ArticlePDF Available

The importance of early identification and intervention for children with or at risk for autism spectrum disorders



There has been a dramatic rise in the number of children being diagnosed with autism spectrum disorders (ASD), which has led to increased attention paid to assessment and intervention issues. This manuscript agrees with Camarata (2014) that the evidence base for early assessment and intervention should be expanded. However, it disagrees with Warren et al.'s (2011) assumption that there are not empirically validated early interventions. Reliable diagnosis has been documented during infancy and toddlerhood, and evidence suggests that the earlier the onset of intervention, the greater likelihood of an improved developmental trajectory. It is argued that early intervention is more cost and time efficient than a "wait and see" approach. With regard to published studies, the large amount of heterogeneity in the ASD population supports the use of rigorous single case experimental design research. It is an error to limit empirical evidence for treatments to only randomized clinical trials, which have the weakness of masking individual differences. Single case experimental designs examine the effects of intervention beyond typical maturation by allowing for clear estimations of developmental trajectories prior to the onset of intervention, followed by evaluation of the impact of the intervention. This commentary discusses the short- and long-term benefits of early diagnosis and intervention.
Early identifi cation
DSM-5 changes in the diagnosis of autism
Since Kanner s (1943) fi rst description of autism,
diagnosis continued to encompass the three general
categories of communication diffi culties, social defi -
cits, and restricted interests/repetitive behaviours.
However, when the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) (American
Psychiatric Association, 2013) was introduced in
May 2013, the three core domains of autism were
pooled into two categories (social communication
and restricted interests) and several of the sub-
classifi cations were removed including Asperger
Disorder, Rett Syndrome, Childhood Disintegrative
Disorder, and Pervasive Developmental Disorder-
Not Otherwise Specifi ed (PDD-NOS) (APA, 2000,
2013). This could likely affect the incidence rate of
ASD (McPartland, Reichow, & Volkmar, 2012;
Worley & Matson, 2012), but may not immediately
affect the prevalence as the recommendation is to
not re-evaluate individuals already qualifying for
ASD under various classifi cations (Hyman, 2013).
This manuscript discusses Dr Stephen Camarata s
article entitled Early identifi cation and early inter-
vention in autism spectrum disorders: Accurate and
effective? We wholeheartedly agree with Dr Camar-
ata that there is a clear need to expand the evidence
base in the area of early diagnosis and intervention
services for children with autism spectrum disorder
(ASD) (Camarata, 2014, p. 8). There is a worldwide
increase in the prevalence of children being diagnosed
with ASD (Blumberg, Bramlett, Kogan, Schieve,
Jones, & Lu, 2013; Kim, Leventhal, Koh, Fombonne,
Laska, Lim, et al., 2011) and, thus, intervention pro-
grams are crucial. Camarata primarily discusses the
need for accurate early identifi cation and early inter-
vention. We continue the discussion by addressing
issues that are essential to understand these areas.
Our article includes a discussion of the changes in the
defi nition of ASD, the categorical exclusion of differ-
ent types of experimental designs, and the harmful
consequences of limiting acceptable designs to only
randomized clinical trials when evaluating treatment
outcomes for children with ASD and their families.
Correspondence: Dr Lynn Kern Koegel, Koegel Autism Center, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA. Email:
International Journal of Speech-Language Pathology, 2014; 16(1): 50–56
ISSN 1754-9507 print/ISSN 1754-9515 online © 2014 The Speech Pathology Association of Australia Limited
Published by Informa UK, Ltd.
DOI: 10.3109/17549507.2013.861511
The importance of early identifi cation and intervention for children
with or at risk for autism spectrum disorders
University of California, Santa Barbara, CA, USA
There has been a dramatic rise in the number of children being diagnosed with autism spectrum disorders (ASD), which
has led to increased attention paid to assessment and intervention issues. This manuscript agrees with Camarata (2014)
that the evidence base for early assessment and intervention should be expanded. However, it disagrees with Warren et al. s
(2011) assumption that there are not empirically validated early interventions. Reliable diagnosis has been documented
during infancy and toddlerhood, and evidence suggests that the earlier the onset of intervention, the greater likelihood of
an improved developmental trajectory. It is argued that early intervention is more cost and time effi cient than a wait and
see approach. With regard to published studies, the large amount of heterogeneity in the ASD population supports the use
of rigorous single case experimental design research. It is an error to limit empirical evidence for treatments to only rand-
omized clinical trials, which have the weakness of masking individual differences. Single case experimental designs examine
the effects of intervention beyond typical maturation by allowing for clear estimations of developmental trajectories prior to
the onset of intervention, followed by evaluation of the impact of the intervention. This commentary discusses the short- and
long-term benefi ts of early diagnosis and intervention.
Keywords: Autism spectrum disorder , early identifi cation , early intervention.
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
Importance of early identifi cation and intervention for ASD 51
This complicates the diagnostic process, as it is dif-
cult to understand why two children with identical
symptoms may have different diagnoses based solely
on the date of diagnosis. Thus, only one child would
receive ASD specifi c interventions while the other
would not even have the diagnosis according to the
DSM-5 guidelines.
Adding to the issues of diagnosing ASD is the fact
that it is indeed a spectrum disorder. Individuals
diagnosed with ASD who have fewer support needs
may present similarly to other developmental disor-
ders, and even those with signifi cant support needs
may have symptoms that overlap with other disor-
ders (e.g., language delays, non-verbal learning dis-
order, social communication disorder). Related, the
addition of social communication disorder (SCD),
which is not considered within the autism spectrum,
will also likely affect the incidence of ASD. Children
diagnosed with SCD previously may have qualifi ed
under the autism spectrum. In an attempt to address
the spectrum issue, the DSM-5 has provided,
albeit vague, severity levels of symptoms in the two
The variability in both symptoms and severity of
ASD has led many to argue that ASD should not
be viewed as a single disorder (Geschwind & Lev-
itt, 2007); its symptoms are complex depending on
individual characteristics and environmental con-
texts. However, studies have documented high reli-
ability of diagnosis at age 18 months if the examiner
is highly trained in ASD (Chawarska, Klin, Paul,
& Volkmar, 2007). Further, retrospective and pro-
spective studies are suggesting that social defi cits
are present during the child s fi rst year of life, and
therefore the current state of the art is leaning
toward an even earlier diagnosis.
In summary, the rationale for changing the DSM
is multi-fold, including improvement in the preci-
sion of the diagnosis, characterization of common
ASD symptoms within a single name, and descrip-
tion of severity level (APA, 2013). The consequences
of these changes are not yet known and there has
been great concern regarding whether the new cri-
teria threaten service delivery and eligibility. For
example, despite that children with less severe
symptoms of ASD are often amenable to interven-
tion and greatly benefi t from increased support,
many of these individuals may no longer qualify for
ASD services (Rondeau, Klein, Masse, Bodeau,
Cohen, & Guil é , 2011). Current research suggests
that some individuals with a DSM-IV diagnosis of
autism may no longer meet criteria for ASD in the
DSM-5. While there is likely to be an inherent
increase in the number of children diagnosed with
ASD, the overall rate will decrease because of the
dropped classifi cations (Taheri & Perry, 2012).
