A systematic review of peer-mediated interventions for children with autism spectrum disorder. Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial A randomized controlled trial of preschool-based joint attention intervention for children with autism. Preschool Deployment of Evidence-Based Social Communication Intervention: JASPER in the Classroom Brief Report: Mediation of Treatment Effect in a Communication Intervention for Pre-School Children with Autism The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder. Social-communicative effects of the Picture Exchange Communication System (PECS) in autism spectrum disorders. Preschool-based social communication treatment for children with autism: 12-month follow-up of a randomized trial. Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Clinical assessment of autism in high-risk 18-month-olds Cognitive, behavior and intervention outcome in young children with autism. Caregiver-Mediated Intervention for Low-Resourced Preschoolers With Autism: An RCT Cognitive remediation therapy (CRT) for young early onset patients with schizophrenia: An exploratory randomized controlled trial Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Incorporating a Peer-Mediated Approach Into Speech-Generating Device Intervention: Effects on Communication of Preschoolers With Autism Spectrum Disorder. Outcomes of children receiving Group-Early Start Denver Model in an inclusive versus autism-specific setting: A pilot randomized controlled trial Joint attention training for children with autism using behavior modification procedures. Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder Randomized Controlled Trial for Early Intervention for Autism: A Pilot Study of the Autism 1-2-3 Project A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder Early Intervention with a Parent-Delivered Massage Protocol Directed at Tactile Abnormalities Decreases Severity of Autism and Improves Child-to-Parent Interactions: A Replication Study Teacher-implemented joint attention intervention: pilot randomized controlled study for preschoolers with autism. Assessment of knowledge about childhood autism among paediatric and psychiatric nurses in Ebonyi state, Nigeria A trial of an iPad™ intervention targeting social communication skills in children with autism Early behavioral intervention is associated with normalized brain activity in young children with autism. Parent-Implemented Social Intervention for Toddlers With Autism: An RCT Learning through interaction in children with autism: Preliminary data from asocial-communication-based intervention Cost Offset Associated With Early Start Denver Model for Children With Autism.
BACKGROUND Peer mediated intervention ( PMI ) is a promising practice used to increase social skills in children with autism spectrum disorder ( ASD ) .  PMIs engage typically developing peers as social models to improve social initiations , responses , and interactions . METHOD The current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group design s. Five studies met the pre-specified review inclusion criteria : four r and omized controlled trials and one pre- and post-test design . RESULTS Four of the studies were conducted in school setting s , whereas one study was conducted in a camp setting . The studies all reported that participants improved in social skills ( e.g. , social initiations , social responses , social communication ) post intervention . Additionally , sustainment , generalization , and fidelity of implementation were examined . CONCLUSION PMI is a promising approach to address social skills in children with ASD , and this approach can be conducted in meaningful real-word context s , such as schools . Limitations of the studies as well as future directions are discussed Summary Background Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children . We therefore investigated the efficacy of such an intervention in a larger trial . Methods Children with core autism ( aged 2 years to 4 years and 11 months ) were r and omly assigned in a one-to-one ratio to a parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention or treatment as usual at three specialist centres in the UK . Those assigned to PACT were also given treatment as usual . R and omisation was by use of minimisation of probability in the marginal distribution of treatment centre , age ( ≤42 months or > 42 months ) , and autism severity ( Autism Diagnostic Observation Schedule-Generic [ ADOS-G ] algorithm score 12–17 or 18–24 ) . Primary outcome was severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months . Complementary secondary outcomes were measures of parent-child interaction , child language , and adaptive functioning in school . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N58133827 . Results 152 children were recruited . 77 were assigned to PACT ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=25 ] ) ; and 75 to treatment as usual ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=23 ] ) . At the 13-month endpoint , the severity of symptoms was reduced by 3·9 points ( SD 4·7 ) on the ADOS-G algorithm in the group assigned to PACT , and 2·9 ( 3·9 ) in the group assigned to treatment as usual , representing a between-group effect size of −0·24 ( 95 % CI −0·59 to 0·11 ) , after adjustment for centre , sex , socioeconomic status , age , and verbal and non-verbal abilities . Treatment effect was positive for parental synchronous response to child ( 1·22 , 0·85 to 1·59 ) , child initiations with parent ( 0·41 , 0·08 to 0·74 ) , and for parent-child shared attention ( 0·33 , −0·02 to 0·68 ) . Effects on directly assessed language and adaptive functioning in school were small . Interpretation On the basis of our findings , we can not recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms ; however , a clear benefit was noted for parent-child dyadic social communication . Funding UK Medical Research Council , and UK Department for Children , Schools and Families BACKGROUND Deficits in joint attention ( JA ) and joint engagement ( JE ) represent a core problem in young children with autism as these affect language and social development . Studies of parent-mediated and specialist-mediated JA-intervention suggest that such intervention may be effective . However , there is little knowledge about the success of the intervention when done in preschools . AIM Assess the effects of a preschool-based JA-intervention . METHODS 61 children ( 48 males ) with autistic disorder ( 29 - 60 months ) were r and omized to either 8 weeks of JA-intervention  , in addition to their preschool programs  ( n = 34 ) , or to preschool programs only  ( n = 27 ) . The intervention was done by preschool teachers with weekly supervision by trained counselors from Child and Adolescent Mental Health Clinics ( CAMHC ) . Changes in JA and JE were measured by blinded independent testers using Early Social Communication Scale ( ESCS ) and video taped preschool teacher-child and mother-child play at baseline and post-intervention . CLINICAL TRIALS REGISTRATION Clinical trials.gov : NCT00378157 . RESULTS Intention-to-treat analysis showed significant difference between the intervention and the control group , with the intervention group yielding more JA initiation during interaction with the preschool teachers . The effect generalized to significantly longer duration of JE with the mothers . CONCLUSIONS This is the first r and omized study to show positive and generalized effects of preschool-based JA-intervention Few research -developed early intervention models have been deployed to and tested in real world preschool programs . In this study , teaching staff implemented a social communication modularized intervention , JASPER , in their daily program . Sixty-six preschool children with autism in twelve classrooms ( 12 teachers ) were r and omized to receive immediate JASPER training ( IT ) or were waitlisted ( WL ) for 3 months with a 1-month follow up . Measures of core deficits ( initiations of joint engagement , joint attention gestures and language , play skills ) and st and ardized cognitive measures were improved for IT over WL children . IT teachers achieved and maintained high fidelity .  Teachers can implement evidence -based interventions with significant improvements in core deficits of their children with ASD Tests of mediation in treatment trials can illuminate processes of change and suggest causal influences in development . We conducted a mediation analysis of a previously published r and omised controlled trial of parent-mediated communication-focused treatment for autism against ordinary care , with 28 children aged 2–5 years ( Aldred et al. in J Child Psychol Psychiatr 45:1–11 , 2004 ) . The hypothesised mediating process , targeted by the intervention , was an increase in parental synchronous response within parent – child interaction . The results showed partial mediation , with change in synchrony accounting for 34 % of the positive intervention effect on autism symptomatology ( Autism Diagnostic Observation Schedule communication and social domain algorithm ) ; the result was confirmed by bootstrap estimation . Improved parental synchronous response to child communication can alter short-term autism symptom outcome with targeted therapy BACKGROUND Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment ( PLI ) or social communication disorder ( SCD ) . Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder ( ASD ) . There is little robust evidence of effectiveness of speech- language interventions which target the language , pragmatic or social communication needs of these children . AIMS To evaluate the effectiveness of an intensive manualized social communication intervention ( SCIP ) for children who have PLI with or without features of ASD . METHODS & PROCEDURES In a single-blind RCT design , 88 children with pragmatic and social communication needs aged 5;11 - 10;8 , recruited from UK speech and language therapy services , were r and omly assigned in a 2:1 ratio to SCIP or to treatment-as-usual . Children in the  SCIP  condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants . All therapy content and methodology was derived from an intervention manual . A primary outcome measure of structural language and secondary outcome measures of narrative , parent-reported pragmatic functioning and social communication , blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention , immediately post-intervention and at 6-month follow-up . Analysis was by intention to treat . OUTCOMES & RESULTS No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability . Significant treatment effects were found for blind-rated perceptions of conversational competence , for parent-reported measures of pragmatic functioning and social communication , and for teacher-reported ratings of classroom learning skills . CONCLUSIONS & IMPLICATION S There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes , but not st and ardized language assessment outcomes , for 6 - 11-year-old children who have pragmatic and social communication needs . These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention . The substantial overlap between the presence of PLI and ASD ( 75 % ) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs BACKGROUND The Picture Exchange Communication System ( PECS ) is a common treatment choice for non-verbal children with autism . However , little empirical evidence is available on the usefulness of PECS in treating social-communication impairments in autism . AIMS To test the effects of PECS on social-communicative