have sufficient expertise. When the decision is made to start a therapeutic trial of medication, the specific target symptoms or behaviors for the medication should be identified, and a plan should be in place for monitoring of outcomes, including desired effects and adverse, or undesired, effects (Myers & Johnson, 2007; Myers, 2009; Carbone, Farley, & Davis, 2010). This could be done using a tool as simple as a daily behavior data sheet, counting the desired outcomes and associated signs of adverse or undesirable reactions. Once done, this can be compared to a baseline of data obtained before the medication was put in place (Munshi, Gonzalez-heydrick, Augenstein, & D'Angelo, 2011). The treatment reviews noted some of the common pitfalls of treatment with psychotropic medication. For example, although monotherapy (use of a single medication) is desirable, patients with complex problems are sometimes treated with more than one psychotropic medication (polypharmacy). There is very little information available about combinations of medications, and it is critical that physicians have a good understanding of the potential interactions among medications and monitor closely for adverse effects, especially if the individual being treated has limited communication skills and is unable to clearly identify if something is not right. Because of the widespread use of the Internet and the highly-variable quality of available information, it is common for parents and other care providers to be exposed to strong advocacy for treatments that have not been shown to be effective in properly designed scientific studies. It is important for physicians to be aware of the empirical evidence behind the treatments they are considering and strive to ensure that the most safe and effective interventions (based on well-designed scientific (Continued on page 5) ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 5 Pediatric Guide continued... studies) are the ones that are selected (Carr & LeBlanc, 2007). Complementary and Alternative Medicine Complementary and alternative medicine (CAM) has been defined by the National Center for Complementary and Alternative Medicine (NCCAM) as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" (NCCAM, 2000). The NCCAM has organized CAM practices into five domains: mind-body medicine, manipulative and body-based practices, energy medicine, biologically-based practices, and alternative medical systems, such as homeopathy and naturopathy, which may utilize therapies found in the other four domains. Many CAM therapies from all 5 of the NCCAM domains have been advocated for the treatment of children with ASDs. The reviews that address CAM therapies state that the vast majority have been inadequately evaluated and cannot be recommended for treatment of ASDs based on the available evidence (Myers & Johnson, 2007; Carr & LeBlanc, 2007; Carbone, Farley & Davis, 2010). Potential risks of CAM treatments include direct toxic effects of biological agents or manipulative techniques, presence of contaminants, interactions with prescribed medications, interference with appropriate nutrition, interruption or postponement of valid therapies, and unwarranted expenditure of time, effort and financial resources (Myers & Johnson, 2007; Carr & LeBlanc, 2007; Carbone, Farley & Davis, 2010). CAM interventions are sometimes divided into two categories, biological and nonbiological; although this is a misnomer because ultimately, the mechanism of action of any effective intervention would necessarily be through impacting central nervous system biology. The most thoroughly evaluated biological CAM treatment for autism, the (Continued on page 6) Shout Outs, Accolades, and Appreciations! By Kerry Ann Conde, MS , BCBA ASAT would like to recognize those individuals and organizations who strive to support our mission. Specifically, we would like to thank and send a "shout out" to... The Association for Behavior Analysis International for reaching out to all 2012 members to share our special Autism Awareness Month call for subscriptions to Science in Autism Treatment Deb Harris from the ELIJA Foundation for listing ASAT on their home page: www.elija.org and in their January 2012 Newsletter Behaviorbabe (www.twitter.com/behaviorbabe) for supporting ASAT on Twitter Autismoaba (www.twitter.com/autismoaba) for supporting ASAT on Twitter Zaira Santana and Adriana Cristуbal for translations of ASAT material into Spanish DJ Cindy Vero of KTU 103.5 FM in NYC for her interview with David Celiberti and Barbara Wells showcasing ASAT and the Rock'n 4 Autism Awareness concert. Listen here: http:// tinyurl.com/ASATradio Dena Russell of the Hoboken special needs Parent Group for spreading the word about ASAT's concert Larry and Kathy Hannon for sharing ASAT materials throughout April within their Dairy Queen stores in Maine McLean in the Morning for the Tyler McLean radio interview with David Celiberti http://soundcloud.com/search?q%5bfulltext% 5d=David+Celiberti If you would like to share information about any initiatives you have undertaken to support ASAT, please write us at [email protected] ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 6 Pediatric Guide continued... hormone secretin, has been thoroughly evaluated and proven to be ineffective. Some of the under-evaluated biological CAM treatments that have been popular in recent years include hyperbaric oxygen, immunoregulatory interventions (such as dietary restrictions, immunoglobulins, and antiviral agents), detoxification therapies (such as chelation), various gastrointestinal treatments (such as digestive enzymes, antifungal agents, probiotics, yeastfree diets, vancomycin, and gluten- and casein-free diet), dietary supplements (large doses of vitamins, magnesium, folic acid), and even stem cell infusions. Examples of non-biological CAM therapies that have waxed and waned in popularity include auditory integration training, behavioral optometry, craniosacral manipulation, dolphin-assisted therapy, and facilitated communication, none of which has been proven to be effective. The AAP has stated that pediatricians should: (1) critically evaluate the scientific evidence of efficacy and risk of harm of various treatments and convey this information to families, (2) help families understand how to evaluate scientific evidence and recognize unsubstantiated treatments and pseudoscience, and (3) insist that studies that examine CAM treatments be held to the same scientific standards as all clinical research (Myers & Johnson, 2007). This requires open lines of communication and families should not be discouraged from sharing information about any CAM treatments that they may be considering (Myers & Johnson, 2007). According to a recent survey, only 36-62% of caregivers who used CAM therapies for their children with ASD shared that information with their child's primary care physician, yet they indicated that that they wanted more information on CAM therapies from physicians (Myers & Johnson, 2007). If families are reluctant to disclose CAM treatments to their child's physicians, the physicians may inadvertently prescribe medication that has a potential interaction with the CAM treatment. When speaking with families, physicians should encourage families to seek additional information if: The treatment is based on overly simplified scientific theories; It is claimed that the therapy is effective for multiple different unrelated conditions or symptoms; It is claimed that children will respond dramatically and some will be cured; Support for the treatment is based on case reports and anecdotes rather than carefully designed studies; There is a lack of reference to peer-reviewed -scientific literature or, denial of the need for controlled studies, or the existing literature directly contradicts the claims of proponents of the CAM treatment; The treatment is said to have no potential or reported adverse effects. Conclusions All treatments should be based on sound, plausible theoretical constructs and objective scientific evidence of efficacy. When treatments are evaluated, well-designed, and ppropriately controlled studies using rigorous methodologies are required to prove that the observed effects are attributable to the intervention being studied. In the published scientific literature, the evidence is strongest for behavior analytic strategies for both teaching new skills and reducing problem behaviors in children with ASDs. In some cases, when serious problem behaviors remain after a function-based approach has been utilized, a trial of psychotropic medication may be warranted to target certain specific symptoms, usually in conjunction with behavioral interventions. By providing their patients with ASDs with ongoing high-quality medical care and guiding them to effective interventions, healthcare providers can help to maximize important outcomes including functional independence and quality of life. References: Carbone, P.S., Farley, M., & Davis. T. (2010). Primary care for children with autism. American Family Physician, 81, 453-460. Carr, J.E. & LeBlanc, L.A. (2007). Autism spectrum disorders in early childhood: An overview for practicing physicians. Primary Care: Clinics in Office Practice, 34, 343-359. Golnik, A., Ireland, M., & Borowsky, I.W. (2009). Medical homes for children with autism: A physician survey. Pediatrics, 123, 966-971. Myers, S.M., Johnson, C.P., & American Academy of Pediatrics Council on Children With Disabilities (2007). Management of children with autism spectrum disorders. Pediatrics, 120, 1162-1182. Munshi, K.R., Gonzalez-Heydrich, J., Augenstein, T., & D'Angelo, E.J. (2011). Evidence-based treatment approach to autism spectrum disorders. Pediatric Annals, 40, 569-574. Myers, S.M. (2009). Management of autism spectrum disorders in primary care. Pediatric Annals, 38, 42-49. National Center for Complementary and Alternative Medicine (2000). Expanding horizons of healthcare: five year strategic plan 2001-2005. Washington, D.C.: U.S. Department of Health and Human Services. ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