Thus, Camarata s (2014) discussion relating to
concern about accurate diagnosis is certainly shared
by others and it is an important area to consider.
Early intervention
Improved outcomes
Many of us who were in the fi eld of autism in the
1960s and 1970s are well aware of the poor out-
comes for children with ASD before numerous
comprehensive interventions were available. Almost
all children with ASD were placed in mental insti-
tutions by adolescence, with some placed as early
as toddlerhood. Anyone who spent time observing
the locked wards of these hospitals would attest to
the undesirable living conditions these children
had to endure. Each decade since has provided a
rich and accumulating database documenting
hundreds of effective interventions for children
with ASD ranging from parent education to school
interventions, behaviour management techniques
(Baker-Ericzen, Stahmer, & Burns, 2007), meth-
ods to improve communication (Koegel, Camarata,
Koegel, Ben-Tall, & Smith, 1998; Smith &
Camarata, 1999), socialization (Harper, Symon, &
Frea, 2008; Koegel, Werner, Vismara, & Koegel,
2005), academics (Koegel, Koegel, Frea, &
Green-Hopkins, 2003; Koegel, Singh, & Koegel,
2010; Robinson, 2011), pragmatics (Kaiser &
Warren, 1985), and so on. Many researchers feel
that ASD is not necessarily a life-long disabling
condition (Koegel & Koegel, 2012; Koegel,
Koegel, Shoshan, & McNerney, 1999), and most
research clinics report that, with intervention,
most children will be included in regular educa-
tion classrooms, and as many as 25% of children
will lose the diagnosis completely (Cohen, Amerine-
Dickens, & Smith, 2006; Helt, Kelley, Kinsbourne,
Pandey, Boorstein, Herbert, et al., 2008; Lovaas,
1987; Sallows & Graupner, 2005). Despite some
methodological concerns with the Lovaas (1987)
study, most researchers feel that the interventions
and resulting outcomes for children with ASD are
much improved today over previous methods. In
fact, prior to Lovaas (1987), Prizant (1983) showed
that, even with the best available interventions, a
staggering number ( 50%) of children diagnosed
with autism remained non-verbal throughout
their lives. In contrast, research today shows that
fewer than 10% of individuals with ASD will
remain non-verbal with intervention (Koegel,
2000). Moreover, data suggest that children
who are completely non-verbal who begin inter-
vention in the early pre-school years are far more
likely to become verbal than children who begin
intervention over the age of 5-years (Koegel, 2000).
The majority of the fi eld agrees that intervention
must start at the earliest point in time (Landa,
2007; Reichow, 2012; Rogers, 1996). The wait
and see method for early intervention of ASD is
likely to have signifi cant negative consequences on
children with ASD (National Research Council,
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
52 L. K. Koegel et al.
Prevention of secondary symptoms
Individuals with ASD often exhibit aggression, tan-
trums, and self-injury. These behaviours are not in
the diagnostic criteria for ASD, but are secondary
symptoms that develop when primary symptoms
are not addressed. Almost all disruptive behaviours
(secondary symptoms) exhibited by children with
ASD have a communicative function (Carr &
Durand, 1985; Iwata, Dorsey, Slifer, Bauman, &
Richman, 1994) and, thus, are often avoided,
reduced, or eliminated, with early intervention
focused on teaching functionally-equivalent replace-
ment behaviours (FERBs) (Horner, Carr, Strain,
Todd, & Reed, 2002). Similarly, co-morbid symp-
toms, such as depression and anxiety (common in
adolescents and adults with ASD; Bauminger &
Kasari, 2000; Howlin, 2000) are often directly related
to diffi culties with socialization, and recent research
suggests that co-morbidity may be reduced if
the core social area is treated (Koegel, Ashbaugh,
Koegel, Detar, & Regester, in press). Alternatively,
failing to provide intervention for these symptoms
due to inaccurate or lack of diagnosis may result in
grave consequences. Early intervention techniques
to address core symptoms of ASD may prevent sec-
ondary symptoms and reduce the need for more
substantial and expensive interventions later in life.
Fiscal issues
Early intervention leads to fi scal savings, as untreated
symptoms of ASD become more abundant and severe
later in life, requiring more costly interventions
(Chasson, Harris, & Neely, 2007; Jacobson & Mulick,
2000; Jacobson, Mulick, & Green, 1998). Further,
these potential lifelong costs are prohibitive for indi-
viduals with ASD that need lasting support. Jacobson
et al. (1998) discussed a cost-benefi t model for early
intensive behavioural intervention for children who
received 3 years of early intervention between the age
of 2 years and school entry. In this model, cost sav-
ings were estimated in the range (in US dollars) of
$ 187 000 $ 203 000 per child aged 3 22 years and
$ 656 000 $ 1 082 000 per individual aged 3 55 years.
Furthering the fi nancial benefi ts of early treatment,
many interventions for infants have shown that par-
ents can be effective change agents with as little as 1
hour per week of professional support (Koegel, Singh,
Koegel, Hollingsworth, & Bradshaw, 2013; Steiner,
Gengoux, Klin, & Chawarska, 2013). By recruiting
parents as active interventionists in the habilitation
process at the earliest point in time, a much less costly
intervention can be implemented.
Parent stress
Parents are generally the fi rst to notice and report a
developmental problem in their children (Johnson &
Myers, 2007). Along with this perspicacious ability
of parents to identify a problem very early in life is
the coinciding stress that is almost universally pres-
ent in parents with a child with a disability (Baker,
Blacher, Crnic, & Edelbrock, 2002; Baker-Ericzn,
Brookman-Frazee, & Stahmer, 2005). Without tools
to address atypical behaviours, such as is the case
with ASD, anxious parents are likely to further
descend into deeper levels of health problems, such
as depression (Dumas, Wolf, Fisman, & Culligan,
1991; Hastings & Brown, 2002), possibly interfering
with their ability to effectively parent (Durand,
Hieneman, Clarke, Wang, & Rinaldi, 2013). In con-
trast, providing parents with tools to address symp-
toms at the earliest point in time is likely to give them
self-confi dence and empowerment (Durand, Hiene-
man, Clarke, & Zona, 2009; Koegel, Bimbela, &
Schreibman, 1996), thereby improving their own
mental health along with their child s behaviour. In
short, including parents in early intervention treat-
ment has signifi cant benefi ts for both the child and
the parents well-being.
Overcoming a disability with early intervention
Although Camarata (2014) suggests that some
consider ASD a lifelong disabling condition, many
researchers in the fi eld have documented case exam-
ples of children who have eliminated their symptoms
to the point where the individuals fi t within the typ-
ical range (Koegel & LaZebnik, 2004; Lovaas, 1987),
and almost half can eventually function without the
need for special support. However, without early
intervention this is unlikely. Most parents and pro-
fessionals have the goal of alleviating symptoms that
could negatively affect the child s ability to engage in
leisure activities and gain employment. Early inter-
vention increases the likelihood of improved long-
term outcomes.