skills in children with autism , concurrently taking into account st and ardized psychometric data , st and ardized functional assessment of adaptive behaviour , and information on social-communicative variables coded in an unstructured setting . METHODS & PROCEDURES Eighteen preschool children ( mean age = 38.78 months ) were assigned to two intervention approaches , i.e. PECS and Conventional Language Therapy ( CLT ) . Both PECS ( Phases I-IV ) and CLT were delivered three times per week , in 30-min sessions , for 6 months . Outcome measures were the following : Autism Diagnostic Observation Schedule ( ADOS ) domain scores for Communication and Reciprocal Social Interaction ; Language and Personal-Social subscales of the Griffiths ' Mental Developmental Scales ( GMDS ) ; Communication and Social Abilities domains of the Vinel and Adaptive Behavior Scales ( VABS ) ; and several social-communicative variables coded in an unstructured setting . OUTCOMES & RESULTS Results demonstrated that the two groups did not differ at Time 1 ( pre-treatment assessment ) , whereas at Time 2 ( post-test ) the PECS group showed a significant improvement with respect to the CLT group on the VABS social domain score and on almost all the social-communicative abilities coded in the unstructured setting ( i.e. joint attention , request , initiation , cooperative play , but not eye contact ) . CONCLUSIONS & IMPLICATION S These findings showed that PECS intervention ( Phases I-IV ) can improve social-communicative skills in children with autism . This improvement is especially evident in st and ardized measures of adaptive behaviour and measures derived from the observation of children in an unstructured setting OBJECTIVE This study reports 12-month follow-up data from a r and omized controlled trial of preschool-based social communication treatment for young children with autism . METHOD A total of 61 children ( 48 males ) with autism , 29 to 60 months of age , had earlier been r and omized either to 8 weeks of preschool-based social communication treatment in addition to st and ard preschool program ( n = 34 ) or to st and ard preschool program only ( n = 27 ) . Significant short-term effects on targeted social communication skills have previously been published . Long-term gains in social communication , language and global social functioning and communication were assessed from video-taped preschool teacher-child and mother-child interactions , Early Social Communication Scales , Reynell Developmental Language Scale , and Social Communication Question naire . RESULTS Compared with those in the control group , the treated children achieved significantly larger improvements in joint attention and joint engagement from baseline to 12-month follow-up . However , no effects were detected on language and global ratings of social functioning and communication . The treatment effect on child initiation of joint attention increased with increasing level of sociability at baseline , whereas nonverbal IQ and expressive language had no moderating effect . CONCLUSIONS This study is the first to show that , similar to specialist-delivered treatment , preschool-based treatment may produce small but possibly clinical ly important long-term changes in social communication in young children with autism . The treatment did not affect language and global ratings of social functioning and communication . More studies are needed to better underst and whether treatment effects may be improved by increasing the intensity and duration of the treatment . Clinical trial registration information -- Joint Attention Intervention and Young Children With Autism ; http:// clinical trials.gov/ ; NCT00378157 BACKGROUND Autism spectrum disorder affects more than 5 million children in south Asia . Although early interventions have been used for the treatment of children in high-income countries , no substantive trials have been done of the interventions adapted for use in low-income and middle-income countries ( LMICs ) . We therefore assessed the feasibility and acceptability of the parent-mediated intervention for autism spectrum disorder in south Asia ( PASS ) in India and Pakistan . METHODS A single-blind r and omised trial of the comparison of 12 sessions of PASS ( plus treatment as usual ) with treatment as usual alone delivered by non-specialist health workers was done at two centres in Goa , India , and Rawalpindi , Pakistan . Children aged 2 - 9 years with autism spectrum disorder were r and omly assigned ( 1:1 ) by use of probabilistic minimisation , controlling for treatment centre ( Goa or Rawalpindi ) , age ( < 6 years or ≥6 years ) , and functional impairment ( Vinel and Adaptive Behaviour Scale Composite score < 65 or ≥65 ) . The primary outcome was quality of parent-child interaction on the Dyadic Communication Measure for Autism at 8 months . Analysis was by intention to treat . The study is registered with IS RCT N , number IS RCT N79675498 . FINDINGS From Jan 1 to July 30 , 2013 , 65 children were r and omly allocated , 32 to the PASS group ( 15 in Goa and 17 in Rawalpindi ) and 33 to the treatment-as-usual group ( 15 in Goa and 18 in Rawalpindi ) . 26 ( 81 % ) of 32 participants completed the intervention . After adjustment for minimisation factors and baseline outcome , the primary outcome showed a treatment effect in favour of PASS in parental synchrony ( adjusted mean difference 0·25 [ 95 % CI 0·14 to 0·36 ] ; effect size 1·61 [ 95 % CI 0·90 to 2·32 ] ) and initiation of communication by the child with the parent ( 0·15 [ 0·04 to 0·26 ] ; effect size 0·99 [ 0·29 to 1·68 ] ) , but time in mutual shared attention was reduced ( -0·16 [ -0·26 to -0·05 ] ; effect size -0·70 [ -1·16 to -0·23 ] ) . INTERPRETATION Our results show the feasibility of adapting and task-shifting an intervention used in a high-income context to LMICs . The findings also replicate the positive primary outcome treatment effects of a parent-mediated communication-focused intervention in the original UK Preschool Autism Communication Trial , with one negative effect not reported previously . FUNDING Autism Speaks , USA BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD UNLABELLED The relations between cognition and autism severity , head size and intervention outcome , were examined . Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities ( DD ) . Eighty-one children ( mean age 25.9 months ) with autism ( n=44 ) and DD ( n=37 ) were assessed at pre- and post 1 year of intervention . Cognitive abilities and autism severity were measured by st and ardized tests . Three pre-intervention cognitive level groups : normal ( IQ>90 ) , borderline ( 70<IQ<89 ) and impaired ( 50<IQ<69 ) were examined . The impaired group had more severe autism symptoms than the borderline and the normal cognitive groups . However , following intervention the groups did not differ in the change in core autism symptoms . IQ scores increased significantly more in the autism group than in the DD group . IQ improvements correlated significantly with reduction in autism symptoms and mostly in stereotyped behaviors . CONCLUSIONS Cognitive ability in autism is associated with autism severity . Two distinct subtypes based on cognitive level are identified . However , baseline cognitive level can not predict the progress rate in autism symptoms with intervention . Improvement of social-communicative behaviors and the intensive intervention are related to significant cognitive increments in autism OBJECTIVES : To compare 2 short-term , community caregiver training interventions for preschool-aged children with Autism Spectrum Disorder who had low re sources . Low re source was defined by the US Department of Housing and Urban Development low-income index or 1 “ indicator , ” ( eg , Medicaid eligibility ) . Child outcomes focused on joint engagement , joint attention , and play . METHODS : Participants included 112 families of a child who had Autism Spectrum Disorder who met criteria for being low-re source d and who were r and omly assigned to 1 of 2 3-month interventions , group caregiver education or individualized caregiver-mediated intervention ( CMM ) .  Children were assessed for social communication skills pre- and post-treatment , and followed up at 3 months . RESULTS : All children improved in joint engagement and initiating joint attention , with significantly greater improvement by the CMM group . Outcomes on play skills were mixed , with improvement of symbolic play for the CMM group and no change in functional play skills . Joint engagement maintained over time for the CMM group , and initiating joint attention maintained for both groups over time . CONCLUSIONS : This study is among the first r and omized trials comparing 2 active interventions with a large sample of low-re source d families . Results suggest improvements in core autism deficits of joint engagement , joint attention , and symbolic play with relatively brief , caregiver-mediated interventions , but additional support is necessary to maintain and generalize these gains over time BACKGROUND Schizophrenia with an onset in adolescence is known to be associated with a poorer outcome and cognitive difficulties . These impairments have an impact on quality of life and represent treatment targets . Cognitive remediation therapy ( CRT ) attempts to improve cognitive deficits by teaching information processing strategies through guided mental exercises . The objective of this study is to evaluate the efficacy of CRT in alleviating cognitive deficits compared to treatment as usual and explore the mediating and moderating effects of cognitive improvement . METHOD Single-blind r and omized controlled trial with two groups , one receiving CRT ( N21 ) and the other st and ard care ( N19 ) assessed at baseline , 3 months ( post therapy ) and follow-up ( 3 months post therapy ) . Participants were recruited from specialist inpatient and community mental health services and were young patients with recent onset schizophrenia ( average age of 18 ) and evidence of cognitive and social behavioural difficulties . The intervention was individual cognitive remediation therapy delivered over a period of 3 months with at least three sessions per week . The main outcome measures were cognition ( memory , cognitive flexibility and planning ) and secondary outcomes ( symptoms , social contacts and self-esteem ) . RESULTS Compared to st and ard care , CRT produced significant additional improvements in cognitive flexibility as measured by the Wisconsin Card Sort Test ( WCST ) . Therapy moderated the effects of improved planning ability on symptoms such that improvements only had a beneficial effect when they were achieved in the context of CRT .  