Phase IV-Community Effectiveness Trial of a Psychosocial Treatment for Children with HFASDs

Friday, May 18, 2012
Sheraton Hall (Sheraton Centre Toronto)
11:00 AM
C. Lopata1, J. A. Toomey2, M. L. Thomeer1, J. D. Fox3, D. Meichenbaum2, M. A. Volker4 and G. K. Lee4, (1)Institute for Autism Research, Canisius College, Buffalo, NY, (2)Summit Educational Resources, Getzville, NY, (3)Autistic Services Inc, Williamsville, NY, (4)Counseling, School and Educational Psychology, University at Buffalo, SUNY, Buffalo, NY
Background: Children with high-functioning ASDs (HFASDs) require comprehensive treatments, yet few have been validated in rigorous studies. A NIMH working-group (Smith et al., 2007) proposed a 4-phase model for conducting ASD intervention studies: Phase I–development/testing of new techniques; Phase II–development/testing of a manualized protocol; Phase III–randomized clinical trials (RCT); and Phase IV–community effectiveness studies (implementation by a community agency). Lopata and colleagues developed and evaluated the efficacy of a summer psychosocial intervention in a series of studies (2006; 2008; 2010) that followed NIMH guidelines including a Phase III-RCT (2010) that established the treatment program’s efficacy.  

Objectives: This Phase IV-community effectiveness trial evaluated the (1) effectiveness of the summer intervention on the ASD-symptoms and social performance of children with HFASDs; and (2) feasibility (satisfaction and fidelity) when administered by a community agency.  

Methods:

Participants. Twenty-eight children, ages 7-10 with HFASDs; inclusion criteria – short-form IQ factor score >80; receptive or expressive language score >80; and score meeting ASD criteria on the ADI-R/ADOS/or SCQ.

Outcome measures. Parent and staff ratings – Social Responsiveness Scale (SRS; assesses ASD features); Behavior Assessment System for Children-2 (BASC2; Adaptive Skills and Social Skills subtests). Child testing – Comprehensive Assessment of Spoken Language (Idiomatic Language subtest); Diagnostic Analysis of Nonverbal Accuracy2 (Child Faces subtest). Satisfaction measured using parent, child, and staff Satisfaction Surveys.

Procedures. Groups included 7 children with HFASDs and 3 staff. The manualized program was implemented 5 days/week, 7.5 hours/day over 5-weeks during the summer. Treatment included (1) social skills instruction, (2) face-emotion instruction, (3) interest expansion activities, and (4) non-literal language instruction, along with weekly parent training. A response-cost system was used to strengthen new skills and reduce problem behaviors. The daily schedule included five 70-minute treatment cycles; each consisting of a 20-minute structured skills group and a 50-minute therapeutic activity. Fidelity was assessed throughout treatment. Efficacy measures were administered pre-post treatment (one-tailed) and satisfaction post-treatment. 

 Results: Results indicated significant decreases in ratings of ASD-symptoms (SRS parent t(26)=4.592, p<.001; staff t(27)=4.178, p<.001) and significant increases in social skills (BASC2 parent t(26)=-2.505, p<.009, staff t(27)=-3.890, p<.001) and adaptive skills (BASC2 parent t(26)=-2.522, p=.009, staff t(27)=-4.626, p<.001). Child testing indicated a significant increase in understanding of non-literal language (CASL Idioms t(27)=-8.081, p<.001) and non-significant increase in decoding of facial emotions (DANVA2 Child Faces t(27)=-1.506, p=.072). Fidelity was 92.3% for skills groups and 93.5% for therapeutic activities. Satisfaction ratings were positive from parents, children, and staff.  

Conclusions: Results of this Phase IV-community effectiveness trial suggest that the comprehensive summer program was feasible when conducted by a community agency (high levels of fidelity and satisfaction). Participation in the program was associated with a significant reduction in ratings of ASD symptoms and significant increases in social and adaptive skills. Children with HFASDs demonstrated a significant increase in understanding of non-literal language (idioms). Decoding of emotions in child faces also improved however this was not statistically significant. A large-scale Phase IV-community-effectiveness controlled trial appears warranted.  

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