Best Practice Review: The Social Communication Questionnaire (SCQ)

Best Practice Review: The Social Communication Questionnaire (SCQ)

The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), was initially designed as a companion screening measure for the Autism Diagnostic Interview-Revised (ADI-R; Rutter, Le Couteur & Lord). The SCQ is a parent/caregiver dimensional measure of ASD symptomatology appropriate for children of any chronological age older than fours years. It can be completed by the informant in less than 10 minutes. The primary standardization data were obtained from a sample of 200 individuals who had participated in previous studies of ASD. 

The SCQ is available in two forms, Lifetime and Current, each with 40 questions presented in a yes or no format. Scores on the questionnaire provide an index of symptom severity and indicate the likelihood that a child has an ASD. Questions include items in the reciprocal social interaction domain (e.g., “Does she/he have any particular friends or best friend?”), the communication domain (e.g., “Can you have a to and fro ‘conversation’ with him/her that involves taking turns or building on what you have said?”) and the restricted, repetitive, and stereotyped patterns of behavior domain (e.g., Has she/he ever seemed to be more interested in parts of a toy or an object [e.g., spinning the wheels of a car], rather than using the object as intended?”).

Compared to other screening measures, the SCQ has received significant scrutiny and has consistently demonstrated its effectiveness in predicting ASD versus non-ASD status in multiple studies. A meta-analysis examining the previous research on the utility of the SCQ as a screening instrument found it to be an acceptable screening tool for ASD (area under the curve = 0.885) (Chesnut et al., 2017). The scale has been found to have good discriminant validity and utility as an efficient screener for at-risk groups of school-age children. The lifetime version is recommended for screening purposes as it demonstrates the highest sensitivity value. A threshold raw score of >15 is recommended to minimize the risk of false negatives and indicate the need for a comprehensive evaluation. Comparing autism to other diagnoses, this threshold score resulted in a sensitivity value of .96 and a specificity value of .80 in a large population of children with autism and other developmental disorders. The positive predictive value was .93 with this cutoff. The authors recommend using different cut-off scores for different purposes and populations. Several studies (Allen et al., 2007; Eaves et al, 2006) have suggested that a cut-off of 11 may be more clinically useful (Norris & Lecavalier, 2010).

The SCQ is one of the most researched of the ASD-specific evaluation tools and can be recommended for screening and as part of comprehensive developmental assessment for ASD (Chestnut et al., 2017; Norris & Lecavalier, 2010; Wilkinson, 2010, 2016). The SCQ (Lifetime form) is an efficient screening instrument for identifying children with possible ASD for a more in-depth assessment. For clinical purposes, practitioners might consider a multistage assessment beginning with the SCQ, followed by a comprehensive developmental evaluation (Wilkinson, 2011, 2016). However, cut-off scores may need to be adjusted depending on the population in which it is used. The evidence also indicates that although the SCQ is appropriate for a wide age range, it is less effective when used with younger populations (e.g., children two to three years). It was designed for individuals above the age of four years, and seems to perform best with individuals over seven years of age.

References

Allen CW, Silove N, Williams K, et al. (2007). Validity of the Social Communication Questionnaire in Assessing Risk of Autism in Preschool Children with Developmental Problems. J Autism Dev Disord. 37, 1272–8.

Chandler, S., Charman, T., Baird, G., Simonoff, E., Loucas, T., Meldrum, D., & Pickles, A. (2007). Validation of the Social Communication Questionnaire in a population cohort of children with autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332.

Chesnut, S. R., Wei,T., Barnard-Brak, L., & Richman, D. M. (2017). A meta-analysis of the social communication questionnaire: Screening for autism spectrum disorder. Autism, 21, 920-928. https://doi.org/10.1177/1362361316660065

Eaves L, Wingert H, Ho H, et al. (2006). Screening for Autism Spectrum Disorders with the Social Communication Questionnaire. Developmental and Behavioral Pediatrics, 27, 95–103.

Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child and Adolescent Psychology, 34, 362-379.

Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263–284.

Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles: Western Psychological Services.