Improvements in cognition in all domains had a direct effect on social functioning and improvements in WCST had a direct effect on overall symptom improvement . CONCLUSIONS Cognitive remediation therapy can contribute to the improvement in WCST even in adolescents . The changes in cognitive outcomes also contributed to improvements in functioning either directly or solely in the context of CRT . Evidence of the mediator and moderator effects of cognitive changes should lead to more effective therapy development OBJECTIVE Risperidone has been found efficacious for decreasing severe tantrums , aggression , and self-injurious behavior in children and adolescents with autistic disorder ( autism ) . The authors report on whether risperidone improves the core symptoms of autism , social and communication impairment and repetitive and stereotyped behavior . METHOD The data base from an 8-week double-blind , placebo-controlled trial ( N=101 ) and 16-week open-label continuation study ( N=63 ) of risperidone for children and adolescents with autism was used to test for drug effects on secondary outcome measures : scores on the Ritvo-Freeman Real Life Rating Scale , the Children 's Yale-Brown Obsessive Compulsive Scale , and the maladaptive behavior domain of the Vinel and Adaptive Behavior Scales . RESULTS Compared to placebo , risperidone led to a significantly greater reduction in the overall score on the Ritvo-Freeman Real Life Rating Scale , as well as the scores on the subscales for sensory motor behaviors ( subscale I ) , affectual reactions ( subscale III ) , and sensory responses ( subscale IV ) . No statistically significant difference was observed , however , on the subscale for social relatedness ( subscale II ) or language ( subscale V ) . Risperidone also result ed in significantly greater reductions in scores on the Children 's Yale-Brown Obsessive Compulsive Scale and Vinel and maladaptive behavior domain . This pattern of treatment response was maintained for 6 months . CONCLUSIONS Risperidone led to significant improvements in the restricted , repetitive , and stereotyped patterns of behavior , interests , and activities of autistic children but did not significantly change their deficit in social interaction and communication . Further research is necessary to develop effective treatments for the core social and communicative impairments of autism Purpose This study examined the effects of incorporating a peer-mediated approach into a speech-generating device ( SGD ) intervention on communication of 45 nonverbal and minimally verbal preschoolers with autism spectrum disorder ( ASD ) and 95 peers without disabilities . The SGD was an iPad 2 ( Apple ) with voice output app . Method Effects were evaluated using a multivariate r and omized control trial design with repeated measures for 4 cohorts across baseline , intervention , generalization , and maintenance phases . Children were r and omly assigned to an experimental treatment that trained peers on use of the SGD or a business-as-usual comparison condition with untrained peers .  Communication outcomes were measured for both children with ASD and peers . Results Children receiving the treatment demonstrated significant increases in rates of communication and more balanced responses and initiations ( a measure of reciprocity ) than children in the comparison group . They were able to generalize improvements and maintain communication gains . Treatment fidelity was high for school staff and peer implementation . Conclusions Results support positive effects on communication of teaching young children with ASD and peers without disabilities to use the same SGD system in typical preschool activities . SGD interventions that utilize peer-mediated approaches may improve core deficits in communication and reciprocity and allow for greater classroom social participation and interactions with peers A major topic of debate is whether children with autism spectrum disorder should be educated in inclusive or specialized setting s. We examined the feasibility and preliminary effectiveness of delivering the Group-Early Start Denver Model to children with autism spectrum disorder in inclusive versus specialized classrooms . We r and omly assigned 44 preschoolers with autism spectrum disorder to receive the Group-Early Start Denver Model  across one school calendar year in classrooms that included only children with autism spectrum disorder or mostly children who were typically developing .  Blind-rated indicators of teaching quality showed similar results across setting s , which were above the local benchmark . Children showed improvements across blinded proximal measures of spontaneous vocalization , social interaction , and imitation and across distal measures of verbal cognition , adaptive behavior , and autism symptoms irrespective of intervention setting . Mothers of participants experienced a reduction in stress irrespective of child intervention setting . Across both setting s , age at intervention start was negatively associated with gains in verbal cognition . Delivery of Group-Early Start Denver Model in an inclusive setting appeared to be feasible , with no significant differences in teaching quality and child improvements when the program was implemented in inclusive versus specialized classrooms BACKGROUND Deficits in joint attention are considered by many research ers to be an early predictor of childhood autism ( e.g. , Osterling & Dawson , 1994 ) and are considered to be pivotal to deficits in language , play , and social development in this population ( Mundy , 1995 ) . Although many research ers have noted the importance of joint attention deficits in the development of children with autism ( e.g. , Mundy , Sigman , & Kasari , 1994 ) and have called for intervention strategies ( e.g. , Mundy & Crowson , 1997 ) , few studies have attempted to target joint attention . In this study , joint attention behaviors were taught to children with autism using a behavior modification procedure . METHODS A multiple-baseline design was implemented to evaluate intervention effects . The following target behaviors were included in the intervention : 1 )  Responding to showing , pointing , and gaze shifting of adult ;  2 ) Coordinated gaze shifting  ( i.e. , coordinated joint attention ) ; and 3 )  Pointing ( with the purpose of  sharing  , not requesting ) . Generalization to setting and parent , follow-up sessions , and social validation measures were also analyzed . RESULTS Joint attention behaviors were effectively trained and targeted behaviors generalized to other setting s. In addition , positive changes were noted by naive observers using social validation measures . CONCLUSIONS Integrating joint attention training into existing interventions may be important for children with autism . In addition , training parents in these techniques may help to maintain joint attention skills outside of the treatment setting The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention We piloted a 2-week “ Autism-1 - 2 - 3 ” early intervention for children with autism and their parents immediately after diagnosis that targeted at ( 1 ) eye contact , ( 2 ) gesture and ( 3 ) vocalization/words .  