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Child choice is defined as the incorporation of child-preferred or child-chosen materials, activities, topics, and toys into learning opportunities. Although the clinician follows the child's lead, the environment remains structured such that desired target behaviors are incorporated into the activities, while maintaining the child's attention, and decreasing the likelihood that the child will avoid the interactions and engage in disruptive behaviors (cf. Dyer, Dunlap, & Winterling, 1990; Kern et al., 1998; R. L. Koegel et al., 1998; Moes, 1998; Sigafoos, 1998). Motivation can also be improved by varying the task sequencing and interspersing previously mastered tasks with new acquisition tasks during a learning activity (Carr, Newsom, & Binkoff, 1980; Davis, Brady, Williams, & Hamilton, 1992; Dunlap, 1984; Winterling, Dunlap, & O'Neill, 1987). The child thus experiences a higher rate of success, a greater likelihood of reinforcement, and consequently, increased responsivity (R. L. Koegel, Carter, et al., 1998).
Broadening shaping criteria to reinforce the children's appropriate attempts
to make social and communicative responses, as compared to a stricter shaping
criterion wherein only responses that are as good or better than previous responses
are reinforced, has been shown to increase the children's acquisition of language
and academic tasks (R. L. Koegel, Carter, et al., 1998; R. L. Koegel & Egel,
1979; R. L. Koegel, O'Dell, & Dunlap, 1988). This may be especially important
for acquisition of first words in nonverbal children (R. L. Koegel et al, 1988),
particularly because related areas such as phonology, pragmatics, and semantics
may not yet be strongly established due to lack of practice of these complex
multiple components that comprise appropriate social interactions (cf. Camarata,
1996; Camarata & Leonard, 1986).
Incorporating the motivational variables described earlier, as a group, into an intervention approach can significantly improve language, academic, and social functioning, while simultaneously decreasing disruptive behavior in children with autism as well as other populations (Dunlap, Kern-Dunlap, Clarke, & Robbins, 1991; Kern & Dunlap, 1998; L. K. Koegel, Koegel, & Carter, 1998; R. L. Koegel, Dyer, & Bell, 1987; R. L. Koegel, Koegel, & Schreibman, 1991; Moes, 1998; Schreibman et al., 1996).
Individuals who are not showing widespread generalization of newly learned skills or autonomy of responding can be taught to self-manage behavior. The general procedure involves teaching individuals to discriminate between appropriate and inappropriate behaviors, then to actively record correct responses, and in some cases to administer self-rewards. This procedure can foster generalization of appropriate behaviors across settings and interactions with others while decreasing the need for constant and long-term vigilance by a clinician (Jones, Nelson, & Kazdin, 1977; Kazdin, 1974; Kern, Marder, Boyajian, Elliot, & McElhatten, 1997; R. L. Koegel, Koegel, & Parks, 1995; Pieree & Schreibman, 1994; Stahmer & Schreibman, 1992). Interventions using self-management have been shown to result in increases in personal competence, problem solving, and independence (L. K. Koegel & Koegel, 1995) and have been successful in targeting a variety of behaviors such as stereotypy (R. L. Koegel & Koegel, 1990), social skills (L. K. Koegel et al., 1992; R. L. Koegel & Frea, 1993; Reese, Sherman, & Sheldon, 1984), disruptive behavior (Newman, Tuntigian, Ryan, & Reinecke, 1997), appropriate play (Stahmer & Schreibman, 1992), and academic skills (Harris, 1986). In addition, implementing a self-management program can promote a cycle of increasing positive interactions, as the children leam to self-recruit reinforcement for appropriate behaviors in the natural environment, thus increasing the likelihood of obtaining reinforcement from individuals outside the intervention setting (Baer, Fowler, & Carden-Smith, 1984; Todd, Horner, & Sugai, 1999).
Summary of Conceptual Framework
Addressing core behaviors during intervention is an emerging strategy in reducing proxy behaviors or symptoms that show an indirect relation with core symptomatology of children with autism. As can be noted in Figure 1, the major or core area in this conceptual framework relates to increasing the child's motivation to engage in social communicative interactions. This involves motivating the child to initiate social interactions, to self-regulate behavior, and to respond to complex interactions involving multiple cues. Thus, specific procedures designed to increase motivation are incorporated into all teaching and learning interactions. Research has shown that addressing this core area may result in large improvements not only in the core areas of social communication, initiations, and self-management but also in many proxy behaviors including reductions in disruptive and stereotypic behavior and improvements in vocabulary and language, speech intelligibility, and play interactions with peers.
Brief Review of Recent Outcome Studies
The following brief review of outcome studies is divided into (a) examples
of studies reporting data on collateral and generalized improvements in multiple
observable behavioral symptoms that are characteristic of children with autism
and (b) examples of global long-term outcome studies.
