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Guiding Children with High-Functioning Autism Through Early Life Transitions: New Approaches

Friday, 3 May 2013: 09:00-13:00
Banquet Hall (Kursaal Centre)
O. Baykaner1, S. Anderson2, S. M. Staunton3, J. Hellriegel4, M. Murin5, W. Mandy6 and D. H. Skuse7, (1)Institute of Child Health, London, United Kingdom, (2)Great Ormond Street Hospital, London, United Kingdom, (3)Behavioural and Brain Sciences Unit, Institute of Child Health, UCL, London, United Kingdom, (4)Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom, (5)National Centre for High Functioning Autism, Department of Child & Adolescent Mental Health (DCAMH), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom, (6)Division of Psychology and Language Sciences, Faculty of Brain Sciences, UCL, London, United Kingdom, (7)Behavioural and Brain Sciences Unit, UCL Institute of Child Health, London, United Kingdom
Background:  For many children with autistic spectrum disorders (ASD) in mainstream education, the transition from primary to secondary school can be particularly stressful. To date, no previous study has developed and systematically evaluated an intervention aimed at facilitating transition at this challenging time.

Objectives: Our objective was to devise a Transition Support Pack, for families and teachers, aimed at facilitating successful transition to secondary mainstream school for a nationally representative sample of children with ASD. We aimed systematically to evaluate the effectiveness of this school-delivered, individualised, intervention in a quasi-Randomised Controlled Trial.   

Methods: Participants comprised children with ASD attending mainstream primary schools (n = 42). Total 40 schools in UK. Sample mean age 11.14 years (SD:0.39); male : female ratio was 5:1. Mean FSIQ 85.92 (SD:22.27).

Recruitment comprised two phases. Schools (1 child/school) were assigned to Phase 1 control (2009/2010) or to Phase II intervention (2010/2011) samples. Children, their parents and primary/ secondary school teachers completed assessments in the last 6 months of primary school. In both phases, a follow-up was conducted 6 months after transition. Children in the control group (n= 27) received no intervention.  The families and schools of children in the intervention group (n=15) received an individualised ‘Transition Management Plan’, based on relevant elements of the Transition Pack assessment.

Results:  In the control group, teachers reported at follow-up that standardized measures of Social Difficulties increased by 0.6 SD, but in the Intervention group they had decreased -5.20 SD (p< 0.01). Hyperactive traits at school (FU – Baseline) were stable in controls (-0.10 SD), but reduced in those with Transitional Support (-2.73 SD, p<0.05). Emotional and Conduct problems increased in controls (0.90 SD, 0.20 SD, respectively), but had improved (-0.87 SD, -0.73 SD respectively) in intervention group. Peer problems reduced to a greater extent in the intervention group (-0.21 SD, -0.91 SD respectively). Pro-social behaviour decreased in controls (-0.74 SD), but increased in the Intervention group (0.53 SD). All results were adjusted for gender, social deprivation score, OFSTED primary and secondary ratings and IQ. No child in Phase II received additional psychiatric or other treatment as a consequence of the intervention, which was focused exclusively on enhancing support to school and family over transition.

Conclusions: The transition from primary to secondary school is stressful for most children with ASD, whether or not they have special educational support. Independent ratings by teachers indicate there is deterioration in some aspects of behavioural adjustment for most children. We devised a supportive program of indirect intervention, mediated through school and home, with preliminary evidence for positive outcomes based on independent teacher-rated measures of adjustment at 6-month follow-up.

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