Early Intensive Behavioral Intervention Research Articles

Implementing early intensive behavioral intervention in community settings.

Although research shows early intensive behavioral intervention can be very beneficial for children with autism spectrum disorder when delivered in university or private intervention centers, little is known about the best way to provide early intensive behavioral intervention within the broader community. The Michigan State University Early Learning Institute was developed to address challenges with providing early intensive behavioral intervention in community settings, with an emphasis on serving children and families on Medicaid. This short report describes the approach taken by the Early Learning Institute and reports data regarding enrollment and utilization among Medicaid families. Results suggest the model has potential to be used within community settings and that children on Medicaid are likely to consistently attend their treatment sessions.

Efficacy of Interventions Based on Applied Behavior Analysis for Autism Spectrum Disorder: A Meta-Analysis.

ObjectiveTo systematically evaluate evidence for the use of interventions based on appied behavior analysis (ABA) to manage various symptoms of children with autism spectrum disorder (ASD). MethodsSensitivity analyses were conducted by removing any outlying studies and subgroup analyses were performed to compare the effectiveness of ABA and early start denver model (ESDM), picture exchange communication systems (PECS) and discrete trial training (DTT). Results14 randomized control trials of 555 participants were included in this meta-analysis. The overall standardized mean difference was d=-0.36 (95% CI -1.31, 0.58; Z=0.75, p=0.45) for autism general symptoms, d=0.11 (95% CI -0.31, 0.54; Z=0.52, p=0.60) for socialization, d=0.30 (95% CI -0.02, 0.61; Z=1.84, p=0.07) for communication and d=-3.52 (95% CI -6.31, -0.72; Z=2.47, p=0.01) for expressive language, d=-0.04 (95% CI -0.44, 0.36; Z=0.20, p=0.84) for receptive language. Those results suggested outcomes of socialization, communication and expressive language may be promising targets for ABA-based interventions involving children with ASD. However, significant effects for the outcomes of autism general symptoms, receptive language, adaptive behavior, daily living skills, IQ, verbal IQ, nenverbal IQ, restricted and repetitive behavior, motor and cognition were not observed. ConclusionThe small number of studies included in the present study limited the ability to make inferences when comparing ABA, ESDM, PECS and DTT interventions for children with ASD.

Thinking in Pictures Educational Services (TIPES): A Preliminary Report of an Intensive Behavioral Intervention for Children with Moderate to Severe Autism Spectrum Disorder

Introduction: Autism spectrum disorder (ASD) is a potentially severely disabling exceptionality, and there is evidence of increasing incidence. In extreme cases major challenges can develop early in childhood for those individuals, their families and educational services. Social isolation, language problems, sensory and behavioural problems can all become entrenched if effective support is not provided. Interventions capable of delivering a recovery trajectory with transition to public/private education for children with moderate to severe ASD have been infrequently reported in the literature. Intensive behavioural intervention (IBI) as delivered within the Thinking in Pictures Educational Services (TIPES) has, as yet, not been tested as an intervention for children with moderate to severe autism. Methodology: IBI was delivered over a minimum of 12 months with 25-40 hours of individual therapy per week. Following a baseline memory paradigm assessment, a participant-specific IBI intervention was delivered. A combination of discrete trial training and ESDM, verbal behavior approach followed by direct instruction programs were used to improve language and social functioning. Baseline and end of intervention Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) scores were recorded and compared to standard age adjusted mean childhood scores for educational ability. Each participant was assessed Assessment of Autism Treatment Evaluation Checklist (ATEC) in order to evaluate the impact of the intervention on the 4 domains of ASD (speech, sociability, sensory, behaviour performance). The primary end point was taken as the last score on the ATEC and ABLLS-R. The primary outcome was attendance in public and privately funded classroom settings. Results: All results within this study were significant. In terms of the primary outcome 9 out of 14 children with moderate to severe childhood ASD treated with IBI, using the TIPES method attended public/private funded sector education during the second year. There was an effect size (number needed to treat) of 2 indicating a very effective intervention. Basic language and learning skills as scored on the ABLLS-R significantly improved (p<0.000). Core characteristics of ASD as measured on the ATEC total scores significantly improved at end of treatment (p<0.012). All ATEC subscale scores significantly improved. Baseline mean speech scores significantly improved (p<0.006) as did sociability (p<0.005), sensory (p<0.078) and behaviour scores (p<0.041). Conclusion: This preliminary study indicated that educational attendance was possible for the majority of children with moderate to severe ASD who were accepted by TIPES and treated with an individualised combined IBI approach based on memory and learning capacity. If these results can be replicated this would be a highly cost-effective intervention.

