List of Studies
2015 Research Competition Grant Awards
Adults with ASD After High School: Pitfalls and Possibilities
Connie Anderson, Ph.D.
There is a critical need for information explaining why many young adults with autism spectrum disorder (ASD) are disconnected from services and educational or employment opportunities in the years post high school. This qualitative, interview-based study focuses on the experiences of young adults and their parents after high school ends. It intentionally includes families of youth across the autism spectrum, both those who were “certificate-bound,” exiting high school around age 21, and those who were “diploma-bound,” exiting around age 18. It also includes families whose young adult is anywhere from one to fifteen years past high school, highlighting the different realities faced as time passes.
The study builds upon an existing project funded by Towson University and the A. J. Drexel Autism Institute. It will increase the number of parent interviews from 20 to 35 and the number of young adult interviews from 3 to 13, making it possible to include a more diverse group of families in terms of socio-demographics, presentation of ASD, and time elapsed since high school. One aim is to identify individual, family, and community characteristics associated with young adult disengagement from or participation in services, post-secondary education, and the world of work. Another is to create a conceptual model of disengagement. If young adults with ASD are “falling off a cliff,” this study is meant to generate hypotheses regarding which individuals are falling off which cliffs.
Facing Your Fears: Supporting Teens with Autism Spectrum Disorders and Intellectual Disabilities
Audrey Blakeley-Smith, Ph.D., University of Colorado Denver, JFK Partners
Adolescents with autism spectrum disorders (ASD) and intellectual disability (ID) are a complex and under-served population. They are at risk for developing significant anxiety that adversely impacts participation in home, school, and community. Anxiety may contribute to social isolation, place adolescents at risk for further mental health concerns and problem behavior, and lead to more restricted school and living situations. While many families seek assistance from their teen’s school and community mental health providers, few are prepared to treat anxiety in this complex population. We will be creating a program entitled Facing Your Fears: Adolescents with Autism and Intellectual Disabilities (FYF:AAID) which will be one of the first to date to explore the efficacy of a family focused, group cognitive behavioral therapy (CBT) treatment for an adolescent ASD and ID population. This pilot study will have two major aims: (1) To obtain feedback from key stakeholders on the specific modifications made to our evidenced based program Facing Your Fears to best treat an adolescent ASD and ID population, and (2) to conduct a pilot study of FYF-AAID, assess the treatment’s acceptability and feasibility, and impact on family functioning. Hypothesized outcomes include reductions in teen anxiety in addition to functional outcomes for adolescents (such as increased engagement in activities, broader social experiences) and their families (improved quality of life).
Examining Person and Environment Factors Associated with Community Participation for Adults with ASD
Dara Chan, Sc.D., University of North Carolina at Chapel Hill
The limited but emerging research on adult outcomes for individuals with Autism Spectrum Disorder (ASD) reports less community participation, social interaction, paid employment, and independent living compared to typically developing peers and other disability groups. However, little is known about the daily activities of adults with ASD and factors that influence participation. The current study combines innovative Global Positioning System (GPS) and Geographic Information System (GIS) measures to describe realtime community integration activities of adults with ASD living with family or in a group home, and investigates critical person and environmental factors associated with participation. Participants will use GPS trackers to capture time away from home, distance traveled, and locations visited for seven days. GIS technology will integrate GPS travel data to create maps of activity locations and assess environmental accessibility related to service use and participation. Follow-up qualitative interviews will assess the importance of community activities and barriers to integration. These results will be combined with adult outcome survey data from a larger study to examine the role of personal factors such as motivation and skill level in a variety of areas (for example communication, vocational, social, and daily living skills) on community participation. The relationship between participation, service use, and caregiver support will also be examined.
Comorbidities in ASD: Developmental Trajectories and Predictors of Adult Outcomes
Juhi Kaboski, Ph.D., University of Notre Dame
Despite growing recognition that individuals with comorbid psychiatric disorders constitute a very large subgroup with autism, there is a dearth of knowledge about this population, such as their developmental trajectories and adult outcomes. Most troubling is the lack of evidence-based treatment protocols and coordination of services to address their unique needs. The proposed research will address this critical gap in the literature by producing among the most comprehensive and integrative findings to date on common comorbidities in ASD and their relationship to multiple outcomes across development. Particular attention will be paid to possible moderating effects of existing treatments and services – medications, school services/accommodations, and insurance (type and level of coverage). To accomplish these research objectives, we will perform secondary data analysis on three large longitudinal datasets: PEELS, SEELS, NLTS-2. When combined, these datasets contain a nationally representative sample of individuals with ASD who received special education services, ages 3 to 26 (n=2,277). The findings of this study will inform parents, educators, professionals, and policy makers in their attempts to better understand this population and to provide evidenced-based treatments and school interventions that could steer this population onto optimal developmental trajectories and adult outcomes.
Effectiveness of a School-Based Executive Function Intervention for High School Students with ASD
Cara Pugliese, Ph.D. and Lauren Kenworthy, Ph.D., Children’s National Health System
There is a critical need for ASD interventions targeting executive functions (EF) including flexibility, goal setting, planning, organization, big picture thinking, and task completion. EF deficits are profound in ASD and related to poor independent living skills. In collaboration with students with ASD, their parents, and teachers, we created “Flexible Futures” (FF), a school-based EF intervention for high school students with ASD transitioning to college. FF targets complex EF demands of adolescence to increase academic success and functional life skills, laying the groundwork for independence in college, and then adulthood. FF is an upward extension of our evidence-based intervention for children with ASD (“Unstuck and On Target”), and employs techniques specifically designed to optimize learning in adolescents. FF specifically targets the EF skills teens need most– self-advocacy, motivation, time-management, and planning. We propose a randomized comparative effectiveness trial of FF and a comparison “treatment as usual” social skills intervention in Fairfax County Public Schools. Our goal is to provide a research-proven EF intervention for immediate use in public and private school settings to reach the broadest number of teens with ASD, and ultimately to set them on a positive trajectory for independence in adulthood. Data will be used for an NIH or similar application to study the impact of EF intervention in adolescence over time, as well as predictors of response.
Regulation of Emotional Lability in Autism Spectrum Disorder through Caregiver Supports (ReLACS)
Kristin Rispoli, Ph.D., Michigan State University
Children and youth with Autism Spectrum Disorder (ASD) often struggle to regulate their emotions, and many experience comorbid mental health issues such as anxiety and depression. Though it is not a diagnostic marker of ASD, poor emotion regulation may significantly impair daily functioning for individuals with the disorder. Nevertheless, interventions targeting emotion regulation are primarily designed for older children and adolescents with ASD. There is a critical need for early interventions that foster emotional modulation in young children with ASD and prevent long-term mental health issues. Parent-mediated interventions are often used to successfully treat core features of ASD, and likewise may be effective in addressing emotion dysregulation. This study is a pilot investigation of the Regulation of Emotional Lability in Autism Spectrum Disorder through Caregiver Supports (ReLACS) intervention, when implemented with parents of preschoolers with ASD. Weekly intervention sessions will teach parents how to support effective emotion regulation using specific techniques, and to tailor intervention using principles of behavioral analysis. A multiple probe design will evaluate intervention effects across 5 dyads. It is predicted that ReLACS will increase parents’ use of strategies to support emotion regulation and reduce dysregulated emotion in their children with ASD. The investigation will also assess parent perceptions of intervention acceptability and effectiveness.
Measuring What Matters:
Understanding the Meaning of Outcomes for Adults on the Autism Spectrum
Collette Sosnowy, Ph.D., Paul Shattuck, Ph.D., Chloe Silverman, Ph.D.
Over the next decade, a half million people with autism spectrum disorder (ASD) will age into adulthood. Compared to peers who received special education for other disabilities, a range of outcomes are significantly poorer for these young adults. Existing conceptual frameworks and measures for adult autism outcomes fall short for several reasons. First, many of the commonly used measures were developed years ago for people with intellectual disability, yet most youth now on the spectrum do not also have an intellectual disability. Second, the recent movement in health research emphasizes patient-centered outcomes that are developed through meaningful engagement with representatives of the population that the research aims to help. Most current measures, however, were developed without input from young adults with ASD, parents/caregivers, or professionals working in the field. Third, researchers recognize "emerging adulthood" as a critical and transitional period of the lifespan, yet current autism outcome measures do not take the developmental challenges that accompany it into account. In addition, we do not have a framework for understanding how variables such as access to services and demographics influence outcomes. This rigorous qualitative study seeks to develop a contemporary conceptual framework of stakeholder perspectives about outcomes for adult autism in order to inform better measures and ultimately improve services and policies.
Social Tools and Rules for Transitions (START): A Young Adult Social Intervention Package
Ty Vernon, Ph.D. and Robert Koegel, Ph.D., University of California Santa Barbara
Young adults with autism face significant challenges as they transition to the social and organizational demands of life after high school. Simultaneously, most individuals experience a decrease in available support services due to aging out of available special education programs. Targeted, comprehensive social programming is required to optimize the short and long-term outcomes of these individuals as they pursue higher education, more complex and intimate relationships, and a viable career path. The proposed research project, the Social Tools And Rules for Transitions (START) program, is intended to evaluate a newly developed social curriculum for simultaneously targeting the functional, conceptual, and motivational components associated with social competence. Using a randomized waitlist-controlled trial design, 42 young adults with autism will participate in the 20-week program. The intervention model incorporates a novel package of socialization strategies, including same-age peer facilitators, didactic (discussion) and experiential (social immersion) components, individualized and group social targets, regular planned social outings, and serial assessment of interpersonal functioning. It is anticipated that participants will experience dramatic, rapid gains to global social competence and their associated quality of life. These anticipated gains are likely to have a profound effect on social, emotional, and vocational outcomes.
2014 Research Competition Grant Awards
Examining the Effectiveness of a Latino Parent Leadership Support Project
Meghan Burke, Ph.D., University of Illinois, Urbana-Champaign
Although many parents struggle to ensure that their children with disabilities receive appropriate educational services, Spanish speaking parents of children with disabilities especially face logistical and attitudinal obstacles in developing strong partnerships with the school as well as retaining needed services. Still further, families of children with autism spectrum disorder (ASD) (versus other types of disabilities) are most likely to encounter conflicts with the school system. Using a randomized control trial, the purpose of this project is to examine the effectiveness of a Latino Parent Leader Support Project (LPLSP) in increasing empowerment, communication with the school, special education knowledge, student progress, quality of the family-school partnership, and satisfaction with services among Spanish-speaking, Latino parents of students with autism. We will also examine the effect of the training upon participation in Individualized Education Program (IEP) meetings. We expect that each of the forty graduates of the LPLSP will support four additional Spanish-speaking families of children with autism. We will conduct pre and post surveys with these families to determine the effectiveness of the LPLSP graduate upon the families’ satisfaction with services, empowerment, and special education knowledge. Thus, in addition to the 40 LPLSP graduates, an additional 160 families will be served by this project.
An Interdisciplinary Approach to the Treatment of Encopresis in
Children with Autism Spectrum Disorders
Nathan Call, Ph.D., Joanna E. Lomas Mevers, Ph.D., and Barbara McElhanon, M.D.
Marcus Autism Center at Emory University
A large percentage of individuals with ASD are delayed in achieving continence with bowel movements or never achieve it at all (i.e., they meet criteria for encopresis). This problem has tremendous ramifications for these individuals and their families because encopresis restricts them from integration with peers, limits access to educational opportunities, and carries significant social stigma. Previous interventions for encopresis in this population have either been unsuccessful or required implementation over very long periods. We propose to study a novel interdisciplinary approach to the treatment of encopresis that capitalizes upon our research group’s expertise in behavioral psychology and gastroenterology. Over-the-counter medications are employed to elicit predictable bowel movements, which in turn make it possible to use behavioral strategies to reinforce continence. Independence is increased by fading out the use of medications and training caregivers to implement all procedures. In this study we will demonstrate the
efficacy of this approach with 20 individuals with ASD and encopresis within a randomized trial with a waitlist control. We will also demonstrate the feasibility of conducting a randomized trial of this intervention so that these results can be facilitated further study of this serious problem.
Teaching Tolerance to Delays in Reinforcement to Children with
Autism and Language Delays
Laura C. Chezan, Ph.D., Old Dominion University
Many children with autism spectrum disorder (ASD) who learn a new response to request access to desired outcomes through functional communication training use this response at higher rates than social partners can support. Therefore, it is critical that treatment focuses on teaching tolerance to delay in reinforcement or “waiting” skills when reinforcement is not immediately available. Our primary purpose in this project is to examine the effectiveness of conditional discrimination in teaching tolerance to delay in reinforcement in four young children with ASD. First, we will teach children to request access to reinforcers in the presence of a visual discriminative stimulus. Next, we will teach children to tolerate delays in reinforcement in the presence of one variation (i.e., green-color) of the discriminative stimulus while gradually increasing the time between emission of a request and delivery of reinforcement. Then we will assess maintenance and generalization to novel social partners, settings, and occasions. We will use a multiple-schedule design with generalization and maintenance probes to assess the effectiveness of our conditional discrimination strategies in producing discriminated responding and increasing children’s requesting interresponse latency to novel settings, social partners, and occasions. We will discuss practical implications and make recommendations for practitioners and researchers.
Inclusion of Typical Peers in a Social Skills Intervention for Adolescents with ASD: A Longitudinal Study
Nicole Matthews, PhD, and Christopher J. Smith, Ph.D.
Southwest Autism Research and Resource Center
Recent estimates indicate that a substantial percentage of individuals with autism spectrum disorder (ASD) are not cognitively impaired. Yet, outcomes for adults with ASD are poor. This suggests that interventions targeting the core symptoms of ASD need to be lifelong. This project will compare the effectiveness of two variants of one of the only empirically supported social skills interventions for adolescents with ASD, the PEERS program. In a well-characterized sample of 48 cognitively-able adolescents with ASD, change in selfand parent-reported social functioning and mental health will be compared among participants who complete either (1) the traditional PEERS program, (2) a peer-mediated variant of the PEERS program (i.e., PEERS with typical peers), or (3) a delayed treatment control (DTC) group. The short-term and long-term generalizability of skills learned during the PEERS programs will also be examined by quantifying adolescents’ social networks within their classrooms. It is predicted that adolescents who complete PEERS with peers will demonstrate (1) more improvement in social skills and mental health and (2) more reciprocated friendships and social network centrality than adolescents in the other two groups. Application of these findings may provide new guidelines for implementation of PEERS and other interventions that will improve social integration of adolescents with ASD in real-world settings.
Online and In Person Parent Education/Support for Families of Children with ASD and Insomnia
Cristine A. Roberts, Ph.D., University of Missouri-Kansas City
Most children with autism spectrum disorder (ASD) have sleep problems that impact their ability to adapt to everyday demands of life. Characteristics of ASD, such as repetitive behaviors and social communication deficits become more problematic when children experience long-term poor sleep. Sleep deprivation is also detrimental to all family members. Face-to-face (F2F) sleep educational sessions for parents have improved children’s sleep and improved families’ quality of life. Interventions using technology such as on-line education have been effective in changing health behaviors in a variety of health conditions. Currently, there are no published studies that evaluate the effect of on-line educational sessions for children with ASD and insomnia. The proposed project employs two formats of education and support: F2F and online. Delivered to small groups of randomized parent participants, results from 72 families will be assessed. The specific aim is to determine whether an online educational program with two sessions, including parent blogging and online facilitator support, provides the same benefit as F2F education/telephone support. Children’s sleep and quality of life appraisals will be compared between the groups. A long-term goal is to apply the results to the design of effective online services to assist families in improving sleep for their child with ASD. The online educational modality could serve greater numbers of families in a convenient, accessible manner.
