Pilot Study of a Comprehensive Psychosocial Summer Treatment for Young Children with HFASD

Background: The number of children diagnosed with autism spectrum disorder (ASD) has been increasing at an alarming rate, highlighting the need for effective treatments (Odom et al. 2014). The concentration of the increase among young high-functioning children with ASD (HFASD) poses a significant challenge, as specialized treatments for these young children are non-existent. While a growing body of evidence suggests that cognitive-behavioral treatments for youth with HFASD may yield positive outcomes (e.g. Laugeson et al. 2012; Frankel et al. 2010), their use with young children with HFASD has not been evaluated.

Objectives:  This study examined the feasibility and initial outcomes of a comprehensive summer psychosocial treatment (summerMAX^yc) for 23 young children, aged 4-6 years with HFASD.

Methods:  Participants: The sample included 23 children, aged 4-6 years with HFASD. Each child had a prior clinical diagnosis of ASD, an SB-5 abbreviated IQ >70 (at least 1 subtest >80), and a PLS-5 expressive or receptive language score >80. All diagnoses were confirmed using the ADI-R. Measures: Social Responsiveness Scale - Second edition (SRS-2), Adapted Skillstreaming Checklist for Young Children (ASC^yc). Procedures: The 5-week cognitive-behavioral treatment (5 days/week, 6 hours/day) included instruction and therapeutic activities targeting social/social-communication skills, facial-emotion recognition, and interest expansion. A behavioral system was also implemented to reduce ASD symptoms and problem behaviors and/or increase skills acquisition and maintenance. Rating scales were completed pre- and post-treatment by parents and staff clinicians.

Results:  Feasibility was supported in high levels of treatment fidelity (all components >93%) and parent- and staff-reported satisfaction. Satisfaction ratings averaged 67.3 out of a maximum of 70 points (average item M=6.7 of a maximum 7) for parents and 45 out of a maximum of 49 points (average item M=6.4 of a maximum 7) for staff-clinicians. Average child satisfaction total was 14.5 of a possible 15 points (average item M=2.9 of a maximum 3). According to parent and staff-clinician ratings, children displayed significant reductions in ASD symptoms and gains in their use of targeted social skills. Pre-post comparisons indicated a significant decrease in parent (SRS-2 p<.001, d=1.70) and staff-clinician (SRS-2 p<.001, d=1.29) rated ASD symptoms, and increase in parent (ASC^yc p<.001, d=1.68) and staff-clinician (ASC^yc p<.001, d=2.30) rated social/social-communication skills.

Conclusions:  Overall, results suggested that the comprehensive young child protocol (summerMAX^yc) can be conducted with a high degree of accuracy (fidelity), parents, children, and staff-clinicians find it quite acceptable, and participation is associated with significant symptom and skills improvements. These findings were considered especially promising as the effect sizes on the two parent and staff-clinician rating measures were large (ds 1.29 and 2.30). Results also suggested that cognitive-behavioral techniques/treatments may be appropriate for young children with HFASD. Despite these initial positive indications, the results must be considered suggestive and the summerMAX^yc protocol requires examination in an RCT.