Barriers to early intervention funding
As Camarata (2014) points out, an increasing num-
ber of states have passed legislation requiring private
insurance companies to cover intervention services
for ASD. Despite the intent of the initiatives, the
autism legislation has been accompanied by numer-
ous class action lawsuits for denial of services (e.g.,
Cigna, Philadelphia; Kaiser, California; Providence,
Oregon). Few would disagree that third party payers
are infamous for denial of claims. Again, this often
delays or eliminates the possibility of early interven-
tion, and magnifi es the costs of intervention in later
Some of the insurance denials along with some recent
publications have suggested that autism (Applied
Behaviour Analysis, or ABA) therapy is experimental
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
Importance of early identifi cation and intervention for ASD 53
and that there is a lack of empirical evidence
for behavioural intervention approaches (Warren,
McPheeters, Sathe, Foss-Feig, Glasser, & Veenstra-
VanderWeele, 2011). The primary rationale relates to
the lack of randomized controlled trial (RCT) studies.
Quite candidly, we (as well as judges that ruled in
favour of the individuals with ASD) believe that there
are many scientifi cally validated interventions avail-
able. While RCTs are often considered the gold stan-
dard for clinical trials (such as drug evaluations), there
are problems when this methodology is applied to
behaviour interventions for individuals with ASD.
First, the heterogeneity of individuals diagnosed with
ASD makes it diffi cult to ascertain which participants
respond to a specifi c intervention and to what degree.
For example, a non-verbal child with ASD may not
respond as well as a verbal child with ASD to a par-
ticular intervention. However, if the study s partici-
pants include both verbal and non-verbal children, one
may mistakenly believe the intervention will help all
children with ASD when the signifi cance was analysed
at the group level. Second, unlike medication studies
where some participants are given a placebo, it may be
impossible to have a non-intervention control group
for young children with ASD. That is, parents who
suspect a delay will seek out services for their child,
which limits the possibility of a control group. While
an argument could be made that the treatment as
usual (TAU) in the community is sub-par, there is
variability in community services and, therefore, it
would be a challenge to compare an experimental and
TAU group. Third, because of the heterogeneity of
individuals diagnosed with ASD (as well as the diffi -
culty of fi nding a non-treatment group), often the
treatment effects are not signifi cant in a group design.
Next, and taking the perspective that there are not
enough RCTs to support the effectiveness of early
intervention, this leads us to question why more behav-
ioural treatment RCTs are not being funded by the
US federal government. One simply has to look at
funded research in the US to see that a disproportion-
ate amount of funding is being spent on physiological
research relative to psycho-educational research in the
area of ASD (Singh, Illes, Lazzeroni, & Hallmayer,
2009). Moreover, the research-to-practice gap from
when a scientifi c discovery is made until it is practiced
is often more than a decade. This means that even if a
RCT were started today, a child would be well past
the early intervention age by the time it was ready for
implementation (Greenwood & Abbott, 2001; Morris,
Wooding, & Grant, 2011). We believe that no one
would argue in favour of denying early intervention
services until more RCTs are conducted.
The value of rigorous single case
experimental designs
A single case research design is a well-accepted, rig-
orous, experimental approach for documenting
treatment effects, and more than 45 journals publish
studies with this highly regarded methodological
design (Kratochwill, Hitchcock, Horner, Levin,
Odom, Rindskopf, et al., 2013). Several hundred
studies have shown the positive effects of early inter-
vention through single case designs (National Autism
Center, 2009). Highly regarded volumes on empiri-
cally supported treatments for many different disor-
ders, including ASD, have reported the outcomes of
a wide range of rigorous experimental designs (e.g.,
Weisz & Kazdin, 2010). With regards to external
validity, single case studies can use procedures that
have been replicated in multiple settings and by mul-
tiple independent investigators to improve confi -
dence in generalizability. Further, single case
experimental designs, by virtue of their repeated
measurement time series analyses, control for any
changes that might be attributable to maturation
alone. In short, single case experimental designs pro-
vide a systematic and methodologically sound
approach to conducting research on early interven-
tion for ASD.
Treat behavioural functioning
There has been some concern that diagnosing a
child with ASD may result in some false positives,
particularly in the more mild cases or very young
children (Rondeau et al., 2011). However, given the
potential effects of ASD on the individual, the family,
and the larger community, and the success of early
intervention, it seems unwise and potentially detri-
mental to delay intervention or adopt the wait
and see if ASD develops approach. Because of the
heterogeneity in the diagnosis of ASD, a more intel-
ligent and sensible approach may be to provide
treatment for behavioural functioning rather than a
diagnostic label. For example, if a child is not talking
at 2 years of age and is uninterested in social interac-
tion, it makes more sense to teach the parents some
procedures to evoke fi rst words in a social context
rather than wait to see if the child is a late talker
or will develop ASD. Similarly, if a child exhibits
excessive tantrums, teaching appropriate replace-
ment communicative utterances would be advisable.
Even if there are some false positives, the risks of not
providing early intervention can be far more serious,
and contrasts negatively with the positive effects of
parent education and attention to specifi c symptoms
at the earliest possible age. In other words, not
addressing all of the symptoms because of a reluc-
tance to diagnose the child with ASD may place him
or her at a disadvantage.
As Hart and Risley (1992) pointed out over 2
decades ago, developmental trajectories are well
established by the pre-school years, and delays in
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
54 L. K. Koegel et al.
communication are very likely to result in a lifetime
of challenges in many other areas. Approaches to
studying social dysfunction in infants have become
quite sophisticated, and the negative consequences
of social dysfunction can be profound (Klin, Jones,
Schultz, Volkmar, & Cohen, 2002). Promising inter-
ventions are available for infants within the fi rst year
of life (Koegel et al., 2013), as well as early in the
infant s second year of life (12 18 months) (Steiner
et al., 2013). These interventions draw from well-
established empirically-validated treatments that
have been effective with older children (Koegel &
Koegel, 2012) and rely heavily on the parents as
primary change agents, making early intervention
both time- and cost-effective, while simultaneously
reducing parent stress. We strongly encourage symp-
toms to be addressed at the earliest point in time so
that parents learn effective strategies to help their
children improve socially and communicatively and
to decrease the possibility of more severe secondary
symptoms. Warren et al. (2011) did not include any
single subject design studies, and only discussed
studies with 10 or more participants. A more com-
prehensive evaluation may be found through the
National Standards Project (National Autism Cen-
ter, 2009) and the National Research Council
(2001). Camarata (2014) points out the importance
of evidence and substantiated approaches to treat-
ing ASD. This is essential. Given the high numbers
of children currently being diagnosed with ASD
(Blumberg et al., 2013) undoubtedly this should be
one of the nation s highest priorities. However, dis-
counting research that uses single subject designs
(that have been used for over 40 years and are
accepted by over 45 professional peer-review jour-
nals) would, in essence, deny effective services to
millions of individuals with ASD that could benefi t
from these interventions. As a society, we cannot
ethically deny intervention to a child when many
scientifi cally sound studies exist, showing remark-
able intervention results for both decreasing unde-
sirable behaviours and improving desirable
behaviours (Eldevik, Hastings, Hughes, Jahr, Eike-
seth, & Cross, 2009; Horner et al., 2002). Stating
that an accurate diagnosis is not possible or that not
enough group studies exist will result in the failure
to provide services for many needy children. A more
intelligent approach would involve individualizing
specifi c empirically-validated interventions (either
through group or single subject research designs)
based on an infant or child s unique behavioural,
environmental, and family characteristics, and then
to carefully document the child s response to inter-
vention (RTI) (Fuchs & Fuchs, 2006) to understand
whether the intervention is effective for that child.