On Target for Life: An Executive Function Independence Skill Intervention for Adolescents with ASD
John Strang, Psy.D., and Lauren Kenworthy, Ph.D.
Children's Research Institute, Children's National Medical Center
There is a critical need for ASD interventions targeting executive function (EF) skills, higher-order cognitive abilities including flexibility, goal setting, planning, organization, big picture thinking, and task completion. EF deficits are profound in ASD, and related to significantly reduced ability to function, and ultimately live, independently. Our lab, in collaboration with students with ASD, their parents and teachers, created “On Target for Life” (OTFL), a school based EF intervention for adolescents with ASD. OTFL is an upward extension of our research proven EF intervention for younger children with ASD (“Unstuck and On Target” ), and employs a range of research based intervention/generalization techniques specifically designed to optimize learning in adolescents. We will conduct a randomized comparative effectiveness trial of OTFL and a comparison social skills intervention in the Fairfax County Public Schools. Assessment will use our lab’s established methods for measuring EF in ASD, including measures that were sensitive to intervention in our randomized comparative effectiveness trial of UOT. Our primary goal is to provide a research-proven EF intervention for immediate use in public and private school settings, so as to reach the broadest number of adolescents with ASD. We will also use the data for an NIH application (and similar grant mechanisms) to study the longitudinal impact of EF intervention in adolescence, as well as predictors of response.
Effects of peer mentoring for college students with autism spectrum disorder
Matthew Segall, Ph.D., Emory University
Increasing numbers of students with autism spectrum disorder (ASD) enroll in post-secondary education every year, creating an urgent need to develop, evaluate and implement programs and supports to assist such students in achieving successful outcomes (e.g., graduation, employment). Many college students with ASD possess the requisite cognitive and academic abilities for success in college courses, yet ASD-associated challenges in executive functioning or social communication often prevent positive outcomes. Peer mentoring, in which college students with ASD meet regularly with trained typically developing peer volunteers, represents an understudied intervention with strong potential for success on a college campus. The current study seeks to implement and evaluate a peer mentoring program on a large college campus in Atlanta. Students with ASD (N=30) will be randomly assigned to a 12-week peer mentoring intervention condition or to a “services as usual” condition; relevant outcomes will include grade point average, retention, social interaction skills, and adaptive behavior skills. Further, it is expected that peer mentors will demonstrate increased knowledge and positive attitudes towards peers with ASD over a 12- week period. Results will elucidate practical strategies, and identify areas requiring further development, for implementing peer mentoring on many college campuses, thus complementing existing campus resources and supports for students with ASD.
2013 Research Competition Grant Awards
Improving Social-Communication and Engagement of Elementary Students with Autism Spectrum Disorders
Jessica Dykstra, Ph.D.,
Frank Porter Graham Child Development Institute at the University of North Carolina
With the rising prevalence of autism spectrum disorder (ASD), school programs are in need of evidence-based interventions to target core deficits in this growing population of children. Social-communication and engagement are key areas of need for children with ASD. These pivotal skills have been shown to positively impact development in other areas such as peer relationships, language abilities, and academic abilities. However, there are few interventions designed to address social-communication and engagement in school-age children with ASD with the most significant needs. The Advancing Social-Communication and Play (ASAP) intervention was designed for public preschools, and shows promise as an effective intervention. The proposed study will extend the existing research by looking at the impact of the ASAP intervention on school-age children with ASD, and the feasibility of the ASAP intervention in elementary schools. The study will use a multiple baseline, single case design across four children with emerging communication skills to examine the impact of ASAP on children’s social-communication and engagement in the classroom. The feasibility of the intervention will be assessed using teacher questionnaires and interviews. The proposed study will provide valuable data on the effect of the ASAP intervention on school-age children, an understudied population. The study will also offer important information on adapting interventions for elementary school settings.
Building Sibling Relationships: The Effects of Sibling Support on Siblings and Children with Autism
Emily A. Jones, Ph.D.,
Queens College, City University of New York
Autism affects the entire family and, in turn, the family system affects outcomes for individuals with autism. Typically developing siblings are part of that family system. The sibling relationship can be strained when one sibling has autism. Siblings of children with autism present with their own adjustment and skill needs. Improving sibling adjustment and the sibling relationship may result in increases in learning opportunities for children with ASD and siblings who play a more significant role in caregiving and advocacy across the lifespan, all of which may improve quality of life for the entire family.
Building on more than 3 years of research developing the Support and Skills Program (SSP) for siblings of children with autism, we will compare the effects of a sibling support group to an attention only control group and examine a booster program to facilitate maintenance of changes in sibling adjustment and the sibling relationship. At the SSP, children with autism receive one to one instruction while siblings participate in a support group and then all children engage in supported recreation activities. Siblings are a largely underserved group or a group served without empirical evidence for the intervention services provided. Siblings can be valuable and effective change agents in the lives of individuals with autism. This research focuses on improving the sibling relationship to achieve these critical outcomes.
A Peer-Facilitated, Multicomponent Social Skills Intervention for Adolescents on the Autism Spectrum
Robert Koegel, Ph.D. and Ty Vernon, Ph.D.,
University of California, Santa Barbara
Adolescents with autism (even those considered “high-functioning”) exhibit diverse profiles with varying degrees of impairment to their social motivation, interpersonal understanding, and concrete skill use. These vulnerabilities, left unchecked, can greatly limit their long-term quality of life. The complexity of their social needs requires comprehensive social programming. The proposed randomized wait list-controlled trial will examine the use of a peer-facilitated, multi-component social skills intervention to simultaneously target motivational, conceptual, and skill deficits. This novel group-based intervention includes the use of high-school social facilitators, individualized skill targets, self-management, experiential and didactic components, parent education, and social homework. Social competence improvements will be serially assessed every five weeks using a variety of measures, including naturalistic conversation samples, survey measures, and data on real-world social encounters. Current pilot data suggests that the proposed group intervention will be highly effective in rapidly improving the social skillset of participating adolescents. Such social improvements have obvious practical implications for this population as they start to pursue adult social endeavors, such as developing meaningful friendships, obtaining and keeping suitable employment, and seeking out romantic relationships.
An Evaluation of a Behaviorally Based Social Skills Group for Young Children Diagnosed with Autism
Justin Leaf, Ph.D. and Mitchell Taubman, Ph.D., Autism Partnership Foundation
A deficit in social skills is a hallmark of individuals diagnosed with autism spectrum disorders (ASD); therefore, it is critical that treatment emphasize teaching social skills. Today, there are multiple strategies to teach social skills to individuals with ASD. One procedure is social skills groups (SSG). Social skills groups are opportunities for three or more individuals diagnosed with ASD to come together and learn specific social skills collectively. Researchers have demonstrated that SSG may be beneficial for individuals diagnosed with ASD; however, there remain several concerns that still must be addressed. This project will evaluate a 16 week behaviorally based SSG for young children diagnosed with ASD. Sixteen participants will be selected for the SSG and randomly divided into either a treatment group or a waitlist control group. A pretest-posttest control group design will be utilized to evaluate the overall increases in social behavior in the treatment group and to determine if there are differences between the two groups. Additionally, we will utilize a multiple baseline design across skills and replicated across participants to evaluate increases on specific social behaviors. Both the group and single subject designs will rely on extensive measurement to assess the generalization of skills in natural settings with typically developing peers. Results from this project will answer questions regarding the efficacy of SSG for individuals diagnosed with ASD.
Improving Access to Care for Challenging Behavior Using a Parent-to-Parent Mentoring Approach
Jennifer Fritz, Ph.D. and Dorothea C. Lerman, Ph.D.,
University of Houston, Clear Lake
Children with Autism Spectrum Disorders (ASD) are more likely to engage in challenging behavior, such as aggression and self-injury, than children without ASD. If left untreated, these behaviors can increase in severity over time, causing significant stress on families. Numerous studies over the 30 years has demonstrated the efficacy of behavioral treatments for these challenging behaviors, particularly an intervention call functional communication training (FCT). Furthermore, caregivers have been able to effectively implement FCT in home settings to reduce their children's challenging behavior. However, all caregivers to date have been trained by professionals. The waiting lists to obtain these professional services can be quite lengthy, and these services are even less accessible to ethnically diverse, low-income families due to financial and language barriers. This study will evaluate a model of training in which caregivers trained by professionals will then train other parents to implement FCT with their children in the home setting. If effective, this model has the potential to expand clinical service availability in rural, low-income communities, as well as to more diverse ethnic groups who face barriers to receiving services for their children’s challenging behavior.
Sexuality Education for Young Adults with Autism Spectrum Disorder
Rachel L. Loftin, Ph.D., Rush University Medical Center
Sexuality education for students is key to preventing unwanted pregnancy and disease, helping students to advocate for the health and safety of their bodies, and enriching quality of life. Sexuality education poses particular challenges for people with Autism Spectrum Disorder (ASD), however, who may have difficulty grasping the abstract and social aspects of human sexuality. Individuals with ASD are at risk of victimization in sexual situations, as well as at increased risk of problematic sexual behaviors that can include undesired touching, public masturbation and other illegal activity. The proposed study will investigate the outcomes, acceptability and feasibility of a curriculum to teach comprehensive sexuality education to young adults with ASD. The comprehensive curriculum includes sound information on reproductive and sexual health from experts in both sexuality education and ASD and will be implemented by educators in a community setting.
Family Patterns in Diagnosis of Children with Autism Spectrum Disorders (ASD)
Nachum Sicherman, Ph.D.,
The average age of autism diagnosis in the United States is close to five years, and even later among children from ethnic minority backgrounds. Such late diagnosis can limit the benefits of behavioral intervention, which has been shown to lead to dramatic improvements in IQ scores and adaptive behavior.
A wide range of ethnic, cultural, linguistic, and socioeconomic factors may lead parents, family members, or health care professionals to ignore or play down concerns about a child’s linguistic and social development, thus delaying diagnosis. In addition, while the nuclear family is key in the diagnosis of ASD, other family members and individuals close to the child, can be instrumental in early diagnosis. However, survey data from such individuals is limited. Our pilot survey of over 100 “friends and family” of children with ASD revealed that 62% of such individuals suspected a developmental delay before the parents. This strongly suggests that important sources of information that could aid in early diagnosis are being missed.
Building on our pilot study, we propose to conduct comprehensive surveys of 5,000 families aiming to investigate causes of delays in diagnosis of ASD and explore correlations between ethnic, demographic and socio-economic groups, diagnostic categories, and family configurations with delays in diagnosis. The research has direct benefits for individuals on the autism spectrum, their families, and related service providers.
2012 Research Competition Grant Awards
Growing Up Aware: A Parent-Based Sexuality Intervention for Children with Autism Spectrum Disorders
Michelle Sondra Ballan, Ph.D., Columbia University
This study seeks to test a five-week, psychoeducational intervention designed to help parents of children with autism spectrum disorders (ASD) understand and promote their child’s healthy sexual development. The Growing Up Aware intervention is derived from the application of a behavioral change model from the public health field. This model focuses on Protection-Motivation theory and uses a task-centered group approach. Based upon the methods of applied behavioral analysis, social mapping and social stories, the intervention is designed to help parents impart communication and educational strategies for competency-based sexuality instruction. A sample of 120 parents of children with ASD, ages 8 through 13, will be recruited from seven school districts within Bergen county, New Jersey. An adaptive randomization procedure will be used to assign participants to either a control or intervention condition. Primary outcomes address: (1) change in parental attitudes and knowledge concerning the sexuality of their children with ASD; (2) change in parental communication skills related to issues of sexuality; and (3) change in level of children’s awareness of sexuality. This study is an initial step towards developing empirically-validated, effective theory-based parent interventions that target children with ASD with appropriate knowledge and skills for navigating normative sexual behavior associated with maturation and transition to adolescence and adulthood.
Identifying Disparities in Access to Treatment for Young Children with Autism
Lucy Bilaver, Ph.D., Chapin Hall at the University of Chicago
The purpose of the proposed study is to identify disparities in access to treatment for young children with autism spectrum disorders (ASD). In particular, this project will identify treatment that occurs both inside and outside the school system. This study will focus on disparities across multiple dimensions including race, region, socioeconomic status, and type of health insurance. While previous research has documented disparities in the age at diagnosis, an understanding of how this phenomenon translates to service use for children in early elementary school is lacking. The study design is observational and longitudinal relying on unique, nationally representative data generated from the Pre-Elementary Education Longitudinal Study (PEELS). The PEELS followed a nationally representative sample of over 3,000 preschool aged (age 3-5) children receiving special education services through 5 waves of data collection beginning in 2003-2004. The unweighted study sample includes approximately 450 children ever identified as having autism during the first 4 waves of data collection. Generalized estimating equations will be used to identify disparities in receipt of treatment services including speech, occupational, and physical therapies, behavior therapy or behavior management program, play therapy or group, and psychological or mental health services. The results of this analysis can be used to identify targets of intervention to reduce service disparities.
Kit for Kids Evaluation Project: An Initial Evaluation of Evidence-Based Peer Educational Materials
Jon Campbell, Ph.D., University of Kentucky
Despite increasing numbers of students with autism spectrum disorders (ASD) being educated alongside typically developing peers, peers’ attitudes towards students with ASD are often negative. The Kit for Kids (KfK) was developed by the Organization for Autism Research (OAR) in order to provide evidence-based educational messages to peers to improve peers’ knowledge, initial attitudes, and behavior towards students with ASD. The proposed research aims to conduct an initial evaluation of (a) the usability of the KfK materials in classrooms, (b) the efficacy of the KfK materials in improving peers’ attitudes and behavioral intentions towards an unfamiliar student with autism, and (c) the usefulness of the KfK materials for a small number of students with ASD in authentic general education settings. The research plan will consist of three phases: (a) Phase I will consist of a small feasibility study conducted with four classrooms, (b) Phase II will consist of a larger analogue study conducted with approximately 40 classrooms, and (c) Phase III will consist of a small effectiveness study with approximately four students with ASD. Data collection will occur across two sites and qualitative (Phase I) and quantitative analyses (Phases II and III) will be utilized in the research plan.
Effects of Incidental Teaching on Expressive Language of School Age Children with ASD who use AAC
Erinn Finke, Ph.D., Penn State University
This study will investigate the efficacy of incidental teaching methodology  for increasing communication for the function of joint attention and use of multi-symbol messages in school age children with Autism Spectrum Disorders (ASD) who use Augmentative and Alternative Communication (AAC) during a book reading activity. The study will implement a single subject multiple probe research design across participants [25; 35], with six children with ASD (ages 8-12) whose language skills can be classified in the “first words” stage of language learning  and who use AAC systems for communication. There will be four phases in this investigation: a) baseline, b) intervention, c) generalization, and d) maintenance. This investigation will contribute important information on the efficacy of incidental teaching methods for increasing communication for joint attention as well as use of multi-symbol messages in school-age children with ASD who use AAC. This study will provide information regarding whether all children with ASD who use AAC benefit from this intervention in the same way, and with the same degree of success, which may assist in reducing trial and error in the intervention decision-making process.
