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Thursday, May 15, 2008
Champagne Terrace/Bordeaux (Novotel London West)
Background: Children with ASD may be served in a number of different community service systems, including those that do not specialize in treatment for this population. Little is known, for example, about the characteristics of the treatment provided in outpatient community-based mental health (CMH) services.
Objectives: To characterize CMH ASD treatment and outcome.
Methods: The current study includes secondary data analyses of a sub-sample of children ages 4-12 with ASD (n=20), drawn from a large-scale observational study characterizing CMH psychotherapy for children with disruptive behavior problems. 91 randomly selected videotaped psychotherapy sessions were coded using a modified Therapy Process Observational Coding System (TPOCS: McLeod & Weisz, 2005) yielding ratings for 27 psychotherapeutic strategies.
Results: The following strategies were observed frequently with children with ASD: Using Positive Reinforcement (86% of sessions), Using Punishment/ Limit-Setting (61%), Affect Education (75%), Problem-Solving Skills (58%). Psychoeducation was frequently observed with parents (78%), however, discussing behavioral principles was observed less frequently: Principles of Punishment, Limit setting (28%); Principles of Positive Reinforcement (21%). Moderate improvement on the Eyberg Child Behavior Inventory (ECBI) was observed, with 69% of children with ASD scoring below the clinical cutoff after 4 months, compared to 25% at baseline.
Conclusions: These findings represent the first observational data characterizing CMH care for children with ASD. Psychotherapy process and outcome was similar for children with and without ASD. Behavioral and specific skill building strategies were frequently observed with children with ASD. While therapists employed a number of strategies consistent with research-based ASD interventions targeting children, the observed frequency of behavioral parent training strategies was lower. These data, combined with supplemental qualitative data (to be presented) regarding therapists’ perceptions of the challenges in treating these children, indicate that CMH services for children with ASD could be significantly enhanced by training providers in specialized ASD interventions.
Objectives: To characterize CMH ASD treatment and outcome.
Methods: The current study includes secondary data analyses of a sub-sample of children ages 4-12 with ASD (n=20), drawn from a large-scale observational study characterizing CMH psychotherapy for children with disruptive behavior problems. 91 randomly selected videotaped psychotherapy sessions were coded using a modified Therapy Process Observational Coding System (TPOCS: McLeod & Weisz, 2005) yielding ratings for 27 psychotherapeutic strategies.
Results: The following strategies were observed frequently with children with ASD: Using Positive Reinforcement (86% of sessions), Using Punishment/ Limit-Setting (61%), Affect Education (75%), Problem-Solving Skills (58%). Psychoeducation was frequently observed with parents (78%), however, discussing behavioral principles was observed less frequently: Principles of Punishment, Limit setting (28%); Principles of Positive Reinforcement (21%). Moderate improvement on the Eyberg Child Behavior Inventory (ECBI) was observed, with 69% of children with ASD scoring below the clinical cutoff after 4 months, compared to 25% at baseline.
Conclusions: These findings represent the first observational data characterizing CMH care for children with ASD. Psychotherapy process and outcome was similar for children with and without ASD. Behavioral and specific skill building strategies were frequently observed with children with ASD. While therapists employed a number of strategies consistent with research-based ASD interventions targeting children, the observed frequency of behavioral parent training strategies was lower. These data, combined with supplemental qualitative data (to be presented) regarding therapists’ perceptions of the challenges in treating these children, indicate that CMH services for children with ASD could be significantly enhanced by training providers in specialized ASD interventions.