The knowledge of Public Health Midwives on Autism Spectrum Disorder in two selected districts of the Western Province of Sri Lanka.

Early interventions are important for improving outcome in autism. However, the diagnosis of autism is often delayed for 3-4 years, which leads to missed opportunities to initiate early intensive behavioural interventions, thus jeopardizing its prognosis. The lack of knowledge among healthcare workers about the features of autism is postulated to be the main reason for this delay. A descriptive cross-sectional study was carried out among the PHMs in the Colombo and Kalutara districts of the Western Province, Sri Lanka. A specifically designed self-administered questionnaire was used to obtain information about the socio-demographic details. The knowledge about the signs and symptoms and common comorbidities of ASD were assessed using the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire". Out of 406 participants, 56.9 % (n = 231) were from the Colombo District. The mean knowledge of the participants on the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire" was 13.23/19 (SD = 2.647). The knowledge was significantly higher in those who had participated in training programmes on autism (p < 0.01) and in those who have had contact with a child with autism (p < 0.05). Of the participants, 17.2 % (n = 70) believed that autism could be completely cured. 43.6 % and 42.2 % believed that poor attention from parents and parental conflicts during pregnancy and early childhood caused autism in children respectively. The knowledge of PHMs on autism is inadequate, with regard to the comorbidities, aetiology and treatment options. In service programmes are useful in improving the knowledge of PHMs on autism.

Investigating the Efficacy of Discrete Trial Training Program in the Development of Sustained Eye Contact in an Adolescent Girl with Autism Spectrum Disorder: A Case Study

Investigating the Efficacy of Discrete Trial Training Program in the Development of Sustained Eye Contact in an Adolescent Girl with Autism Spectrum Disorder: A Case Study

Autism: a curse on today’s society

Autism is a group of neurodevelopment disorders characterized by impaired communication, impaired social interaction and restricted, repetitive and stereotyped patterns of behaviours or interests in the first 3 years of life. It shows a strong male bias and found four times more in males than in females. According to a study in the US, in 2014, overall 1.68% of victims were reported to have Autism Spectrum Disorder (ASD), whereas the percentage was increased by 15% and 150% respectively over the year 2012 and 2000. Numerous genes have been discovered that have roles in ASD but still a good understanding of the pathophysiological process of ASD is not established. ASD costs are estimated to be approximately $250 billion annually in the U.S. Moreover, it is suggested that by 2025, ASD costs will rise to over $450 billion. Thus, the financial burden on families is increasing. There is no effective screening tool for proper diagnosis is available. Based on Infant Toddler Checklist (ITC) and Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) some tests like ADOS-G, ADI-R, CARS etc. are used for diagnosis. There are medications to cure symptoms but no single medication for ASD. However, some therapies (like ABA- Applied Behavioural Analysis, DTT- Discrete Trial Training, and Symptomatic treatments, etc.) are there that show positive responses towards improvement from a disease state. Some crucial advancement has been achieved in the last decades. Here in the work we have focused on the diagnostic methods and treatment available for the symptoms of Autism. So, it can be said that the day is not too far away when the remedy to cut the curse of autism will be in our hands.

Effects of Remote Performance Feedback on Procedural Integrity of Early Intensive Behavioral Intervention Programs in China

In order to ensure the effects of early intensive behavioral interventions for children with autism, performance feedback is often used to improve procedural integrity. However, in areas where access to professionals is limited, onsite feedback may not be feasible. Researchers suggest that providing remote feedback may improve procedural integrity, but they often examined feedback along with other components. Thus, the purpose of this study is to investigate the effects of remote feedback alone on improving procedural integrity of discrete trial teaching (DTT) and incidental teaching (IT) of three interventionists in China. The interventionists received delayed remote feedback on either DTT or IT via video communication. Using an alternating treatment design, we directly compared the procedural integrity under the two conditions: with and without delayed remote feedback. Results showed that all interventionists improved procedural integrity only after feedback was introduced, suggesting that delayed remote feedback alone was effective in improving procedural integrity. The discussion addresses the practical and research implications of the findings.