Health-Related Quality of Life and its Determinants in Adults with Autism Spectrum Disorders
Rahul Khanna, Ph.D., University of Mississippi
Autism is one of the major public health concerns facing the United States (US). Much of the attention of the scientific community has been focused towards studying outcomes among children with autism, with limited work being done among adults with the disorder. A thorough review of the literature did not reveal any previous study of health-related quality of life (HRQOL) and health utilities among adults with autism in the US. Both HRQOL and health utilities are key health outcome metrics that are commonly used in making treatment decisions and in the conduct of economic evaluations. Through an online survey, the proposed study will assess the physical HRQOL, mental HRQOL, and health utility among adults with autism. The SF-12v2 will be used to collect HRQOL and health utility information. The psychometric profile of SF-12v2 will be tested. Most importantly, the study will determine the factors influencing HRQOL and health utilities among these adults. The role of disease severity, social support, coping, and use of treatment services in predicting health outcomes among adults with autism will be researched. With the increasing prevalence of autism, a generation of children with the disorder will be reaching adulthood in the next few years. By providing baseline HRQOL and health utility values among adults with autism, the proposed project will assist policy makers in designing healthcare interventions to better serve the needs of this growing population.
Using Lag Schedules of Reinforcement to Teach Play Skills to Children with Autism Spectrum Disorders
Russell Lang, Ph.D., Texas State University
Previous research has demonstrated that teaching play may reduce stereotypy, improve language, and facilitate socialization. Despite this success, behavioral play interventions are often criticized for relying on external reinforcers, lacking generalization measures, and for involving contrived contexts and procedures. Further, the happiness of the child engaging in play is often not measured, and the feasibility and effects of conducting play intervention in school is not known. In this study, lag reinforcement schedules will be used to teach play to children with autism in a school classroom. Lag schedules differ from alternative schedules of reinforcement by targeting variability in behavior. This study has three primary aims: (a) examine the validity of constructivist criticisms of ABA-based play interventions, (b) evaluate effects of play intervention implemented in a school, and (c) evaluate the effect of lag reinforcement on the generalization of play. The results from this study will have theoretical implications regarding constructivist and behavioral perspectives on play. More importantly, this study will have implications for applied practice. Specifically, reductions in stereotypy, increases in play, and the occurrence of novel forms of play, are expected to occur, generalize across contexts, and maintain over time. Finally, these improvements are expected to cause parents to report that their child is happier and playing more appropriately.
Sleep Education Program for Adolescents With Autism Spectrum Disorders
Whitney Loring, Psy.D., Vanderbilt University
Sleep problems affect many children with autism spectrum disorders (ASD) and are a major concern for parents of these children. Many studies of sleep problems in ASD have focused on young children, with less understood about the treatment of sleep problems in adolescents/young adults with ASD. Sleep problems can negatively impact daytime functioning in adolescents/young adults, including social challenges, hyperactivity, and daytime sleepiness, and can also affect family stress. Treatment of sleep problems with medications is not always successful and often has adverse side effects. Treatments that educate the adolescent/young adult, along with parents, on how to improve sleep patterns are an innovative opportunity to improve not only sleep but daytime functioning and family stress. We propose an education-based program to improve sleep in adolescents/young adults with ASD. The goals of this program are to assess the impact of the program on both nighttime sleep and daytime functioning. Following completion of questionnaires and wearing of an actigraphy watch, adolescents/young adults and their parents will be involved in 2 one-hour individual sessions and 2 follow-up phone calls. These sessions will focus on daytime habits, bedtime routines, sleep timing, relaxation techniques, and other strategies. After the sessions are complete, measures obtained at baseline will be repeated to assess whether the intervention improved nighttime sleep and daytime functioning.
Creating a More Effective Path to Housing for People With ASD
John Maltby, M.S., Westchester Institute for Human Development
The present study will address the pressing need for affordable and accessible supported housing for people with ASD by developing and evaluating, in partnership with people with ASD and their families, an online Resource Guide that comprehensively arrays housing information sources, entitlements, eligibilities, and individualized living options. The goal will be to establish how to facilitate housing for people with ASD, whether they will be able to do so at a lower cost, and whether they can be empowered by increased knowledge of the process. The product will support informed decision making and self-determination/self-direction in housing. Expected outcomes include the development and validation of the Resource Guide application, the creation of an active Community of Practice to create a body of accessible housing knowledge, a means to individualized housing for several family participants in that Community of Practice and, a sustainable path for additional families to take in the future.
Increasing Variability of Verbal Initiations through the Responses of Conversation Partners
Anna Petursdottir, Ph.D., Texas Christian University
Intense preoccupation with circumscribed interests (CIs) is a subtype of restricted or repetitive behavior, which is one of the defining features of autism spectrum disorders (ASDs). CIs may interfere with individuals’ social functioning and peer relations, as perseveration on CIs can be off-putting to other people. In the proposed single-case design study, we will examine how the responses of conversation partners may result in a decrease in CI-related conversation initiations and an increase in other types of initiations. Specifically, we will systematically manipulate the extent to which a conversation partner ignores conversation initiations or reinforces them by continuing social interaction. To this end, we will utilize lag reinforcement schedules in which reinforcing consequences are delivered only following responses that differ from a specific number of previous responses, resulting in increased variability of responding. At least 6 individuals diagnosed with an ASD will be recruited to participate. An assessment will be performed to ensure that attention functions as a reinforcer for the participants. We will then examine the effects of one or more lag schedule parameter on the variability of conversation initiations, as well as the generalization and maintenance of any positive effects observed.
Enhancing Traditional Group Social Skill Instruction using Video-based Group Instruction Tactics
Joshua Plavnick, Ph.D., and Brooke Ingersoll, Ph.D., Michigan State University
A primary challenge for many individuals diagnosed with high functioning autism is a significant impairment in social interaction. Social difficulties for this group are closely related to community inclusion, academic outcomes, employment, independence and mental health. Despite attempts to mitigate this deficit, current social skills treatments have not closed the social gap between individuals with autism and their peers. The present investigation examines the potential of video-based group instruction (VGI), a novel procedure that leverages video technology to increase motivation and intensity, to enhance outcomes when teaching social skills to small groups of students with autism. The proposed study includes 14 individuals with autism, who will participate in a 14-week social skills training program. A within-subjects design will be used to assess for performance differences in targeted social skills taught under two intervention conditions. A traditional social skills condition involves 1.5 hours per week of social skill instruction with instructor modeling and feedback as well as a parent education program. The VGI condition involves the same elements as the traditional condition plus video modeling during instructional sessions and access to video-based materials via a secure website outside of group sessions. This study will provide preliminary information about the efficacy of VGI to enhance traditional social skills instruction for individuals with autism.
Factors Affecting Teacher Implementation of ReThink Autism Program
School districts are struggling to provide educational services and meet the needs of a large number of children with ASD. Rethink Autism (RA), a web-based platform to train school staff, assess children, implement ABA-based curriculum, and track children's development, provides a promising alternative to this challenge. The goal of this proposal is to assess the effectiveness of RA on teacher performance and children's outcomes within middle school, self-contained settings. A quasi-experimental, non-equivalent groups design will be used for the study. A total of 18 classrooms, composing three groups serving children with ASD, will be included in the study. (1) The first group will receive the RA program, (2) the second group will receive the RA program and coaching from an autism specialist, and (3) the third group will receive the Failure Free Reading curriculum and will constitute the business as usual model (BAU) used by Broward County Public Schools. In order to assess the effective of RA with and without coaching in comparison to the BAU model, child and teacher level measurements will be administered. Inferential statistics will be used to analyze the effectiveness of RA with and without coaching support. Both teacher and student level factors will be studies to assess the effective of the different educational models. Analyses of variance (ANOVA) with repeated measures will be performed.
Nurit Sheinberg, Ed.D., Nova Southeastern University
An Experimental Evaluation of Matrix Training to Teach Graphic Symbol Combinations in Severe Autism
Oliver Wendt, Ph.D., Purdue University
This project will investigate the acquisition and generalized production of graphic symbol combinations in nonverbal children with autism who are using augmentative and alternative communication (AAC). About 50% of individuals with autism have severe speech and language disorders to an extent that they cannot meet their daily communication needs. These individuals are candidates for AAC intervention. AAC augments or replaces spoken language through alternative means such as graphic symbols or electronic devices. Previous research showed AAC users with autism were able to learn graphic symbols primarily for requesting, labeling, and rejecting. Their utterances, however, remained at the single-symbol stage, and little is known how to teach multiple-symbol utterances to this population. Moving from single- to multiple-symbol utterances and generalizing those productions is a critical step towards the emergence of syntax and generative language. Matrix training is an innovative approach for teaching multiple symbol combinations and their generalization. Matrix training uses linguistic elements (e.g., nouns, verbs, adjectives) presented in systematic combination matrices, and arranged to induce generalized rule-like behavior. This study applies a multiple probe design to assess learning and generalization of action-object combinations in five participants with nonverbal autism who will receive matrix training through an innovative iPad app.
2011 Research Competition Grant Awards
Effectiveness of a Virtual Coach Application in Social Skills Training for Teens with ASD
Elizabeth Laugeson, Psy.D, and Alex Gantman, Psy.D
Jane & Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles (UCLA)
Social and communication deficits appear to be the most prevalent issues for teens with autism spectrum disorders (ASD), often leading to problems with independence and psychosocial functioning. An evidence-based parent-assisted manualized social skills treatment known as PEERS has shown efficacy in three clinical trials for transitional youth with ASD. Significant improvements were reported in overall social skills, social responsiveness, frequency of peer interactions, empathy, social skills knowledge and use, and decreased loneliness. Previous studies using PEERS utilized parent or teacher coaching to help generalize newly learned social skills to other settings. However, the active use of parents or teachers as coaches creates artificial and possibly stigmatizing and obtrusive social situations that may limit development of real, naturally occurring social relationships with peers. The current proposal seeks to test a novel and innovative social coaching method using widely available technology that will promote social coaching and instruction through virtual means using skills from the PEERS curriculum. This study will test the effectiveness of the PEERS Virtual Coach (VC) mobile application through a randomized controlled trial. Teens in the PEERS VC condition who receive the PEERS intervention in addition to VCing through this interactive visual platform are expected to show greater treatment gains than teens in the PEERS treatment only and delayed treatment control.
A Preliminary Investigation of the Neurobehavioral Basis of Sensory Behavior in Autism
Ericka Wodka, Ph.D
Hugo W. Moser Research Institute at Kennedy Krieger, inc.
Abnormal sensory behaviors are among the most common behavioral concerns of parents of children with autism, often causing significant family stress. A variety of (often unsupported) therapies and treatments are offered to children with autism and their families in community-based centers and schools, aimed at addressing these sensory-related problems. As a result, considerable time and financial resources are dedicated to such therapies. To date, there is little appropriate scientific evidence to support or justify these treatments. The present project aims to investigate competing hypotheses about why children with autism display abnormal sensory behavior. Within the same sample of children (with and without autism), we will examine the relationship between basic tactile perception (e.g., differences in the way things feel), attention (e.g., ability to shift attention from one stimulus to another), language (e.g., vocabulary knowledge and expression), and abnormal sensory behaviors. We aim to clarify these relationships to inform treatment and intervention targets and goals. This study will be the first to consider multiple “competing” models to explain abnormal sensory behavior in autism. Clearly defining processes that could serve as intervention targets (that could potentially be more easily, efficiently, or effectively addressed) not only could improve the quality of life for children with autism and their families, but could also reduce time and financial burdens.
Predictive Factors of Participation in Employment for High School Leavers with Autism
Hsu-Min Chiang, Ph.D
Teacher’s College at Columbia University
The purpose of this proposed study is to identify the factors predictive of participation in employment for high school leavers with autism. Why is this study needed? Although some individuals with autism are able to obtain paid work, the majority of individuals with autism do not participate in employment. Current knowledge about the factors that are predictive of participation in employment for individuals with autism is very limited. To investigate factors that can predict employment outcomes for high school leavers with autism can provide critical information for educators to well prepare individuals with autism for postsecondary employment. Study methodology in brief. A secondary data analysis of the National Longitudinal Transition Study 2 (NLTS2) data will be performed. NLTS2 is a 10-year-long study focusing on secondary school students receiving special education across the United States in all disability categories, including autism. The outcome variable for this study will be participation in employment and the predictor variables will include variables related to family characteristics, student characteristics, and transition planning and employment support services. The association between each predictor variable and the outcome variable will first be assessed. The variables significantly associated with the outcome variable will then be entered into a backward logistic regression analysis.
Evaluation of Synchronous Online Parent Skill Training
Marcie Desrochers, Ph.D, BCBA-D, and Erin DiCesare
The College at Brockport-SUNY and the Mary Cariola Children's Center
Although parents are an essential element in treatment services for their child with autism, it can be expensive and time-consuming to teach them how to develop their child’s adaptive behaviors, especially if the family resides in a rural area. This research involves evaluating the effectiveness of an online training program to equip parents with knowledge and skills of empirically-based behavioral procedures to teach their child desirable behaviors. Not only does this online training program feature interactive internet instruction of basic content in behavioral psychology, but also synchronous web-based video interactions (parent rehearsal of techniques with their child and performance feedback provided by a qualified professional) to hone parents’ teaching skills. Systematic research, using a multiple probe research design, will be conducted in an iterative fashion to evaluate and replicate the effectiveness of this online parent training program. Parents’ knowledge and skills when implementing behavioral techniques and observations of the children’s behaviors will be measured before, during and immediately after the online instructional program with a two week follow-up. It is hypothesized that we will find greater parent knowledge test scores, greater accuracy in parents’ implementing teaching programs, greater child compliance with task demands, and fewer child problem behaviors following completion of the online training program compared to that before.
Using a Direct Observation Assessment Battery to Assess Outcome of Early Intensive Behavioral Interval
Rebecca P.F. MacDonald, Ph.D, BCBA, and William Ahearn, Ph.D
The New England Center for Children
Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. While a number of skills have been identified as possible pivotal skills for best outcomes, changes in performance are often measured using standardized assessments rather than direct observation of target behaviors. The title of the research we propose is Using a Direct Observation Assessment Battery to Assess Outcome of Early Intensive Behavioral Intervention for Children with Autism. We have conducted our assessment with 141 children with autism and 101 typical peers between the ages of 1 and 5. We found that age (under 3 years old) at entry and cognitive level were two variables correlated with best outcome. The purpose of this research proposal is to analyze other pivotal skills as they relate to best outcome. We propose analyzing differences in the complexity of play, language and imitation as they are associated with outcome, as well as the role of stereotypy in influencing responsiveness to EIBI. The second goal is to prepare a training manual of our direct observation assessment for a large scale replication. Compilation of these data will provide robust evidence supporting importance of EIBI for children ages 18-36 months. It is our hope that these data will be used to help promote legislation necessary to increase funding at the national level for early intervention services.
