Determining treatment outcome in early intervention programs for autism spectrum disorders: A critical analysis of measurement issues in learning based interventions
Introduction
One of the most discussed issues in the child treatment literature is the success of early intervention programs with autism spectrum disorder (ASD) children (Matson & Minshawi, 2006; Moore & Goodson, 2003). These interventions, which address the range of symptoms evinced by ASD children, are behavioral/learning-based procedures. This pragmatic factor defines the parameters for the present review.
Various claims have been made about the specific effects of these programs, but a general consensus appears to be growing in the research literature. The consensus is that early intervention is valuable and, within limits, the more intense the intervention, the greater the gains despite variability in outcomes within groups of children treated (Symes, Remington, & Brown, 2006). Despite the considerable research focus on these treatment studies, however, little has been done to analyze the various dependent variables that have been used and the effect these assessment methods have on how treatment effects are perceived. When guidelines regarding assessment for children with autism spectrum disorders (ASD) are published, they tend to focus almost exclusively on differential diagnosis (AACAP, 1999).
To date, behaviorally-based interventions have been found to be by far the most effective means of intervention for children with ASD (Schreibman, 2000). Many more studies are available on behaviorally-based interventions than other topics and thus, the bulk of the review will focus on the dependent measures used in these studies. More recently pharmacological interventions have begun to appear and some guidelines for assessment have been described. Therefore, while assessment is gleaned primarily for behavioral treatments these data also have implications for pharmacology outcome studies. Other methods of intervention, some of which are quite unusual, have been proposed. Some authors have suggested that treatments have become so unusual that they refer to autism in particular as a fad magnet for off the wall interventions (Metz, Mulick, & Butter, 2005). For this review, assessment guidelines for mainstream behavioral and pharmacological treatment will be the theme for the paper.
Section snippets
Outcome measures for behavioral interventions
It would not be possible to cover the vast literature on treatment in one paper. Therefore, selective studies were reviewed to develop the general points about the type of dependent variables employed. Two methodologies are evident. The first method follows a strict behavior analytic approach. These studies employ singe case designs with one to five children being evaluated. Multiple baseline and/or reversal designs are used as the primary means of methodological control. A second, much
Behavior analysis outcome measures
Typical of these applied behavior analysis single case design studies in general are the operational definition of one to three problems/challenging behaviors such as self-injury, stereotypies, and aggression. Studies of this nature typically note in the description of participants that the children evince an ASD, typically autism. However, the purpose of the study typically, as noted, is on dealing with a few specific behaviors, usually self-injury (Mohr & Sharpley, 1985), aggression,
Program treatment outcome
As the field has advanced and matured with respect to this massive literature on testing a few specific targets, more ambitious efforts geared toward multiple behavior domains have emerged. Occurring with this shift in focus has been the use of more and more expansive dependent measures, which assess a broad range of success criteria on which individual and groups of autistic and PDD-NOS children can be measured. These two diagnostic groups among all the ASD groups have received most of the
How do researchers define effective
The assertion made here is that the outcome measures that researchers choose to include in their studies define the “universe” of potential effects. Using this definition it is clear that I.Q. and measures of language are the clear favorites to date in this regard. Interestingly, behaviorally-based programs rarely include measures of the core symptoms of autism such as the ADI-R or CARS, despite the fact that autism or PDD-NOS children, versus Rett's, Childhood Disintegrative Disorder, or
Trends
Relative to assessment of outcomes, a few observations are in order. First, group designs are becoming more common as a means of assessment versus single case research designs. Second, standardized I.Q. and adaptive measures initially introduced over 25 years ago still appear to be a primary measure of outcome (Lovaas et al., 1973). Third, operational target behaviors as outcome measures are being used less frequently. Fourth, in the place of operation target behaviors are measures of general
Concluding remarks
Despite various methodological flaws from an assessment standpoint in the existing early intervention literature with ASD, there have been a sufficient number of replications to declare the methods “promising”. This finding should be no surprise since the techniques employed are based on a massive empirical literature on applied behavior analysis (Matson & Minshawi, 2006). Despite these promising gains, one would hope and expect to see more defined and refined assessment methods as the
References (45)
- et al.
Toward a functional analysis of self-injury
Analysis and Intervention in Developmental Disabilities
(1982) - et al.