RTI allows us to change, modify, discontinue, or
continue a particular intervention. As Lovaas (1987)
showed, if a child is responding to intervention, a
larger dose may result in the ability of a child to
be indistinguishable from his or her peers. The
potential positive outcome of early detection and
intervention is not something that should be denied
to any child or family, and will ultimately have a
positive impact on society.
Declaration of interest: The authors report no
confl icts of interest. The authors alone are respon-
sible for the content and writing of the paper.
American Psychiatric Association . (2000) . Diagnostic and Statistical
Manual of Mental Disorders (4th ed. , text rev.). Washington, DC:
American Psychiatric Association .
American Psychiatric Association . (2013) . Diagnostic and
Statistical Manual of Mental Disorders (5th ed.) . Arlington, VA:
American Psychiatric Publishing .
Baker , B. L. , Blacher , J. , Crnic , K. A. , & Edelbrock , C . (2002) .
Behavior problems and parenting stress in families of three-
year-old children with and without developmental delays .
American Journal on Mental Retardation , 107 , 433 444 .
Baker-Ericzn , M. J. , Brookman-Frazee , L. , & Stahmer , A . (2005) .
Stress levels and adaptability in parents of toddlers with and
without autism spectrum disorders . Research and Practice for
Persons with Severe Disabilities , 30 , 194 204 .
Baker-Ericzen , M. J. , Stahmer , A. C. , & Burns , A . (2007) . Child
demographics associated with outcomes in a community-
based Pivotal Response Training program . Journal of Positive
Behavior Interventions , 9 , 52 60 .
Bauminger , N. , & Kasari , C . (2000) . Loneliness and friendship
in high functioning children with autism . Child Development ,
71 , 447 456 .
Blumberg , S. , Bramlett , M. , Kogan , M. , Schieve , L. , Jones , J. , &
Lu , M . (2013) . Changes in prevalence of parent-reported
autism spectrum disorder in school-aged U.S. children: 2007
to 2011 2012 . National Health Statistics Report , 65 , 1 7 .
Camarata , S . (2014) . Early identifi cation and early intervention
in autism spectrum disorders: Accurate and effective?
International Journal of Speech-Language Pathology , 16 ,
1 10 .
Carr , E. G. , & Durand , V. M . (1985) . Reducing behavior problems
through functional communication training . Journal of Applied
Behavior Analysis , 18 , 111 126 .
Chasson , G. S. , Harris , G. E. , & Neely , W. J . (2007) . Cost com-
parison of early intensive behavioral intervention and special
education for children with autism . Journal of Child and Fam-
ily Studies , 16 , 401 413 .
Chawarska , K. , Klin , A. , Paul , R. , & Volkmar , F . (2007) .
Autism spectrum disorder in the second year: Stability and
change in syndrome expression . Journal of Child Psychology
and Psychiatry , 48 , 128 138 .
Cohen , H. , Amerine-Dickens , M. , & Smith , T . (2006) . Early
intensive behavioral treatment: Replication of the UCLA
model in a community setting . Journal of Developmental and
Behavioral Pediatrics , 27 , 145 155 .
Dumas , J. E. , Wolf , L. C. , Fisman , S. N. , & Culligan , A . (1991) .
Parenting stress, child behavior problems, and dysphoria in
parents of children with autism, Down syndrome, behavior
disorders, and normal development . Exceptionality: A Special
Education Journal , 2 , 97 110 .
Durand , V. M. , Hieneman , M. , Clarke , S. , Wang , M. , &
Rinaldi , M. L . (2013) . Positive family intervention for severe
challenging behavior in a multisite randomized clinical trial .
Journal of Positive Behavior Interventions , 15 , 133 143 .
Durand , V. M. , Hieneman , M. , Clarke , S. , & Zona , M . (2009) .
Optimistic parenting: Hope and help for parents with challenging
children . New York, NY: Springer Publishing .
Eldevik , S. , Hastings , R. P. , Hughes , J. C. , Jahr , E. , Eikeseth , S. ,
& Cross , S . (2009) . Meta-analysis of early intensive behavioral
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
Importance of early identifi cation and intervention for ASD 55
services for students with autism . Language, Speech, and Hear-
ing Services in Schools , 34 , 228 235 .
Koegel , L. K. , Koegel , R. L. , Shoshan , Y. , & McNerney , E . (1999) .
Pivotal response intervention II: Preliminary long-term out-
comes data . Journal of the Association for Persons with Severe
Handicaps , 24 , 186 198 .
Koegel , L. K. , Singh , A. K. , & Koegel , R. L . (2010) . Improving
motivation for academics in children with autism . Journal of
Autism and Developmental Disorders , 40 , 1057 1066 .
Koegel , L. K. , Singh , A. K. , Koegel , R. L. , Hollingsworth , J. R. ,
Bradshaw , J . (2013) . Assessing and improving early social
engagement in infants . Journal of Positive Behavior Interven-
tions . doi: 10.1177/1098300713482977
Koegel , R. L. & Koegel , L. K . (2012) . The PRT pocket
guide: Pivotal response treatment for autism spectrum disorder .
Baltimore, MD: Paul H. Brooks Publishing .
Koegel , R. L. , Bimbela , A. , & Schreibman , L . (1996) . Collateral
effects of parent training on family interactions . Journal of
Autism and Developmental Disorders , 26 , 347 359 .
Koegel , R. L. , Camarata , S. , Koegel , L. K. , Ben-Tall , A. , &
Smith , A. E . (1998) . Increasing speech intelligibility in
children with autism . Journal of Autism and Developmental
Disorders , 28 , 241 251 .
Koegel , R. L. , Werner , G. A. , Vismara , L. A. , & Koegel , L. K .
(2005) . The effectiveness of contextually supported play date
interactions between children with autism and typically devel-
oping peers . Research and Practice for Persons with Severe Dis-
abilities , 30 , 93 102 .
Kratochwill , T. R. , Hitchcock , J. H. , Horner , R. H. , Levin , J. R. ,
Odom , S. L. , Rindskopf , D. M. , et al . (2013) . Single-case
intervention research design standards . Remedial and Special
Education , 34 , 26 38 .