Increasing Functional Vocational Skills in Adolescents and Adults with Autism Using Behavioral Economics
Robert LaRue, Ph.D, Lara M. Delmolino, Ph.D, Kate E. Fiske Massey, Ph.D, and Kimberly N. Sloman, Ph.D
The Douglass Developmental Disabilities Center at Rutgers University
Autism is a developmental disorder characterized by difficulties in communication and social interaction, and is often accompanied by the presence of maladaptive behavior (e.g., aggression, self-injurious behavior). Increasing functional skill development is particularly important for individuals with developmental disabilities. However, prompting older individuals to engage in non-preferred activities (e.g. household chores) can be extremely difficult from a practical standpoint. Trying to physically prompt older individuals to complete such tasks may put staff, family members and the individual themselves at risk for injury. The purpose of the current protocol is to address escape maintained behavior by altering the economic structure of the environment. By altering the “fee” for specific chores and “cost” to access preferred items, it may be possible to increase the likelihood that individuals will willingly participate in non-preferred tasks without physical prompting.
Training Paraprofessionals to Provide Appropriate Social Opportunities for Children with ASD
Robert Koegel, Ph.D, and Lynn Kern Koegel, Ph.D
Koegel Autism Center at University of California, Santa Barbara (UCSB)
The literature on Autism Spectrum Disorder (ASD) has indicated a critical need for paraprofessional training (Jones, & Bender, 1993; Giangreco, Broer, & Edelman, 2010). As a result of this lack of training, children with ASD typically are not receiving adequate social support in the school setting, resulting in limited responsiveness, limited or nonexistent social initiations, minimal conversational reciprocity, and an overall difficulty sustaining social engagement with typical peers (Knott, Dunlap, & Mackay, 2006; DiSalvo, & OsWald, 2002). Within the context of a multiple baseline experimental design across participants, we plan on training paraprofessionals to use motivational components of Pivotal Response Treatment. We anticipate that training paraprofessionals will lead to: increased rate of paraprofessionals’ engagement in facilitative behaviors, and an increased overall positive affect from the paraprofessionals. We also anticipate that training paraprofessionals will lead to gains for the target children evidenced by: increased responsiveness, increased social initiations, increased conversational reciprocity, and an overall increased in sustaining social engagement with typical peers.
2010 Research Competition Grant Awards
Identifying Socially-Based Reinforcers for Young Children with ASD
Anibal Gutierrez, Ph.D., BCBA-D
University of Miami, Center for Autism and Related Disabilities
Traditionally, skill development programs for children with Autism Spectrum Disorders (ASD) have relied on the use of tangible non-social reinforcers due to the fact that many children with ASD do not find social consequences to be rewarding. However, it may be important to utilize socially-based reinforcers to develop certain social skills, like joint attention. There has been little empirical emphasis to date developing procedures to systematically identify social reinforcers. The purpose of this project is to develop and evaluate methods to best identify socially based reinforcers for children with ASD. This project will employ behaviorally-based social reinforce assessments that closely mirror assessments already established for the identification of non-social reinforcement. In addition, Dr. Gutierrez will evaluate the efficacy of novel reinforcement assessment procedures using eye-tracking equipment.
Increasing Independence and Task Completion in Adolescents and Adults with Autism using Independent Work Systems
Kara Hume, Ph.D.
The University of North Carolina at Chapel Hill,
Frank Porter Graham Child Development Institute
Individuals with autism often have difficulty completing tasks or a series of tasks independent of staff support. The proposed line of research will extend the use of work systems; an evidence-based practice with school-aged children that provides visual information about what one is expected to do, to adolescents and adults. Two multiple baseline studies will examine the impacts of work system usage across setting on on-task behavior, accurate task completion, and levels of adult prompting. In addition, data related to task complexity will be explored. The study is expected to yield valuable information to caregivers and service providers regarding the efficacy of independent work systems for individuals with autism.
Development of a Transportation Skills Assessment Tool (TSAT) for Individuals with Autistic Spectrum Disorder to Aid in Finding Safe and Accessible Community Transportation Services
Patrick Szary, Ph.D.
Rutgers, The State University of New Jersey,
Center for Advanced Infrastructure and Transportation
This proposal is for the development and distribution of a Transportation Skills Assessment Tool (TSAT) for individuals with the Autistic Spectrum Disorder to understand the skills necessary to ride various paratransit and community transportation services. The TSAT will evaluate transportation services frequently used by individuals with disabilities for competitive and noncompetitive employment sites, education services, shopping, Medicaid/Medicare transportation, non-emergency medical appointments (including any therapies), social and recreational activities, etc. While these services are available to individuals with disabilities, they are often underutilized by individuals on the autism spectrum. Providing a tool to understand necessary skills for various transportation services offered will allow for a larger segment utilize these existing services, some of which are mandated for individuals with disabilities. The development of this tool will allow for an increase in access to transportation, which can in turn lead access to employment, housing and community life opportunities thus increasing the quality of life for individuals on the spectrum.
RCT of Mind Reading and In Vivo Rehearsal for Children with HFASDs
Marcus Thomeer, Ph.D. and Christopher Lopata, Psy.D.
Institute for Autism Research at Canisius College
Children with high-functioning ASDs (HFASDs) are characterized by core impairments in social-communication including deficits in recognition (decoding) and display (encoding) of facial and vocal emotions and expressions. The purpose of this randomized clinical trial is to evaluate the efficacy of an innovative multi-component manualized treatment on the emotion recognition skills and autism features of 7-12 year old children with HFASDs. Treatment is administered during 24 90-minute sessions (over 3 months) and active components include an interactive emotion-recognition software program (Mind Reading; MR), in vivo rehearsal trials, and a structured behavioral reinforcement system. Each treatment session is manualized to ensure implementation is standardized, participants meet time parameters using and accessing areas of MR, content is prescribed, and fidelity is monitored and maintained. Outcome measures consist of a direct child measure of emotion recognition skills, a parent rating scale assessing child emotion recognition and display skills, a parent rating scale assessing autism features, and parent and child satisfaction surveys. A 1-2 month follow-up is used to assess skill generalization and maintenance.
Expanding the Reach of Toddler Treatment in Autism Spectrum Disorder
Laurie Vismara, Ph.D., BCBA-D
University of California
Davis Medical Investigation of Neurodevelopmental Disorders Institute
The purpose of the proposed study is to demonstrate the efficacy of telemedicine-delivered parent coaching program for providing innovative, individualized interventions to families of children with Autism Spectrum Disorder (ASD). The project's overall goal is to develop and pilot test the use of telemedicine technology to deliver a manualized, parent-implemented intervention for families of children with ASD, ages 15-48 months. The intervention will use an Internet-based video/conferencing program to teach families how to integrate the parent curriculum of the Early Start Denver Model (ESDM; Rogers & Dawson, 2010) into natural, developmentally and age-appropriate play activities and caretaking routines in their homes. Data will be collected weekly on whether: (a) parents engage in an Internet-delivered intervention program designed to support their child's social-communicative development; (b) the Internet program promotes sensitive and responsive parent-child interactions. thereby facilitating improvements in child outcomes; (c) parents perceive the Internet program to be easy and satisfying to use; and (d) changes in children's behaviors surface inside nontargeted home activities and with a second caregiver.
Outcomes of a Community Center-Based Program For Toddlers with Autism Spectrum Disorders
Samuel Odom, Ph.D. and Connie Wong, Ph.D.
The University of North Carolina at Chapel Hill
Frank Porter Graham Child Development Institute
As more children with autism spectrum disorders (ASD) are being identified and diagnosed earlier (before age 3), it is extremely important to establish evidence-based practices for toddlers with ASD. Little is known about the effects of center-based interventions for toddlers with ASD. Therefore, the purpose of the proposed research is to evaluate outcomes of a center-based model of intervention for toddlers with ASD. The first aim is to compare outcomes of young children with ASD who attended an existing, comprehensive, 20 hour/week, center-based toddler program to other young children with ASD in the same community who did not attend the program by examining program and school records. The second aim is to explore child and family characteristics along with intervention approaches affecting optimal outcomes. Finally, the third aim is to examine family perceptions on their satisfaction with early intervention services received, reasons for selecting specific early intervention programs, and perspectives on home-based and/or center-based intervention programs for toddlers with ASD by collecting data from a survey and through semi-structured interviews with families. Thus, the results of this study will provide practical information to families in making educated treatment decisions for their toddlers recently diagnosed with ASD as well as to service providers in offering treatment recommendations related to center versus home-based programs and guiding intervention practices for individual children and families.
2009 Research Competition Grant Awards
University of Georgia – Carolina Autism Resource and Evaluation Center (UGA-CARES): A Collaborative Autism Screening Project Utilizing Web-Based Technology
Jon Campbell, Ph.D.
University of Georgia Department of Educational Psychology
and Instructional Technology
For young children with autism spectrum disorders (ASD), early detection and screening have garnered considerable attention, in part, due to consensus that children with ASDs identified and enrolled in early intervention programming evince improved outcomes. As a result, several screening instruments have been developed for early detection of ASD. Most ASD screeners used with young children rely on parent report to provide information about symptoms suggestive of the presence of an ASD. Parents are considered ideal informants for completing screening instruments due to their access to children’s behavior observed in naturalistic settings, which cannot be replicated in pediatric offices. The primary aim of this study is to compare the predictive validity of three parent-report ASD screening instruments for preschoolers and young children. The researchers are interested in comparing and contrasting screeners’ predictions of results from a standardized diagnostic assessment, which includes a gold standard diagnostic measure. Researchers will also be examining whether the predictive validity of screening measures differs across racial/ethnic groups and SES. A secondary aim of the study targets application of a web-based video analysis tool to confirm results from diagnostic evaluations. Incorporating web-based video technology to establish reliability of gold standard diagnostic test results will allow the researchers to investigate the utility of a novel web-based video analysis tool to support ASD diagnostic practice from remote locations.
The Effects of a Reciprocal Questioning Intervention on the Reading Comprehension and Social Communication of Students with Autism Spectrum Disorder
Kelly Whalon, Ph.D.
The College of William and Mary, The School of Education
Reading is a critical skill for student success in school and access to post school opportunities. While a number of children with autism spectrum disorder (ASD) will develop the decoding skills necessary to read text, they will continue to struggle with reading comprehension. No Child Left Behind (NCLB) and the Individuals with Disabilities Education Improvement Act (IDEA 2004) mandate that all children receive evidence-based reading instruction consistent with the National Reading Panel (NRP) recommendations. Beginning evidence suggests that children with ASD can benefit from instruction consistent with the NRP recommendations, but this research base is limited. The proposed intervention incorporates an NRP advocated strategy and research based instructional supports responsive to the learning needs of students with ASD. Children with ASD will be taught a reciprocal questioning strategy in the context of a partner reading activity with a general education peer. Single subject designs will be used to measure the impact of the intervention on participant comprehension of fiction and nonfiction texts, as well as social communication. Enhancing both the academic and prosocial behaviors of children with ASD are instructional priorities. Results can generate recommendations that will assist teachers in meeting the academic and social communication needs of learners with ASD in the context of an academic activity. Findings will be disseminated to researchers, practitioners, and families.
High School Inclusion Program for Students with Autism Spectrum Disorders
Carolyn Hughes, Ph.D.
Vanderbilt University, Peabody College
Department of Special Education
Many high school students with autism spectrum disorders (ASD) spend their school days socially isolated from their peers without disabilities even when they are educated in the same classrooms or share the same lunch hours. Unless efforts are made to teach students with ASD to interact with their peers without disabilities and provide opportunities for this interaction to occur, it is unlikely these students will learn critical social skills required for personal satisfaction and success not only in school but in their postsecondary adult lives. This is a one-year pilot project designed to (a) teach social interaction skills among students with ASD and their peers and (b) promote the inclusion of these students in both academic and non-academic activities throughout their school day and across multiple settings, such as general education classes, physical education classes, the library, or cafeteria. This intervention will comprise three components: (a) teaching valued social interaction skills via peer mediation, (b) supporting students without disabilities in their social interactions with their peers with ASD, and (c) providing inclusive opportunities for students with and without ASD to interact with each other across multiple environments and activities. Social skills instruction and social inclusion activities will be facilitated by students’ peers (“mentors”) in order to promote performance generalization. Multiple measures will be used to evaluate the effectiveness of the model. Findings will be used to leverage external funding for expansion and replication of the project.
Social Skills Training for Young Adults with Autism Spectrum Disorders
Alexander Gantman, Psy.D.
UCLA Semel Institute for Neuroscience and Human Behavior
The negative impact of social deficits among individuals with Asperger’s Disorder (AD) and High Functioning Autism (HFA) cannot be understated. These deficits often lead to peer rejection, social isolation, withdrawal, and psychological distress. Social difficulties often extend into interpersonal relationship domains for individuals transitioning from adolescence into young adulthood (18-22). Social skills training has increasingly become a popular method for helping children and adolescents with AD/HFA adapt to their social environment. However, a review of the research literature on AD/HFA suggests that there are little to no evidence-based interventions that are specifically aimed at improving the social skills of young adults with AD/HFA. Using independent rater, caregiver, and self-report measures, the current proposal seeks to test the effectiveness of improving social functioning of transitional youth 18-22 years of age with AD/HFA using an adapted caregiver-assisted evidence-based social skills treatment intervention. It is anticipated that the proposed feasibility study will help young adults with AD/HFA to utilize the rules of social behavior and communication needed to develop relationships and improve in other areas of socialization and psychosocial functioning.
Peer-Mediated Interventions for Elementary School Students with Autism Spectrum Disorders
Audrey Blakeley-Smith, Ph.D.
University of Colorado Denver, Departments of Psychiatry and Pediatrics
Positive social relationships are considered critical to functioning and well-being for all children. Yet, the social deficits of students with autism spectrum disorders (ASD) place them at risk for peer rejection and problem behavior. Peer-mediated interventions have emerged as an effective means of increasing social interaction between students with ASD and their typically developing peers. In the first year of study, these researchers assessed the effectiveness of matching intervention strategies to deficits both in elementary school students with ASD (e.g., poor initiation/responding) and their peers (e.g., negative attitudes, poor responding). Peer attributions were assessed and targeted. Improved quality of life and social skills, increased social engagement with peers, and a positive shift in peer attribution were noted. However, generalization to other peers was limited. In the proposal for this second year of study, the researchers will extend the model by adding a classroom wide component in addition to the small group work with a select cohort of peers. The goals of the peer-mediated intervention are: (a) to increase opportunities for positive interaction between students with ASD and their peers by expanding peer support; (b) to assist peers in reframing attributions of the behavior of students with ASD through psycho-education; (c) to train peers in interaction strategies; and (d) to decrease rejection and problem behavior in selected activities.
Writing instruction for children with autism spectrum disorders: A study of self-regulation and strategy use
Kristi Asaro-Saddler, Ph.D.
University of Albany, SUNY
In this study, the Self-Regulated Strategy Development (SRSD) approach will be utilized to investigate the effect of teaching children with Autism Spectrum Disorder (ASD) who have difficulty with writing a story or a persuasive essay. Although SRSD has been found in over 35 empirical studies to be an effective method to teach writing strategies to elementary students with and without disabilities, the effects of this approach to strategy instruction on children with ASD is largely unknown. Therefore, in this study, researchers will extend SRSD research to this population of children. The effects of SRSD will be explored on two writing genres commonly taught in elementary schools; story writing and persuasive essays. Although there have been other studies conducted to improve the story writing ability of children with ASD, persuasion has been a genre previously unexplored with this population. The younger students (Grades 2-3) will learn a story writing strategy, and the older students (Grades 4-5) will learn a persuasive essay writing strategy. Students will write stories or essays at pre-intervention, post-intervention, and maintenance to determine whether the effects of learning the story writing or persuasive essay strategy improved their writing in terms of components of a story or persuasive essay, number of words written, and overall holistic quality.