Wilkinson, L. A. (2010).  A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London and Philadelphia: Jessica Kingsley Publishers.

Wilkinson, L. A. (2011). Identifying students with autism spectrum disorders: A review of selected screening tools. Communiqué, 40, pp. 1, 31-33.

Wilkinson, L. A. (2017).  A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition). London and Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© Lee A. Wilkinson, PhD

Inclusive Education for Students with Autism

Inclusive Education for Autistic Students 

The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) (P.L. 108-446) (http://idea.ed.gov/) guarantees a free and appropriate public education (FAPE) in the least restrictive environment (LRE) for every student with a disability. The LRE provision mandates that “to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled, and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.”  In general, inclusion (or inclusive education) with typical peers is considered to be the best placement option for students with disabilities. It should also be noted that while the least restrictive environment (LRE) provision of IDEA requires that efforts be made to educate students with special needs in less restrictive settings, IDEA also recognizes that some students may require a more comprehensive program and intensive level of service.

Research

Child characteristics such as severity of autism symptoms are thought to determine educational placement. However, where a child lives may significantly impact whether they are placed in an inclusive or segregated classroom, a national analysis suggests. The study published online in the journal Focus on Autism and Other Developmental Disabilities examined external factors, including state of residence and state funding formulas, to determine their potential influence on placement outcomes. On average, about 37 percent of students identified with autism spectrum disorder (ASD) spent at least 80 percent of their school day in inclusive environments. But the numbers varied considerably from one state to the next, ranging from just 8 percent in Washington, D.C. to 62 percent in Iowa. 

There was considerable variation among states in placing students with autism in inclusive, mainstreaming, self-contained, and separate schools. Specifically, states varied substantially in the percentage of students with autism educated in each setting, with some states consistently favoring inclusion (Colorado, Connecticut, Idaho, Iowa, Minnesota, Nebraska, North Dakota, West Virginia, and Wisconsin). Other states, however, generally leaned toward more restrictive settings (Alaska, Delaware, Florida, Hawaii, Louisiana, New Hampshire, New Jersey, New York, South Carolina, and Washington, D.C.). States in the Eastern United States tended to have more restrictive placement rates than states in the Western United States. State special education funding was found to have a minimal impact on placement outcomes.

These findings suggest that factors that are external to child characteristics (e.g., severity of ASD symptoms) influence educational placement decisions for students with ASD. “If child-specific factors were solely responsible for education placement decisions, one would expect states to have similar rates of inclusive, self-contained, mainstreaming and separate school placements for students with ASDs,” the author commented. “Instead, … results indicate that educational placement varies by state.” 

Implications

Overall, it is unlikely that child characteristics alone determine placement outcomes. Although school districts should make every effort to place students in integrated settings to maximize interaction with typical peers, analysis of the public data presented in this study suggests that many states are still falling short of including autistic students in general education settings for significant portions of the day. Inclusion with typically developing students is important for a child with autism as peers provide the best models for language and social skills. However, inclusive education alone is insufficient, evidence-based intervention and training is also necessary to address specific classroom challenges. The argument must shift from should we include autistic students in general education to understanding how to include them successfully. It is critical to identify how practices that benefit students with autism, including structure (visual, communication, and social supports), positive behavior supports, and systematic instruction, can be implemented effectively in general education settings. 

Jennifer A. Kurth,  Educational Placement of Students With Autism: The Impact of State of Residence, Focus on Autism and Other Developmental Disabilities, first published on September 3, 2014 doi:10.1177/1088357614547891.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Book Review - "THE LOVING PUSH"

The Loving Push: ​How parents and professionals can help spectrum kids become successful adults 
by Temple Grandin, PhD and Debra Moore, PhD

Young adults on the autism spectrum face significant challenges as they transition to adulthood, with many being socially isolated, unemployed, and lacking services. Unfortunately, research suggests that the vast majority of these young adults will be residing in the parental or guardian home during the period of emerging adulthood. It is clear that more needs to be done to help them thrive to the best of their abilities and attain a high quality of life. "The Loving Push” by Drs. Grandin and Moore addresses these issues with a direct, yet empathetic and positive discussion of ways in which parents and professionals can enhance the potential of "spectrum kids" of any age and help them achieve productive and meaningful adult lives.