Seventeen children were r and omized into the Intervention ( n = 9 ) and Control ( n = 8) groups . Outcome measures included the Autism Diagnostic Observation Schedule , Ritvo-Freeman Real Life Rating Scale , Symbolic Play Test , and Parenting Stress Index .  Children with autism improved in language /communication , reciprocal social interaction , and symbolic play . Parents perceived significant improvement in their children ’s language , social interaction , and their own stress level . This intervention can serve as short-term training on communication and social interaction for children with autism , and reduce the stress of their parents during the long waiting time for public health services BACKGROUND Technology-based interventions for Autism Spectrum Disorder ( ASD ) have proliferated , but few have been evaluated within the context of a r and omised controlled trial ( RCT ) . This RCT evaluated the efficacy of one technology-based early intervention programme ( Therapy Outcomes By You ; TOBY ) in young children with ASD . METHODS TOBY is an app-based learning curriculum design ed for children and parents as a complement to early behavioural intervention . Eighty children ( 16 female ) were recruited to this RCT within 12 months of receiving a diagnosis of ASD ( M age = 3.38 ; SD = 0.69 ) and r and omised to receive either treatment-as-usual ( community-based intervention , n = 39 ) or the TOBY therapy ( at least 20 min/day ) plus treatment-as-usual ( n = 41 ) for a period of 6 months . Outcomes were assessed at 3 and 6 months postbaseline . ( Australian New Zeal and Clinical Trials Registry : ACTRN12614000738628 ; www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=365463 ) . RESULTS Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months , but only 2 min/day during the second 3 months . There was no group difference in scores on the primary outcome , the Autism Treatment Evaluation Checklist , at either the 3- or 6-month follow-up . However , significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes : the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index . Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function , although these decreased in magnitude from the 3- to 6-month follow-up . CONCLUSIONS This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD . However , sustained use of the app over the full 6-month period was a challenge for most families Tactile abnormalities are severe and universal in preschool children with autism . They respond well to treatment with a daily massage protocol directed at tactile abnormalities ( QST massage for autism ) . Treatment is based on a model for autism proposing that tactile impairment poses a barrier to development . Two previous r and omized controlled trials evaluating five months of massage treatment reported improvement of behavior , social/communication skills , and tactile and other sensory symptoms . This is the first report from a two-year replication study evaluating the protocol in 103 preschool children with autism . Parents gave daily treatment ; trained staff gave weekly treatment and parent support . Five-month outcomes replicated earlier studies and showed normalization of receptive language ( 18 % , P = .03 ) , autistic behavior ( 32 % , P = .006 ) , total sensory abnormalities ( 38 % , P = .0000005 ) , tactile abnormalities ( 49 % , P = .0002 ) , and decreased autism severity ( medium to large effect size , P = .008 ) . In addition , parents reported improved child-to-parent interactions , bonding , and decreased parenting stress ( 44 % , P = .00008 ) . Early childhood special education programs are tasked with addressing sensory abnormalities and engaging parents in effective home programs . Until now , they have lacked research -based methods to do so . This program fulfills the need . It is recommended to parents and ECSE programs ( ages 3–5 ) at autism diagnosis OBJECTIVE The vast majority of children with an autism spectrum disorder ( ASD ) attend public preschools at some point in their childhood . Community preschool practice s often are not evidence based , and almost none target the prelinguistic core deficits of ASD . This study investigated the effectiveness of public preschool teachers implementing a vali date d intervention ( the Joint Attention and Symbolic Play/Engagement and Regulation intervention ; JASP/ER ) on a core deficit of autism , initiating joint attention . METHOD Sixteen dyads ( preschoolers with ASD and the public school teachers who worked in the child 's classroom ) were r and omly assigned to the 6-week JASP/ER intervention or a control group . RESULTS At the end of the intervention , JASP/ER teachers used more  JASP/ER strategies than the control teachers , and JASP/ER preschoolers used more joint attention in their classroom than control children . Additionally , JASP/ER children spent more time in supported engagement and less time in object engagement than control preschoolers on a taped play interaction . CONCLUSIONS Findings suggest that teachers were able to improve a core deficit of children with ASD in a public preschool context Background There is increasing public and professional awareness of autism spectrum disorders with early recognition , diagnosis and interventions that are known to improve prognosis . Poor knowledge about childhood autism among paediatric and psychiatric nurses who are members of multidisciplinary teams that care for such children may be a major barrier to early interventions that could improve quality of life and prognosis in childhood autism . Factors that influence knowledge about childhood autism among these nurses are not known . This study assessed knowledge about childhood autism among paediatric and psychiatric nurses in Ebonyi state , Nigeria and determined the factors that could be influencing such knowledge . Methods Forty specialist paediatric and forty psychiatric nurses , making a total sample of eighty , were r and omly selected from all the health care facilities in Ebonyi state , Nigeria .  