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Science in Autism Treatment
Volume 9,2 Spring 2012
Message from SIAT Co-editor, Josh Pritchard, PhD, BCBA Wow! Each issue of the Science in Autism Treatment leaves me amazed. Each quarter we have such great content contributors for our issue. As with any publication, we have great ideas and articles pitched for the issue that for some reason or another tend to lag behind schedule. Each issue, as this happens, we say things like, well, this might be a short issue. We always strive to balance the endless amount of information with compassion for you, our readers in mind. We try not to create 100 page issues! However, even when we shift content from a planned issue to the next (and this happens every issue), we still find our pages filled to the brim. I have edited several professional science-based newsletters before, and one of the most difficult roles has been to scrounge up enough content to pull together a 3-4 page newsletter worth reading. Because of our stellar volunteer contributors (too numerous to mention by name here!), this is not a problem that we encounter. We are seeing a lot of discussion about the "epidemic that is autism" in the news and social media. As Dan mentioned in this issue (p 14), this is sure to generate an even larger amount of treatment options that are simply not supported by science, evidence, and sometimes even logic. As an organization, we see an enormous amount of work ahead in our future to try and keep abreast of all those who are trying to cash in on the vulnerable families affected. I urge you to take a moment and look at our board and our volunteers. You will notice that this is a group of very busy professionals, parents and science advocates who give freely because they care. From our tireless president supported by his veteran officers to the newest board members, we are a busy, productive group. I marvel at how much ASAT accomplishes with a 100% volunteer board. However, the best is yet to come. I think 2011 will pale in comparison to what ASAT has in store for 2012. Here is where you come in. We need support. In 1999, when SIAT began, it cost $15 per year. With inflation calculated, that would be about $20 today. If you find SIAT informative, and you want to support science-based treatment of autism, we ask that you consider donating at least that much. Any amount helps us to accomplish our mission. Our children deserve better than much of what passes as "treatment" for autism. Help us make sure they get what they deserve: http://asatonline.org/donate. Yours in Science,
ASAT conference by Denise Grosberg, MA BCBA
We are very pleased to announce that for the first time ever, the Association for Science in Autism Treatment and Bilinguals Inc. Pediatric Therapy (http://www.bilingualsinc.com/) co-hosted an autism conference on April 3, 2012 titled Science and Technology: Driving Autism Intervention. This all day conference took place at Baruch College in New York City, bringing together the shared agenda of both organizations to help ALL
families of children with autism access and learn about scientifically validated treatments and interventions. This confer-
ber, who spoke about improving obser-
vational learning skills in children with
autism. Also of note was a workshop
entitled "Technology and Learning: de-
veloping innovative teaching methods
for individuals with autism spectrum
disorders," presented by ASAT Vice
President Mary McDonald, and "Using
ence featured autism specific vendors, the Principles of Science in Everyday
networking opportunities and educational Educational Practices with Young Chil-
presentations by ASAT members. Our dren with Autism,",presented by ASAT
keynote speaker was Bridget Taylor,
Board Member Daniel W. Mruzek.
Psy.D., BCBA-D andASAT Board mem-
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 9
Review of Randomized Control Trial of DIR/Floortime Therapy: "Learning through interaction in children with autism: Preliminary data from a social-communicationbased intervention" by Sara Gershfeld, MA, BCBA and Tristram Smith, PhD
Background
and a behavioral perspective.
sample size, it is unclear how many
Parents and clinicians frequently Over the course of development children did not qualify for this study,
face the issue of making informed of DSP approaches, treatment op- did not enroll, or dropped out. Casen-
decisions amongst heated debates tions such as the Hanen Method
hiser and colleagues also mentioned
over the most effective approaches (Manolson, 1992), Relationship De- that recruitment occurred with par-
for treating young children with au- velopment Intervention (RDI;
ents that were interested in receiving
tism (Prizant & Wetherby, 1998). Of Gutstein, 2001), and Developmental a DIR-based intervention. It is not
the current approaches used to treat Individualized Relationship-based articulated whether parents who
autism, there lies a continuum rang- (DIR) Intervention (Greenspan &
were eligible but did not have a spe-
ing from intensive discrete-trial-
Wieder, 2006) have received atten- cific interest in DIR therapy were not
training, to behavior analytic treat- tion from parents of individuals with included in this sample.
ment that combines many different autism despite a lack of research
Numerous exclusionary criteria
instructional methods, to social-
that uses the "gold standard" of re- were applied that are not atypical for
pragmatic and developmental ap- search methodology ­ a randomized these types of comparison studies
proaches. This article provides a
controlled trial.
(Dawson et al., 2009). Twenty-five
basic description of a class of inter-
In this study, Casenhiser and col- participants were assigned to a tar-
ventions that have recently received leagues (2011) examine a DSP ap- get group that received 2 hours of
increased attention ­ Developmental proach known as a developmental, DIR®-based therapy per week and
Social Pragmatic (DSP) interventions. individual-difference, relationship- parent coaching at the Milton & Ethel
Casenhiser, Shanker and Stieben based (DIR®) model, which is often Harris Research Initiative (MEHRIT).
(2011) evaluate DSP as a method of interchangeably referred to as Floor- Twenty-six participants were as-
improving social interaction skills of time Therapy. The DIR®/Floortime signed to a community group that
children with autism spectrum disor- approach focuses on helping individ- received an average of 3.9 hours/
der (ASD) and state that these differ- uals with ASD master skills related to week of a variety of different services
ent approaches may teach the same communication, thinking through ranging from an unspecified combi-
types of behavior, but approach them understanding of developmental
nation of speech therapy, applied
differently than a traditional behav- milestones, respecting a child's indi- behavior analysis (ABA), occupational
ioral approach.
vidual differences and challenges, therapy, social skills, day care, and/
For example, most interventions and asserting the importance of
or other alternative treatments in-
acknowledge that eye contact is re- building relationships with primary cluding diets and hyperbaric oxygen
lated to increased joint attention and caregivers to encourage develop- therapy.
language (Casenhiser, 2011). As ment. Although the theory behind
Although the community group
such, interventions aim to teach chil- this type of approach is well explored represents a diverse spectrum of
dren with autism to make eye con- using anecdotal evidence in Green- treatments that a typical individual
tact. A DSP perspective might sug- span and Weider's book "Engaging with autism might receive, neither
gest that exhibiting eye contact is not Autism," there is a lack of robust evi- treatment groups received interven-
what is important, but rather that it is dence to validate its effectiveness tion at the suggested intensity docu-
imperative to share the eye contact experimentally (Greenspan & Weider, mented through experimental litera-
in a social or play experience. Thus, 2006). As such, Casenhiser and col- ture to show progress in a number of
Casenhiser (2011) reasons that a leagues evaluate the DIR®/Floortime developmental domains. Additionally,
DSP model focuses on the function approach as an intervention aimed the intervention received by the com-
of the behavior to engage socially at improving the socio-
munity group was well below the
with a peer or adult, whereas a be- communication skills of individuals hourly level of researched low-
havioral approach might look at the with autism using a randomized con- intensity interventions (Eldevik, Eik-
topography of the behavior as im- trol trial.
eseth, Jahr,& Smith, 2006), despite
portant independent of whether it
numerous past research studies indi-
occurs in a social experience or not Method
cating that intensive behavioral inter-
(for example, attending to instruc-
This study enlisted 51 children vention is more effective than eclec-
tion). This basic assumption forms a ranging from 2 to 5 years old. Though tic therapy (Howard, Sparkman, Co-
divide between the DSP perspective this highlights the relatively large
(Continued on page 10)
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 10
Review of RCT continued...
hen, Green, & Stanislaw, 2005). Lastly, the authors cantly greater on these items than those made by the
did not indicate whether the community group partici- community group, except in the domain of compliance.
pants received this eclectic combination of services In all measures, the community treatment group did
from the same providers or if there were any standard worse at the end of 12 months except in the category
methods documenting whether staff had the proper of independent thinking.