The authors convey a critical message that, more than other children and youth, those on the autism spectrum must overcome "learned helplessness" and move beyond their comfort zone in order to reach their full, unique potential. Pushing is necessary,” the authors write, “because those on the spectrum are unlikely to automatically pick up the mundane but necessary tasks of daily life without us intentionally nudging them and providing them with information, encouragement, and persistence.”

"The Loving Push" consists of Three Parts: Part I -The Path to Success Starts Here: Restoring Hope; Part –II: Stretching Your Child & Avoiding Pitfalls; and Part III: Preparing Your Child for Adulthood. Each part features Chapters containing important information, lessons, tips, and advice on how to “Lovingly Push” youth on the spectrum to reach their potential and achieve a successful transition to adulthood. The book begins by sharing 8 inspiring profiles of persons on the spectrum and using their real-life stories to illustrate the three essential components of success: “Avoiding Learned Helplessness, Learning Optimism/Resisting Habitual Negative Thinking, and The Critical Impact of Mentors.” The section on “Getting Families and Schools to Work Together” is especially important, given that transition planning is a critical part of preparing students for life after high school and producing the best outcomes. Young adults on the spectrum are particularly vulnerable during the initial years in the transition to adulthood when there is a shift in service provision after leaving high school. The authors recommend that teachers, parents, and professionals “lovingly” guide, push, and mentor our children and youth as early as possible, and for as long as possible.

The book also addresses the issue of co-occurring anxiety and depression. The authors discuss counseling and evidence-based psychotherapy approaches such as cognitive-behavioral therapy (CBT) and “mindfulness” techniques to reduce stress, and improve mood and psychological well-being. Group support for children, teens, and parents is referenced, as well as important commentary on “Psychotherapy Approaches Not Recommended.” Tips and cautions about medication use for anxiety and depression are also discussed.

“The Loving Push” devotes considerable attention to the problem of compulsive electronic gaming and how it can turn kids on the spectrum into “media recluses” and social isolates. Since children and youth on the spectrum tend to engage in restricted and repetitive behaviors, they are at higher risk for developing addictive game play patterns. Preoccupation with video games and trouble disengaging from them limits the opportunity for learning critical social and problem-solving skills. This Chapter warns parents and educators about the dangers of video games and screen-based media and lists steps they can take to minimize the negative effects of compulsive gaming.

Far too often, parents and teachers of kids on the autism spectrum focus more attention on teaching academic and behavior management skills than on daily living skills. Parents are often surprised to learn that daily living skills are more important than autism symptoms, language or IQ when it comes to employment and life satisfaction. Part III (Preparing Your Child for Adulthood) discusses the building blocks for independent living such as household skills (i.e., cooking, cleaning), driving or using public transportation, educational/vocational preparation, and social/community connection. Explicit teaching of these life skills prior to the transition to adulthood is crucial if we expect kids on the spectrum to have the necessary skills to live independently and negotiate adult life.

The central theme of “The Loving Push” is that the focus of intervention/treatment for spectrum kids must shift to promoting the adaptive behaviors and basic life skills that can facilitate and enhance ultimate functional independence and quality of life in adulthood. This includes helping them learn the skills needed to meet new developmental challenges such as independent living, vocational engagement, post-secondary education, and self-supporting employment. Drs. Grandin and Moore provide a much needed “push” in this direction. As the authors’ note, “With more and more young adults on the spectrum entering adulthood everyday, we don’t have time to lose.”

"The Loving Push” is a valuable resource and must read guide to preparing spectrum kids for a successful transition to self-reliance and independence in adult life. The book is not only highly recommended for parents, caregivers, and families, but also for professionals in private practice, schools, colleges/universities, and community settings who work with children, teens, and adults on the spectrum.

