Study #1: Parent Mediated Joint Engagement Intervention
In both observational and experimental treatment studies, language outcomes for children with autism are highly variable. Some children develop age-appropriate language skills while others remain nonverbal. By 10-13 years of age, as many as one-quarter to one-half of children with autism will not have developed functional language (Lord & Schopler, 1989; Sigman & Ruskin, 1999). In explaining the variability in language outcome, several studies have shown that joint attention ability is associated with language development. Children with autism who actively share and follow the attention of others (via coordinated attention to toys and people, showing toys or pointing to events and objects) also have better language skills from 1 to 8 years later (Charman, et al., 2005; Mundy, Sigman, & Kasari, 1990; Sigman & Ruskin, 1999; Stone & Yoder, 2001). An important moderator of joint intervention treatment outcome was the child’s initial language ability. Other moderators of treatment outcome may be child and family background characteristics. In the modestly sized RCT described above, as in all efficacy studies in autism, there were few total subjects from diverse economic and ethnic backgrounds. Thus, it is unknown the extent to which focusing on joint engagement skills results in similar outcomes for children and parents from different ethnic, racial and economic conditions. Through this study, we will use large samples of children from diverse environments to explore these factors as potential moderators of treatment outcome.
Study #2: Study of Peer Relationships at School-Primary School Children
Improving peer relationships and increasing the possibilities for friendship development are both critical treatment needs of children with ASD who are fully included in regular classrooms. Investigators in the AIR-B have contributed observational and developmental studies on peer relationships of children with autism as well as recently completed randomized controlled treatment studies for school- aged children (as part of the STAART mechanism funded via NIH). Study data comparing 3 different treatment models to control condition (inclusion) suggests that a combination of target child social skill development along with training typical peers from the same classroom was most effective for improving social engagement on the playground, and increasing social networks reported by the classroom peers. The target child alone social skills treatment was not effective in changing social networks. These data suggest that intervening with the typical peers in the child’s classroom is necessary if changes in peer relationships are to occur. However, it is unknown if the school changes generalize to home.Thus, the proposed project will compare these treatments with some modifications for implementation at schools across a diverse population of children. We will examine the benefits of the two promising treatments for improving peer relationships and friendships at school and at home.
Study #3: Web-based Social Skills Intervention for School-aged Children with ASD
Peer relationships are considered a key factor in healthy development from early childhood through adulthood. However, children with autism are at a distinct disadvantage when it comes to developing and maintaining peer relationships, regardless of age or developmental level, which reflects a core deficit of social communication. Several clinical interventions have been designed to help improve social communication skills for children with autism. However, the availability of these interventions is limited, particularly for children in rural and low socioeconomic status areas. There is evidence to suggest that video-based and computer-based interventions can be useful in building individual social skills and enhancing peer relationships for children with autism. Our goal is to compare the effectiveness of a web-based social skills intervention with a wait-list control on children’s social interaction outcomes. This will enable us to determine the utility of a web-based format for teaching social skills to children with autism spectrum disorders.
Study #4: Study of Peer Relationships at School-Teens
Significant delays in social communication are a core deficit for teens with autism spectrum disorders (ASD). As the number of teens with ASD who attend mainstream schools in the United States continues to rise, it is clear that more effective, empirically supported interventions are needed if schools are to meet the social and emotional needs of their increasingly diverse student body. Several clinical interventions have been designed to help improve social relationships for children with autism; however the evidence base exists only for young preschool aged children. These studies suggest that peer mediated interventions are effective at improving the initiations and responses of children with ASD when these interventions are conducted in the classroom. While teens with high functioning ASD are increasingly being placed into regular education classes, they often have little peer relationship support or intervention in the classroom, and are considered an under-served population of individuals with autism. The goal of this study is to compare the effects of two separate, manualized group interventions designed to improve social outcomes for teens with autism.
Many of the measures the investigators in the AIR-B have developed as part of our research projects continue to be refined for use by researchers. These measures are often tedious and labor intensive (e.g., ADI-R can take several hours to complete, playground observations are very detailed and take hours to code and summarize) and do not lend themselves to wide dissemination among community service providers. Thus, it is critical that valid measures are developed that can be applied in a number of different settings by non-researchers. As part of each of the two studies on ASD interventions, we have a number of standardized and well- validated outcome measures used in efficacy studies. However, we will also pilot test rapid experimental measures that can be tested for validity against the standardized measures. Such an approach requires more testing during the course of the research studies, but if rapid measures prove valid and informative, then their application will be critical to widespread dissemination of our findings. For validated measures, we will examine whether these can be adapted for use with automated scoring using PDAs or other handheld devices, further facilitating their use. The measures tested include an engagement rating during playground observations at school, an engagement rating during routines at home (Wetherby and Lord measure), a social network measure, and a parent report of play date experience.