Using a Direct Observation Assessment Battery to Assess Outcome of Early Intensive Behavioral Intervention for Children with Autism
Rebecca MacDonald, Ph.D. BCBA
The New England Center for Children
Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. When compared to other groups of children with autism receiving non-behavioral intervention treatment or minimal treatment, groups receiving behavioral intervention achieved greater gains. These changes in performance are usually measured with standardized testing. Few studies have reported direct observational measures of change. Appropriate play, joint attention skills and standard measures of cognitive functioning such as imitation skills and instruction following have all been identified as important instructional targets for children with autism. Some researchers have used them as criteria for determining outcome, although often in the form of indirect testing and questionnaires.
The purpose of this research is twofold. First the researchers propose increasing the number of both typical and children with autism assessed using a direct observation assessment. Secondly, they propose to analyze both new data samples and data from a 10-year longitudinal sample of performance of young children with autism at entry and yearly. Performance on play, joint attention, stereotypy and cognitive skills will be examined to determine outcomes for children with autism enrolled in an early intensive behavioral intervention program. Performance will be compared to direct measures taken for typically developing same-age peers, but additional interest will be taken in the examination of within-group variables that may influence outcome such as age at intake, length of intervention and initial performance on a direct assessment battery.
2008 Research Competition Grant Awards
Examination of Prerequisite Skills for Learning Using Video Modeling
Rebecca P. F. MacDonald, Ph.D., BCBA
William H. Ahearn, Ph.D., BCBA
New England Center for Children
While video modeling is an effective and efficient instructional technique for many children with autism, there are some children who do not learn using video modeling. In a pilot study, we developed a pre-assessment battery of tests to measure levels of performance on a variety of skills that could influence learning using video modeling and found that poor responding on delayed match-to-sample tasks was associated with failure to learn using video modeling. Delayed matching-to-sample (DMTS) is a widely used procedure to measure short term memory and it appears that memory may play an important role in learning using video modeling. In video modeling the child observes the video and then imitates the model. This requires that the child remember the observed actions for the duration of the video and the period of time between the video and the task presentation. We are interested in further investigating the prerequisites for video modeling and to evaluate the role of delayed matching in video modeling. We plan to teach delayed matching to determine whether this could translate into the child then demonstrating learning through video modeling. As part of this project we propose two experiments. In the first study we propose evaluating the relation between delayed match-to-sample performance and imitation of a video model. In the second study we propose teaching delayed match-to-sample to see if this could translate into the child learning through video modeling. This research could lead to a quick way for educators to assess whether video modeling is an appropriate teaching procedure for a specific child and a prescribed teaching method for preparing children to learn using video modeling.
Training Paraprofessional Staff to Provide Proactive Support for Individuals with Severe Autism in Inclusive Settings
Dennis H. Reid, Ph.D., BCBA
Carolina Behavior Analysis and Support Center, Ltd.
A common strategy of agencies providing support in inclusive settings for individuals with autism at the severe end of the spectrum is to assign a staff person to provide 1:1 support. These personal instructors (PIs) usually have paraprofessional backgrounds and often receive minimal training in how to provide instruction during naturally occurring routines or how to reduce challenging behavior. The purpose of this proposal is to evaluate a means of training PIs to provide proactive support to individuals with severe autism in inclusive settings, including school classrooms, an adult education program, and supported work. Initially, baseline observations of PI interactions with their assigned individuals with autism will be conducted during regularly occurring activities. Observations will focus on interactions involving antecedent (e.g., correct versus incorrect presentations of instructions and prompting) and consequence (e.g., correct versus incorrect responses to adaptive and challenging behavior) support. Observations of the performance of the individuals with autism will also be conducted regarding desired instruction following active versus passive participation in daily activities and challenging behavior. Subsequently, a performance- and competency-based training program will be provided to individual PIs (Experiment 1) and small groups of PIs (Experiment 2) in a classroom format, followed by on-the-job feedback. Training will include information about proactive support strategies in general as well as information individualized to particular PI/learner pairs based on baseline observations of problematic interactions. To enhance practical application in typical applied settings, the classroom training will encompass less than one day. It is anticipated the training will result in improved support provided by PIs, with corresponding improvement in the functioning of the individuals with severe autism. Information stemming from the investigation could then be applied by service providers to train new PIs and improve functioning of currently employed PIs and their learners in inclusive settings.
Feeding Problems among Children with Autism: The Impact of Parent Education in Modifying Aberrant Eating Habits
William G. Sharp, Ph.D.
David L. Jaquess, Ph.D.
The Marcus Autism Center
The purpose of the current study is to investigate the topography and treatment of feeding difficulties related to autism spectrum disorders (ASD). We propose to: (a) assess the types of feeding difficulties exhibited by children with ASD, as well as the effect that these difficulties have on a child’s nutritional status and family functioning; and to, (b) evaluate the impact of a parent-education intervention targeting problematic feeding behavior and related sequelae among children with ASD. Previous intervention studies aimed at addressing the mealtime difficulties exhibited by children with ASD have focused exclusively on intensive feeding interventions and there is no research investigating the efficacy of parent directed feeding therapy. This study seeks to test whether it is possible to extend the benefits of therapist-mediated behavioral feeding interventions to parents of children with ASD. Through this process, a set of comprehensive educational resources will be evaluated, which will provide practitioners and parents with a caregiver-driven level of intervention involving educational handouts and didactic training. Research in this area is critically important, as children with ASD display high rates of atypical feeding behavior resulting in significant nutritional deficits and medical issues. Research is needed to focus on direct observation of mealtime behavior and the impact that parent training may have on ameliorating feeding related difficulties, as it will provide a more comprehensive picture of the feeding difficulties exhibited by children with ASD and their treatment. By examining the degree to which caregivers who receive low-intensity training can effectively implement behavioral strategies targeting food selectivity and refusal, this line of research will help shape the type of services available to children with ASD exhibiting mealtime difficulties.
Transporting Evidence-Based Practices from the Academy to the Community: School Based Cognitive Behavioral Therapy for Children with Autism Spectrum Disorders
Jeffrey J. Wood, Ph.D.
Marilyn Van Dyke, M.A., CCC-SLP
University of California, Los Angeles, and
The Help Group
The proposed study will involve training community practitioners to implement a cognitive behavioral intervention for the treatment of anxiety in children with autism. The practitioners, who will consist of therapists and speech-language pathologists, will be selected from the Help Group’s Village Glen School, a Los Angeles area school specializing in the education of children with autism. The Behavioral Interventions for Anxiety in Children with Autism (BIACA) project at UCLA, which was developed with funding from the Cure Autism Now (Autism Speaks) Foundation, has proven to be an efficacious treatment targeting anxiety, social adjustment, and adaptive functioning skills in children with autism spectrum disorders. The on-site school practitioners will be trained to conduct weekly cognitive behavioral therapy sessions with children, their parents as well as the entire family. The intervention incorporates traditional anxiety treatment components including coping skills training (e.g., cognitive restructuring), in vivo exposure, operant procedures, and parent communication techniques. Additional treatment components have been added to enhance intervention response specific to children with autism spectrum disorders, including emotion education, social skills/friendship skills training, and peer tutoring/mentoring modules. The proposed project will take an initial step in disseminating this state-of-the-art treatment into the community. Dissemination efforts will emphasize education of community practitioners on the use of a modular treatment model, as well as providing weekly supervision (ongoing training and consultation) to ensure fidelity of intervention implementation. This modular treatment approach provides practitioners with flexibility to accommodate the wide range of clinical profiles characteristic of this population. Children’s outcomes will be assessed through parent, teacher and child reports as well as in-vivo behavioral playground observations to determine if the treatment is having the expected positive impact, and to guide further training and supervision efforts.
Measuring the Effects of Training Parents to Provide Intervention via the Arizona Telemedicine Program
Daniel Openden, Ph.D., BCBA
Christopher J. Smith, Ph.D.
Southwest Autism Research and Resource Center
With the dramatic increase in children diagnosed with autism spectrum disorders (ASD) has come a shortage of qualified interventionists to provide services. The lack of interventionists is even more of a challenge for those who reside in rural or remote regions. Two previous studies demonstrated that an intensive one-week parent training program is effective for teaching parents to implement Pivotal Response Treatment (PRT). Both studies included minimal follow-up support procedures (i.e. phone calls and emails), which may not have addressed the changing needs of their children. With a randomized clinical trial we will evaluate the efficacy of using telemedicine as a tool for providing immediate feedback and continued support for parents. The dependent measures, parent fidelity of implementation of PRT and functional verbalizations produced by the child, will be collected by each parent-child dyad at baseline, post initial in-vivo parent training and again at follow-up. In addition, the study will look at the associations among cognitive functioning, adaptive behavior, and the response to PRT. The results of this study may have important implications for the delivery of cost-effective and efficacious intervention for families in rural or remote areas.
Transition to Adulthood: Service Utilization and Determinants of Functional Outcomes
Paul T. Shattuck, Ph.D.
The transition from adolescence to adulthood is a challenging developmental turning point for all youth. This period is especially difficult for youth with autism. However, just when they need help the most, youth with autism face three major service-related risks: loss of entitlement for services as they age out of eligibility for special education; potential loss of health insurance coverage as they age out of eligibility for their parents’ private insurance or the State Children’s Health Insurance Program; and the shift to adult services systems (which have a different architecture, lack federal entitlements, and have fewer insurance options). How do patterns of service utilization change as youth with autism age into young adulthood? Are there disparities? Are there discontinuities? Are some patterns of service use associated with better functional outcomes in young adulthood? This study will examine these questions using longitudinal data on 922 youth with autism from the National Longitudinal Transition Study 2, a nationally representative sample that generalizes to all special education students in the autism exceptionality category who were in 7th through 12th grade and ages 13 through 16 on December 1, 2000. Data were collected every two years via multiple methods including parent/guardian interviews, youth interviews, teacher surveys, school program (IEP) surveys, school and community characteristics surveys, direct student assessments, and alternate student assessments. Findings from this study will be nationally representative and highly generalizable. Identifying underserved populations, barriers to service access, and factors that enable improved access will help target policy reforms and the design of new transition services. Understanding which services are strongly associated with positive outcomes will inform decisions about resource allocation for new programs.
2007 Research Competition Grant Awards
Development of an Executive Function-based Intervention for Autism Spectrum Disorders
Laura Anthony, Ph.D.
Children’s National Medical Center
Children with Asperger Syndrome and High-Functioning Autism (AS/HFA) are bright, caring people plagued by problems with aspects of executive function (EF): flexible thinking/behavior, integration, planning, and organizing. These EF problems interfere with learning and behavior in the classroom (e.g., trouble transitioning, getting stuck on things), and relate to the repetitive behaviors and social difficulties characteristic of AS/HFA. This proposal seeks develop and investigate an intervention to address the core EF component of flexible thinking, while also building other, supporting EF skills. Because there are no tested school-based EF interventions for children with AS/HFA, this project builds upon an EF cognitive remediation intervention for children with traumatic brain injury (TBI). This project will employ a participatory research framework to (1) adapt the intervention components and develop a draft of the intervention materials, (2) conduct a pilot study evaluating the effectiveness of the intervention, and (3) revise the intervention and/or measures based on feedback and results.
Sleep Disturbance and Daytime Functioning in Children with Autism
Susan Mayes, Ph.D.
Penn State College of Medicine
More than half of parents of children with autism report a sleep disturbance in their children, including difficulty falling asleep, waking during the night, awaking early in the morning, short total sleep time, and nightmares. Little research has been conducted on sleep problems in children with autism. According to the National Institute of Health (2005), “Little is known about characteristics or consequences of sleep disturbances in most childhood psychiatric disorders” and “the consequent impact on mood, neurobehavioral and academic functioning, safety, and health is considerable.” The goals of this study are to (1) determine the frequency, type, and severity of sleep problems in 200 children with autism as a function of child characteristics (age, IQ, gender, and severity of autism), (2) analyze differences in sleep disturbances in children with autism as a function of comorbid mood and behavior problems, anxiety, depression, and mental retardation, and (3) examine the relationship between sleep disturbance and academic, neuropsychological, behavioral, and emotional functioning.
Peer-mediated Intervention for Elementary School Students with Autism Spectrum Disorders
Audrey Blakeley-Smith, Ph.D. and
Susan Hepburn, Ph.D.
University of Colorado at Denver Health Sciences Center
Social deficits have been described as the most defining feature of autism and are noted to cause difficulties across the life span. The socially inappropriate behavior and/or poorly developed social skills of elementary school students with ASD and the negative attributions that peers can make for their behavior place them at risk for peer rejection, adjustment difficulties, and problem behavior. The proposed study is a peer training program designed to specifically target peer rejection and peer attributions towards elementary school students with ASD. The goals of the peer-mediated intervention are: (a) to assist peers in reframing perceptions/attributions of the behavior of students with ASD through psycho-education; (b) to increase opportunities for positive social interaction between students with ASD and their peers by identifying school activities that optimize positive social interaction; (c) to train peers in social interaction strategies; and (d) to decrease rejection and problem behavior in selected school activities.
An Examination of the Effectiveness of Manipulative Letter Instruction on the Decoding Skills of Young Children with Autism Spectrum Disorders
Maureen Conroy, Ph.D.
Virginia Commonwealth University School of Education
The ability to read is an essential skill in our society for learning and developing independence. Unfortunately, many students with Autism Spectrum Disorders (ASD) have difficulty acquiring early literacy skills, such as decoding and comprehension. Thus, the need to develop scientifically-based instructional strategies to address this critical skill deficit in individuals with ASD is imperative. The current proposal addresses this need by investigating the use of an innovative instructional reading strategy called Manipulative Letter Instruction on the development of early literacy skills in students with ASD. Manipulative Letter Instruction involves explicit and systematic instruction in the alphabetic principle that makes the abstract concept of blending and segmenting phonemes more concrete for students. Using a group design, the efficacy of Manipulative Letter Instruction will be compared to an alternative treatment (i.e., Repeated Reading of Connected Text). This study will help to provide additional information about early literacy skills in students with ASD and inform current instructional reading practices for teaching these skills to students with ASD. Additionally, a number of dissemination activities will be implemented to share the outcomes of the proposed research with other researchers and practitioners in the field.
Increasing Social Engagement in Young Children with Autism Spectrum Disorders using Video Self-modeling and Peer Training
Scott Bellini, Ph.D.
Indiana Resource Center for Autism
Impairments in social-emotional functioning are a central feature of autism spectrum disorders (ASD) and can create great difficulties in the life of an individual on the autism spectrum. Social skill deficits increase the likelihood of the individual experiencing social failure, peer rejection, and isolation leaving the individual vulnerable to developing anxiety, depression, and other forms of psychopathology. The proposed line of research will expand previous research addressing deficits in social functioning, through the implementation of a video self-modeling (VSM) procedure and a peer mediated intervention. VSM is a positive behavioral support strategy that integrates a powerful learning medium for children with ASD (visually cued instruction) with an effective intervention modality (modeling, coaching, and social problem solving). Results from the present study will be the first step towards the development of a manualized treatment protocol that will be available to parents and professionals throughout the nation wishing to design data-driven social skills intervention procedures for students with ASD.