training necessary to administer the therapy used in
Speech-language pathologist staff, blind to the par-
the community group. For example, for an individual ticipant condition, conducted pre- and post-
receiving ABA, training and supervision should assure assessments and found no significant difference on
competencies in a number of areas including experi- two standardized language scales (PLS-4, Zimmer-
ence designing and implementing comprehensive ABA man, Steiner, & Pond, 2006; CASL, Carrow-Woolfolk,
programming for individuals with autism, which should 1999). A modified standardized measure had predic-
involve areas ranging from "learning to learn" (e.g. lis- tors of language change (mCBRS, Kim & Mahoney,
tening, imitating, following directions), social interac- 2004), but the authors noted that it was difficult to
tion, self-care, school-readiness, communication, to ensure validity since this scale had been modified fol-
play and leisure (Celiberti, Buchanan, Bleecker, Kreiss, lowing scale standardization. Caregiver behavior was
& Rosenfeld, 2004). If these and other competency- also investigated and statistical differences showed
based measures are not met, it is expected that an that the MEHRIT group showed improvement on all
individual with autism receiving this type of service at items except a Sensory-Motor Support item. No signifi-
any intensity or duration will likely make minimal (or at cant associations for compliance were indicated in
least less than optimal) progress. Thus, concerns can this scale either.
be raised regarding the control group chosen in this
Though these results indicate some improvement
trial.
based on the intervention, statistical significance only
Treatment implementation for the target group indicates that the differences between groups
occurred by licensed speech-language pathologists or (however small) are not likely due to chance factors,
occupational therapists. These staff members were but does not indicate that these differences are mean-
trained for 3 weeks on a number of DIR® techniques. ingful. It is also unclear how the group averages apply
The authors do not address a basic question regarding to individual children within the groups (for example,
external validity: Is the training received by these staff how many children within each group made significant
members aligned with the training level of typically gains or to what extent outcomes varied from child to
trained DIR/Floortime therapists? The authors men- child). In addition, because the intervention contained
tion that there is a certification offered through Serena multiple components, it is uncertain how each compo-
Weider, but many DIR/Floortime therapists do therapy nent influenced the behavior of the parent and child.
without this certification. Even with a certification,
there lacks a manual or guide used to standardize the Discussion
intervention techniques. There is no measure of
By standards of experimental autism literature,
whether the providers implemented the intervention this experiment has notable strengths. Casenhiser and
as intended by the developers of the intervention.
colleagues enrolled a relatively large sample size. The
Thus, it is difficult to say what occurred in the interven- randomized control trial used a randomized design
tion session or how it could be replicated. As such, consisting of two groups ­ a treatment ("target") group
results of the study may not reflect those that would and a control group. Participants were randomly as-
be observed if an individual with autism received this signed to either group. Participants were paired based
treatment in a natural setting.
on age and baseline language level. This sampling pro-
cedure ensured that both treatment groups were simi-
Results & Data Analysis
lar before intervention. Well-established outcome
Results indicated that there were no significant measures were used to identify participant progress,
differences observed on all scales prior to treatment. and included an assessment of whether parents ac-
Ratings were coded by trained staff blind to the treat- quired new skills. The experiment also monitored the
ment condition. After treatment, the researchers ex- treatments obtained outside of the study.
amined the relationship between participant group
Aside from these strengths, this study leaves con-
placement and 5 scale items (attention to activity, in- siderable question regarding the validity of the treat-
volvement, compliance, initiation of joint attention and ment group improvement when compared with a poor-
enjoyment in interaction). Improvement was signifi-
(Continued on page 11)
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 11 Review of RCT ly conceptualized control condition. This control condition was not a "no-treatment" control group, but instead was an undefined blend of procedures with no evidence of procedural integrity, at a level considered less than adequate in the research literature. A better comparison might have contrasted the MEHRIT treatment group with a no-treatment group; an eclectic group at the correct duration or dosage; or a group receiving a behaviorbased treatment with high procedural integrity. In addition, results were significant on a modified scale, potentially lacking validity. A significant area of treatment administration that did not show significant results was in the domain of compliance. Compliance is an important skill for individuals with autism, and many demonstrate opposition when required to complete basic tasks (Ducharme & Drain, 2004). The necessity of learning-to-learn skills such as compliance, attending, orienting, choice-making and simple imitation must be taught early in the intervention process before more complex skills, such as social communication and play, can be addressed (Luiselli, Russo, Christian, & Wilczynski, 2008). It is standard to ensure that a foundation for these skills is present before addressing some of the variables that were explored in this study. Treating an individual with autism often encompasses biological, developmental and/or behavioral approaches to autism treatment. These approaches all aim to remediate the most pertinent symptoms of an individual with autism. Among behavioral and developmental approaches, there are misconceptions about the difference between these two approaches and the utility of both. Casenhiser (2011) attempts to validate Developmental Social Pragmatic (DSP) Interventions, specifically DIR®/Floortime (Prizant & Wetherby, 1998). Although this study provides an indication of the effectiveness of this approach, it should be independently replicated before it is considered empirically valid. DIR® is an emerging treatment, however families are urged to continue with treatments that are currently empirically supported. References: Arnold, A., Randye, B.I., & Claire, C. M. (2000). Eye contact in children's social interactions: What is normal behaviour? Journal of Intellectual and Developmental Disability, 25(3), 207­217. Casenhiser, D.M., Shanker, S.G., & Stieben, J. (2011).Learning through interaction in children with autism: Preliminary data from a social-communication-based intervention. Autism, 0 (0), 1-22. Carrow-Woolfolk, E. (1999). Comprehensive Assessment of Spoken Language. Circle Pines: MN: American Guidance Service. Celiberti, D., Buchanan, S., Bleecker, F., Kreiss, D., & Rosenfeld, D. (2004). The road less traveled: Charting a clear course for Autism Treatment. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., &Varley, J. (2009). Randomized, con- trolled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125(1), 17-23. Ducharme, J.M., & Drain, T.L. (2004). Errorless academic compliance training: improving generalized cooperation with parental re- quests in children with autism. Journal of American Academy of Child Adolescent Psychiatry, 43(2), 163-171. Eldevik, S., Eikeseth, S., Jahr, E., & Smith, T. (2006). Effects of low-intensity behavioral treatment for children with autism and mental retardation. Journal of Autism and Developmental Disorders, 36, 211-224. Green, G. (1996). Early behavioral intervention for autism: What does research tell us? In Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 29­44). Austin, TX: Pro-Ed, Inc. Greenspan, S.I., & Wieder, S. (2006). Engaging autism: Using the floortime approach to help children relate, communicate, and think. Cambridge: MA: Da Capo Press. Gutstein S.E., Burgess, A.F., & Montfort, K. (2007). Evaluation of the relationship development intervention program. Autism: The International Journal of Research and Practice, 11(5), 397­411. Gutstein, S. (2001). Solving the Relationship Puzzle. Arlington, TX: Future Horizons. Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and ec- lectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359­383. Kasari, C., Paparella, T., Freeman, S., & Jahromi, L.B. (2008). Language outcome in autism: Randomized comparison of joint atten- tion and play interventions. Journal of Consulting and Clinical Psychology,76(1): 125­137. Kim, J.M., & Mahoney, G. (2004). The effects of mother's style of interaction on children's engagement: Implications for using respon- sive interventions with parents. Topics for Early Childhood Special Education, 24(1), 31. Luiselli, J.K., Russo, D.C., Christian, W.P., & Wilczynski, S.M. (2008). Effective practices for children with sutism: Educational and be- havior support interventions that work. New York, NY: Oxford University Press. Manolson, A. (1992). It takes two to talk. Toronto: Hanen Centre. Prizant, B.M., & Wetherby, A.M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic devel- opmental approaches to communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19,329­353. Smith, T., & Lovaas, O. I. (1998). Intensive and early behavioral intervention with autism: The UCLA Young Autism Project. Infants and Young Children, 10(3), 67­78. Zimmerman, I.L, Steiner, V.G., & Pond, R.E. (2006). PreSchool language Scale-4. New York: The Psychological Corporation and Harcourt Brace Jovanovich. ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 12