A socio-demographic question naire and knowledge about childhood autism among health workers ( KCAHW ) question naire were administered to them and the study was a point survey . Results The total mean score on the KCAHW question naire among the nurses that participated in the study was 12.56 ± 3.23 out of a total of 19 possible . The mean score for the paediatric nurses was 11.78 ± 3.64 while psychiatric nurses had mean score of 13.35 ± 2.58 . The mean scores in Domain 1 were 6.17 ± 1.75 for the paediatric nurses and 6.52 ± 1.43 for the psychiatric nurses . The mean scores in Domain 2 were 0.65 ± 0.48 for the paediatric nurses and 0.80 ± 0.41 for the psychiatric nurses . Domain 3 showed mean scores of 1.97 ± 1.25 for the paediatric nurses while psychiatric nurses scored 2.62 ± 1.23 . Domain 4 yielded the mean scores of 2.97 ± 1.54 and 3.42 ± 0.98 for the paediatric and psychiatric nurses respectively . There was significant relationship between the total mean score on the KCAHW question naire for the two groups and the area of specialisation of the nurses ( t = -2.23 , df = 78 , p = 0.03 ) and there was also significant relationship between previous involvement in managing children with childhood autism as a specialist paediatric or psychiatric nurse and the total mean score on the KCAHW question naire ( t = 6.90 , df = 78 , p = 0.00 ) . Conclusion The scores reflect deficits in knowledge about childhood autism among the study cohorts . Paediatric and psychiatric nurses as members of multidisciplinary teams that care for children with childhood autism are expected to provide holistic care and adequate counselling to the families of these children . Unfortunately in this environment , they are not fully equipped with enough knowledge about childhood autism . Education on childhood autism is therefore needed and can be provided through continuing medical education and emphasizing childhood autism in their training curriculum . This will enhance early identification and diagnosis of childhood autism with early interventions that are known to improve prognosis This study evaluated a technology-based early intervention for social communication skills in pre-schoolers in a r and omised controlled trial . Participants were 54 children aged under 6 years with a diagnosis of autism , assigned to either intervention or control conditions . The app engaged children , who played consistently , regardless of developmental level , and was rated highly by parents . There were no significant group differences in parent-report measures post-intervention , nor in a measure of parent – child play at follow-up . Therefore , this intervention did not have an observable impact on real-world social communication skills and caution is recommended about the potential usefulness of iPad ™ apps for amelioration of difficulties in interaction . However , positive attitudes among participants , lack of harms and the potential of apps to deliver therapeutic content at low economic cost suggest this approach is worth pursuing further , perhaps targeting other skill domains OBJECTIVE A previously published r and omized clinical trial indicated that a developmental behavioral intervention , the Early Start Denver Model ( ESDM ) , result ed in gains in IQ , language , and adaptive behavior of children with autism spectrum disorder . This report describes a secondary outcome measurement from this trial , EEG activity . METHOD Forty-eight 18- to 30-month-old children with autism spectrum disorder were r and omized to receive the ESDM or referral to community intervention for 2 years . After the intervention ( age 48 to 77 months ) ,  EEG activity ( event-related potentials and spectral power ) was measured during the presentation of faces versus objects .  Age-matched typical children were also assessed . RESULTS The ESDM group exhibited greater improvements in autism symptoms , IQ , language , and adaptive and social behaviors than the community intervention group . The ESDM group and typical children showed a shorter Nc latency and increased cortical activation ( decreased α power and increased θ power ) when viewing faces , whereas the community intervention group showed the opposite pattern ( shorter latency event-related potential [ ERP ] and greater cortical activation when viewing objects ) . Greater cortical activation while viewing faces was associated with improved social behavior . CONCLUSIONS This was the first trial to demonstrate that early behavioral intervention is associated with normalized patterns of brain activity , which is associated with improvements in social behavior , in young children with autism spectrum disorder OBJECTIVES : To compare the effects of two 9-month  parent-implemented interventions within the Early Social Interaction ( ESI ) Project . Both individual-ESI , offered 2 or 3 times per week at home or in the community , and group-ESI , offered once per week in a clinic , taught parents how to embed strategies to support social