A Clinical Randomized Control Trial of Joint Attention Intervention in Young Children with ASD
Jennifer S. Durocher, Ph.D.
University of Miami Center for Autism and Related Disorders
Joint attention, of the capacity of coordinate attention between objects and people to share the experience with others, is an important hallmark of early development. The ability to respond to and initiate joint attention is frequently impaired in children with ASD. Joint attention skills have been found to predict play, language and cognitive abilities in typical children and in those with autism. The primary purpose of this proposal is to conduct a randomized control study to evaluate the efficacy of joint attention intervention for 40 children with ASD between the ages of 2 and 5 years. This study will add to the field by providing additional empirical evidence of the efficacy of joint attention intervention and, more importantly, allow us to better understand the characteristics of children with ASD that predict better response to intervention.
Identifying the Supports that Promote Success of College Students with Asperger Syndrome
Janet Graetz, Ph.D.
Oakland University School of Education and Human Services
All college students are faced with numerous challenges and stressful situations both within and outside the academic arena. For students with disabilities, and especially those with Asperger Syndrome, these challenges can be particularly overwhelming. This study examines the college experience for students with Asperger Syndrome and identifies the supports that lead to a successful college experience. The study will involve 15 to 20 students with Asperger Syndrome who are attending Oakland University in Rochester, Michigan. Participants will be asked to complete assessments and self-recording surveys that will provide researchers information regarding their study and learning skills, peer involvement, residential experiences, extracurricular involvement (both recreational and academic), family structure and support, interpersonal skills, stress management, and self-advocacy. The self-reported surveys will be completed by participants through the use of a website. They will be asked to log on to a website that asks specific questions about their previous week at Oakland University. Questions will identify 1) the supports they utilized that week, 2) the extracurricular activities they attended, and 3) their use of peer supports. In addition, each website will have a section that will be a personal diary site where participants can share their thoughts and feelings regarding the previous week at Oakland University.
Joint Attention Intervention for Nonverbal Children with Autism
Connie Kasari, Ph.D.
UCLA Graduate School of Education
Children with autism demonstrate significant impairments in both responding to and initiating joint attention skills. Joint attention skills include showing, pointing and alternating looks that are used to share an event or object with another. These skills develop in very young children, and the lack of joint attention is often a first signal to alert parents to a possible diagnosis of autism. Joint attention skills are also associated with language outcome. Children who demonstrate more joint attention skill also develop better language abilities. Thus, joint attention skills are a potentially important target of early intervention for children with autism. In this study, we aim to test the effects of a theoretically and empirically derived treatment for joint attention skills for young, nonverbal children with autism. A small controlled clinical trial is proposed where preschool aged children with autism are randomized to either an ABA-based preschool program plus manualized joint attention intervention or to ABA-based preschool services only. Participants will be thirty children with autism, aged 3 to 5 years, who are classified with autism, and are nonverbal with documented limited progress in language skill. Our study addresses an important priority in the autism research matrix (National Institute of Mental Health, 2004) notably the goal of improving intervention efforts so that 90% of children with autism are able to speak.
Evaluating the Effectiveness of the Social Cognition Training Tool (SCOTT) in ASD on Behavioral, Occulomotor, and Neuronal Levels
Isabel Dziobek, Ph.D.
Max Planck Institute for Human Development
Social cognitive difficulties are central to autism spectrum conditions (ASC) and have some of the most vexing effects on the lives of people with ASC and their families. However, only a limited amount of intervention tools exist targeting social cognitive (dys)functions. Most of those tools use non-lifelike stimuli and are not sufficiently appealing to people with ASC to generate the high repetition training needed to significantly improve on social cognitive skills. Moreover, applied research is lacking that documents the effectiveness of those trainings on the behavioral as well as the brain level. Building on our expertise in designing and validating diagnostic and intervention tools for social cognitive functions for people with autism, we have developed the Social Cognition Training Tool (SCOTT). The SCOTT is a computer-based intervention that encompasses 4 different training modules of varying complexity using lifelike video-based stimuli and virtual reality environments. The central aim of the proposed study is to document effectiveness of the SCOTT. Towards that aim, we will perform a 12-week intervention program enrolling 40 adolescents and adults diagnosed on the autism spectrum. Using standard social cognition tests and ratings of social skills in everyday life, we are aiming at assessing treatment success at close and distant behavioral generalization levels. In addition, we are seeking to identify more objective correlates of improved social cognitive functions by measuring eye fixation patterns and brain structure as well as brain function. We believe that our research can be directly applied to benefit people with autism and their families. Our long-term goal is to improve social cognitive skills using the SCOTT and thereby optimizing the ability of people with autism to lead rewarding and productive lives.
Evaluating Intensive Behavioral Interventions in Autism
Phil Hineline, Ph.D., BCBA and
Saul Axelrod, Ph.D., BCBA
Lovaas et al. (1987) demonstrated that effective intervention for autism is within reach, indicating that early, intensive, carefully designed procedures based upon behavioral principles could improve the prognosis for nearly all children with this disorder. Subsequently, the Lovaas, or “Discrete-Trial” model, has evolved somewhat, while additional comparison studies have continued to indicate its effectiveness. Meanwhile, additional behaviorally-based techniques and interventions have been introduced. Two of these, known as the “Applied Verbal Behavior” approach (Sundberg & Partington, 1998) and the Competent Learner Model (Tucci, 1986) have been vigorously advocated, mainly on the basis of their underlying rationale and a few published single-case evaluations. Their adoption has occurred despite the lack of comparative evaluations of their respective effectiveness relative to the Discrete Trial model. The present project entails exploratory analyses and evaluations of the three approaches as implemented within public-school settings. Assessment of before-vs.-after standard outcome measures will indicate whether the Verbal Behavior and Competent Learner Model approaches produce improvements comparable to those that have already been reported for Discrete-Trial interventions, and thus whether subsequent head-to-head comparisons would be justified. In addition, by tracking progressive changes in detailed curriculum profiles for individual children this project will also assess the degree to which the two models differ in actual practice from each other and from the Discrete-Trial model, or whether they would better be viewed as hybrids of the Lovaas approach. A third objective will be to gather preliminary data regarding the degree to which each approach is dependent upon high-levels of staff competence. This objective concerns the possibility that a technique identified as “best practice” when implemented in a well-staffed research center may not be the most effective approach in settings with far fewer resources, such as public schools, which the majority of children must rely on for intervention.
Efficacy of Community-based Instruction and Supported Employment on the Competitive Employment Outcomes of Transition-age Youth with Autism
Paul Wehman, Ph.D.
Children’s National Medical Center
It has been estimated that 1.5 million Americans and their families are now affected by autism, costing the U.S. at least $35 billion annually. In light of this information, employment as a post-school outcome is critical if individuals with autism spectrum disorders (ASD) are to become participating members of society. The researchers for this study believe that employment is the "key" for opening the door to full inclusion for individuals with ASD in their communities. Therefore, the goal of this project is to demonstrate that transition age youth with autism can learn work skills in community businesses that result in the identification and selection of jobs of choice.
Virginia Commonwealth University (VCU) will work with the Faison School for Autism in Richmond, VA to identify students who will be provided the opportunity to participate in community-based work experiences and paid work opportunities. Community businesses will be identified and selected reflective of each student's interests and skills. Vocational and work related skills that are the actual job duties for the positions targeted will be taught using applied behavior analysis procedures. Single subject designs will be used to demonstrate that the effect of training ("treatment") results in consistent behavior change / increased vocational competence of students with autism within integrated community environments. In addition, the proposed project will produce and disseminate applied research that will aid students with autism, parents, families, and professionals in designing and implementing Individualized Education Programs (IEPs) that lead to competitive employment outcomes.
2006 Research Competition Grant Awards
Evaluating intensive behavioral interventions for autism: “Discrete trial” and “Applied Verbal Behavior”
Phil Hineline, Ph.D., BCBA and Saul Axelrod, Ph.D., BCBA
Lovaas et al. (1987) demonstrated the effective intervention for autism was within reach, indicating that early, intensive, carefully designed procedures based upon behavioral principles could improve the prognosis for nearly all children with that disorder. Subsequently, the Lovaas, or “discrete trial” model has evolved somewhat, while additional comparison studies have continued to indicate its effectiveness. Meanwhile, additional behaviorally-based techniques and interventions have been introduced. One of these, known as the “Applied Verbal Behavior” approach (Sundberg & Partington, 1998) has been vigorously advocated, mainly on the basis of its underlying rational and a few published single-case evaluations. The present investigation entails exploratory analyses and evaluations of the two approaches as implemented within public-school settings. Assessment of before-vs.-after outcome measures will indicate whether the Verbal Behavior approach produces improvements comparable to those reported for discrete trial interventions.
Comorbid Psychiatric Disorders in Adolescents and Young Adults with Asperger’s Disorder
Carla Mazefsky, Ph.D.
Children’s Hospital of Pittsburgh
Research and numerous clinical accounts suggest that children with autism have high rates of ADHD, depression, anxiety, and OCD; however, little is known about the risk for psychiatric disorders in young adulthood and for individuals with Asperger’s disorder (AD). This is a particularly significant research gap given the stressful nature of adolescence and the transition to adulthood and the large, negative impact that psychiatric disorders have on overall adjustment. Part of the problem is the absence of a method for clinicians to measure whether adolescents and young adults with AD have other psychiatric disorders. Resolving this issue would involve determining what symptoms or problems are related to having AD versus due to a different psychiatric disorder, as well as developing a better understanding of the accuracy of individuals with AD’s self-report on questionnaires that assess emotional distress. This study aims to clarify these issues and identify rates and characteristics of psychiatric disorders in adolescents and young adults with AD. The results will provide information that will help clinicians quickly identify psychiatric problems through increasing our understanding of the usefulness of self-report questionnaires and key symptoms/warning signs. These improvements will ultimately allow for better communication of treatment needs and more appropriate and specific treatments to improve overall quality of life for adolescents and young adults with AD.
Growing Up on the Autism Spectrum: A Parent Education and Skill Building Curriculum
Shana Nichols, Ph.D.
Fay J. Lindner Center for Autism/NS-LIJ Health System
Adolescence is a difficult time period for individuals with autism spectrum disorders (ASDs) and their parents, and yet issues related to negotiating developmental transitions and the biological processes associated with growing up have been neglected in the field. It is generally accepted that sexuality needs to be taught within the context of human relationships, and that parents are the most important and best sex educators for their children (SIECUS, 2001; 1996). However, parents of children with ASDs are often apprehensive of teaching about sexuality, or are unsure about how to respond to their child’s emerging sexual behaviors, particularly if the behavior is inappropriate. The proposed program is the first to evaluate the effectiveness of a parent curriculum in targeting not only the needs of youth with ASDs regarding sexuality development, but also the needs of their parents in reducing stress and increasing parents’ sense of competence in dealing with this difficult set of issues. Measures will assess parent stress and competence, parent knowledge of sexuality and developmental disabilities, and youth sexual behavior and knowledge. Individualized and general goals will be established for all participants. Findings from the current program will provide important information about sexual development and learning in youth with ASDs, and how to assist parents in educating their children. Outcome data will also serve as a starting point for much needed future program development, and also for best practices in addressing issues of sexuality and puberty for youth on the autism spectrum.
Parental sleep education program for children with autism spectrum disorder
Beth Malow, M.D., M.S.
Vanderbilt Kennedy Center for Research on Human Development
Sleep difficulties are common reasons why parents seek medical intervention for their children with ASD. A major concern reported by parents of children with ASD is insomnia, characterized by difficulty getting their children to fall asleep or stay asleep. Although there are many causes and treatments of insomnia in ASD, the contribution of parental sleep education to treating insomnia has been understudied. In the proposed study, our goals are: 1) to examine the relationship between insomnia, sleep habits, daytime behavior, and parental stress and 2) to conduct a parental sleep education program and determine whether this education program improves sleep habits, minimizes time to fall asleep and night wakenings, positively affects daytime behavior, and impacts favorably on parental stress levels. To measure the program’s success, data will be obtained prior to and after the program in the form of surveys, sleep diaries, and actigraphy (wristwatch-like monitors that quantify movement and rest as a surrogate for wakefulness and sleep).
A Multi-method Assessment and treatment of Social Skills Core Deficit in ASD
Raymond Romanczyk, Ph.D., BCBA
Institute for Child Development at SUNY Binghamton
The significant social limitations of children with ASD lead to difficulty in perception and understanding of important social cues in the environment, in developing relationships with others, and in simple social interactions. This project addresses social development in the full range of individuals with ASD, encompassing children who have little or no language or communication skills. The project applies a multi-method assessment of dimensions not used in the basic process of functional analysis so that we can focus on process variables as well as simple behavior aggregation by environmental variables. Anxiety is one of the constructs frequently referred to in the social developmental literature, but is generally understudied or simplistically studied. No systematic research on social development in children with ASD exists that objectively measures anxiety and the related factor of attention to specific social stimuli. We will conduct behavioral, psycho-physiological and objective attention measurement (eye gaze) assessments of children’s response to a variety of child appropriate social and non-social stimuli with the goal being to create a synthesis of measurement of attention, anxiety, motivation and specific stimulus response characteristics to better understand the mechanism of poor social development, and then intervene using child-specific information.
The Effects of Precision Teaching with Frequency Building of Language Component Skills on the Performance of Language Composite Skills in Adolescents and Adults with Autism
Marlene Cohen, Ed.D., BCBA
Douglass Developmental Disabilities Center
Rutgers, the State University of New Jersey
In the field of Applied Behavior Analysis, much focus is placed on the intense training needs of young children with autism. Many educators believe that adolescents and adults with autism are less likely to make significant strides than their younger counterparts. Precision Teaching with frequency building procedures is one method that holds promise as an efficient and effective means of instruction for older learners. The current research is proposed to extend previous clinical demonstrations of the profound impact of Precision Teaching with frequency building procedures on the functional use of fine motor skills into the realm of language skill acquisition. Pilot research with verbal language components has indicated results similar to those of previous fine motor skill studies. Specifically, that targeted intervention to increase the fluency of speech and language component skills results in demonstration of new, untaught skills and a cumulative effect of more rapid acquisition of related language skills. The focus of the proposed research is to explore whether instruction of component skills should end when minimum frequency aims are initially achieved, or if continuing instruction of component skills to higher frequencies will yield increased, positive effects on performance of language composite skills. The planned research will also examine the cumulative effect of frequency building of three component skills on performance of a single composite skill.
The Identification of Early, Mutli-systemic Factors Influencing Treatment Initiation for Children with ASD
Brian Lopez, Ph.D. and Dina E. Hill, Ph.D.
University of New Mexico School of Medicine
Although early intervention for children with ASD has been shown to be highly effective, no studies have examined the factors that affect a family’s ability to initiate such treatment for their child. Delays in the initiation of early intervention for children with ASD can significantly impact their long-term developmental trajectory and outcomes. The proposed research will use a multi-systems approach to investigate the child-, family-, and community factors associated with treatment initiation following a diagnosis of ASD. The findings will provide professionals with the critical information that will allow them to better target limited resources to those families who would otherwise not initiate early treatment for their children, to improve children’s long term prognosis, to reduce parent stress, and to improve families’ quality of life.