Focus on Science: The Pitfalls of Testimonials by Daniel W. Mruzek, Ph.D., BCBA-D
ASAT Advisory Board
F. J. Barrera, PhD, BCBA-D
When searching for a great restaurant or choosing a learning channels" and
Stephen Barrett, MD
movie to go see, often we consider the personal re- "promote language acquisi-
Martha Bridge Denckla, MD
ports of neighbors, work associates and friends. Why tion". Of those 100 parents, it Curtis Deutsch, PhD
not? Their "testimonies" give us a quick method for is reasonable to expect that at William V. Dube, PhD
judging the probability that a particular restaurant or least a small number of them-
movie will be a good investment. Of course, our
perhaps 5 or 10%- may report
friends and associates are not always right, but their that the product "seems to
testimonials serve as either short-cuts or as corrobora- help", even if the trampoline is
Deborah Fein, PhD Eric Fombonne, MD Richard Foxx, PhD, BCBA-D
tion of other sources of information (e.g., restaurant or not at all effective as an inter- Gina Green, PhD, BCBA-D
movie reviews). As such, they contribute to efficient vention in the way described
William Heward, EdD, BCBA-D
decision-making about relatively low-stakes events. by the marketer. A savvy mar- Ronald Kallen, MD
We commonly see testimonials made by happy consumers presented by marketers of autism treatments. Indeed, testimonials are a standard feature on websites marketing pills, exercises, devices, interventions and therapies to potentially unwary consumers. Many
keter is watching for members of this small subgroup of consumers as their source of new testimonials! And, how about all of the par-
Alan Leslie, PhD Bennett Leventhal, MD Johnny L. Matson, PhD Joyce E. Mauk, MD
testimonials take the form of simple, quoted state- ents who purchased the tram- Catherine Maurice, PhD
ments (e.g., "The [marketed treatment] has had an poline and, subsequently rec-
Bobby Newman, PhD, BCBA-D
amazing effect on my son!"). On the internet, video ognized that it did not "open
testimonials may be particularly compelling. Marketers learning channels" and
know that the testimonials of
"promote lan-
some people, including attractive
guage acquisi-
people, familiar celebrities, and
tion"? You can
John Pomeroy, MD Stephen Porges, PhD Sharon Reeve, PhD, BCBA-D Joyce Rosenfeld, MD, FACEP
people who may remind the poten-
be assured
Arthur Toga, PhD
tial consumer of him- or herself
that their opin- Paul Touchette, PhD
may be particularly effective. Adding pleasant theme music and using artful filming may complete
ions will not grace the marketer's web-
Roberto Tuchman, MD Paul Yellin, MD
the effect and increase the proba-
site, social media or glossy print ad-
bility that families separate from
vertisement. As a result, the market-
their hard-earned money.
ers promote an illusion of product ef-
But, how should we use testimoni-
fectiveness where one may not exist
al evidence in selecting potential
at all.
autism treatments? When confronted with testimoni- It is for these reasons that parents and other consum-
als about possible autism treatments, it is recom-
ers of autism "treatments" are cautioned to view testi-
mended that families be especially cautious, particularly when the testimonials are the only source of support for the intervention. Marketers can find a few indi-
monials skeptically. Testimonials are a wonderful way for business people to market merchandise but a poor
viduals who provide testimony that their product is way for families to determine true effectiveness of a
effective, even when the product is wholly ineffective. treatment, device or intervention. Decisions regarding
This is because, as consumers, our opinions about the autism treatment are best guided by the scientific rec-
quality of a product- including perceived effectiveness- ord, as supplied by trusted sources (e.g., a competent
are colored by our previous experience, what we have been told by others, and our expectations. Furthermore, because human behavior- including the behavior of individuals with autism- is variable (i.e., changes
physician, psychologist or other autism expert). When it comes to making decisions about expensive autism interventions and the allocation of precious resources,
across time), a treatment benefit may appear to exist, persons with autism- and their families- deserve noth-
even when it does not exist at all.
ing less.
For example, imagine that a marketer sold a "special"
trampoline to 100 parents with the guarantee that Have an idea for Focus on Science? Send it to:
daily use of the trampoline by their child would "open [email protected]
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 13
Treatment Summary: Son-Rise We chose this issue's treatment summary to illustrate the dangers that Dr. Mruzek warned us about on page 12: a treatment that relies extensively on testimonials as their evidence. Description: The Son-Rise Program was developed and trademarked by Barry and Samahria Lyte Kaufman decades ago. The program offers training sessions to parents and others on how to implement home-based programs for children with a wide range of disabilities. The program is based upon the Kaufmans' own personal theories of learning and development. A central principle of the Son-Rise program is that parents must convey an attitude of "total acceptance" of their child including all of his/her behaviors. The training that the Kaufmans offer places emphasis not on the child's skills, or behaviors, or challenges, but more on the parents and caregivers. Research Summary: There have been no scientific studies of Son-Rise for individuals with autism spectrum disorders. Recommendations: Researchers may wish to conduct studies with strong scientific designs to evaluate SonRise. Professionals should present Son-Rise as untested and encourage families who are considering this intervention to evaluate it carefully.
New CDC Autism Numbers Highlights the Need for Effective Treatment By Daniel W. Mruzek, PhD, BCBA-D
As many readers have no doubt heard by now, the Center for Disease Control (CDC) and Prevention's Autism and Developmental Disabilities Monitoring (ADDM) Network recently reported that about 1 in 88 children has been identified with an autism spectrum disorder (ASD) in the United States, with the ASDs almost 5 times more common in boys (1 in 54) than in girls (1 in 252). These numbers represent a sizable increase over previous estimates of the occurrence of ASD and caught the attention of media outlets all over the world. The CDC attributed improved identification of autism, particularly in historically under-served populations, as one reason for the higher estimate of prevalence, but more research is needed to determine whether there actually are more individuals with autism than in the past. Regardless of all the factors that may be responsible for the increased prevalence estimate, these new estimates highlight the importance of helping families access effective treatment quickly and helping families and others distinguish science-based treatments from unproven or disproven treatments. For marketers of fad "treatments", "miracle cures" and interventions lacking scientific validation, these
most recent CDC numbers are no doubt interpreted as signs of a "growth industry" for their trade. Unfortunately, this trade is too often conducted on the backs of individuals with autism, on the hopes of consumers trying to make the best treatment decisions, and at the expense of hard-earned family income. As a non-profit, volunteer-driven organization dedicated to supporting individuals and families affected by autism, ASAT sees these new CDC numbers as a striking reminder that the need for scientifically validated autism interventions and supports has never been greater. This is true for young, newly diagnosed children who benefit from effective early intervention, for students with autism who, with proper supports, contribute to the richness of our schools, and for adults with autism who have a right to active, meaningful participation in their communities. We invite you to team up with ASAT in taking a firm stand in the face of deceptive marketers and promoting effective, science-validated treatments for individuals with autism. Together, we can make a difference in the lives of individuals with autism and their families.
