The Effects of a Comprehensive Intervention Model on Functional Communication, Speech, and Language in Preschoolers with ASD

Background: Comprehensive Treatment Models (CTM) address core deficits of ASD to facilitate positive outcomes for children with ASD and their families. Research evaluating the effectiveness of CTMs for children with ASD found evidence of greater skill development for children who participated in CTM than those who received standard community care (Dawson et al., 2010; Drew et al., 2002; Smith et al., 2000; Strain & Bovey, 2011); however, measures of functional social-communication were notably absent. Measures of language development alone do not accurately reflect the development of communication skills, including the use of alternative or augmentative modes of communication, the development of a variety of communicative functions, and child initiated communication. A retrospective pilot conducted on archived data (Booker & Leew, 2011) indicated significant changes occurred in children’s communication and language skills following 12 – 18 months of intervention at Society for Treatment of Autism (STA).

Objectives: The overall objective of this study was to assess the efficacy of an individualized comprehensive treatment program on functional communication, speech, and language in preschoolers with ASD.

Methods: A convenience sample of four boys with ASD, aged 38 to 42 months, participated in this study. All children received standard-of-care individualized social-pragmatic behavioral intervention from a STA trans-disciplinary treatment team for ten months. Pre-post performance on standardized assessment measures and single subject across subjects and behaviors design provided individual and group evidence of treatment effects.

One treatment session per week per child and every generalization session were digitally recorded and subsequently coded using an observational code (raw counts and rates of behavior) developed for the study. Intervention effectiveness was determined using percentage of data points exceeding the median (PEM), as it reflects effect size (Ma, 2006). Further qualitative data was collected through parent/caregiver surveys.

Results:

• Intake language levels (CSBS) for all children surpassed prelinguistic communication development;

• Significant group changes in functional verbal skills, positive affect sharing, and three-point gaze shifts (CSBS);

• Significant group changes in MSEL Developmental Quotients and PLS-5 language composite and subscale raw scores;

• No change in VABS standard scores;

• Moderate to high treatment effects for all participants in reducing the rate of interfering behaviors and increasing adequacy of verbal communicative acts; communicative mode treatment effect appeared to be dependent on participant intake characteristics;

• All parents indicated their child’s behavior and communication to be slightly or significantly improved, and indicated a positive to very positive effect on their family functioning and parental stress level.

Conclusions: Comprehensive interventions need to be dynamically examined to determine effectiveness and to see if achieved gains are actually meaningful and functional for children with ASD and their families. Language and communication interventions for preschool children need to especially address evidence-based predictors so that the potential of social-communication development may be used to support subsequent language learning and social language use. Clinical implications and future studies will be discussed.