Grandin, T., & Moore, D. (2015). The Loving Push: How Parents and Professionals can Help Spectrum Kids Become Successful Adults. Arlington, TX: Future Horizons. 

Lee A. Wilkinson, PhD, is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© Lee A. Wilkinson, PhD

Special Needs Students Bullied More than Others

Research

Students with special needs face a number of challenges in our nations’ schools and communities. Although students in general and special education experience bullying, there is little research investigating bullying (i.e., as a bully, victim, or bully–victim) among students with disabilities. A study published in the Journal of School Psychology found that students receiving special education services for behavioral disorders and those with more noticeable disabilities are not only more likely to be bullied than their general education peers, but are more likely to engage in bullying behavior themselves.

Participants in the study were 816 students, 9 to 16 years of age, from nine Midwestern elementary and middle schools in one school district. From this total group, 686 were not receiving special education services (categorized as “no disability”), and 130 were receiving special education services (categorized as “observable disability,” “non-observable disability,” and “behavioral disability”). Data on students’ involvement in bullying, office referrals, and prosocial behavior were collected. Self-report measures were used to assess students’ experiences with bullying and victimization and how often students engaged in various aggressive and prosocial behaviors.

The results indicated that students with behavioral disorders reported the highest levels of bullying others and being bullied themselves. The study also found that students with observable disabilities (e.g.., language impairments, hearing impairments, and mild intellectual disability) were more likely to bully others and to be victimized compared with students in general education.  As the authors comment, “The observable nature of the disability makes it easy to identify those students as individuals with disabilities, which may place them at a greater risk for being the easy target of bullying. Being frustrated with the experience of victimization, those students might engage in bullying behavior as a form of revenge.”

The study also found that students with non-observable disabilities, such as a learning disability, reported similar levels of bullying and victimization as students without disabilities. They also reported significantly less victimization compared with students with more outward behavioral disabilities. While both boys and girls engaged in bullying, there was no significant gender difference in both general education and special education students when it came to the behavior. Although fifth grade students in general education reported much more victimization than sixth-, seventh-, eighth- and ninth-graders, there was no difference for students in special education.

Implications

What are the implications of this study? The authors offer several suggestions for school-based bullying prevention and intervention programming. For example, anti-bullying interventions emphasizing prosocial skills should be implemented for students, regardless of their ability. Students in general education could help the process by serving as prosocial role models for students with disabilities. Teachers may also provide reinforcement for prosocial behavior or assign students in general education with students in special education in small groups to work on class projects together to promote positive interaction. For students with both behavioral and observable disabilities, providing support and teaching strategies to cope with peer victimization are important. Helping students with observable disabilities become better integrated into general education classes may help prevent them from being bullied. "Programming should be consistently implemented across general and special education, should occur in each grade and should be part of an inclusive curriculum," the authors recommend. "A culture of respect, tolerance and acceptance is our only hope for reducing bullying among all school-aged youth."

Lee A. Wilkinson, PhD, is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. He is also editor of a text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest books include, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT and A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd edition).

Transitioning Back to School: Tips for Parents of Children with Autism

Transitioning Back to School: Tips for Parents of Children with Autism

Students throughout the country will soon be making the transition to a new school year or a new grade. This includes an increasing number of special needs children identified with autism spectrum disorder (ASD). Since Congress added autism as a disability category to the Individuals with Disabilities Education Act (IDEA) in 1990, there has been a dramatic increase in the number of students receiving special education services under this category. 

The beginning of a new school year is an exciting yet anxious time for both parents and
children. It typically brings a change in the daily routine established over the summer months. This transition can be especially challenging for families with children on the autism spectrum. While change can be difficult, the following tips will help prepare a child with ASD for the new school year and make the transition back to school easier.

1. Prepare and reintroduce routines.

• Familiarize and reintroduce your child to the school setting. This may mean bringing your child to the school or classroom, showing your child a picture of their teacher and any classmates, or meeting the teacher before the first day of school. If possible, arrange to visit the teacher or the school a week or two before the first day. If this isn’t feasible, visit the school building or spend some time on the playground. Driving by the school several times is another good idea. You may also want to drive your child on the first day as well if they ride a bus to school. For many children with ASD, riding a bus to school on the first day can result in a sensory “overload.” Gradually easing them into the transportation routine will be helpful for everyone.

