Who Are Blossomers? Case Studies of Children with Autism Who Blossomed through ABA Parent Training

Background: Research has found that about 10% of children with autism show developmental trajectories known as “bloomers” (Fountain, Winter, & Bearman, 2012) or “improvers” (Gotham, Pickles, & Lord, 2012). These children initially present as low-functioning and show rapid improvement until they later present as high-functioning. Children with autism have been classified in the improving trajectory based on rapid increase in skills (i.e., communication, social, intellectual) or decrease in core autistic symptoms. Despite recent interest in developmental trajectories, there remains a need for in-depth description of children who “blossom,” including risk and protective factors and treatment services accessed.

Objectives: The initial objective was to identify preschool children with autism who were “blossomers,” i.e., made rapid initial progress in cognitive and adaptive skills, in an applied behaviour analysis (ABA) parent training program.  A secondary objective was to provide a rich description of the children during their early years and at follow-up, 1 to 5 years later.

Methods: Archival data from a three-month ABA parent training program were used to examine the initial progress of 32 children (81% boys) with autism (initial mean age = 41 months; range = 19 to 61 months). Parents most commonly were 35 to 44 years of age; mothers (88%); had some college or post-graduate education and family income of $50K to $75K (Can). The program provided 180 hours of parent training on the principles of ABA and how to implement ABA with their children. Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales – Second Edition (VABS-II) scores from pre- and post-parent training were used to classify the initial progress of the children. “Blossomers” were described in detail through archival data and follow-up. Parents and children were invited back for parent interviews, questionnaires, and an updated intellectual and adaptive assessment.

Results: The total group gained an average of 11.30 points in MSEL composite standard scores and 3.22 points in VABS-II composite standard scores over the 3 month program. Preliminary data analysis identified six children who made substantial gains in both MSEL and VABS-II composite standard scores. The “blossomer” group of children showed an average of 19 points gain in MSEL scores (range 9 to 33 points) and 10.33 points gain in VABS-II scores (range 6 to 17 points). Those six children were identified as blossomers and invited for case study follow-up with their parents.

Conclusions: Case studies described the characteristics of children who were classified as “blossomers.” Archival data on parental stress and burnout levels, parental beliefs in the effectiveness of ABA, parental levels of empowerment and demographic factors such as parental education and socioeconomic status were investigated. Factors explored upon follow-up included the extent parents still use ABA principles; the role of the family support system; parenting qualities; child characteristics, academic supports, peer relationships; and additional interventions. These findings highlight the characteristics of children who advanced from low- to high-functioning, and the individual, family, and system factors involved. Clinical implications are discussed. Data collection is ongoing.