Landa , R . (2007) . Early communication development and inter-
vention for children with autism . Mental Retardation and Devel-
opmental Disabilities Research Reviews , 13 , 16 25 .
Lovaas , O. I . (1987) . Behavioral treatment and normal educa-
tional and intellectual functioning in young autistic children .
Journal of Consulting and Clinical Psychology , 55 , 3 9 .
McPartland , J. C. , Reichow , B. , & Volkmar , F. R . (2012) . Sensitiv-
ity and specifi city of proposed DSM-5 diagnostic criteria for
autism spectrum disorder . Journal of the American Academy of
Child and Adolescent Psychiatry , 51 , 368 383 .
Morris , Z. S. , Wooding , S. , & Grant , J . (2011) . The answer is 17
years, what is the question: Understanding time lags in trans-
lational research . JRSM , 104 , 510 520 .
National Autism Center . (2009) . National standards project:
Addressing the need for evidence-based practice guidelines for autism
spectrum disorder. Findings and conclusions . http://www.national %20Findings%20 & %20Conclu
National Research Council (US) . Committee on Educational
Interventions for Children with Autism . (2001) . Educating chil-
dren with autism . Washington, DC: National Academies Press .
Prizant , B . (1983) . Language acquisition and communicative
behavior in autism: Toward an understanding of the whole
of it . Journal of Speech and Hearing Disorders , 48 , 296 307 .
Reichow , B . (2012) . Overview of meta-analyses on early intensive
behavioral intervention for young children with autism spec-
trum disorders . Journal of Autism and Developmental Disorders ,
42 , 512 520 .
Robinson , S. E . (2011) . Teaching paraprofessionals of students
with autism to implement pivotal response treatment in
inclusive school settings using a brief video feedback training
package . Focus on Autism and Other Developmental Disabilities ,
26 , 105 118 .
Rogers , S . (1996) . Brief report: Early intervention in autism .
Journal of Autism and Developmental Disorders , 26 , 243 246 .
Rondeau ,
E. , Klein , L. S. , Masse , A. , Bodeau , N. , Cohen , D. , &
Guil é , J. M . (2011) . Is pervasive developmental disorder
not otherwise specifi ed less stable than autistic disorder? A
meta-analysis . Journal of Autism and Developmental Disorders ,
41 , 1267 1276 .
intervention for children with autism . Journal of Clinical Child
and Adolescent Psychology , 38 , 439 450 .
Fuchs , D. , & Fuchs , L. S . (2006) . Introduction to response to
intervention: What, why, and how valid is it? Reading Research
Quarterly , 41 , 93 99 .
Geschwind , D. H. , & Levitt , P . (2007) . Autism spectrum disor-
ders: Developmental disconnection syndromes . Current Opin-
ion in Neurobiology , 17 , 103 111 .
Greenwood , C. R. , & Abbott , M . (2001) . The research to practice
gap in special education . Teacher Education and Special Educa-
tion: The Journal of the Teacher Education Division of the Council
for Exceptional Children , 24 , 276 289 .
Harper , C. , Symon , J. , & Frea , W . (2008) . Recess is time-in: Using
peers to improve social skills of children with autism . Journal
of Autism and Develpmental Disorders , 38 , 815 826 .
Hart , B. , & Risley , T. R . (1992) . American parenting of language-
learning children: Persisting differences in family-child inter-
actions observed in natural home environments . Developmental
Psychology , 28 , 1096 1105 .
Hastings , R. P. , & Brown , T . (2002) . Behavior problems of
children with autism, parental self-effi cacy, and mental health .
American Journal on Mental Retardation , 107 , 222 232 .
Helt , M. , Kelley , E. , Kinsbourne , M. , Pandey , J. , Boorstein , H. ,
Herbert , M. , et al . (2008) . Can children with autism recover?
If so, how? Neuropsychology review , 18 , 339 366 .
Horner , R. H. , Carr , E. G. , Strain , P. S. , Todd , A. W. , & Reed , H.
K . (2002) . Problem behavior interventions for young children
with autism: A research synthesis . Journal of Autism and Devel-
opmental Disorders , 32 , 423 446 .
Howlin , P . (2000) . Outcome in adult life for more able individu-
als with autism or Asperger syndrome . Autism. Asperger
Syndrome , 4 , 63 83 .
Hyman , S . (2013) . New DSM-5 includes changes to autism cri-
teria . APA News, American Academy of Pediatrics . http://aap-
Iwata , B. A. , Dorsey , M. F. , Slifer , K. J. , Bauman , K. E. , &
Richman , G. S . (1994) . Toward a functional analysis of
self-injury . Journal of Applied Behavior Analysis , 27 , 197 209 .
Jacobson , J. W. , & Mulick , J. A . (2000) . System and cost research
issues in treatments for people with autistic disorders . Journal
of Autism and Developmental Disorders , 30 , 585 593 .
Jacobson , J. W. , Mulick , J. A. , & Green , G . (1998) . Cost-benefi t
estimates for early intensive behavioral intervention for young
children with autism: General model and single state case .
Behavioral Interventions , 13 , 201 226 .
Johnson , C. P. , & Myers , S. M . (2007) . Identifi cation and evalu-
ation of children with autism spectrum disorders . Pediatrics ,
120 , 1183 1215 .
Kaiser , A. P. , & Warren , S. F . (1985) . Pragmatics and generaliza-
tion . In S. F. Warren , & A. K. Rogers-Warren (Eds.) ,
Teaching functional language: Generalization and maintenance
of language skills (pp . 392 442 ). Baltimore, MD: University
Park Press .
Kanner , L . (1943) . Autistic disturbances of affective contact .
Nervous Child , 2 , 217 250 .
Kim , Y. S. , Leventhal , B. L. , Koh , Y. , Fombonne , E. , Laska , E. ,
Lim , E. , et al . (2011) . Prevalence of autism spectrum disorders
in a total population sample . The American Journal of Psychia-
try , 168 , 904 912 .
Klin , A. , Jones , W. , Schultz , R. , Volkmar , F. , & Cohen , D . (2002) .
Defi ning and quantifying the social phenotype in autism .
American Journal of Psychiatry , 159 , 895 908 .
Koegel , L . (2000) . Interventions to facilitate communication in
autism . Journal of Autism and Developmental Disorders , 30 ,
383 391 .
Koegel , L. K. , & LaZebnik , C . (2004) . Overcoming autism .
New York: Viking Penguin .
Koegel, L. K ., Ashbaugh, K ., Koegel, R. L ., Detar, W. J ., &
Regester, A . (in press). Increasing socialization in adults with
asperger s syndrome . Psychology in the Schools , in press.
Koegel , L. K. , Koegel , R. L. , Frea , W. , & Green-Hopkins , I
(2003) . Priming as a method of coordinating educational
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
56 L. K. Koegel et al.
Sallows , G. O. , & Graupner , T. D . (2005) . Intensive behavioral treat-
ment for children with autism: Four-year outcome and predic-
tors . American Journal on Mental Retardation , 110 , 417 443 .