Therapies for Children with Autism Spectrum Disorder:
- Vanderbilt Evidence-based Practice Center. (2014). Therapies for Children with Autism Spectrum Disorder: Behavioral Interventions Update. Agency for Healthcare Research and Quality.
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Table of Contents
Autism, Ahead of Print.
Social camouflaging describes the use of strategies to compensate for and mask autistic characteristics during social interactions. A newly developed self-reported measure of camouflaging (Camouflaging Autistic Traits Questionnaire) was used in an online survey to measure gender differences in autistic (n = 306) and non-autistic adults (n = 472) without intellectual disability for the first time. Controlling for age and autistic-like traits, an interaction between gender and diagnostic status was found: autistic females demonstrated higher total camouflaging scores than autistic males (partial Î·2 = 0.08), but there was no camouflaging gender difference for non-autistic people. Autistic females scored higher than males on two of three Camouflaging Autistic Traits Questionnaire subscales: Masking (partial Î·2 = 0.05) and Assimilation (partial Î·2 = 0.06), but not on the Compensation subscale. No differences were found between non-autistic males and females on any subscale. No differences were found between non-binary individuals and other genders in either autistic or non-autistic groups, although samples were underpowered. These findings support previous observations of greater camouflaging in autistic females than males and demonstrate for the first time no self-reported gender difference in non-autistic adults.
Autism, Ahead of Print.
This study aimed to define the core components of Family Navigation for autism spectrum disorder, a promising intervention to reduce disparities in care for this population. Teams from four trials of Family Navigation for autism spectrum disorder completed the Template for Intervention Description and Replication checklist to outline intervention components. Through intervention component analysis and qualitative synthesis, we identified 11 core components across three domains: Training and Supervision, Navigator Tools, and Navigator Activities. We discuss the importance of identifying these core components and implications for future research and practice.
Autism, Ahead of Print.
Heterogeneity of treatment response is common in children with autism spectrum disorder. Thus, many providers vary the intervention used based on child characteristics and learning domain. An improved understanding of how to match treatments to different children and domain areas may enhance efforts to individualize treatment and improve treatment response. This study evaluated the relative efficacy of discrete trial training and pivotal response training for teaching young children at risk for autism spectrum disorder receptive and expressive language, play, and imitation skills. Using a single-subject adapted alternating treatments design, children received both the treatments for 12â€‰weeks. Data were collected during treatment and at 3-month follow-up. All participants acquired target skills in both treatments and demonstrated some generalization, maintenance, and spontaneous skill use. Pivotal response training and discrete trial training were each more effective for some children and domains. The results suggest that early rates of learning may be predictive of longer-term treatment response and useful in informing treatment decisions.
Autism, Ahead of Print.
Professionals have expressed concerns about the quality of autism-related information available from Internet-based sources. The purpose of this study was to examine the source, content, usability, and actionability of autism spectrum disorderâ€“related information contained in 100 different videos directed to families of children with autism spectrum disorder uploaded to YouTube. Upload sources were identified, and video content was coded. Understandability and actionability of the videos were examined using Patient Education Materials Assessment Tool for Audiovisual Materials. The collective number of views of the videos was almost 100 million. The length of videos was 691.17 min (i.e. 11.5 h) with the shortest video being 30 s and the longest video being 37.36 min. The YouTube videos related to autism spectrum disorder covered a range of issues, although much of the content was focused on signs and symptoms. No difference in content reporting was noted based on sources for most categories, although differences were noted in some categories (e.g. professionals mentioned diagnosis and resources more frequently). Poor understandability and actionability scores (i.e. below 70%) were reported for all videos regardless of video source. However, the videos generated by the professionals were superior in terms of understandability. Study implications and recommendations for further research are discussed.
Autism, Ahead of Print.
This study examined parent couplesâ€™ participation in and satisfaction with speech-language therapy for school-age children with autism spectrum disorder in the United States. Responses from 40 fatherâ€“mother couples (n = 80 parents) were examined across therapy components (i.e. parentâ€“therapist communication, assessment, planning, and intervention). Descriptive frequencies, chi-square tests, intraclass correlations, and dyadic multilevel modeling were used to examine participation across fathers and mothers and within parent couples. Compared to mothers, fathers communicated less with therapists and participated less in assessment and planning. Fathers also had lower satisfaction than mothers with parentâ€“therapist communication and planning. Although few parents participated in school-based therapy sessions, 40% of fathers and 50% of mothers participated in homework. However, few parents received homework support from therapists. Results are discussed in terms of clinical implications for interventionists to more effectively engage both fathers and mothers in family-centered speech-language therapy for school-aged children with autism spectrum disorder.
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