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 14 The 2nd Annual Rock'n 4 Autism Awareness Concert: We rocked, we rolled, and we raised awareness for science-based autism treatment by Denise Grosberg, MA, BCBA and David Celiberti, PhD, BCBA-D The 2nd Annual Rock'n 4 Autism Awareness Concert, co-hosted by ASAT and Hoboken-based HOPES CAP, Inc., rocked out on Saturday afternoon, April 28th. Beautiful weather and an enthusiastic crowd contributed to the success of this indoor/outdoor event. Some highlights included: Attendees enjoyed two sets from the Fuzzy Lemons, a popular and beloved family-friendly rock band. The kids tore up the dance floor! We were lucky to have another guest appearance by NY Jets Player, Mike Devito, who was available for pictures and autographs! Thank you to Joe Epstein who took photographs of concert attendees with Mike, as well as to Emily Krohn and Angel Davila who took wonderful photographs throughout the event. Hoboken Mayor Dawn Zimmer stopped by and spoke to the crowd (Just a few days earlier, Mayor Zimmer had declared April 25th as Autism Awareness Day in Hoboken). ASAT Board members Barbara Wells, Ruth Donlin, Mary McDonald, Marianne Clancy, Peggy Halliday and David Celiberti, ASAT Externs Lauren Schnell, Dena Russell, Caitlin Reilly, and Germaine Ibrahim and Clinical Corner Coordinator Nicole Pearson were on hand to ensure a successful event. We were grateful to be joined by 50 volunteers including individuals from HOPES CAP Inc., Autism New Jersey, Hoboken Mommies, Starbucks, Stevens Institute of Technology and Hoboken Volunteers. Over 100 local businesses contributed money, merchandise and/or services to make the event a success. We listed all donors who contributed money, services, or items worth over $200 on page 15. Attendees vied over some silent auction items such as a Jets-signed football, a summer pool pass, artwork, gym memberships, and a hotel stay in San Juan, just to name a few. Barbara Wells and David Celiberti were interviewed by Cindy Vero from KTU Radio in NYC. Listen here: http://tinyurl.com/ASATradio Aside from organizing a spectacular, family-friendly event here in Hoboken for families of children with autism and the broader community, our goal was to leave an indelible imprint in the local area with respect to awareness of autism, its treatment, and access to high-quality information to guide treatment decisions. Some of the many local initiatives that will be funded by this benefit concert include: Comprehensive compilations of resources for families of children with autism and service providers who are attending this event, provided at no charge. Creation of autism lending libraries in HOPES Hoboken locations and one location in Plainfield, NJ; as well as an additional lending library for the Hoboken special needs Parent Group. Full scholarships for several local parents to attend autism-related conferences. Information packets to be shared with local pediatricians for distribution to parents of children with autism. Future plans include making this information available to family physicians serving adults with autism as well; and Financial assistance for the Hoboken Special Needs Parent Group, which is committed to supporting the broader community of parents of children with special needs. Additionally, some of the many national initiatives that will be supported by this benefit concert included: Creation of a resource booklet for pediatricians and primary care physicians: Beyond an ASD Diagnosis: Supporting Families Over the Lifespan. Identification of 3000 new family members and service providers in the US who will receive free subscriptions to Science in Autism Treatment; and Translation of printed material about autism treatment into Spanish. We are already beginning to plan for next year's concert! ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Benefactor Level Sponsors and Donors ($1000 and higher) Applied Companies Candice Stern Graphic Design KoKo Fit Club of Hoboken Provident Bank Foundation UCP of Hudson County Alliance Level Sponsors ($500-999) A Whole New World Academy Chamonix Skin Care Christopher Street Cookies Clear Channel Radio Different Roads to Learning Joanne Shu, Prime Real Estate Group Hartshorn Portraiture Hoboken Boot Camp HOPES CAP Inc. K.C. Kids Hoboken David Rees, New York Life Party Decorations by Theresa Party Faces by Rachel Party with Purpose PNC Bank Maxwell Lane Riverside Pediatrics Ellen Samitt Hugo Gonzalez, State Farm Sweet Nicholas Travelin' Tumblers Ace Endico Company Store WB Wood
Page 15 Patron Level Sponsors ($200-499) A & P Hoboken A Room to Grow BAMA Galleries Bricks 4 Kidz Court Street Restaurant & Bank Dino and Harry's Domino's Pizza Dunkin Donuts The Edison Hotel Essence of the Garden Full House Printing Guitar Bar Hoboken Hot House Hoboken Mommies Hudson Place Realty, Inc. Intercontinental Hotel San Juan, PR Johnny Rockets Kicking the Spectrum King's Super Market, Inc. Downtown LA Kick Boxing Monroe Movement Center Erika Muller, Muller Insurance New Jersey Skate Shop New York Jets Taekwondo School Progressive Pediatrics Provident Bank Rita's Italian Ice Safe Kids of Hudson County SKF Books Solares, Inc. Small Business for Education Foundation Starbucks The Villa Salt River Wise Vision and Hearing Heartfelt thanks to HOPES CAP Inc. for being such a wonderful partner in planning and hosting this incredible event!
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Page 16
Science in Autism Treatment
Volume 9,2 Spring 2012
Clinical Corner: Expanding Interest My child is doing well with many of his ABA programs, even the ones that focus on play. Unfortunately, he doesn't play with most of the toys that we give him, and he has worked for the same five things since our program began a year ago (marshmallow peeps, Thomas trains, tickles, Wiggles songs, and raisins). What can I do to expand his interests and maybe even get those interests to function as reinforcers for teaching targets?
Answered by Tanya Baynham, MS, BCBA Program Director, Kansas City Autism Training Center Inherent in a diagnosis of autism is the fact that the child will engage in restricted or repetitive behavior and may also have restricted interests. Expanding those interests, specifically in the areas of toys and play, is an important programming goal as it can result in a number of positive effects. First, rates of socially appropriate behaviors may increase while rates of inappropriate behaviors may decrease. For example, engaging a child in looking at a book may decrease his stereotypic behaviors or passivity (Nuzzolo-Gomez, Leonard, Ortiz, Rivera, & Greer, 2002). Second, interest expansion can lead to new social opportunities for children and enable greater flexibility when bringing them to new environments. For example, a child with a new preference for coloring may be taken to a restaurant because he will sit and color the menu, or he can attend Sunday school because he will color a picture when directed. Third, the addition of new reinforcers in ABA programs may help prevent satiation or allow you to allocate more highly preferred items for difficult teaching targets and less preferred items for easier targets.
Expanding the preferences, interests and play repertoires of children with autism can be challenging but the benefits of doing so, including greater flexibility and improved social behavior, make the efforts worthwhile. In this edition of Clinical Corner, Tanya Baynham offers practical and fun strategies that both parents and teachers can use to successfully expand the interests of children with autism in the areas of toys and play. Nicole Pearson, PsyD Clinical Corner Coordinator sented, number of different toys approached/ contacted across a week (in and/or out of session), engagement duration with new toys, and affect while engaging with toys. It is sometimes helpful to track changes across specific categories (e.g., social activities, food, social toys, sensory toys, etc). If your child only watches Thomas videos, you may narrow the focus to the category "videos" in order to track expansion of interests to different types of videos. Keeping in mind the previous point about a teacher's role in expanding a child's interests, you may also want to set goals to ensure changes in teacher behavior such as, "Present three new items each day."
Stocco, Thompson, and Rodriguez (2011) showed that Once data are being taken, it is important to imple-
teachers are likely to present fewer options to individu- ment procedures likely to expand you child's interests.
als with restricted interests and allow them to engage One way to expand toy play is to present, or pair, a pre-
longer with items associated with those restricted in- ferred item with the item you want to become more
terests. The authors suggest one possible reason for preferred (Ardoin, Martens, Wolfe, Hilt and Rosenthal,
this is that teachers might be sensitive to the negative 2004). Here are a few examples:
behaviors (e.g., whining, pushing the toy away) that can Use peeps as the game pieces in a game you
accompany the presentation of a new toy. The results
want your child to enjoy, then eat the peeps at
of this study prompt us to be aware of our own role in
different points during the game;
potentially limiting a child's access to novel experienc-
Sing a favorite song as you help your child up
es or activities and to find effective ways of expanding
the ladder of an unfamiliar slide on the play-
a child's interests without evoking tears and other neg-
ground; and
ative behavior.
Tickle your child before turning each page while
reading a book.
Most importantly, make reinforcer expansion a teach-
ing focus and take data. First, track the number of dif- A second way to expand interests is to think about why
ferent toys and activities with which your child engages your child engages in those restricted interests. If he
to identify your child's current patterns. Then, measure likes Thomas because of the happy face, put Thomas
the effects of your attempts at reinforcer expansion on stickers on a ringstacker. If he likes Thomas because
your child's behavior. Ala'i-Rosales, Zeug, and
of the wheels, present other vehicles with wheels. If
Baynham (2008) suggested a variety of measures that your child likes peeps because they blow up in the mi-
can be helpful in determining whether your child's
crowave, put Mentos in a cola bottle or use baking so-
world is expanding. These include: number of toys pre-
(Continued on page 17)
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 17
Clinical Corner continued...
da to make a volcano. If he likes peeps because they
large sets or on shelves, requesting items out of
are squishy, use marshmallows in art projects or in a
view, requesting while watching television com-
match by feel game. A third way to expand interests is mercials);
described by Singer-Dudek, Oblak, and Greer (2011), Teach the skill of making forced choices
who demonstrated that some children will engage
(presenting a few options and asking the child to
more with a novel toy after simply observing another
choose) and then offer forced choices of items
child receiving reinforcers after playing with it. To ap-
that you would like your child to explore. Associat-
ply these findings to your child, the teacher could give
ing these items with choice may motivate your
Thomas trains to a sibling who just played with novel
child to engage with them; and
items such as play dough or shaving cream.