communication throughout everyday activities . METHODS : Participants in the r and omized controlled trial included 82 children diagnosed with autism spectrum disorder at 16 to 20 months . Children were matched on pretreatment nonverbal developmental level and pairs were r and omly assigned to treatment condition . Child outcomes included measures of social communication , autism symptoms , adaptive behavior , and developmental level . Child outcomes are reported from baseline to the end of the 9-month interventions . RESULTS : Children in individual-ESI showed differential change on a st and ardized examiner-administered observational measure of social communication , as they improved at a faster rate than children in group-ESI . Individual-ESI also showed differential efficacy on a parent report measure of communication , daily living , and social skills , as they showed improvement or stability , whereas group-ESI led to worsening or no significant change on these skills . Finally , individual-ESI showed differential change on examiner-administered measures of receptive language skills , as children in individual-ESI improved significantly , whereas group-ESI showed no change . CONCLUSIONS : These findings support the efficacy of individual-ESI compared with group-ESI on child outcomes , suggesting the importance of individualized parent coaching in natural environments . The efficacy of a parent-implemented intervention using little professional time has potential for community viability , which is particularly important in light of the lack of main effects on child outcomes of most other parent-implemented interventions The study evaluates a social-communication-based approach to autism intervention aim ed at improving the social interaction skills of children with autism spectrum disorder . We report preliminary results from an ongoing r and omized controlled trial of 51 children aged 2 years 0 months to 4 years 11 months . Participants were assigned to either a target treatment or community treatment group . Families in the target treatment group were given 2 hours of therapy and coaching each week in an intervention emphasizing social-interaction and the parent-child relationship . Children in the community treatment group received a variety of services averaging 3.9 hours per week . After 12 months , outcomes were measured to determine changes in the groups in social interaction and communication . In addition , a regression analysis was conducted to determine whether changes in social interaction skills were associated with language development . Results suggest that children in the treatment group made significantly greater gains in social interaction skills in comparison to the community treatment group , but no between-group differences were found for st and ard language assessment s. Initiation of joint attention , involvement , and severity of language delay were found to be significantly associated with improvement of language skills in children with autism . Finally caregiver skills targeted by the intervention were found to be significantly associated with changes in children ’s interaction skills OBJECTIVE To determine the effect of the Early Start Denver Model ( ESDM ) for treatment of young children with autism on health care service use and costs . METHOD We used data from a r and omized trial that tested the efficacy of the ESDM , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents , for 2 years . Parents were interviewed about their children 's service use every 6 months from the onset of the intervention to follow-up ( age 6 years ) . The sample for this study consisted of 39 children with autism who participated in the original r and omized trial at age 18 to 30 months , and were also assessed at age 6 years . Of this sample , 21 children were in the ESDM group , and 18 children were in the community care ( COM ) group . Reported services were categorized and costed by applying unit hourly costs . Annualized service use and costs during the intervention and post intervention for the two study arms were compared . RESULTS During the intervention , children who received the ESDM had average annualized total health-related costs that were higher by about $ 14,000 than those of children who received community-based treatment . The higher cost of ESDM was partially offset during the intervention period because children in the ESDM group used less  applied behavior analysis (ABA)/early intensive behavioral intervention ( EIBI )  and  speech therapy services than children in the comparison group . In the postintervention period , compared with children who had earlier received treatment as usual in community setting s , children in the ESDM group used less ABA/EIBI , occupational/physical therapy , and speech therapy services , result ing in significant cost savings in the amount of about $ 19,000 per year per child . CONCLUSION Costs associated with ESDM treatment were fully offset within a few years after the intervention because of reductions in other service use and associated costs . CLINICAL TRIAL REGISTRATION INFORMATION Early Characteristics of Autism ; http:// clinical trials.gov/ ; NCT0009415
CONCLUSION Non-specialist mediated interventions for autism spectrum disorder demonstrate effectiveness across a range of outcomes for children with autism and their caregivers
INTRODUCTION In recent years , several non-specialist mediated interventions have been developed and tested to address problematic symptoms associated with autism .
These can be implemented with a fraction of cost required for specialist delivered interventions .
This review represents a robust evidence of clinical effectiveness of these interventions in improving the social , motor and communication deficits among children with autism .