Singh , J. , Illes , J. , Lazzeroni , L. , & Hallmayer , J . (2009) . Trends
in US autism research funding . Journal of Autism and Develop-
mental Disorders , 39 , 788 795 .
Smith , A. , & Camarata , S . (1999) . Using teacher implemented
instruction to increase language intelligibility of children
with autism . Journal of Positive Behavior Interventions , 1 ,
141 151 .
Steiner , A. M. , Gengoux , G. W. , Klin , A. ,
& Chawarska , K . (2013) .
Pivotal response treatment for infants at-risk for autism
spectrum disorders: A pilot study . Journal of Autism and
Developmental Disorders , 43 , 91 102 .
Taheri , A. , & Perry , A . (2012) . Exploring the proposed DSM-5
criteria in a clinical sample . Journal of Autism and Developmen-
tal Disorders , 42 , 1810 1817 .
Warren , Z. , McPheeters , M. L. , Sathe , N. , Foss-Feig , J. H. ,
Glasser , A. , & Veenstra-VanderWeele , J . (2011) . A systematic
review of early intensive intervention for autism spectrum
disorders . Pediatrics , 127 , e1303 e1311 .
Weisz , J. R. , & Kazdin , A. E. , (Eds.). (2010) . Evidence-based
psychotherapies for children and adolescents . New York, NY:
Guilford Press .
Worley , J. A. , & Matson , J. L . (2012) . Comparing symptoms of
autism spectrum disorders using the current DSM-IVTR
diagnostic criteria and the proposed DSM-5 diagnostic crite-
ria . Research in Autism Spectrum Disorders , 6 , 965 970 .
Int J Speech Lang Pathol Downloaded from by CDL-UC Santa Barbara on 03/12/14
For personal use only.
... The failure to recognize and respond to children with ASD is a lost opportunity to provide suitable interventions to ameliorate the symptoms they experience and to provide support to their families [17]. Furthermore, the earlier this happens, the greater are the benefits [18]. ...
: Screening tools for the early identification of developmental disabilities are strongly advised, yet culturally valid tools are not readily available for use in low- and middle-income countries. The present study describes the context and the processes used to develop a suitable screening procedure for use in the Kurdistan region of Iraq. This was based on an autism rating scale—GARS-3—developed in the USA for use primarily with children’s parents. It was administered to three groups of children: those with a pre-existing diagnosis of ASD; those with a confirmed diagnosis of a developmental disability; and those who were typically developing—735 participants in all. The 10 items from the 58 items in the full GARS-3 scale that best discriminated the three groups of children were identified. Subsequent analysis confirmed that the ten-item summary scores had reasonable internal reliabilities, with a good specificity and sensitivity in distinguishing children with ASD from those that were typically developing but less so for children with other developmental disabilities. The study confirms the universality of autism symptoms but also the different emphasis Kurdish parents may place on them. Nevertheless, screening procedures need to be developed in the context of support services that can undertake follow-up diagnostic assessments and provide suitable interventions for use by parents to promote their child’s development. The study provides an example of how this can be possible in low- and middle-income countries. Keywords: autism spectrum disorders (ASD); autism; screening; developmental disabilities; low- and middle-income countries; LMIC; Kurdistan; Iraq
... Caution is therefore needed in making comparisons among the various subscales, although they may give some insights into the strengths and weaknesses of certain children. Indeed, the wide variation in scores found among children with ASD in the study is reflective of the condition and the need for individual focused interventions [18,19]. Moreover, the overall amount of variance explained in this study and that in the U.S. was less than 50%. ...
Full-text available
There is marked variation internationally in the prevalence of children identified as having autism spectrum disorders (ASD). In part, this may reflect a shortage of screening tools for the early identification of children with ASD in many countries. This study aimed to evaluate the Kurdish translation of the Gilliam autism rating scale—third edition (GARS-3), a scale commonly used in Western countries that evaluates six domains related to the ASD definition from the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, notably Restricted/Repetitive Behavior, deficits in Social interaction and Social Communication, as well as differences in Cognitive Style, Maladaptive Speech, and Emotional Response. GARS-3 assessments were completed through interviews with parents of 735 children, 442 (53%) of whom were diagnosed with ASD. 165 (22%) with an intellectual disability, 49 (7%) with communication disorders, and 133 (18%) typically developing children. The reliability, construct, and predictive validity of the scale was assessed, and the scores suggestive of a child having ASD were identified. The factor structure was broadly replicated, especially on items relating to social interaction and social communication. The cutoffs for the total scores that were indicative of possible ASD had a high degree of specificity and sensitivity in distinguishing children with ASD from typically developing peers. Some children with I.D. and communication disorders may also score above the threshold, and further assessments should be sought to confirm the presence of autistic traits. Although GARS-3 could be recommended for use in Kurdistan and possibly similar cultures, further prospective research is needed to confirm a diagnosis of assessment with children who score above and below the cutoff scores identified in this study. Moreover, the development of normative data drawn from Kurdish samples of children would be advantageous, although ambitious, given the lack of diagnostic services in many low- and middle-income countries.
... Discovery Variability in age of autism diagnosis and intervention as a determinant of shortand long-term child and family outcomes (Elder et al., 2017;Koegel et al., 2014) Caregiver social networks identified as a determinant of service use for underserved children (Gulsrud et al., 2021) Limited understanding of tertiary determinants of disparities in access to post-diagnosis care (e.g., differences in who is found eligible for public health services; how systems shape treatment provision in organizational settings) Limited understanding of conditions in which networks comprised of caregivers, informal caregivers, and school-and community-based service providers contribute to child outcomes Limited data sources on post-diagnosis services, including lack of data on social networks. Limited funding to support: (1) integrated, multi-disciplinary tertiary determinants research; ...
Most published autism research, and the funding that supports it, remains focused on basic and clinical science. However, the public health impact of autism drives a compelling argument for utilizing a public health approach to autism research. Fundamental to the public health perspective is a focus on health determinants to improve quality of life and to reduce the potential for adverse outcomes across the general population, including in vulnerable subgroups. While the public health research process can be conceptualized as a linear, 3‐stage path consisting of discovery – testing – translation/dissemination/implementation, in this paper we propose an integrated, cyclical research framework to advance autism public health objectives in a more comprehensive manner. This involves discovery of primary, secondary and tertiary determinants of health in autism; and use of this evidence base to develop and test detection, intervention, and dissemination strategies and the means to implement them in ‘real world’ settings. The proposed framework serves to facilitate identification of knowledge gaps, translational barriers, and shortfalls in implementation; guides an iterative research cycle; facilitates purposeful integration of stakeholders and interdisciplinary researchers; and may yield more efficient achievement of improved health and well‐being among persons on the autism spectrum at the population‐level. Scientists need better ways to identify and address gaps in autism research, conduct research with stakeholders, and use findings to improve the lives of autistic people. We recommend an approach, based in public health science, to guide research in ways that might impact lives more quickly.
