Creating an Observation System to Quantify Symptomatology Progress during Treatment in Children with Autism Spectrum Disorders

Background:  

Self-reported or parental reported paper and pencil measures are typically used in research settings to generate behavioral profiles of child participants and to quantify changes in their behaviors and symptomatology. Evidence suggests that the change of emotional or maladaptive responses has been difficult to measure using these standard paper and pencil tasks in the ASD population. Currently there is no known system that can assess the progress during therapy through the use of an unbiased observation system.

Objectives:  

• To create a reliable observation system that can document change as it is occurring across time during treatment sessions in children with ASD.
• To assess the degree of overlap between a new observation system (PASTOS) and other scales that measure similar constructs such as the Multidimensional Anxiety Scale for Children (MASC), the Social Skills Rating System (SSRS) and the Self-Efficacy Questionnaire for Children (SEQ-C).

Methods:  

This study examined treatment session transcripts of twenty-two elementary school-aged children who were participating in a randomized controlled trial of cognitive behavioral therapy (M = 9.0 years, SD = 2 years) diagnosed with high functioning autism spectrum disorder (IQ above 70) and anxiety disorders. In order to assess the therapeutic process, treatment sessions 2, 4, 10, and 15 were chosen to be coded by observers. Coders listened to the entire treatment session while reading the transcript; at the conclusion of an audiotaped session, the coders assigned an extensiveness rating for various symptoms, from 1 to 7, with 1 = not at all, 3 = some of the time, 5 = considerably and 7 = extensively for 27 items divided into 5 subscales. The five subscales consisted of:  1) anxiety and related emotional states, 2) self-help skill mastery, 3) core autism symptoms, 4) child coping strategies, 5) parent-child interactions. Correlations were run using the five subscales and total PASTOS scores with MASC, SSRS and SEQ-C scores.

Results:  

• Significant correlations were found between PASTOS and MASC scores at both baseline and post treatment.
• No significant correlations were found between PASTOS scores and SEQ-C ratings at baseline, but total PASTOS scores correlated with total SEQ-C scores at post treatment. At the subscale level, total SEQ-C positively correlated with PASTOS’s social communication subscale at post treatment. Self-perception and parental communication subscales also correlated with SEQ-C ratings at post treatment in expected directions.
• SSRS’ self-control subscale positively correlated with PASTOS’ anxiety and self-perception scales at post treatment.

Conclusions:  

This investigation sought to create an alternative system to evaluate progress of children with ASD during treatment sessions. The results suggest that PASTOS is a promising system for tracking changes in anxiety and related emotional states, child coping strategies, and self-skill mastery when compared to parental reports. Further research should explore additional alternatives to tracking progress of symptomatology and methods to make observation systems efficient and usable by coders within a standardized training regimen.