2. Expect the unexpected.

• Parents cannot anticipate everything that might happen during the school day. Allow more time for all activities during the first week of school. Prepare your child for situations that may not go as planned. Discuss a plan of action for free time, such as lunch and recess. Use social stories to familiarize your child with routines and how to behave when an unexpected event occurs. Anticipate sensory overload. The activity, noise and chaos of a typical classroom can sometimes be difficult to manage. Establish a plan of action for this situation, possibly a quiet room where the child can take a short break. If your child has dietary issues, determine in advance how this will be managed so as to avoid any miscommunication.

3. Review and teach social expectations.

• Although many children may transition easily between the social demands of summer activities and those required in the classroom, children on the autism spectrum may need more clear-cut (and literal) reminders. Review the “dos and don’ts” of acceptable school behavior. You can also create a schedule of a typical school day by using pictures and talk about how the school day will progress. Create a social story or picture schedule for school routines. Start reviewing and practicing early. If possible, meet with teachers and administrators to discuss your child’s strengths and challenges. Remember, you are your child’s best advocate. Establish communication early to develop positive relationships with your child’s teacher and school. Rehearse new activities. Ask the teacher what new activities are planned for the first week. Then, prepare your child by performing, practicing, and discussing them. This rehearsal will reduce anxiety when new activities take place during the beginning of school.

In summary, do everything possible to help reduce the stress level for your child and family during this transition time. Don’t forget to prepare yourself! A calm and collected parent is better able to help their child make a successful transition back to school.

Lee A. Wilkinson, PhD, is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).

Autistic Traits and Sensory Experiences in Adults

Autistic Traits and Sensory Experiences in Adults

Unusual sensory processing experiences are common among individuals with autism spectrum disorder (ASD), and are now part of the Diagnostic and Statistical Manual 5th Edition (DSM-5) diagnostic criteria. Although previous research indicates that ASD traits are associated with sensory scores in the general population, it is unclear whether they characterize the “broader phenotype” of ASD which includes individuals with mild impairments in social and communication skills that are similar to those shown by individuals with ASD, but exhibited to a lesser degree. 

Research

A study published in the Journal of Autism and Developmental Disorders sought to replicate the reported relationship between ASD traits and sensory traits across the entire range of symptom severity, and to investigate its specificity in a large sample of adults both with and without ASD. Adults (n = 772) with and without an ASD were administered the Autism Spectrum Quotient (AQ) together with the Adult/Adolescent Sensory Profile (AASP), the Cardiff Anomalous Perceptions Scale (CAPS), and the Glasgow Sensory Questionnaire (GSQ), all questionnaire measures of abnormal sensory responsivity. Of the 772 participants, 23 reported having autism and 55 reported a first-degree relative with the disorder. Another 147 participants indicated having another psychiatric condition, such as depression, and 85 reported having migraine headaches on a regular basis.

The results indicated that self-reported atypical sensory experiences were positively correlated with ASD trait scores on all three sensory questionnaires. The more autistic traits, the more sensory problems he or she reported. Individuals with the most autism traits, such as narrow interests or social difficulties, showed high levels of atypical sensory behavior on all three questionnaires. Although the study’s sample was predominantly (72 %) female, the investigators found that the relationship between sensory symptoms and ASD traits was very similar for both genders. They also found that ASD traits were correlated with levels of anxiety symptoms. Participants who reported being anxious had both more autism traits and more unusual sensory responses than those who were not anxious. This suggests that  sensory processing issues and anxiety symptoms are related, yet separate, phenomena.

