A Pilot Randomized Control Trial of the Functional Behavioural Skills Training Group for Young Nonverbal Children with Severe Autism

Background:  Currently, there is little research supporting the effectiveness of Intensive Behavioural Intervention for treating nonverbal children who are more severely affected with autism. Furthermore, there is little research focusing on alternative interventions such as functional behavioural skills training.

Objectives:  This pilot randomized control trial (RCT) evaluates an innovative functional behavioural skills training for children with ASD and their parents. Changes in child functional skill and parent skill outcomes in the treatment and control groups were tested.

Methods:  Twenty-four  children (ages 38-82 months, mean = 58.8 months) with independent diagnoses of Autistic Disorder, who had not learned early cognitive skills such as verbal and motor imitation and expressive and receptive labels, were randomized to treatment or control groups. Eight children and their parents in the treatment group and 7 children and their parents in the control group completed the study. A manualized parent training and child training group was provided weekly for 4 months by trained ABA  therapists who were not involved in assessing the outcome measures.

At baseline, all child participants were assessed using  the Mullen Scales of Early Learning, Vineland Adaptive Behaviour Scales-II , Developmental Behaviour Checklist (DBC) and Functional Behaviour Skills Assessment (FBSA). The Vineland-II, DBC and FBSA were repeated at post-treatment. Parents completed  questionnaires including the Parenting Sense of Competence, the Caregiver Strain, and the Parent ABA Knowledge Questionnaire at baseline and post-treatment. 

Results:  The pilot RCT was completed by 62.5% of participants. Nine participants dropped out due to family issues, child care, and time constraints. Results from the treatment group improved more than results from the control group on difference scores for the DBC Total (treatment M= -5.83 SD=10.91, control M=10.5 S.D.= 15.9) and Parent ABA Knowledge (treatment M= 3.0 S.D. 2.52 and control M= 0.6  S.D.= 2.79). Post-treatment DBC Cohen’s d effect size was 0.4 and Parent ABA Knowledge Cohen’s d effect size was 0.2. Additionally, preliminary pre-post data from the FBSA handwashing skill indicated that 71.4% of the children in the treatment group became more engaged in the skill in comparison to only 28.5%  of the children in the control group. However, results from the treatment group did not show improvement in comparison to the results from control group on difference scores for the Vineland-II ABC (treatment M= -1.29, SD= 6.95 and control M= 4, SD= 3.92).

Conclusions:  This study has taken important steps forward in developing and testing the feasibility of  functional behaviour skills intervention for nonverbal children with autism and their parents. Results indicated that skills that were directly taught to the children and parents tended to improve in the treatment group compared to the control group.  Further study is required to increase sample size, to validate the initial findings from the FBSA and to offer this innovative treatment to more nonverbal children. Overall, this study will provide greater opportunity to maximize resources, individualize treatment options and increase the continuum of services.