Practical Functional Assessment: A Case Study Replication and Extension with a Child Diagnosed with Autism Spectrum Disorder

Recent literature has described the analysis and treatment of problem behavior that involves an open-ended interview to inform the conditions under which problem behavior is likely to occur, conducting a synthesized contingency analysis, and implementing treatment that includes functional communication training, delay and denial tolerance training, and increasing the amount of demands presented after a denial (e.g., Hanley et al. Journal of Applied Behavior Analysis, 47(1), 16–36, 2014). This process has been described as an Interview-Informed Synthesized Contingency Analysis (IISCA) or practical functional assessment. Much of the literature evaluating the practical functional assessment has originated from authors within the same research group. The purpose of the present study was to replicate and extend previous research on the practical functional assessment with a different group of researchers and in a different setting (i.e., an early intensive behavioral intervention clinic). This study sought to extend previous literature by including additional measures of social validity on the open-ended interview, contingency analysis, treatment, and pre-post measures on parental stress. The results were similar to previous research with an overall reduction in problem behavior and increases in functional communicative responses and compliance with demands.

EMERGENCE OF THE SKILLS THAT DEFINE NAMING IN CHILDREN WITH AUTISM

Individuals with autism lack flexibility to emit novel language. We explored the emergence of the skills that define the naming capacity in four young children with autism who received an early intensive behavioral intervention. They learned to tact objects or pictures (i.e., saying the name when seeing the object) then we probed, with no prompts or reinforcement, the emergence of selecting the same objects(pointing to the object or picture when hearing the name); they also learned to select a different set of items and we probed the emergence of tacts. Initially, two children did not demonstrate the emergence of any relation and the other two demonstrated the emergence of the selections. The procedure was repeated 15-21 months later. The first children demonstrated the emergence of the selections and the remaining children demonstrated the emergence of both selections and tacts. The results suggest that both selections and tacts can emerge in children with autism when they are taught with specific behavioral procedures.

Dishabituation of Operant Responding in Preschool-Aged Children

In applied settings, reinforcer satiation and the resulting response decrements may negatively affect otherwise effective treatments and can be difficult to avoid for some learners; previous research has suggested that a more precise explanation for these decrements may involve habituation to the sensory properties of repeatedly presented reinforcers, a process that carries with it different implications that may be useful in practice. One such implication is that habituated responding can undergo dishabituation, a recovery of habituated responding, following a brief stimulus change. The current study examined the effects of a dishabituation procedure on the operant responding of three children, all within the age range of children who typically receive early intensive behavioral intervention services. The participants engaged in an operant task in which they placed various task stimuli (e.g., pieces of foam, blocks, or poker chips) into a container in exchange for a small edible item or access to a toy. In each condition, once responding decreased to a predetermined level, the reinforcer (i.e., an edible) or an antecedent variable (i.e., the research assistant facilitating the task or the task stimulus) was changed for 2 min and then returned for an additional 2 min, whereas all other stimuli remained the same. Results indicated dishabituation patterns were observed in eight out of nine experimental conditions compared to control (no change) conditions in which responding did not recover, suggesting dishabituation procedures may provide options for at least temporarily reinstating the effectiveness of reinforcers.

Effectively Integrating Direct Instruction and Discrete Trial Training Across Routines, Activities, and Environments

With young children, there is often an instructional focus on naturalistic interactions between the child and environment. In special education, there are times when direct instruction (di) and discrete trial training (DTT) are both needed, requiring a balance of explicit DTT and child-initiated instruction. This article discusses what individually and developmentally appropriate di and DTT practice and real-life examples look and sound like, and explains how to embed them across routines, activities, and environments.