Implications

These results have implications for the integration of sensory processing issues into the diagnosis and assessment of ASD. For example, the study confirms the association between sensory experiences and autism across the entire autism spectrum, suggesting that sensory traits might serve as a dimensional measure of the severity of ASD. It should be noted, however, that unusual sensory experiences are not unique to ASD. The researchers found that trait anxiety, a history of psychiatric conditions, and a history of migraines were all associated with higher sensory scores, even after controlling for ASD traits. Thus, individuals with these conditions may report high levels of unusual sensory experiences, which could potentially lead to a misdiagnosis of ASD. It also appears unlikely that atypical sensory experiences underpin all ASD symptoms. Even so, it does appear that if sensory symptoms were treated successfully, then some core ASD symptoms, such as stereotypies, might also be reduced (or vice versa). Further research is needed to examine this issue. Finally, the cognitive/biological basis of the relationship between autistic traits and sensory problems is unknown, and further work is required to determine whether improving sensory processing could effectively reduce the severity of ASD symptoms.

Reference

Horder, J., Wilson, C. E., Mendez, M. A., & Murphy, D. J. (2014). Autistic traits and abnormal sensory experiences in adults. Journal of Autism and Developmental Disorders, 44, 1461-1469. doi:10.1007/s10803-013-2012-7

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

Evidence-Based Interventions for Autism

The National Autism Center has released its review and analysis of interventions for autism spectrum disorder (ASD) based on research conducted in the field from 2007 to 2012. The second phase of the National Standards Project (NSP2) provides an update to the summary of empirical intervention literature evaluated by Phase 1 of the National Standards Project (or NSP1) published in 2009. The National Standards Project is the only systematic review of ASD interventions for individuals across the lifespan based on behavioral and educational studies.

The primary goal of the Project was to provide critical information about which interventions/treatments have been shown to be effective for children, adolescents, and young adults with ASD. Nationally recognized experts in autism, as well as other leaders representing diverse fields of study, were involved in both phases of the National Standards Project and guided the process of evaluation. Dozens of article reviewers analyzed 1,165 studies related to interventions for ASD throughout both phases of the project. The combined the results of Phases 1 and 2 have produced the largest compilation of studies reviewed to date.

Interventions

The interventions were subsequently categorized as 1) Established, and producing beneficial outcomes known to be effective; 2) Emerging, with some evidence of effectiveness, but still requiring more research, and 3) Unestablished, and having little or no evidence of effectiveness. NSP2 updated the original findings, added information, and determined whether any of the Emerging interventions in NSP1 had moved into the Established or Unestablished categories.

For children, adolescents, and young adults under 22 years of age, the researchers identified fourteen (14) “Established’ interventions; eighteen (18) “Emerging” interventions; and thirteen (13) “Unestablished” interventions. This information is especially important to service providers, educators, caregivers and parents as it identifies evidence-based treatments and provides standards and guidelines on making treatment choices. The following interventions (alphabetically) were identified as falling into the “Established” level of evidence and have the most research support, produce beneficial outcomes, and are known to be effective.

• Behavioral Interventions
• Cognitive Behavioral Intervention 
• Comprehensive Behavioral Treatment for Young Children
• Language Training (Production)
• Modeling
• Natural Teaching Strategies
• Parent Training
• Peer Training 
• Pivotal Response Training
• Schedules
• Scripting
• Self-Management
• Social Skills Training
• Story-based Intervention

“The National Standards Project is an ongoing effort designed to give educators, families, practitioners, and organizations the information and resources they need to make informed choices about effective interventions that will offer individuals with ASD the greatest hope for their futures,” said Hanna C. Rue, Ph.D., BCBA-D, Executive Director of the National Autism Center.

Implications

It is important to note that the NSP2 ratings are not intended as an endorsement or a recommendation as to whether or not a specific intervention is suitable for a particular child with ASD. The document cautions readers that “research findings” are only one component of evidence-based practice to consider when selecting interventions. NSP2 is not intended to dictate which interventions can or cannot be used for individuals with ASD. Moreover, it should not be assumed that these interventions will universally produce positive outcomes for all individuals with ASD. The researchers also note that intervention selection is complicated and should be made by a team of individuals who can consider the unique needs and history of the individual with ASD, along with his or her environment. Likewise, the judgment of the professionals with expertise in ASD must be taken into consideration in the decision-making process, together with stakeholder values and preferences. 
 