... Early diagnosis and treatment can mitigate the negative consequences of ASD (Boyd et al., 2010). Early intervention can steer children at risk of developing ASD towards a more typical developmental trajectory and prevent the development of compensatory behavioural issues (Koegel et al., 2014). Since early interventions have been increasingly investigated in the past decade, it is necessary to aggregate and evaluate the available evidence. ...
Single-case designs (SCDs) are used to evaluate the effects of interventions on individual participants. By repeatedly measuring participants under different conditions, SCD studies focus on individual effects rather than on group summaries. The main limitation of SCDs remains its generalisability to wider populations, reducing the relevance of their findings for practice and policy making. With this limitation in mind, methodological developments for synthesising SCD data from different studies that investigate the same research question have intensified in the past decades (e.g. multilevel modelling). However, these techniques are restricted to comparing two interventions at a time and can only incorporate evidence from studies that directly compare the two treatments of interest. These limitations could be addressed by using network meta-analysis that incorporates both direct and indirect evidence to simultaneously compare multiple interventions. Despite its potential, network meta-analytical techniques have yet to be applied to SCD data. Thus, in this paper, we argue that network meta-analysis can be a valuable tool to synthesise SCD data. We demonstrate the use of network meta-analysis in SCD data using a real dataset, and we conclude by reflecting on the challenges that SCD researchers might face when applying network meta-analysis methods to their data.
Full-text available
Introduction This protocol delineates the research design and analytical framework used to evaluate the effectiveness of the WHO-CST (CST, caregiver skills training) in Hong Kong. The WHO-CST aims to enhance the caregiver skills of parents of children with potential autism spectrum disorders (ASD) and/or developmental delays. Methods and analysis In this study, 130 eligible caregiver–child dyads were recruited and randomly assigned to the experimental and wait-list-control groups. A randomised controlled trial design was adopted to compare the changes between the two groups regarding caregivers’ skills, knowledge and practices when interacting with their children with impairments due to ASD. Assessments were conducted before, immediately after and 1 month after the completion of the WHO-CST programme. The primary measurement tool was the joint engagement rating inventory developed by WHO experts to gauge how parents engage their children. A 10-min video recording of their dyadic interaction and behaviours in a defined play setting was used for the measurement. A set of other measurements of caregivers’ knowledge, confidence and experience of using the caregiving skills were also measured. Ethics and dissemination Ethics approval was received from the Human Research Ethics Committee (EA1901033), The University of Hong Kong. The final findings of this study will be disseminated through public reports, peer-reviewed publication or at a conference launched for the WHO-CST programme. Trial registration number ChiCTR2000034585.
Missed appointments (MAs) at child development centres (ChDCs) cause multiple problems: they preclude timely diagnosis and treatment of both the invited child and children whose appointment was delayed due to overbooking, as well as disrupting efficient organisational management. The aim of this study was to assess the rate and describe the reasons for missed appointments at Israeli ChDCs, and to evaluate the association of socio‐demographic, clinical, and administrative variables with MA rates. This nested case‐control study included all children scheduled for initial appointments (N = 1143) at three centres during 1 year. Parents of children who missed their appointment and a sample of those who attended were interviewed by telephone. The rate of missed appointments was 26.6%, and the most frequent reasons were unexpected events (26.0%) and lack of insurance coverage (23.4%). Variables associated with lower MA rates were: having had ≥3 types of rehabilitative interventions (odds ratios (OR) = 0.26; 95% confidence interval [CI] 0.16–0.44), detailed referral letter (OR = 0.48; 95%CI 0.30–0.75), telephone reminder (OR = 0.37; 95%CI 0.24–0.57) and health maintenance organisations or private insurance coverage (OR = 0.12; 95%CI 0.06–0.17 and OR = 0.56; 95% CI 0.38–0.89, respectively). Encouraging physician's referral letters and personal‐contact reminders can reduce missed appointments. Understanding the family's and the child's personal characteristics, and the organisational/administrative aspects of missed appointments may guide efforts to ensure timely care for every child. The missed appointment (MA) rate at Child Development Centres (ChDCs) was 26.6%The most frequent reasons was unexpected personal events, for example, child's illnessChildren who had received previous rehabilitative therapy had lower MA ratesOrganisational factors, for example, insurance, reminders, were associated with MA rates The missed appointment (MA) rate at Child Development Centres (ChDCs) was 26.6% The most frequent reasons was unexpected personal events, for example, child's illness Children who had received previous rehabilitative therapy had lower MA rates Organisational factors, for example, insurance, reminders, were associated with MA rates
Prelinguistic skills play an important role in children’s communication development. These skills are considered as significant bases for language acquisition and function conductive to later social development. Means of communication, communicative functions, skills with cognitive bases, and language comprehension are important prelinguistic skills. There is a critical period for acquiring prelinguistic skills and early identification of communication deficits is an important issue to be considered. The present study aimed to develop a communication skills checklist for Persian children aged 6- to 24-month-old and evaluate its psychometric properties. Parents of 277 Persian children aged 6- to 24-month-old participated in the current study. A checklist was first developed after an extensive literature review and various psychometric analyses in addition to regression analyses were carried out to determine its validity and reliability. The final checklist contained 36 items with high face validity and content validity (CVI > 0.62, CVR > 0.79). Also, the checklist demonstrated a high association with the CNCS (Pearson’s correlation coefficient = 0.85, p < 0.001), and the construct validity showed significant differences between the four age groups (F-test = 197.881, p < 0.001). The results of the internal consistency measurement (Cronbach’s alpha coefficient = 0.952) and the test-retest reliability test (ICC = 0.933, p < 0.001) revealed excellent reliability of the checklist. In conclusion, based on the psychometric assessment, this checklist is a promising tool for assessing communication skills in Persian children aged 6 to 24 months.
To date, a deficit-oriented approach dominates autism spectrum disorder (ASD) research, including studies of infant siblings of children with ASD at high risk (HR) for the disabilities associated with this disorder. Despite scientific advances regarding early ASD-related risk, there remains little systematic investigation of positive development, limiting the scope of research and quite possibly a deeper understanding of pathways toward and away from ASD-related impairments. In this paper, we argue that integrating a resilience framework into early ASD research has the potential to enhance knowledge on prodromal course, phenotypic heterogeneity, and developmental processes of risk and adaptation. We delineate a developmental systems resilience framework with particular reference to HR infants. To illustrate the utility of a resilience perspective, we consider the “female protective effect” and other evidence of adaptation in the face of ASD-related risk. We suggest that a resilience framework invites focal questions about the nature, timing, levels, interactions, and mechanisms by which positive adaptation occurs in relation to risk and developmental pathways toward and away from ASD-related difficulties. We conclude with recommendations for future research, including more focus on adaptive development and multisystem processes, pathways away from disorder, and reconsideration of extant evidence within an integrated risk-and-resilience framework.
Full-text available
This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.
