A number of studies of parent-mediated interventions in autism spectrum disorder have been published in the last 15 years. We reviewed 19 randomized clinical trials of parent-mediated interventions ...for children with autism spectrum disorder between the ages of 1 and 6 years and conducted a meta-analysis on their efficacy. Meta-analysis outcomes were autism spectrum disorder symptom severity, socialization, communication-language, and cognition. Quality of evidence was rated as moderate for autism spectrum disorder symptom severity, communication-language, and cognition, and very low for socialization. Weighted Hedges’ g varied from 0.18 (communication-language) to 0.27 (socialization) and averaged 0.23 across domains. We also examined the relationship between outcome and dose of parent training, type of control group, and type of informant (parent and clinician). Outcomes were not significantly different based on dose of treatment. Comparing parent training to treatment-as-usual did not result in significantly different treatment effects than when parent training was compared to an active comparison group. Based on parent report only, treatment effects were significant for communication-language and non-significant for socialization, yet the opposite was found based on clinician-rated tools. This meta-analysis suggests that while most outcome domains of parent-delivered intervention are associated with small effects, the quality of research is improving.
Exploratory factor analysis (EFA) is a widely used but poorly understood statistical procedure. This paper described EFA and its methodological variations. Then, key methodological variations were ...used to evaluate EFA usage over a 10-year period in five leading developmental disabilities journals. Sixty-six studies were located and evaluated on multiple procedural variations. Only 35% (
n
= 23) of studies used EFA; principal components analysis was the model used most often (
n
= 40, 61%). Orthogonal rotation was used most often (
n
= 39, 59%). A large portion of studies ran analyses with a subject: item ratio larger than 5:1 (
n
= 49, 74%). Most researchers employed multiple criteria for retaining factors (
n
= 45, 68%). Overall, results indicated that published recommendations and guidelines for the use of EFA are largely ignored.
Parents of children with autism spectrum disorder (ASD) face higher levels of caregiver strain compared to parents of children with other disabilities. This study examined child clinical features ...that predict high levels of caregiver strain for 374 parents of children with ASD. Caregiver strain was measured using the Caregiver Strain Questionnaire (CGSQ) objective, subjective internalized, and subjective externalized subscales. Confirmatory factor analysis indicated an acceptable fit for the original CGSQ three-factor solution. The strongest child predictors across CGSQ subscales were: disruptive behavior for objective strain, autism severity and disruptive behavior for subjective internalized strain, and oppositional behavior and hyperactivity for subjective externalized strain. Individualized interventions that attend to specific elements of parental strain may reduce strain and improve family wellbeing.
•Methodological rigor has steadily improved as social skills training has increased.•Most studies are using a manualized intervention and validated outcome measure.•Recommendations are proposed for ...future trials.•Potential assessment and outcome battery are considered.
Group-based social skills training (SST) is a common treatment for children with autism spectrum disorders (ASD). There has been exponential growth in group-based SST in recent years. This review evaluated the SST literature published between 2000 and 2012 on a number of methodological variables. Key quality indicators included conducting a randomized controlled trial (RCT), having a well-characterized sample, using a manualized intervention, and using validated outcome measures. We identified a total of 48 studies. Thirteen studies (27%) were RCTs. Twenty-two studies (46%) had well-characterized samples, but only four (8%) explicitly allowed eligibility for individuals with intellectual disability. Eighteen (38%) had 10 or fewer participants in each active treatment condition. Most studies used or adapted a manual (71%), and had validated outcome measures (92%). Several rating scales and performance measures have seen widespread use. Methodological rigor has been improving as the field grows, especially with regard to the key quality indicators. We provide additional recommendations for future trials regarding study design, expanding participant characterization, statistical methods and analyses, and outcome measures.
This study evaluates the feasibility of the NIH Toolbox Cognition Battery (NIH-TCB) for use in autism spectrum disorder (ASD). 116 autistic children and adolescents and 80 typically developing (TD) ...controls, ages 3–17 years, completed four NIH-TCB tasks related to inhibitory control, cognitive flexibility, processing speed, and episodic memory. While the majority of autistic and TD children completed all four tasks, autistic children experienced greater difficulties with task completion. Across autistic and TD children, performance on NIH-TCB tasks was highly dependent on IQ, but significant performance differences related to ASD diagnosis were found for two of four tasks. These findings highlight the potential strengths and limitations of the NIH-TCB for use with autistic children.
This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior.
This was a 24-week, 6-site, randomized trial of parent ...training versus parent education in 180 children with ASD (aged 3-7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented.
At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p = .004; effect size = 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p = .11; effect size = 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gains in Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment.
These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time. Clinical trial registration information-Randomized Trial of Parent Training for Young Children With Autism (RUBI); http://clinicaltrials.gov/; NCT01233414.
Parents or teachers rated 487 non-clinically referred young people with Pervasive Developmental Disorders on the Nisonger Child Behavior Rating Form. The objectives of the study were to examine the ...relative prevalence of specific behavior problems, assess the impact of subject characteristics, and derive an empirical classification of behavioral and emotional problems for this population. Results indicated that the youngsters experienced high rates of behavior and emotional problems. Cluster analysis suggested that six- and eight-cluster solutions best fit the ratings provided by parents and teachers, respectively. Both parent and teacher cluster solutions contained groups of children characterized as problem free, well adapted, hyperactive, anxious, and with undifferentiated behavior disturbances. The empirically derived clusters were supported by data external to the analyses.
For individuals with autism spectrum disorder (ASD), behavioral inflexibility can affect multiple domains of functioning and family life. The objective of this study was to develop and validate a ...clinical interview version of the Behavioral Inflexibility Scale. Trained interviewers conducted interviews with parents of 144 children with ASD and 70 typically developing children (ages: 3–17 years). Using exploratory factor analysis, the Behavioral Inflexibility Scale-Clinical Interview (BIS-CI) was found to be unidimensional. Reliability data indicated the measure was internally consistent (
α
= 0.80), achieved excellent inter-rater reliability (ICC = 0.97) and test–retest reliability (ICC = 0.87). These findings demonstrate that the BIS-CI is a reliable and valid measure to determine the functional impact of behavioral inflexibility.
This study assessed the psychometric properties of the Modified Checklist for Autism in Toddlers (M—CHAT) and the Social Communication Questionnaire (SCQ) in a sample of preschool children referred ...for possible pervasive developmental disorders (PDDs). The sample consisted of 82 children between the ages of 18 and 70 months (54 with a PDD diagnosis and 28 with non-PDD diagnoses). M—CHAT scores were analyzed for 56 children aged 18—48 months old and SCQ scores were analyzed for 65 children aged 30—70 months old. Optimal sensitivity and specificity were achieved using the cutoff score of any three items on the M—CHAT and lowering the cutoff score of the SCQ. The diagnostic agreement of both instruments was also compared in an overlapping subsample of 39 children aged 30—48 months. Overall, the M—CHAT and SCQ appear to more accurately classify children with PDDs who have lower intellectual and adaptive functioning.
We explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD).
Participants were 658 children with ASD ...(age 3–17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics.
Of the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented.
In this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.
•We observed a high frequency of multiple concomitant DSM-defined disorders.•50% of children who met criteria for ADHD also met criteria for ODD.•46% of children who met criteria for ADHD also met criteria for an anxiety disorder.•Findings highlight the importance of improving diagnostic practices in ASD.
PDF