The report is available for free download at: http://www.nationalautismcenter.org/national-standards-project/phase-2/

About the National Autism Center

The National Autism Center is May Institute’s Center for the Promotion of Evidence-based Practice. It is a nonprofit organization dedicated to serving children and adolescents with autism spectrum disorder (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities. For more information about the National Autism Center, please visit http://www.nationalautismcenter.org/.

Lee A. Wilkinson, PhD, is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also the editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd edition).

Schools Need Improved Definitions & Evaluation Procedures for Autism

The dramatic increase in the number of students qualifying for special education under autism in our schools may be due, in part, to vague definitions together with ambiguous, variable, and irrelevant evaluation procedures, according to a study published in the journal, Autism Research and Treatment. The study examined the definition of autism published by each state education agency (SEA) and the District of Columbia, as well as SEA evaluation procedures for determining student eligibility for autism. The researchers compared components of each SEA definition from two authoritative sources: DSM-IV-TR and IDEA-2004.

The results indicated that many more SEA definitions incorporate IDEA-2004 features than DSM-IV-TR features. However, despite similar foundations, SEA definitions of autism displayed considerable variability. Many of the definitions were too vague to be of much use. Evaluation procedures were found to vary even more across SEAs. There often was little concordance between the definition (what autism is) and evaluation procedures (how autism is identified). Definition components often were not addressed by evaluation features, even in a cursory way. One of the least recommended evaluation features was the requirement to administer an autism-specific evaluation as part of the eligibility process. Of the SEAs that included an autism assessment in the evaluation process, none specified the use of a recognized instrument such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scales (CARS). Although several of these SEAs did indicate the required use of a state-created autism checklist, none gave any reference to a source or psychometric characteristics of those checklists

Recommendations for state and federal policy changes are discussed. For example, the researchers suggest that the publication of DSM-5 provides SEAs with the opportunity to expand and update their current definition of autism. They note that the DSM-5 criteria for autism spectrum disorder (ASD) encompass all of the elements stated by the current IDEA definition. The DSM-5 also recognizes the salience of sensory processing problems and co-occurring (comorbid) disorders (e.g., ADHD). The study recommends that SEAs consider the DSM-5 criteria for ASD as they consider revisions to their state definition of autism and corresponding procedures by which assessors will provide data for eligibility determination. Likewise, IDEA-2004 is overdue for Congressional reconsideration and possible amendment, so there is an opportunity to also update and clarify the federal educational definition of autism. Improved, more specific definitions and evaluation procedures will enable SEAs and school districts to better serve students with autism and more efficently allocate resources.

Malinda L. Pennington, Douglas Cullinan, and Louise B. Southern, “Defining Autism: Variability in State Education Agency Definitions of and Evaluations for Autism Spectrum Disorders,” Autism Research and Treatment, vol. 2014, Article ID 327271, 8 pages, 2014. http://dx.doi.org/10.1155/2014/327271

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

Social Isolation in Young Autistic Adults

The dramatic increase in the prevalence of autism spectrum disorder (ASD) among children indicates that a correspondingly large number of youth will be transitioning into adulthood in the coming years. Investigating social participation of young adults with ASD is important given that social participation is an indicator of life quality and overall adaptive functioning. A study using data from the National Longitudinal Transition Study 2 examined rates of participation in social activities among young adults who received special education services for ASD.

According to the study, young adults with ASD were significantly more likely to never see friends, never get called by friends, never be invited to activities, and be socially isolated. Nearly 40 percent of young autistic adults never saw friends and half were not receiving any phone calls or being invited to activities. Researchers found that 28 percent had no social contact at all. The social struggles of young people with ASD were also significantly more pronounced than those of other disability groups. For example, while almost one-third of those with ASD qualified as socially isolated because they never received telephone calls or went out with friends, fewer than 10 percent of individuals with intellectual disability and only 2 to 3 percent of people with emotional disturbance or learning disabilities fell into this category.