2005 Research Competition Grant Awards—$30,000 each
Demonstration of a Parent Mediated Generalization
Program to Enhance Outcomes During EIBI for Children with
Spectrum Disorders: PEPING Up EIBI
Eric M. Butter, Ph.D.
The Columbus Children’s Hospital Autism Center
Columbus Children’s Research Institute and
The Ohio State University Nisonger Center
In recent years, great interest has been focused on the increasing incidence
of autism spectrum disorder and the development of effective treatments.
Early Intensive Behavioral Intervention (EIBI) is one treatment with empirical
support, however little is understood about what components of EIBI are
critical to its efficacy and there is growing concern that clinical outcomes
are falling short of those reported by Lovaas (1987). PEPING Up EIBI represents
a manual based psychosocial treatment designed to complement on-going
early intensive behavioral intervention (EIBI) for children with an autism
spectrum disorder. The proposed treatment program is a 12 month parent
training intervention designed to teach parents of children with autism
spectrum disorders strategies to accelerate their child’s learning
rate and to promote generalization of skills to settings outside of the
EIBI treatment environment. A randomized clinical pilot trial comparing
a uni-modal and combined treatment will be implemented. The experimental
group will involve parents participating in a highly individualized but
standardized and systematic parent training program in addition to the
EIBI program their child has already been enrolled. The control group
will receive EIBI treatment as usual with no additional parent training.
Outcome assessment will include one year changes in specific target skills
(as identified by the parent), learning rate (IQ, language, adaptive behavior),
autism symptoms (ADOS, PDD-BI), and parenting stress. If the parent training
program is effective, the practical implications for children and families
pursuing effective autism treatments will be immediate. Additionally,
the study design and evaluation measures offer further scientific value
by evaluating the utility of several assessment measures and their sensitivity
to treatment effects.
The Effects of Precision Teaching with Frequency
Building of Fine Motor Skills on the Performance of Functional
in Adolescents and Adults with Autism
Marlene J. Cohen, Ed.D., BCBA
Douglass Developmental Disabilities Center
Rutgers, the State University of New Jersey
In the field of Applied Behavior Analysis, much focus is placed on the
intense training needs of young children with autism. Many educators believe
that adolescents and adults with autism are less likely to make significant
strides than their younger counterparts. Precision Teaching with frequency
building procedures is one method that holds promise as an efficient and
effective means of instruction for older learners. The current research
is proposed as an attempt to replicate previous clinical demonstrations
of the profound impact of Precision Teaching with frequency building procedures
on the functional use of fine motor skills in adolescents and adults with
autism during activities of daily living. Further, this research seeks
to explore whether instruction of component motor skills should end when
minimum frequency aims are initially achieved, or if continuing instruction
of component skills to higher frequencies of performance will yield greater,
positive effects on performance of functional composite skills. In addition,
the proposed research will begin to examine whether maximum improvement
is seen when component skills that are addressed in teaching are directly
related to the movements involved in composite skills, or whether more
generalized improvements in adaptive skills can be seen in skills that
are not topographically related to the trained component skills.
A comparison of simultaneous prompt and constant prompt
procedures on teaching skills to young children with autism
Kevin P. Klatt, Ph.D., BCBA
Department of Psychology
University of Wisconsin – Eau Claire
Various procedures have been used to teach new communication, social,
and play skills to children with autism. One of the most common procedures
used in both analog and natural settings is the use of a prompt delay
procedure. This procedure requires the teacher to give the child an instruction,
followed by a prompt to help the child respond correctly, and then the
prompt is faded across trials until the child responds independently.
More recently, a simultaneous prompt procedure also has been used to teach
new skills to children and adults with developmental disabilities. This
procedure requires the teacher to provide an immediate prompt on all teaching
trials. This procedure presumably prevents the child from making errors
because the prompt is immediate. Although both procedures have been used
successfully to teach new skills to persons with developmental disabilities,
little research has been conducted comparing the two procedures or evaluating
the effectiveness of either with young children with autism. The purpose
of this study is to investigate the effectiveness of two types of constant
prompt delay and the simultaneous prompt procedure in teaching new skills
to young children diagnosed with autism.
Development of an instrument for measuring change
in social behavior for children with autism spectrum conditions:
The Social Reciprocity Observation Measure
Kathleen Koenig, MSN
Yale Child Study Center
Autism spectrum disorders (ASDs) are severe, disabling conditions that
impact affected individuals and their families throughout the lifespan.
Treatments for ASDs have burgeoned in the last ten years, with many options
available to families. The search for the best treatments is extremely
costly to families, in terms of time, energy and other resources. Moreover,
it is difficult to judge the efficacy of treatment if standard outcome
measures are not employed for testing interventions.
The aim of this program of research is to test and refine an instrument,
the Social Reciprocity Observation Measure (SROM), which is a ten item
scale designed to measure children’s reciprocal social behavior
in a naturalistic setting. The development of this instrument is modeled
after the ADOS, in that it brings key knowledge about impairments in social
functioning common to children with ASDs together with a well established
method of measurement – direct observation. The SROM goes one step
further in moving the observation to a naturalistic setting, for greater
30 children with an ASD will be observed and coded multiple times using
the SROM after inter-rater reliability has been established. Construct
validity will be examined through multi-trait, multi-method analysis of
the SROM and measures of social functioning completed by parents and clinicians,
and reliability of individual items will be examined as well. Once the
psychometric properties of the instrument are sufficiently demonstrated,
the SROM can be piloted as a change measure.
The development of this instrument addresses a critical methodological
problem in the field of autism intervention-- the lack of adequate outcome
measures. Use of the SROM will advance the measurement of treatment effects
on this core symptom of autism in the real world. Further, it will make
it easier for parents, teachers and researchers to compare the results
of treatment studies addressing the social impairment of ASDs.
A Multi-Method Assessment and Treatment of
the Social Skills Core Deficit in ASD
Raymond G. Romanczyk, Ph.D., BCBA and Jennifer M. Gillis,
Institute for Child Development
The significant social limitations of children with ASD lead to difficulty
in perception and understanding of important social cues in the environment,
in developing relationships with others, and in simple social interactions
with others (e.g., smiling, waving hello when seeing someone familiar,
expressing empathy, etc).
This project addresses social development in the full range of individuals
with ASD, encompassing children who have little to no language or communication
skills. The project applies a multi-method assessment of dimensions not
used in the basic process of functional analysis, so that we can focus
on process variables as well as simple behavior aggregation by environmental
variables. Anxiety is one of the constructs frequently referred to in
the social development literature, but understudied or simplistically
studied. No systematic research on social development in children with
ASD exists that objectively measures anxiety and the related factor of
attention to specific social stimuli. We will conduct behavioral, psycho-physiological,
and objective attention measurement (eye gaze) assessments of children’s
response to a variety of child appropriate social and non-social stimuli.
Our goal is to create a synthesis of measurement of attention, anxiety,
motivation, and specific stimulus – response characteristics to
better understand the mechanisms of poor social development, and then
intervene using this child-specific information. The combining of behavioral
and biological measurement approaches will assist in integrating what
are now often viewed as very separate conceptual approaches.
The project will develop a new assessment instrument for social development
deficits, to be used by caregivers, to identify important child characteristics
that directly lead to specific choice of intervention procedures. The
instrument will be validated through this multi-method assessment. While
the current study focuses on social skills and anxiety, the methodology
we are proposing has broad applicability to numerous areas of clinical
Joint Attention Intervention for Children with Autism
Emily A. Jones, Ph.D., BCBA
Kathleen M. Feeley, Ph.D., BCBA
Long Island University
Two of the three core areas of impairment in children with autism are
social interaction and communication. Research has documented a key early
developing social-communicative behavior that is specifically impaired
in children with autism and reflects these two core areas of impairment,
referred to as joint attention. Joint attention involves two people sharing
attentional focus on interesting objects and events. Given the key role
that joint attention plays in social and language development and its
unique impairment in children with autism, we have suggested in previous
work that it is important to examine the development of effective interventions
to teach this key behavior. In a previous study we successfully utilized
discrete trial instruction and pivotal response training strategies to
teach joint attention to preschoolers with autism in their preschool programs.
In the proposed investigation we seek to expand that work by demonstrating
the effectiveness of the intervention with parents as interventionists
within the home setting. Participants will take part in two studies. In
Study 1, participants will be taught two joint attention skills (respond
and initiate) by their parent(s) using the same procedures used in previous
work. In Study 2, parents will teach joint attention within the context
of routines (e.g., reading a book, watching the ducks at the park). In
both studies, generalization and changes in more qualitative measures
of social-communicative characteristics (e.g., involves two people sharing
attentional focus on interesting objects and events) will be also be evaluated.
Assessment of Characteristics of Students with Asperger
and the Evaluation of the Mind Reading Computer Software on the
Emotion Recognition Ability
of Students with Asperger Syndrome
Brenda Smith Myles, Ph.D.
Department of Special Education
University of Kansas
The purpose of the proposed project is twofold: a) to identify the multi-faceted
characteristics of children with Asperger Syndrome (AS) (Phase I) and
b) to investigate the abilities of participants to learn to recognize
emotions using a computer software program, Mind Reading program CD/DVD
version 1.0 (Phase II) (Baron-Cohen, 2004.) Ninety students with AS and
30 neurotypical peers (Phase II only) between the ages of 8 and 11 will
participate in the proposed study.
The first phase of this study is designed to develop a better understanding
of AS. Specifically, this phase of the study will examine the following
characteristics of children with AS: a) AS severity, b) family and student
demographics, c) social/emotional profile, d) systemizing and empathizing
ability, e) temperament, f) cognition, and g) adaptive behavior.
During Phase II the researcher will investigate the abilities of participants
to learn to recognize emotions using a computer software program, Mind
Reading Program CD/DVD version 1.0 (Baron-Cohen, 2004.) Since no studies
have been conducted using the Mindreading software, the proposed project
will improve understanding of a) the skills individuals with AS have in
understanding emotions and b) their response to computer-aided instruction.
Moreover, the project will investigate the feasibility of computer based
intervention for children and youth with AS.
Family-Focused Cognitive-Behavioral Intervention for Anxiety
in Children with High-Functioning Autism or Asperger Syndrome
Judy Reaven, Ph.D.
Susan Hepburn, Ph.D.
Health Sciences Center
University of Colorado
Children with high-functioning autism or Asperger Syndrome are at high
risk for developing a variety of anxiety disorders. The few treatment
studies conducted thus far have investigated the efficacy of medications
in the reduction of anxiety symptoms for persons with ASD. Although psychosocial
interventions are extremely effective in reducing anxiety symptoms in
the general pediatric population, these strategies have yet to be systematically
applied to children with ASD. Previous research has demonstrated that
when traditional CBT protocols are modified for children with ASD and
co-occurring anxiety symptoms, reductions in anxiety symptoms can occur.
The primary purpose of this proposal is to assess the effectiveness of
a family-focused intervention package on reduction of anxiety symptoms
with high-functioning ASD.
Twelve children (and their parents) will participate in the pilot group
treatment study, which employs a single subject, multiple baseline design.
Three treatment groups will run for 12 consecutive weeks and include both
a child and a parent component. Start dates for the group will be staggered,
and multiple measures of child anxiety and parenting sense of competence
will be collected during the extended baseline period. The 12 weeks of
treatment will be divided into two intervention blocks: a) a neurobehavioral
introduction to anxiety disorders and an introduction to CBT strategies,
and b) implementation and generalization of tools and strategies to treat
the anxiety symptoms. Common CBT relaxation training will be included
in the intervention package. Anticipated outcomes of this pilot study
include completion of a set of treatment manuals describing a family-focused
approach to reducing anxiety symptoms in children with ASD. In the future,
these treatment manuals will be used in randomized clinical trials of
2004 Research Competition Grant Awards—$30,000 each
Improving Social Skills Using Computer-Based Interventions
Kevin Ayres, M.A.
Department of Education
The University of Georgia
The purpose of this study is to investigate a computer and video based
intervention to improve social skills of children with autism. By collaborating
with parents, teachers and students, the program will specifically target
for each student, those social skills that they and their caregivers determine
are most critical. Research on direct instruction of social skills is
important for individuals with autism because of the deficits these individuals
commonly show and the amount of repeated explicit practice they need to
begin to succeed in social situations. Computer mediated instruction can
provide the high intensity repetition and variety of exemplars that these
learners may require to increase their social competence.
While many programs have targeted social skill intervention for children
with autism and document improvements, one factor that is rarely considered
is the degree to which small changes in a student’s social behaviors
may influence peers. With positive influences on peer attitudes, a student
may increase the opportunities they have to interact and assimilate into
peer groups. This study will directly evaluate student performance but
also evaluate change in the larger social context of the student’s
Further, successful evaluation of a program like the one described in
this proposal could provide teachers and care givers another instructional
tool to meet the needs of their students. Ultimately, the proposed project
will consist of the development and evaluation of a computer based program
that will then be made available via the Internet for teachers and parents.
Educators can then customize the program for their students needs by following
a set of accompanying instructions that will lead them through individualizing
social skill objectives and instruction.
Early Identification of Autism: Warning Signs from Brain
Karen Pierce, Ph.D.
Eric Courchesne, Ph.D.
Department of Neurosciences
University of California, San Diego
To develop a protocol for identifying infants at-risk for autism
at the 1-year well-baby check-up based on a combination of behavioral
and brain growth indices. A further objective is to study the brain
and behavior characteristics of infants at-risk for autism.
Pediatricians will participate in a seminar that will teach them
to identify the possible brain growth (i.e., dramatic changes in head
circumference from birth to 1-year) and behavioral profiles (e.g., a
failure to respond to their name) of infants at-risk for autism. Parents
from participating pediatrician practices will complete an autism screening
and behavioral and neurobiological testing. Results from brain and behavioral
tests will be compared between those at-risk for autism and their normally
developing peers. The overall success of the program for identifying
autism at 1-year will be evaluated when a firm diagnosis can be determined
at age 3.
First, it is anticipated that the project will be successful
in training pediatricians to identify infants at-risk for an autism
spectrum disorder (ASD). Second, it is anticipated that the at-risk
infants will display differences from normal on both head circumference
measures as well as behavioral indices of social awareness, attention
and exploration. Third, for those infants who go on to receive an MRI,
it is anticipated that brain abnormalities will be present at 1-year
that mimic the predictions based on head circumference findings. Specifically,
we hypothesize increased overall brain volume. Other brain abnormalities
that may be detected via MRI await discovery.
Long Term Significance:
The importance of identifying autism at the youngest ages possible
cannot be overestimated. Caring for a child with autism is
costly both financially and emotionally for parents and school
systems alike. Earlier identification means earlier treatment and thus
a better outcome for the child and family. Furthermore, given the relative
absence of information regarding autism during the first year of life,
this research may pave the way for pivotal discoveries regarding the
first stages of behavioral and biological dysfunction in this disorder.
2003 Research Competition Grant Awards—$30,000 each
Removal of Social Barriers to Employment For Persons with
Autism Spectrum Disorders
John C. Burke, Ph.D.