Attention skill during the first 6 months of age in autism spectrum disorder
Journal of the American Academy of Child and Adolescent Psychiatry
(2002) - et al.
A 20-year review of punishment procedures and alternative methods to treat problem behaviors in developmentally delayed persons
Research in Developmental Disabilities
(1989) - et al.
Behavioral treatment of autistic persons: A review of research from 1980 to the present
Research in Developmental Disabilities
(1996) - et al.
Training interpersonal skills among mentally retarded and socially dysfunctional children
Behaviour Research and Therapy
(1980) - et al.
Reliability of the Matson evaluation of drug side-effects (MEDS)
Research in Developmental Disabilities
(1998) - et al.
A comparison of traditional psychotherapy and social skills training for improving interpersonal functioning of mentally retarded adults
Behavior Therapy
(1981) Reliability and validity of the revised fear survey schedule for children (FSSC-R)
Behaviour Research and Therapy
(1983)- et al.
Early intensive intervention for children with autism: Therapists’ perspective on achieving procedural fidelity
Research in Developmental Disabilities
(2006) Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders
Journal of the American Academy of Child and Adolescent Psychiatry
(1999)
Manual for the teacher's report form and 1991 profile
Practitioner review: Diagnosis of autism spectrum disorder in 2- and 3-year-old children
Journal of Child Psychology and Psychiatry
Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time
Journal of Child Psychology and Psychiatry
Autism spectrum disorders at 20 and 42 months of age: Stability of clinical and ADI-R diagnoses
Journal of Child Psychology and Psychiatry
Intensive behavioral treatment at school for 4- to 7-year-old children with autism
Behavior Modification
Atypical antipsychotics in the treatment of schizophrenia: Systematic overview and meta-regression analysis
British Medical Journal
How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism?
Journal of Child Psychology and Psychiatry
Depression in persons with autism: Implications for research and clinical care
Journal of Autism and Developmental Disorders
Adult outcome for children with autism
Journal of Child Psychology and Psychiatry
Assessing change in early intervention programs for children with autism
Journal of Autism and Developmental Disorders
Rating Scales to assess depression in school-aged children
Acta Paedopsychiatrica
Presentation, assessment and treatment of depression in a young woman with learning disability and autism
British Journal of Learning Disabilities
Cited by (134)
A critical review of outcome measures used to evaluate the effectiveness of comprehensive, community based treatment for young children with ASD
2016, Research in Autism Spectrum DisordersCitation Excerpt :Specific attention was paid to evaluating how well the tests were linked to the underlying diagnostic construct of ASD, how well the sample population was described and matched to the instruments, and if test users reported on reliability, validity, administration protocols, modifications, test bias, and minimum training requirements. As the use of different cognitive tools at pre and post test was identified as an area of concern by Matson (2007), this particular practice was also evaluated. The checklist was piloted on six studies and then revised with input from two other senior ASD researchers to ensure it was accurately capturing the intended domains of interest and that there was agreement on the correspondence between the Standards and the chosen evaluative criteria.
Age-related trends in treatment use for children with autism spectrum disorder
2015, Research in Autism Spectrum DisordersAre outcome measures for early intensive treatment of autism improving?
2014, Research in Autism Spectrum DisordersResponse to Early Intensive Behavioral Intervention for autism-An umbrella approach to issues critical to treatment individualization
2014, International Journal of Developmental NeuroscienceCitation Excerpt :Language abilities of the children improve more when the children start with high adaptive behavioral skills and vice versa. Surprisingly, despite the clear call for the inclusion of measurement of ASD core symptoms and challenging behaviors, most EIBI studies failed to address these dependent variables (Matson, 2007). This is kind of disappointing, as children with severe ASD exhibit significantly more and higher levels of challenging behaviors (Matson et al., 2008) with stereotypical behaviors being the most commonly reported (Jang et al., 2011).
Extending the Usefulness of the Brief Observation of Social Communication Change (BOSCC): Validating the Phrase Speech and Young Fluent Version
2024, Journal of Autism and Developmental DisordersA Psychometric Evaluation of the Quality of Life for Children with Autism Spectrum Disorder Scale
2022, Journal of Autism and Developmental Disorders