Update on the MCHB Autism Intervention Research Network on Behavioral Health
April 15, 2014
The Autism Intervention Research Network on Behavioral Health consists of a group of senior researchers, junior faculty and trainees at seven different research centers who are focused on delivering behavioral interventions to under-resourced, under-served and under-represented children with autism spectrum disorder (ASD). Supported by the Maternal and Child Health Bureau, the goal of both AIR-B I (2008-2011) and AIR-B II (2011-2014) has been to develop novel, evidence-based interventions for children from low-resource community settings.
Research Studies of the Network:
We have implemented five large cross-site randomized controlled trials (RCTs), all in low resource community settings, as well as several descriptive and smaller scale intervention studies. In AIR-B I we completed three RCTs. One study compared two parent-mediated interventions targeting core deficits in preschoolers in under-resourced homes. A second study compared two different social skills programs for children in under resourced schools. A third study, leveraged with additional funding, implemented two peer-mediated social inclusion interventions in secondary schools. Smaller projects included a pilot study of an intervention for teaching assistants to foster inclusion during recess and another pilot study focusing on enhancing the peer relationships of girls with ASD. Papers are currently published, in press or under review, with most still embargoed.
Our experience from AIR-B I galvanized us to move even further into the community. In AIR-B II we proposed a community-partnered participatory research approach to delivering interventions in low-resourced school districts, in order to reach the most under-served children with ASD and to test the exportability of our interventions. Together with our community partners we chose and are currently implementing two interventions in urban schools that serve students from economically disadvantaged households. One intervention is based in special education classrooms and focuses on helping students make transitions between activities throughout their daily routine. The second intervention focuses on the recess inclusion intervention pilot-tested in AIR-B I. A theme that cuts across all AIR-B II projects is tailoring interventions that address community needs and are accessible to school staff and parents alike.
Highlights:
Caregiver-Mediated Intervention for Low-Resourced Preschoolers
with Autism: A RCT
Young children with autism spectrum disorder (ASD) have core deficits in engaging in play with others, and initiating effective social communication gestures. These skills are important to children's later development of social and language skills. In this cross-site study of 112 low-resourced preschoolers and their parents, families were randomized to receive active parent coaching on teaching social communication skills, particularly targeting joint attention with their children in the home or to a parent education group format in which parents received instruction on the same social communication goals but no active coaching. Both intervention groups received two hours of intervention weekly for twelve weeks with one twelve-week follow up. This study was unique in its focus on parents of under-resourced children, with intervention delivered in their homes or neighborhoods, and emphasis on the core developmental impairments of young children with ASD. Pediatrics, accepted for publication.
Social experiences of girls with ASD at school
ASD affects more boys than girls, and we have little information on the social functioning of girls with ASD in school. AIR-B researchers have published two studies that explored the social experiences of girls with ASD at school. The first study was a qualitative, in depth analysis of girls interacting with each other over several weeks. This discourse analysis was based on 12 hours of video footage collected during 16 'lunch club' sessions among four girls, one with ASD. Of interest in this study was how girls may sanction relationships that exclude others based on subtle nuanced interactions. Results found that the persistence in topic by the girl with ASD and her limited attention to subtle conversational cues resulted in greater exclusion within the group over time. In contrast to boys who often engage with each other in structured, physical games, girls with ASD may require specialized interventions to guide their inclusion within girl groups. Full study details are available in Discourse Studies, 2013, 15 (2), 147-166.
The second study examined the social networks of 100 girls and boys with and without ASD, closely matched on IQ, gender, and classroom placement. Children completed a friendship survey about their friends in the class and groups that played together at recess. From this survey we obtained information about social preferences and acceptance, social connections, reciprocal friendships, and rejection experiences. The study is the first study to examine gender in children with ASD's social relationships, and results yielded some unique considerations for girls at school. Journal of Child Psychology and Psychiatry, accepted for publication.
Remaking Recess: Targeting paraprofessionals on the school playground
This small, randomized trial yielded important pilot and feasibility data that guided the development of the cross- site intervention study we are currently implementing in urban schools. Children in four schools were randomized to receive immediate intervention or later (wait-listed) intervention. Paraprofessionals on the playground were taught to intervene with target children and to engage all children in games or activities with the goal of improving peer engagement on the playground. The results of this study will appear in Behavior Therapy.
School interventions: Perceptions of teachers, parents and administrators
In preparation for implementation of interventions in schools, focus groups were conducted across three urban school districts. Altogether 35 parents and 89 educators participated in these focus groups. Three themes emerged from the groups and were remarkably consistent across the large and diverse urban school districts: tension among stakeholders, need for improved staff training, and acceptance of differences. The study results have been submitted for publication. Results also led to the selection and implementation of two school -based interventions across the three districts. These interventions center on peer engagement on the playground and management of classroom behaviors and transitions. Teachers and paraprofessionals have been taught interventions with support from AIR-B researchers; completion of these studies is scheduled for 2014.
GUIDELINES and TOOLS
A systematic review of behavioral interventions focused on the core deficits of ASD was published in Pediatrics supplement, November 2012. This guideline provides information on evidence-based behavioral interventions for parents and professionals. Full details can be found in Pediatrics 2012; 130:S169-S178
Several tools also have been produced by the network, and these can be found on our website, www.airbnetwork.org. Tools include our remaking recess materials for paraprofessionals, social menus for lunchtime conversation building, and the Playground Observation of Peer Engagement (POPE) measure.
AIR-B participating sites: UCLA (lead site; Connie Kasari, PhD), Cornell-Weill Medical Center (Catherine Lord, PhD), Florida State University (Amy Wetherby, PhD), Kennedy Kreiger Institute (Rebecca Landa, PhD), University of Pennsylvania (David Mandell, ScD), University of Rochester (Tristram Smith, PhD), University of Washington (Bryan King, MD).