The Effect of a Mediation-Blocking Task on the Acquisition of Instructive Feedback Targets.

The inclusion of instructive feedback in discrete-trial training has been shown to increase the efficiency of learning. However, the behavioral mechanism underlying the effectiveness of this procedure has not yet been determined. Researchers have suggested that learners covertly self-echo the feedback, which mediates later responding. The present study sought to understand the role of self-echoics in the acquisition of untaught targets. Participants were directly taught to tact pictures, then given instructive feedback after the praise statement. The 3 experimental conditions were (a) a typical instructive feedback procedure; (b) a vocal mediation-blocking procedure, in which the participants were asked to engage in a competing vocal response immediately after the instructive feedback; and (c) a motor-distraction procedure, in which the participants were asked to engage in a motor response immediately after the instructive feedback. The inclusion of the vocal mediation-blocking task had little effect on the participants' ability to learn the instructive feedback targets for all 3 participants.

Autism Beyond Early Intensive Behavioral Intervention

Autism spectrum disorder (ASD) affects many individuals worldwide. Researchers have identified effective interventions for teaching new skills and reducing challenging behaviors that have resulted in improvements in the lives of individuals with ASD and their families. Namely, assessments and interventions based on the science of behavior analysis have strong empirical support for improving the quality of life of individuals with ASD. Although beneficial, the majority of this research has involved young children, which is not always easily applied to adolescents and adults due to unique characteristics of this population. This special issue addresses the need for research with older individuals with ASD by presenting a variety of papers evaluating behavioral interventions for adolescents and adults and discussing the specific needs related to this population.

Systematic Review of Matrix Training for Individuals With Autism Spectrum Disorder

Matrix training is an intervention that systematically programs for the occurrence of generative outcomes, mostly in the area of language. A literature search identified studies that evaluated matrix training with individuals with autism spectrum disorder (ASD). Based on 12 reviewed studies, we asked questions regarding participant characteristics, targeted skills, matrix designs, evidence-based teaching strategies, percentage of learning that occurred through direct teaching and recombinative generalization, and the quality of the studies. With 29 total participants, mostly preschool and elementary ages, the most common teaching strategy implemented was a discrete trial training paradigm targeting language development. Overall, findings suggest that matrix training produced an average of 69% of learning without direct teaching across the areas of language, play, sentence construction, and spelling.

7.3 BEHAVIORAL INTERVENTIONS FOR ASD: A REVIEW OF THE EVIDENCE AND EMERGING TECHNOLOGIES

The goal of this session is to review the latest evidence for behavioral interventions in ASD, including early intensive behavioral intervention, the Early-Start Denver Model, applied behavioral analysis, joint attention symbolic play engagement regulation, pivotal response training group, social skills training, and CBT. This presentation also aims to review the emerging integration of technology into behavioral therapies for ASD core symptoms, executive functioning, and emotion regulation.

Comparing Neighborhoods of Children With Autism Spectrum Disorder in a Medicaid Waiver Program and a State Population, 2007-2015.

This study investigated equity in enrollment in a Medicaid waiver program for early intensive behavioral intervention for children with autism spectrum disorder (ASD). State administrative, Medicaid, and U.S. Census data for children enrolled in the waiver program between 2007 and 2015 (N=2,111) were integrated. Multivariate and bivariate analyses were used to compare enrollees' neighborhood demographic characteristics with those of the state's general population, with controls for enrollees' age, sex, and race-ethnicity. Findings indicate that in general, enrollment was equitable. During the years in which there were inequities, children who lived in neighborhoods of privilege were favored. These neighborhoods had higher median incomes, lower poverty levels, and fewer female-headed households and were located in urban areas. As states work to provide equitable treatment to children with ASD and their families, it is important to track potential inequities between children who do and do not enroll in services and to use this information to inform outreach efforts. States may turn to South Carolina for insight on how to ensure equity.