Kentucky Autism Training Center
University of Louisville
The present study endeavors to improve opportunities for individuals
with autism to become socially integrated into the workplace by providing
brief training to employers and co-workers of individuals with autism
related to the specifics of autism as a diagnosis. The goal of the study
will be to determine if data reflects an increase in the subjects' scores
on attitude and interaction scales from baseline measurement. Of further
inquiry will be whether the measured level of severity is contributory
to any statistically significant changes in subjects’ attitude or
interaction scores using a repeated measures analysis of variance design
involving two groups with random assignment. If the training is found
to be effective, the intervention model will be disseminated using print
and electronic media and professional development training activities.
This study is believed relevant based upon a review of the literature
that suggests that while natural supports are increasingly utilized in
supported employment settings, many individuals with severe disabilities,
such as autism, may be at a disadvantage for the development of natural
supports due to issues of impaired social communication and behavior.
If brief training specific to autism is related to increased scores on
attitude and interaction scales, then the inclusion of such training into
job placement for individuals with autism may prove an efficacious means
of developing natural supports.
The New Friendship Study, Part III:
The Influence of Information
on Middle School Students’ Attitudes
and Behavioral Intentions towards
a Peer with Autism
Jonathan M. Campbell, Ph.D.
Department of Educational Psychology
The University of Georgia
Despite the increasing numbers of children with autism being included
in regular education settings, recent research has demonstrated that,
as a group, peers assign negative personality characteristics to children
with autism and report negative attitudes about socializing with them.
Peers’ negative evaluations of children with autism are robust across
gender, more negative for older children, and have been shown to persist
despite a brief educational intervention about the condition of autism.
In contrast, Campbell, Ferguson, Herzinger, Jackson and Marino (2003)
recently documented the benefits of providing information to typical third
through fifth graders about autism as evidenced by less negative evaluations
of the autistic child when information was present versus absent in a
videotaped message. Ferguson, Campbell, Herzinger, Jackson and Marino
(2003) also collected pilot data to investigate if source of information
improved attitudes and behavior intentions towards children with autism.
Ferguson et al. (2003) found that children reported more interest in working
on academic tasks with an autistic child when teachers and parents provided
information about autism versus an outside professional, defined as a “doctor” in
the pilot investigation.
The purpose of this project is to continue our study of the influence
of information on children’s impressions of an unfamiliar child
diagnosed with autism by extending our findings to middle school children.
The significance of the study is that it will provide information for
regular and special educators in middle schools about how to introduce
a new child with autism into a regular education setting.
Campbell, J.M., Ferguson, J.E., Herzinger, C.V., Jackson, J.N., & Marino,
C. (2003). Brief information about autism improves typical children’s
perceptions. Manuscript submitted for publication.
Ferguson, J.E., Campbell, J.M., Herzinger, C.V., Jackson, J.N., & Marino,
C. (2003). (The impact of information source on peers’ initial impressions
of children diagnosed with autism). Unpublished raw data.
Problem Behavior: The Development of a
Inventory for Use by Families
Edward G. Carr, Ph.D.
Department of Psychology
State University of New York at Stony Brook
Many children with autism engage in serious problem behavior such as
aggression, self-injury, tantrums, property destruction, and high levels
of disruption. These behaviors harm the quality of life for the families
involved and prevent the child from being successfully integrated into
the neighborhood school, peer social group, local community, and later
in life, the workplace. Therefore, it is important to reduce or eliminate
problem behavior. Research has shown that systematic assessment of the
factors that set off problem behavior can produce information that is
very helpful in designing effective treatment intervention. However, assessment
is often a time-consuming, laborious process that is difficult for families
and their service providers to perform in typical community contexts such
as the home. Therefore, the purpose of the proposed research is to develop
an efficient, user-friendly inventory that can be employed to help families
identify the full range of factors that are involved in the child’s
problem behavior. The Contextual Assessment Inventory (CAI) is designed
to capture, in a simple format, what is known, from the current research
literature, about the factors associated with problem behavior. With the
help of a professional, families fill out the CAI at home. The factors
involved may be biological in nature (e.g., illness-related, side effects
of medication.) They may be social in nature (e.g., being teased, not
being able to communicate about one’s needs.) Or, they may be related
to some aspect of ongoing activities or routines (e.g., having to wait
for something desirable, being asked to carry out a disliked chore.) An “information
module” will be developed so that the data from the CAI can be used
by families and their service providers to systematically select effective,
relevant, evidence-based treatment interventions that currently exist
in the published clinical and educational literature.
Teaching the imitation and spontaneous use of gestures
using a naturalistic behavioral intervention in young children
Brooke Ingersoll, Ph.D.
Autism Treatment and Research Program
Hearing and Speech Institute
Children with autism exhibit deficits in the imitation and spontaneous
use of descriptive, conventional and effective gestures both in structured
settings and in more natural contexts such as play with others. These
deficits are a barrier to both communication and socialization, and are
thus an important focus of early intervention programs for children with
autism. Reciprocal Imitation Training (RIT), a recently designed naturalistic
imitation intervention, has been shown to increase spontaneous, generalized
object imitation skills in young children with autism during play.
This study is designed to assess whether RIT can be adapted to target
the imitation of descriptive, conventional, and affective gestures in
young children with autism. Children who exhibit deficits in the spontaneous
imitation and use of gestures will be selected to participate. This project
will conduct a single-subject, multiple baseline design across five children
with autism. Dependent measures will include behavioral and standardized
measures of gesture imitation and spontaneous use, as well as additional
related behaviors such as language and joint attention. This design will
allow for fine-grained, detailed analysis of individual responsiveness
to the treatment for both the targeted behaviors (gesture imitation and
spontaneous use) and non-targeted behaviors (e.g., language and joint
It is expected that the participants will exhibit increases in their
imitation ability in both the treatment setting and on measures of generalization.
In addition, it is expected that the children will also exhibit increases
in their spontaneous use of gestures and other social-communicative behaviors
including language, joint attention, and social interaction skills. These
results will provide support for the effectiveness of RIT to teach gesture
imitation and use and will provide a new and exciting option for the treatment
of young children with autism who are not yet using or imitating gestures.
Social Skills Development in Children with Autism Spectrum
Lawrence Scahill, MSN, Ph.D.
Yale Child Study Center
This is a one-year pilot study which will evaluate the acceptability
and efficacy of a Social Skills Development Program (SSDP) for children
with Autism Spectrum Disorders (ASDs.) The objectives of SSDP are to increase
social motivation and to enhance appropriate social behaviors in reciprocal
social interaction. These objectives have been chosen because they reflect
core deficits in social and communication skills for children with ASDs,
can be measured, and can be targeted in a structured social skills training
Thirty children with ASDs will be recruited in a rolling recruitment
process beginning January, 2004. Each child will be fully assessed regarding
the target behaviors, and then each will enter a group consisting of five
children with as ASD and two typically developing peers, “peer trainers.” The
treatment, which consists of a 12-week, 90-minute intervention, is based
on applied behavioral strategies within the context of an intensive group
socialization experience. Activities designed to promote social interaction
will provide a basis for learning social initiation and appropriate social
behavior. Moreover, these behaviors will be taught explicitly and practiced.
Typical peers will be trained to provide practice and reinforcement of
the target behaviors. Behavior change will be assessed using standard
measures through parent interview and direct observation of the child
in a naturalistic setting. These data will address the clinical significance
of the program, whether the program is acceptable to families, and to
what degree interview and observational data converge. A final outcome
of the program will be the development of a manual in which the intervention
program is described comprehensively, so larger, replication studies can
be con ducted to answer the full range of questions regarding social skills
intervention for children with ASDs.
Inaugural Research Competition Grant Awards - $30,000 each
Fluency Research for Children with Autism
Principal Investigator: Richard M. Kubina, Jr. Ph.D.
Assistant Professor of Special Education
The Pennsylvania State University
The maintenance of program gains for children with autism is
a significant issue for clinicians, educators, and parents of children
with autism. While “Precision Teaching” has an established
history of research in education, providing a viable measure for behavioral
and decision-making progress in young learners, the technique, particularly
as it pertains to “fluency’ in skill acquisition and retention,
has not yet been researched with autistic students. Fluency means that
a person can competently perform a behavior with high degrees of accuracy
(Binder, 1993,1996). There are three recognized associated “critical
learning outcomes” (according to Binder) that occur with fluency:
(1) long-term retention of the behavior after practice has been terminated,
(2) endurance – the ability to perform a behavior at a steady
pace in the face of external distraction, and (3), application or the
integration of one element or component behavior to a composite or compound
behavior. As noted by Kubina in his proposal, several applied and experimental
studies have demonstrated the positive effects of fluency, but these
studies do not contain comparable information for students with autism.
One common learning difficulty children with autism exhibit is lack
of “maintenance” or the ability to perform an acquired behavior
over a long period of time. This study will establish a series of experiments
studying the effects of fluency for students with autism. The three
experiments will critically examine the learning outcomes associated
with fluency for these students. The first segment of the project will
analyze the comparative effects of mastery and fluency on the retention
of a receptive language skill. The second phase will compare the effects
of fluency and traditional maintenance for a receptive language skill.
The third experiment will explore the relationship of a fluent receptive
labeling skill and the applications to an expressive labeling skill.
All of these experiments will involve multiple students with autism.
The outcomes may positively impact education and therapeutic interventions
by experimentally demonstrating both practical and salubrious effects
Study Timeline and Methods
Four students with autism between the ages of 4 and 8 will participate
in this study. They will be selected (January – February, 2003)
based on their previous experience with discrete trial instruction,
demonstrated deficits in vocabulary, and evidence of some receptive
picture identification skill. The study will take place during teaching
sessions in the students’ classrooms. Program materials will include
10 pictures from a standard set, such as the “Picture This” computerized
program. Dependent measures in this study will be accurate responding
(defined as pointing to the correct picture within 3 seconds) and the
independent variable will Fluency Research for Children with Autism
Page 2 be the “mastery” and “fluency” conditions,
based on a sampling of response rates of age matched typical peers within
a similar task. During the teaching phase, the teacher will use a discrete
trial teaching format. Each student will be prompted in their picture
identification responses to a point of 90% accuracy or above for two
consecutive days across two different therapists. The procedure will
then be repeated until the student demonstrates mastery across 20 novel
pictures. The pictures will then randomly be divided into two groups:
mastery and fluency. Retention probes will be conducted at 1 day, 2
weeks, 1 month, and 3 month intervals following the termination of each
respective condition. Probes will be conducted in 20-second timed trials,
and data will be recorded on the number of items identified within 20-second
trials as well as the accuracy of each response. The first experiment
will take place March – May, 2003, the second June – August,
2003, and the final experiment September – October, 2003.
Each child will be assessed using the Receptive and Expressive
One Word Vocabulary Test as well as the Peabody Picture Vocabulary Test.
Baseline data of experimental pictures will also be established using
trial-by-trial measures. The data from the probes portion of the study
will be expressed as percentage of accurate responses, calculated by
dividing the number of accurate response by the total number of responses
multiplies by 100%. The data will also be expressed as frequency of
correct responses per time interval. Conclusion and Application A chronic
problem found in many programs for children with autism, especially
slower learners, is that maintenance programs begin to get cumbersome.
Frequently, it becomes less of a priority to practice maintenance skills
then it is to work on new skill acquisition programs. As a result, it
is often the case that a child looses skills that eventually need to
be re-taught at a later time. While it is hypothesized that teaching
to “fluency” may eliminate the need for maintenance work
for many learners with autism, there is no empirical evidence to date
to support this belief. The findings from this study would have a significant
impact on the development and implementation of programs for children
Teaching Social Communication Using Picture Activity Schedules
Principal Investigator: Robert Stromer, Ph.D.
Associate Professor and Senior Scientist
University of Massachusetts Medical School, Shriver Center
Teaching with activity schedules may yield social communication
skills that are not readily achieved with discrete trial or naturalistic
methods (e.g., Krantz, 2000; McClannahan & Krantz, 1997). To date,
research has focused on developing the speech skills that children with
autism were able to use to engage their communicative partners (e.g.,
Krantz & McClannahan, 1993, 1998). In contrast, the present project
examines interventions to teach children to use pictures in their socialization,
a repertoire resembling the Picture Exchange Communication Skills or
PECS (e.g., Bond & Frost, 1998, 2002). Pilot work has demonstrated
that activity schedules are procedures capable of accommodating a variety
of instructional materials, learner entry skills, and children who use
PECS. Research using activity schedules to broaden children’s
PECS skills has not been done. Moreover, recent projects began exploring
how computers might enhance learning by such methods. This study will
also help determine the potential for computers to teach social communication
skills in the context of activity schedules. Children selected for this
study will possess few if any functional speech skills but are able
to use pictures to communicate, as in the Picture Exchange Communication
System (PECS). The specific aims of the project are to verify that:
(1) computer enhanced activity schedules teach children to use pictures
to make requests and comments and (2) the computer enhanced activity
schedules teach children to use pictures to initiate and sustain social
Study Timeline and Methods
Eight children will be recruited for the study, four younger
(ages 4 to 6 years) and four older (ages 7 to 10 years) who all have
a diagnosis of severe autism (DSMV-IV criteria). The children will have
receptive, but few if any expressive skills, based on the Peabody Vocabulary
Test (Dunn & Dunn, 1997), Expressive One-Word Picture Vocabulary
Test (Brownell, 2000) and analysis of language samples gathered in structured
and free play settings (e.g., Hepting & Goldstein, 1996). Each child
will then proceed through the following: a one-month preteaching of
PECS, with a sentence construction goal of 80% correct for 10-trial
blocks in each phase; one-to-three months of preteaching of activity
schedules. For Study 1, Requesting and Commenting, over the following
three months, targeted interventions will be used teach the child to
use pictures to: (a) make requests (b) identify own activities (c) identify
listener activities. For Study 2, Social Interactions, the following
three months will be used to learn to use pictures to: (a) invite playmate
(b) ask for attention and (c) attend to playmate.
Analyses in the studies involve within subject, multiple baseline (probe) designs
across behaviors to be taught and expected via generalization. Such designs are
routinely used in applied research (e.g., Kazdin, 1982; and see Dauphin et.al.,
2002). The designs not only inform analyses of individual data, they are compatible
with the objectives and the accountability requirements of providing educational
services to the children involved. The outcomes are positive if, in contrast
to tests before intervention, each child achieves perfect or nearly perfect scores
after intervention. A child who masters the scheduled PECS skills in the protocol
is also expected to perform the generalization tasks without further teaching.
Conclusion and Application The data will support the view expressed by Krantz
(2000) who suggests that activity schedules may have special utility in addressing
the challenges of teaching social and communication skills (see also Koegel,
2000; Lord, 2000; Rogers, 2000; Schreibman, 2000). Activity schedules are a natural
complement to discrete trial and naturalistic teaching methods designed to foster
social communication. As in preliminary efforts, it is expected that the results
of this study would have immediate application in teaching. Such outcomes seem
likely because the research is conducted in the context of partnerships with
parents and teachers trying to solve everyday problems of social significance.
Also, the present study will support others showing that such schedules may be
adapted for children with special needs and used to supplement other forms of
teaching, as in discrete trial and naturalistic interventions. Activity schedules
are appropriate for teaching every student to behave independently, whether or
not they have extensive verbal skills. Knowledge gained from this project will
help fill a void in the empirical knowledge and address a pressing need in everyday
practice. The results of this study will be used to support a large-scale, multi-site
project appropriate for federal funding.