Full-text available
Purpose: The importance of coordination of educational services has been well documented in the literature. For students with disabilities, coordinated programs result in more rapid acquisition of targeted behaviors and the increased likelihood of long-term maintenance of gains. The purpose of this study was to assess whether "priming" or exposing students with autism and disruptive behaviors to school assignments before their presentation in class would affect academic performance and problem behaviors. Method: Two students diagnosed with autism who attended general education classrooms, both of whom exhibited numerous disruptive behaviors and low academic performance, participated in this study. A repeated reversals design was used to monitor student progress. Results: The results demonstrated decreases in problem behavior and increases in academic responding when priming sessions occurred. Clinical implications: Application is discussed in terms of a mechanism for speech-language pathologists to assist classroom teachers with a systematic educational coordination plan that can quickly produce improved school performance.
Full-text available
Empirical studies have documented a variety of social abnormalities in infancy that indicate risk for later social and behavioral difficulties. There is very little research illustrating the presence of such behavioral vulnerabilities with frequent repeated measures, and the feasibility of designing interventions for improving social engagement in infants under one year of age. In the context of a multiple baseline research design, three young infants, ages 4, 7, and 9 months referred for concerns about social engagement were assessed for affect, social interest, eye contact avoidance, and response to name. Additionally, the feasibility of implementing an intervention to target social behaviors was examined. Results demonstrated that: (1) consistently low or erratic levels of social behavior were evident throughout the baseline assessment period; (2) these patterns could be improved with a brief intervention (a modified Pivotal Response Treatment) showing an immediate increase and stability of social engagement; and (3) social engagement remained at a stable and high level at follow-up. The results are discussed in terms of implications of early assessment and intervention for clinical populations, including infants with Autism Spectrum Disorder.
Deviant language characteristics, deficits in social interaction, and ritualistic and compulsive behaviors are now considered to be among the definitive characteristics of the autistic syndrome. There have been few attempts to bring a sense of cohesion to the varied communicative symptomatology evident in autism, because much of the research literature has been product oriented rather than process oriented, and has focused on language structure rather than function. Therefore, behaviors such as immediate echolalia, delayed echolalia, and interactive rituals as often viewed as isolated, deviant phenomena, rather than as phenomena related to predominant cognitive processing modes and cognitive-linguistic development in autism. This discussion reviews symptomatology of autistic communication in reference to "gestalt" versus "analytic" modes of cognitive processing, language acquisition, and language use. Based on research on language behavior of normal and autistic children, specific issues are considered, including a reconsideration of echolalic behaviors, patterns of social interaction, and patterns of cognitive-linguistic development in autism.
In an effort to responsibly incorporate evidence based on single-case designs (SCDs) into the What Works Clearinghouse (WWC) evidence base, the WWC assembled a panel of individuals with expertise in quantitative methods and SCD methodology to draft SCD standards. In this article, the panel provides an overview of the SCD standards recommended by the panel (henceforth referred to as the Standards) and adopted in Version 1.0 of the WWC's official pilot standards. The Standards are sequentially applied to research studies that incorporate SCDs. The design standards focus on the methodological soundness of SCDs, whereby reviewers assign the categories of Meets Standards, Meets Standards With Reservations, and Does Not Meet Standards to each study. Evidence criteria focus on the credibility of the reported evidence, whereby the outcome measures that meet the design standards (with or without reservations) are examined by reviewers trained in visual analysis and categorized as demonstrating Strong Evidence, Moderate Evidence, or No Evidence. An illustration of an actual research application of the Standards is provided. Issues that the panel did not address are presented as priorities for future consideration. Implications for research and the evidence-based practice movement in psychology and education are discussed. The WWC's Version 1.0 SCD standards are currently being piloted in systematic reviews conducted by the WWC. This document reflects the initial standards recommended by the authors as well as the underlying rationale for those standards. It should be noted that the WWC may revise the Version 1.0 standards based on the results of the pilot; future versions of the WWC standards can be found at
What is Pivotal Response Treatment? What's the research behind it, what does it look like in practice, and what are some good examples of how to use it? Now one concise book gives professionals and parents all the basics of the widely used PRT an empirically supported treatments for autism recognized by the National Professional Development Center on Autism Spectrum Disorders and the National Standards Project. A great resource for educators, behavior specialists, early interventionists, SLPs, occupational therapists, and families, this reader-friendly pocket guide is the perfect introduction to PRT, the popular approach that uses natural learning opportunities to modify pivotal areas of behavior. Pioneering autism experts Robert and Lynn Koegel speak directly to the reader, demystifying PRT and clearly explaining why it leads to widespread and rapid progress for children. Filled with helpful tips and many practical examples based on actual children, the book reveals the key principles behind motivating children with natural reinforcers reducing disruptive behavior with PRT encouraging communication and social initiations developing a challenging curriculum that helps children make progress assessing children meaningfully in natural environments closely collaborating with parents on goals and interventions helping families weave interventions into everyday routines ensuring that children generalize skills to other settings decreasing parents' stress and offering positive support Throughout the book, the Koegels engage readers with down-to-earth guidance based on best practice, true stories from their decades of experience with children and families, and clear explanations of what the research says about PRT. And the end-of-chapter questions for teachers, therapists, and parents reinforce key points and prepare them for effective PRT implementation. An essential first step in PRT training and a must-have for every member of a child's support team, this quick and practical introduction will get everyone on board with PRT and equip them with the fundamentals they need to use it in the real world.A featured book in our Better Behavior Kit!"
Objectives: This report presents data on the prevalence of diagnosed autism spectrum disorder (ASD) as reported by parents of school-aged children (ages 6-17 years) in 2011-2012. Prevalence changes from 2007 to 2011-2012 were evaluated using cohort analyses that examine the consistency in the 2007 and 2011-2012 estimates for children whose diagnoses could have been reported in both surveys (i.e., those born in 1994-2005 and diagnosed in or before 2007). Data sources: Data were drawn from the 2007 and 2011-2012 National Survey of Children's Health (NSCH), which are independent nationally representative telephone surveys of households with children. The surveys were conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics with funding and direction from the Health Resources and Services Administration's Maternal and Child Health Bureau. Results: The prevalence of parent-reported ASD among children aged 6-17 was 2.00% in 2011-2012, a significant increase from 2007 (1.16%). The magnitude of the increase was greatest for boys and for adolescents aged 14-17. Cohort analyses revealed consistent estimates of both the prevalence of parent-reported ASD and autism severity ratings over time. Children who were first diagnosed in or after 2008 accounted for much of the observed prevalence increase among school-aged children (those aged 6-17). School-aged children diagnosed in or after 2008 were more likely to have milder ASD and less likely to have severe ASD than those diagnosed in or before 2007. Conclusions: The results of the cohort analyses increase confidence that differential survey measurement error over time was not a major contributor to observed changes in the prevalence of parent-reported ASD. Rather, much of the prevalence increase from 2007 to 2011-2012 for school-aged children was the result of diagnoses of children with previously unrecognized ASD.