If your child does not initiate play, make sure com-
ponent skills of games are mastered before teach-
The methods described may only be effective in pro-
ing the play activity. For example, teach "Ned's
ducing functional play if your child has the skills nec-
Head" or "Memory" once your child can match.
essary to engage appropriately with the toys. If your
Introduce "Hi Ho Cheerio" only after your child can
child is not spontaneously playing with toys with which count objects.
he has been taught to engage, consider the following
potential reasons: the play skill may not have been
References
taught to a natural criterion where the child has
"mastered" it independently, the program may include Ala'i-Rosales, S., Zeug, N. M., & Baynham, T. (2008).
a verbal instruction required for the child to begin
The development of interests in children with au-
playing, the teacher may place the toy in front of the
tism: A method to establish baselines for analyses
child or present it in a visually different way from how
and evaluation. Behavioral Development Bulletin,
it would be on a shelf (e.g., a puzzle or ring-stacker
14, 3-16.
taken apart versus assembled). These features can become discriminative for playing with the object. If spontaneous play is the goal, consider fading any verbal instructions, adding teaching steps until the child is selecting the toy from a shelf or its natural place in the home, and teaching the child how to initiate the play sequence without any teacher interaction.
Ardoin, S. C., Martens, B. K., Wolfe, L.A., Hilt, A. M., & Rosenthal, B. D. (2004). A method for conditioning reinforce preferences in students with moderate mental retardation. Journal of Developmental and Physical Disabilities, 16, 34-55. Nuzzolo-Gomez, R., Leonard, M., Ortiz, E., Rivera, C.,& Greer, D. (2002). Teaching children with autism to
Here are some final strategies to consider when expanding your child's interests: Prioritize toy rotation. Depending upon the number
prefer books or toys over stereotypy or passivity. Journal of Positive Behavioral Interventions, 4, 80 ­87.
and diversity of toys with which your child engag- Singer-Dudek, J., Oblak, M., & Greer, R. D. (2011). Es-
es, you may rotate toys on an hourly, daily, weekly, tablishing books as conditioned reinforcers for
or monthly basis. Removing a high preference
preschool students as a result of observational
commonly used toy from the rotation can result in
intervention. Journal of Applied Behavior Analysis,
increased approach and engagement with other
44, 421-434.

toys; Provide the toy you want to become reinforcing for "free" in addition to the toy your child chooses during a reinforcement break; Teach skills that lead to independent initiations of
Stocco, C. S., Thompson, R. H., & Rodriguez, N. M. (2011). Restricted interests and teacher presentation of items, Journal of Applied Behavior Analysis, 44, 499-512.
activities (e.g., scanning and selecting among
Current ASAT Externs Dena Buonarota Russell, MA Germaine Ibrahim, MEd Caitlin Reilly, BA Lauren Schnell, MEd, BCBA Mark Sullivan, BA
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 18 ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Does your agency share ASAT's values? ASAT believes that individuals with autism have the right to effective treatments that are scientifically demonstrated to make meaningful, positive change in their lives. We believe that it should not be so challenging for families to find accurate information about the efficacy of various autism interventions. ASAT works toward a time... .......... when all families would be empowered with skills in identifying and choosing the most effective, scientifically-validated interventions for their child. ..........when the media would educate and not confuse parents by providing accurate information and asking the right questions. ..........when all providers would be guided by science when selecting and implementing their interventions.
What it means to be a sponsor..... ASAT's sponsors have indicated their support of the following tenets: 1.All treatments for individuals with autism should be guided by the best available scientific information. 2.Service providers have a responsibility to rely on sciencebased treatments. 3.Service providers should take steps necessary to help consumers differentiate between scientifically -validated treatments and treatments that lack scientific validation. 4.Consumers should be informed that any treatment lacking scientific support should be pursued with great caution. 5.Objective data should be used when making clinical decisions.
Page 19 .....Become a 2012 Sponsor Now! These sponsorships not only provide financial support used specifically for our dissemination efforts, but also send a clear message that ASAT's vision is shared by others within the professional community. The tasks of educating the public about scientifically-validated intervention and countering pseudoscience are daunting ones, and ASAT appreciates the support of all of its sponsors. If you are interested in becoming a 2012 Sponsor, please visit the sponsor page on our website at www.asatonline.org/about_asat/ sponsors.htm#learn. Thank you for your consideration!
2011 Sponsors in Real Science, Real Hope Sponsorship Initiative
CHAMPION $2,000 Autism Partnership Four Points, Inc. Little Star Center Central Valley Autism Project BENEFACTOR $1,000 Different Roads to Learning Rethink Autism Accelerated Educational Software Stepping Stones Pacific Autism Learning Services Organization for Research and Learning
ALLIANCE $500 Autism Intervention Services Autism New Jersey Eden II Programs ELIJA Foundation ELIJA School Providence Service Corporation Quality Services for the Autism Community (QSAC) Quest Autism Program Virginia Institute of Autism PATRON $200 Aging with Autism Alpine Learning Group Autism Awareness Asperger Syndrome and high Functioning Autism Association (AHA), Inc.
Autism Research and Treatment The Bay School Behavioral Intervention Association Brooklyn Autism Center Child Study Center of Fort Worth Connecticut Center for Child Development First Steps for Kids, Inc Gary Mayerson & Associates Institute for Educational Achievement Kansas City Autism Training Center Lizard Children's Learning Centre New England Center for Children New Haven Learning Center NY Center for Autism- Charter School Pyramid Educational Consultants, Inc. Room to Grow SKF Books Somerset Hills
IMPORTANT DISCLAIMER: ASAT has no formal relationship with any of the sponsor organizations. Furthermore, their stated endorsement of the above tenets is not verified or monitored by ASAT. Although ASAT expects that all sponsoring organizations will act in accordance with the above statements, ASAT does not assume responsibility for ensuring that sponsoring organizations engage in behavior that is consistently congruent with the statements above. ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 20
Science in Autism Treatment
Volume 9,2 Spring 2012
In addition to our entire board of directors, we acknowledge the following donors in 2011. Without their support, our important work could not be carried out. Champion $2000 and above The Leah and Alain Lebec Foundation, Inc. Alison & Bernard Webb, In Honor of Peggy Halliday
Alliance $100 - $1000 Rachel Angelos Bangor Motorsports, Luke McCannell and Kurt Thomas Rusdy Budisusetyo Warren & Judith Carter Michele Clark-Groff David Diosi Tara Donohue Sharon Q. Fitzgerald Pamela Gorski Gina Green Nea Hanscomb William Heward Charla Hutchinson Tracie Lindblad Joyce Elizabeth Mauk Dominic Mazzoni Luke and Kelly McCannell Beth McKee Audrey Meissner Nancy Phillips Kristine Quinby Donna Quinn Howard Rachlin Sharon Reeve Carlos Rudge Deborah Sedberry Caroline Simard Tom & Carol Sloan Roberto Tuchman Saralyn Walker Key Bank Mike & Kelly Windsor, In Honor of Janice Windsor
Benefactors $1000 - $1999 Ethel & Nathan Cohen Foundation Patrick & Kristen Ramsey Anonymous
Patron $1 - $99
Toli Anastassiou Linda Bekman, In Memory of James & Ann Celiberti Lea Bell Gordon Bourland Bernard Caputo Douglas & Josette Celiberti, In Memory of Carol Celiberti Maricel Cigales Marianne Clancy Michael Cohen Ed & Marianne Colangelo Panagiota Debery William Dube Stephen Eversole Wilfried Gehne Megan Halliday, In Honor of Peggy Halliday Bethany Halliday Sandra Harris William Horn Joel & Sandra Hornstein
Daniel Kessler Kate Lambert Debbie Lancette, In Honor of Sarah Jack Toby Martin Paul McDonnell John & Marlene McElwee Linda S. Meyer Ellen Murphy Elizabeth Neumann Judy Newport Diana Parisy Wayne Piersel Belinda Robinson David & Joyce Roll Johan Sanne Mark Stafford David Tornabene Leanne Tull Jenny Wells Autism Early Intervention Clinics
If you were a 2011 donor and we inadvertently left you off this list, please accept our apologies and e-mail us at [email protected] ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 21
Media Watch Update by Barbara Jamison, Media Watch Coordinator
ASAT Board of Directors
ASAT Responds to ABC's "From Miracle to Nightmare" (January 08, 2012) ABC's Chris Cuomo provides a stunning expose on facilitated
David Celiberti, PhD, BCBA-D President
communication and the horrific effects on the family of a child with autism. Mary E. McDonald, PhD, BCBA-D
ASAT Responds to AP's "School accused of putting autistic student in
Vice President
bag" (January 12, 2012)
A startling and sad example of what can happen when school personnel Barbara Wells
"are neither prepared nor equipped to meet the unique needs of students Treasurer
with autism." ASAT Responds to NY Times story "A French Film Takes Issue With the Psychoanalytic Approach to Autism" (January 22, 2012)
Florence DiGennaro, PhD, BCBA-D Secretary
NY Times journalists Jolly and Novak take on the French psychoanalytic community and its abysmal failure to provide safe, effective treatment for autism. Read response by Catherine Maurice (author of Let Me Hear Your Voice and Founding Member of ASAT) and David Celiberti (ASAT President).