“Difficulty navigating the terrain of friendships and social interaction is a hallmark feature of autism,” said Paul Shattuck of Washington University who coauthored the study. “Nonetheless, many people with autism do indeed have a social appetite. They yearn for connection with others. We need better ways of supporting positive social connection and of preventing social isolation.” 

This study indicates that there are growing numbers of adolescents and young adults with ASD in need of substantial support. In fact, the lack of services available to help young autistic adults transition to greater independence has been noted by researchers for a number of years and has become an increasingly important issue as the prevalence of ASD continues to grow and as identified children reach adolescence and adulthood. The focus of intervention/treatment must shift from remediating the core deficits in childhood to promoting adaptive behaviors that can facilitate and enhance ultimate functional independence and quality of life in adulthood. This includes new developmental challenges such as independent living, vocational engagement, post-secondary education, and family support. 

Orsmond, G. I., Shattuck, P. T., Cooper, B. P., Sterzing, P. R., & Anderson, K. A. (2013). Social Participation among young adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders. DOI 10.1007/s10803-013-1833-8

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (Second Edition).

PEERS® Program Improves Social Skills for Teens on the Autism Spectrum

PEERS® Program Improves Social Skills for Autistic Teens

Impairment in social reciprocity is the core, underlying feature of ASD. Socialization deficits are a major source of impairment, regardless of cognitive or language ability and do not decrease with development. In fact, distress often increases as children approach adolescence and the social milieu becomes more complex. Research evidence suggests that when appropriately planned and systematically delivered, social skills instruction has the potential to produce positive effects in the social interactions of children with ASD. Both the National Professional Development Center on

Autism (NPDC) and the National Autism Center (NAC) have identified social skills training/instruction as an evidence-based intervention and practice. 

Commonly used approaches include individual and group social skills training, providing experiences with typically developing peers, and peer-mediated social skills interventions, all targeting the core social and communication domains. Child-specific social skills interventions frequently include (a) general instruction to increase knowledge and develop social problem solving skills, (b) differential reinforcement to improve social responding,(c) structured social skills training programs, (d) adult-mediated prompting, modeling, and reinforcement, and (e) various behavior management techniques such as self-monitoring.

A study appearing in the Journal of Autism and Developmental Disorders adds to research database suggesting that social interactive training is an effective and promising technique for promoting communication and social skills in youth with autism. The study examined the efficacy and durability of the UCLA Program for the Education and Enrichment of Relational Skills (PEERS®), a parent-assisted 14-week social skills group intervention for more capable adolescents on the autism spectrum. The PEERS® approach applies CBT methods of instruction including didactic lessons (psychoeducation), role-play demonstrations, cognitive strategies, behavioral rehearsal exercises, performance feedback, homework assignments and review, and parent involvement within a small group treatment format. In a series of 90-minute weekly sessions the students were taught to interact in real-world social situations through role playing and homework assignments. The teens’ parents also attended sessions to learn how to appropriately coach their kids at home. Results indicated that teens receiving PEERS® significantly improved their social skills knowledge, social responsiveness, and overall social skills in the areas of social communication, social cognition, social awareness, social motivation, assertion, cooperation, and responsibility, while decreasing autistic mannerisms and increasing the frequency of peer interactions. Independent teacher ratings revealed significant improvement in social skills and assertion from pre-test to follow-up assessment. Examination of the strength of improvement indicated maintenance of gains in nearly all domains with additional treatment gains at a 14-week follow-up assessment. 

“This is exciting news,” commented Elizabeth Laugeson, an assistant clinical professor of psychiatry at the University of California, Los Angeles who led the study. “It shows that teens with autism can learn social skills and that the tools stick even after the program is over, improving their quality of life and helping them to develop meaningful relationships and to feel more comfortable within their social world.”

Reference and further Reading

Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R.,  &  Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS Program. Journal of Autism and Developmental Disorders, 42, 1025-1036. DOI:10.1007/s10803-011-1339-1

Research Publications on PEERS®

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).