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Summary of Advances Cover 2013

Summary of Advances

In Autism Spectrum Disorder Research


Question 5: Where Can I Turn for Services?

Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders - Boyd BA, Hume K, McBee MT, Alessandri M, Gutierrez A, Johnson L, Sperry L, Odom SL. J Autism Dev Disord. 2014 Feb;44(2):366–380. [PMID: 23812661]

For children with ASD, early intervention can greatly enhance social, behavioral, and cognitive skills, leading to more favorable developmental trajectories and improved outcomes. Like most young children, those with ASD spend a significant amount of time in school settings; therefore, it is critically important to ensure that school- based treatment programs are efficacious. Researchers in this study sought to examine the effects of two different comprehensive treatment models (CTMs) that are widely used in schools: the Learning Experiences and Alternative Program for Preschoolers and their Parents (LEAP) and the Training and Education of Autistic and Related Communication-Handicapped Children (TEACCH) program. These are two long standing CTMs that are used frequently, yet have very different approaches. LEAP uses applied behavior analysis (ABA) approaches as well as some principles of early childhood education, with the goal of reducing characteristics of ASD that interfere with learning. The LEAP intervention is employed in inclusive settings, with children with ASD receiving instruction in the same classrooms as typically developing students who learn to help their autistic peers socially and academically. TEACCH, on the other hand, makes changes and accommodations to the student's environment to promote the child's engagement and learning. Thus, in most classrooms where TEACCH is used, children with ASD are educated using an adult-led approach in a group separate from their typically developing peers. For this study, investigators assessed 185 preschool students with ASD in 22 LEAP, 25 TEACCH, and 27 non-model specific (NMS) classrooms across four states: North Carolina, Colorado, Florida, and Minnesota. All classrooms had to meet an "average" rating (score of 3 out of 5) on four subscales of a validated classroom quality measure—the PDA Program Assessment. NMS classrooms were considered the control group, did not use TEACCH or LEAP methods, and were a mixture of inclusive and self-contained classrooms. The teachers were offered "refresher" instruction to maintain fidelity of how the LEAP and TEACCH interventions were implemented, and researchers controlled for fidelity of the interventions to ensure they were being delivered appropriately. Students were assessed on a number of measures that included cognitive, behavioral, psychological, and social skills at the beginning and end of the school year. All data were obtained at least 6 months apart, across three data sources (parent report, teacher report and student performance).

Investigators assembled the test measures into seven composite variables that were grouped based on the features and outcomes being rated and statistical correlation between student's scores on each individual measure. These variables included: autism characteristics and severity, communication, sensory and repetitive behaviors (parent and teacher report), reciprocal social interaction (parent and teacher report), and fine motor skills. At the end of one school year, researchers found that students in each type of classroom performed better at the end of the year in the areas of autism characteristics and severity, communication, and fine motor skills. Of note, there were no significant differences found in students' scores between intervention models. However, with regard to cognitive ability, children in TEACCH classrooms with lower ability showed more improvement in measurements for autism characteristics and severity. This may be due to the environmental and behavioral supports found in TEACCH classrooms that are more advantageous to children with greater cognitive impairment, or perhaps children with more severe symptoms have more room for improvement. Researchers found that, while the LEAP and TEACCH approaches are different (i.e., LEAP is peer-mediated in inclusive settings and TEACCH is adult-led in specialized settings), many teachers used a number of similar classroom practices. Therefore, these common best practices, as well as common features between the various instructional approaches, may be what influence the child's improvement the most. While reports of the importance of high-quality classrooms have been anecdotally reported in the literature in the past, this study provides evidence to support that claim. Overall, these data imply that high quality classrooms lead to benefits for ASD children; however, the degree of ASD severity may play a role in the type of classroom that best fits the individual child.

Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements - Nahmias AS, Kase C, Mandell DS. Autism Int J Res Pract. 2014 Apr;18(3):311-320. [PMID: 23188885]

The Individuals with Disabilities Educational Act (IDEA) requires that, to the maximum extent possible and appropriate, children with disabilities should receive a free public education in the "least restrictive environment" (i.e., in a "regular classroom" with non-disabled peers). Several studies on treatment models for preschool aged children with ASD have observed that inclusion of children with ASD in classroom settings alongside their typically developing peers have resulted in cognitive gains for children with ASD. However, such studies are few and often not generalizable to broader populations as they were not implemented by community providers, lacked comparison groups, or contained insufficient sample sizes. In addition, researchers continue to debate the feasibility of employing ASD intervention strategies in inclusive classroom settings, with some researchers arguing that inclusive classrooms may expose children with ASD to social rejection from typically developing peers. Researchers in this study thus sought to comparatively examine the impact of community-based early intervention. They reviewed the preschool educational records of 98 preschool aged children with ASD placed in one of three settings: inclusive classrooms (with typically developing peers), mixed disability classrooms, and autism-only classrooms. Children in inclusive groups received intervention services (typically 3 hours a day, 3 days a week) from early childhood or special education teachers in classrooms for typically developing children. Children in mixed disability classrooms in center-based preschools received early intervention (typically 2-3 hours a day, 3 days a week) from early childhood or special education teachers in classrooms with children with developmental or other disabilities. Children in autism-only groups received early intervention in center-based autism support preschools (typically 5 hours a day, 5 days a week) via one or a combination of the following interventions: Applied Behavioral Analysis (ABA); Training and Education of Autistic and Related Communication Handicapped Children (TEACCH); Developmental, Individual Difference, Relationship-based (DIR)/Floortime model; visual supports; sensory integration; and creative art therapies. Most programs in all groups included instruction based on a curriculum aligned with early learning standards (e.g. Creative Curriculum, HighScope). Children in all groups also received speech, occupational, and physical therapies in addition to their weekly early intervention services.

Question 5

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