Leigh Broughan, MA, BCBA Preeti Chojar, MCA Marianne Clancy Kathryn Dobel, JD
ASAT Responds to Star Tribune piece "Autism foundation's IRS filings raise Ruth Donlin, MS
eyebrows" (January 27, 2012)
Elizabeth Dyer, MA, CCC-SLP
Thumbs up to Star Tribune reporter Jane Friedmann for her article alerting Daniela Fazzio, PhD, BCBA
consumers to so-called autism organizations who prey on unsuspecting donors. ASAT Responds to LA Times story "Families Cling to Hope of Autism Recovery" (January 30, 2012) Writer Alan Zarembo of the LA Times highlights the work of Ivar Lovaas and the field of applied behavior analysis, but ASAT calls him to task about what is lacking in his article. ASAT Responds to the Cape Cod Institute Program (February 02, 2012) The Cape Cod Institute Summer 2012 Program lists several autism treatment approaches as "evidence-based comprehensive treatments." But what research actually exists to back up that claim?
Joseph Forgione, MBA Sabrina Freeman, PhD Sara Jane Gershfeld, MA, BCBA Peggy Halliday, M.Ed., BCBA Barbara Jamison, BA Scott Myers, MD, FAAP Daniel W. Mruzek, PhD, BCBA-D Joshua K. Pritchard, PhD, BCBA Tristram Smith, PhD Bridget Taylor, PsyD, BCBA-D

ASAT Responds to News.com.au's "Cost of autistic children cripples parents up to $50,000 a year" (February 14, 2012)
ASAT
"The reality is that thousands and thousands of Australian children with P.O. Box 188
autism will soon become thousands and thousands of young adults with Crosswicks, NJ 08515-0188
autism..." ASAT Responds to Irish Times article "French film ban raises autism issue" (February 17, 2012) We commend reporter Paul O'Donoghue for bringing to light France's unsubstantiated psychoanalytical theory and approach to treatment of
E-mail: [email protected] Website: www.asatonline.org Facebook: www.facebook.com/Asatonline Twitter: www.twitter.com/asatonline
people with autism.
ASAT Responds to Des Moines Register's "Autistic man struggles in Iowa's mental health system" (February 23,
2012)
ASAT applauds journalist Tony Leys for revealing the "heart-breaking reality that many individuals with autism in
Iowa face when they enter an adult system that is ill-equipped to address more severe behavioral needs."
ASAT Responds to Huffington Post's "The Autism Vaccine Controversy and the Need for Responsible Science
Journalism" (March 31, 2012)
Once an idea is promulgated and perpetuated in the media, it can be difficult to retract from the sphere of public
thinking -- even if it has been discredited.
ASAT Responds to UPI.com's "Doctor fired over autism treatment" (April 5, 2012)
Why did a NJ hospital dismiss a neuroscientist over the proposed use of hyperbaric oxygen therapy for patients
with autism?
ASAT Responds to Palm Beach Post's "Autism rate rises; disorder now affects 1 in 88 children" (April 12, 2012)
Writers O'Connor and Elmore report on the latest CDC autism prevalence rates, but ASAT calls them to task about
misleading information in their article.
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 22 Research Review: RCT of a Manualized Social Treatment for High-Functioning Autism Spectrum Disorders Lopata, C., Thomeer, M. L., Volker, M. A., Toomey, J. A., Nida, R. E., Lee, G. K., Smerbeck, A. M., & Rodgers, J. D. (2010). RCT of a manualized social treatment for high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 1297-1310. Reviewed by: Jessica Rothschild, Caldwell College
Why research this topic?
This newsletter contains two article summaries that examine ways to
Individuals with high-functioning autism spectrum disorders (HFASDs) often have difficulty understanding abstract concepts, non-literal language, and identifying facial expression. In addition, they may have a
improve social skills in children with autism, assessed through group designs. Landa, Holman, O'Neill, and Stuart (2011) looked at the effects of a classroom-based intervention on the social development of 48 2-year-olds. Lopata, Thomeer, Volker, Toomey, Nida, Lee, Smerbeck, and Rodgers (2010) investigated a published curriculum's (Skillstreaming) effects on 36 7-12 year olds' peer interaction skills. We are also introducing our first summary of
limited range of interests and engage in
a research review. In general, a research review is a compilation of multiple
repetitive behavior that others regard as
studies that all investigate one particular topic or intervention. The purpose
socially inappropriate. These difficulties may
of the review is to present conclusions on the overall effectiveness of a particular intervention based on the current research. The topic evaluated in
collectively interfere with social
this research review is The Picture Exchange Communication System. Enjoy!
relationships across their lifespan. However,
little research is available on interventions Sharon A. Reeve, Ph.D, BCBA-D that might improve social relationships. The SIAT Research Corner Coordinator
purpose of this randomized clinical trial was
to evaluate a social intervention program based on a What did the researchers find?
manual developed by the authors.
Results of standardized testing measures revealed
What did the researchers do?
a statistically significant improvement in social skills
Thirty-six children with HFASD between the ages of performance for the treatment group when compared
7 and 12 were randomly assigned to a treatment
to the wait-list control group. The areas of social
group or a wait-list control group. In the treatment knowledge and understanding of idioms revealed the
group, teaching was conducted in a group format that greatest statistically significant effect. Parent and
focused on improving peer interaction, expanding staff rating measures also revealed that the
children's range of interests, and helping them
participants engaged in higher levels of targeted
interpret facial expression and non-literal language. social skills after treatment.
Each meeting began with 20 Minutes of intensive What are the strengths and limitations of the study?
instruction, based on a published curriculum
What do the results mean?
(Skillstreaming). The instruction sequence included
The results of the direct child measures and
defining each skill, modeling the skill, identifying the behavioral ratings suggest that the manualized
individual's needs, role-playing, providing feedback, program provided intensive instruction, targeted
and assigning homework. After the instructional time, appropriate social skills based on the social deficits
participants engaged in a 50-minute cooperative
those individuals with HFASDs experienced, and
activity to practice the skills taught during instruction increased these social skills. Some limitations of the
and then reported which skills they used. A point
study included a lack of clearly defined skills which
system was implemented in which children received could possibly result in inaccuracies in the
points for using their new social skills and lost points measurement of these skills and a lack of follow-up
if they engaged in problem behavior or did not follow data to indicate if the treatment gains were
rules.
maintained over time. Both of these limitations should
be addressed in future studies.
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Page 23
Research Review: The Effectiveness of the Picture Exchange Communication System (PECS) on Communication and Speech for Children with Autism Spectrum Disorders: A Meta-Analysis Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the picture exchange communication system (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of SpeechLanguage Pathology, 19, 178-195. Reviewed by: Kathleen Moran, Caldwell College
Why this topic?
What were the strengths and limitations of the
The Picture Exchange Communication System
study? What do the results mean?