A Structured Intervention to Increase Response Allocation to Instructional Settings for Children with Autism Spectrum Disorder

Access to early intensive behavioral intervention for children with autism spectrum disorder is commonly recommended. Intervention programs may include high rates of instructional trials, which may evoke escape-maintained problem behavior. Recent research on “pairing” or “rapport-building” interventions have sought to reduce the likelihood that problem behavior occurs during instruction using antecedent manipulations. The current study evaluated a structured intervention that included differential reinforcement and demand fading to increase participants’ response allocation to instructional settings without the use of physical guidance. Nine minimally verbal girls under the age of 6 years with autism spectrum disorder enrolled in the study. The protocol was effective for seven of the nine participants. One participant did not complete the protocol due to competing behavior and an additional participant did not require the intervention. Our findings suggest that the structured intervention was effective in increasing appropriate behavioral repertoires that are necessary for children with autism spectrum disorder to effectively benefit from early educational programs.

A comparison of mand training and discrete trial training on the acquisition of vocal mands suggests that an antecedent verbal stimulus may inhibit independent manding

Q (1) Is mand training or discrete trial training (DTT) more effective in increasing the rate of acquisition of independent vocal mands?(2) What teaching procedures can produce a transfer of stimul...

The effects of early autism intervention on parents and family adaptive functioning.

This review describes the effects of intervention for young children with autism spectrum disorder (ASD) on parents. Like all children, children with ASD bring both negative and positive experiences for parents and families-from increased resource needs, to higher levels of parenting-related stress, to positive personal growth for family members. It is increasingly recognized that, although children with ASD are the primary targets of early ASD intervention, ASD intervention also impacts parents. From the time emerging developmental concerns begin to be identified, through the process of obtaining a diagnosis and initiating services, parents play a central role in addressing the needs of young children with ASD, including implementing and supporting early intervention. Parents experience the impact of intervention directly, through interaction with providers within the health care and educational systems. Parents also experience indirect impacts of ASD intervention due to accelerated developmental progress of children who are benefitting from services and when children make slower progress than expected or have challenging behaviors. Parental stress and psychological well-being are legitimate targets of intervention and compelling research objectives, needing no additional justification. However, parents are also the major contributors to family adaptive functioning-the activities families employ to support positive outcomes for children with ASD (e.g., family-orchestrated child experiences, parent-child interaction, child health and safety functions; Guralnick, 1997). A parent's ability to carry out adaptive functions is, in part, related to their levels of stress and psychological well-being. Thus, there is a transactional process in which parents are both impacted by and have an impact on ASD interventions for their child. Evaluating the effect of ASD intervention on parents is needed to develop new strategies for helping parents and children with ASD reach their full potential. This review will provide an overview of research on the impact of early ASD intervention on parents. Evidence regarding the impact of three types of intervention (i.e., early intensive behavioral intervention, parent-implemented intervention, and programs directly targeting parent stress) on parent well-being and family adaptive functioning will be reviewed. Potential moderators of the impact of ASD intervention on parents and family adaptive functioning will be discussed. We conclude that research on the impact of ASD intervention on parents of young children with ASD is a promising avenue for improving the lives of children with ASD and their families.

Behavioral Pediatrics Meets Behavioral Economics: Autism, Mandates, and High Deductibles

* Abbreviation: ASD — : autism spectrum disorder We do not yet know what causes autism spectrum disorder (ASD), but we do know that early intensive behavioral intervention for children with ASD can improve outcomes.1,2 The cost is high, but, from a societal point of view, the benefit will likely outweigh the cost both financially and clinically.3,4 Yet financial barriers, particularly among patients with private insurance, can prevent children and families from receiving needed services.5 Recognizing this, policy makers in many states passed laws mandating that commercial insurers cover ASD-specific interventions. Mandates improved access to care by increasing use of ASD-specific services, particularly in younger children, suggesting that the new policy was effective and increased access to autism treatment of children covered by commercial insurance.6 In addition, more children were diagnosed with ASD in the states with ASD mandates, suggesting that providers were more likely to make the diagnosis when the payment system allowed for early treatment.7 Neither of these findings are surprising; the experience with Medicaid’s Early and Periodic Screening Diagnostic and Treatment suggested that expanding benefits expands access.8 … Address correspondence to David Keller, MD, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 E 16th Ave, B065, Denver, CO 80045. E-mail: david.keller{at}childrenscolorado.org