(PECS), based on the principles of applied behavior Although PECS is well-researched compared to other
analysis, is a popular approach for teaching children communication interventions, this review should be
with autism to communicate by selecting pictures viewed with caution because there is still only a
and handing them to a communication partner. Due small number of controlled empirical studies
to the lack of systematic reviews of the effectiveness evaluating PECS, especially for speech outcomes.
of the standard PECS protocol on communication Also, if PECS does lead to vocal speech, it is unclear
and speech outcomes for children with autism, the from the available research which of its components
purpose of this review was to conduct a meta-
is responsible for this development. Another
analysis (a method for statistically combining results limitation of the studies is that they did not measure
across studies) to integrate research findings in the how accurately PECS was implemented. A further
current PECS literature.
concern is that the studies did not show clear
What did the researchers do?
evidence that children's speech and picture
The researchers reviewed and included
communication are maintained and generalized
eleven studies published in English peer-reviewed from training to novel settings when using PECS.
journals. The included articles were published
Strengths of the review included careful procedures
between 1994 and 2009 from four different
for identifying studies and abstracting information
databases. The researchers used different
from them. For example, the researchers included
combinations of four words during their search
tables summarizing the specifics of each study,
(PECS, Autism, Picture Exchange Communication outcome measures, identification of excluded
System, and Bondy and Frost). The researchers
studies and reasons for exclusion, and citations for
included only articles that had at least one child
all studies (excluded and included) referenced. In
participant with autism.
addition, they conducted reverse searches and cross
What did the researchers find?
-referenced results with articles listed on the PECS
The researchers concluded that PECS is
official research page. The researchers also included
effective in helping children with autism use pictures a brief overview of PECS in the beginning of the
to communicate; however, evidence that PECS helps study.
children acquire vocal speech is not as strong,
Further research should include assessment of
perhaps because the quality and quantity of
speech development outcomes based on PECS
research on speech outcomes has been insufficient intervention, increased documentation of procedural
to produce a clear pattern of results. The
integrity across studies, evaluations of
researchers also established three child
generalization and maintenance of PECS,
characteristics that may be pretreatment identifiers comparisons of PECS to alternative treatments, and
of children with autism likely to respond to PECS: examinations of potential influence of pre-
limited motor imitation, strong object exploration, intervention characteristics.
and limited joint attention.
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
Science in Autism Treatment
Volume 9,2 Spring 2012
Page 24 Research Review: Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial Landa, R. J., Holman, K. C., O'Neill, A. H., & Stuart, E. A. (2011). Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 52, 13-21. Reviewed by: ToniAnne Giunta, Caldwell College Why review this topic? Autism Spectrum Disorders (ASDs) are characterized by deficits in social skills and communication in areas including recognition and use of facial expression, imitation, reciprocity in interaction, social/ affective signaling, joint attention, symbolic behavior, language understanding, and conventional use of gestures. These deficits can greatly limit opportunities for language and social learning. However, little research is available on interventions intended to alleviate such deficits. To address this gap, the present study tested interventions for improving socially engaged imitation (SEI), imitation of joint attention (IJA), and shared positive affect (SPA) in two-year-old children with autism. The primary questions were (a) are there differences in outcome measures of SEI, IJA, and SPA with learners receiving a supplemental social curriculum in their intervention?; (b) are there differences in expressive language growth and nonverbal cognitive functioning with learners receiving a supplemental social curriculum?; and (c) will gains established during interventions maintain throughout a six-month follow-up? What did the researchers do? Forty-eight learners with ASD, ages 21-33 months, were randomly assigned to one of two groups: Interpersonal Synchrony (IS) and Non-Interpersonal Synchrony (Non-IS). Both groups received 2.5 hours of classroom-based intervention per day for four days a week over a six-month period. Instruction included discrete-trial teaching and pivotal-response treatment, with an emphasis on the use of highly motivating tasks, materials, and natural consequences. Target skills were selected from the Assessment, Evaluation, and Programming System for Infants and Children developmental curriculum. Parent education classes supplemented classroom instruction. The IS group received more opportunities to (a) respond to and initiate joint attention to objects, people, and events (e.g., by placing interesting pictures on the walls to increase the likelihood of using these skills); (b) imitate others during social interactions (e.g., modeling social targets and providing prompts when necessary); and (c) share positive affect (e.g., introducing activities that involved imitation of peers and adults performing silly actions with objects). Learners were assessed using the Communication and Symbolic Behavior Scales Developmental Profile (for IJA and SPA), an imitation assessment (for SEI), and the MSEL developmental tests (for expressive language and nonverbal cognition). What did the researchers find? The researchers found significant differences in outcomes between groups for SEI, but not for IJA and SPA (i.e., more SEI performed by the IS than Non-IS group). They also found significantly higher levels of nonverbal cognition for the IS group at the follow-up, but minimal differences in expressive language between the groups. In regard to growth over time (i.e., timing, rate, and direction of change that provides insight to whether intervention gains remain after termination of the intervention), the IS group showed significantly more growth over time and more rapid growth on every outcome measure when compared to the Non-IS group. What are the strengths and limitations of the study? What do the results mean? This was the first study conducted that assessed the effects of a classroom-based intervention on social development for two-year-olds. The findings show that gains in social development can be made in relatively brief periods of time. Future research, however, is warranted in many areas, including in (a) determining whether toddlers with ASD who develop SEI learn more efficiently within other domains of development and (b) separating the components of the intervention to determine which ones are most effective in increasing social development. Furthermore, a control group was not included, making it difficult to infer that gains in secondary outcomes were affected by the interventions alone. ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment
International News by Daniela Fazzio, PhD, BCBA-D In this issue we are celebrating the variety of countries represented in Science and Autism Treatment's subscriptions and welcoming a new country. We now have a subscription from Russia. !
We know that autism is in every country and the challenges we face in disseminating science in autism treatment and debunking pseudoscience are also reality everywhere.
Below are the top countries outside of the Unit-
ed States with the most subscribers. If you have
suggestions about how we can improve our
reach, or if you would like to share an interna-
tional story, write to us at
[email protected]
Canada
Finally, we have translated two flyers into Spanish; one with content about our website and one with information about our newsletter. They will be on our website soon, but if you need one you can request by email at [email protected]
United Kingdom Australia Ireland India Brazil Israel
Looking forward to hearing from you!
New Zealand Philippines
Page 25
In addition to our Advisory Board, a number of individuals lend their time and talents to support ASAT's mission and initiatives. As you can see, we have individuals who support each aspect of our organization. If you want to assist, please email us at [email protected]
ASAT Public Relations Jennifer Hieminga, MEd, BCBA Lewis Mazzone, MA Audrey Meissner, MEd, BCBA Sage Rose, PhD Nancy Philips, BA Jessica Zilski-Pineno, MSEd Pediatrician and Physician Awareness Project Zachary Houston, MS, BCBA Elisabeth Kinney, MS, BCBA Lauren Schnell, MEd, BCBA ASAT Finance Committee Dena Buonarota Russell, MA Denise Grosberg, MA, BCBA Germaine Ibrahim, MEd
ASAT's Newsletter, Science in Autism Treatment Laurie Brophy, LCSW Kerry Ann Conde, MS, BCBA Justin DiScalfani, MA Kate Fiske, PhD, BCBA-D Denise Grosberg, MA, BCBA Amy Hansford, MS Elizabeth Neumann, MA, BCaBA Renita Paranjape, MEd, BCBA Nicole Pearson, PsyD Sage Rose, PhD Caroline Simard-Nicolas, MS, BCBA Leanne Tull, MADS, BCBA ASAT's Website, www.ASATonline.org Kerry Ann Conde, MS, BCBA Caroline Simard-Nicolas, MS, BCBA Amanda Wadsworth, MSEd
Media Watch Toli Anastassiou, MA, BCBA Geoffrey Debery, MA, BCBA Justin DiScalfani, MA Mary Goward-Philips, BA Hannah Hoch, PhD, BCBA­D Sharon Reeve, PhD, BCBA-D Anya K. Silver, MA, BCBA Shannon Wilkinson, MADS, BCaBA
ASAT Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

P Halliday, Z Houston, E BCBA, MS Kinney

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