Autism: Young children benefit regardless of high-quality treatment model

Brian Boyd

Researchers at the University of North Carolina at Chapel Hill have found that preschoolers with Autism Spectrum Disorder (ASD) who receive high-quality early intervention benefit developmentally regardless of the treatment model used—a surprising result that may have important implications for special-education programs and school classrooms across the country.

"This is the first study designed to compare long-standing comprehensive treatment models for young children with ASD," said Brian Boyd, a fellow at UNC's Frank Porter Graham Child Development Institute (FPG) and one of the study's co-principal investigators.

Boyd also is an assistant professor in occupational science and occupational therapy in UNC's School of Medicine.

"We know that more children are being diagnosed with ASD each year, and that it can cost an estimated $3.2 million to treat each child over a lifetime. Understanding that a child can benefit from a high-quality program, rather than a specialized program, may help reduce those costs by decreasing the need for teachers and other school practitioners to be trained to deliver multiple specialized services," Boyd said.

He stressed it remains important to ensure educators are trained to provide high-quality programs that meet the special behavioural, communication and other needs of children with ASD.

Previous research has shown that when children with ASD have access to early intervention via treatment programs, they improve developmentally. Until now, however, debate has persisted over which approach to use, said Boyd.

The study appeared in the June issue of Journal of Autism and Developmental Disorders.

Two frequently used comprehensive treatment models have a long history: LEAP (Learning Experiences and Alternative Program for Preschoolers and their Parents) and TEACCH (now known only by its acronym).

FPG's study examined the relative effects of the LEAP and TEACCH school-based comprehensive treatment models when compared to each other and to special-education programs that do not use a specific model.

The multisite study took place only in high-quality classrooms and enrolled 74 teachers and 198 3- to 5-year-olds in public school districts.

The study found that children made gains over the school year regardless of the classroom's use of LEAP, TEACCH or no specific comprehensive treatment model.

Kara Hume

"Each group of children showed significant positive change in autism severity, communication and fine- motor skills," said Kara Hume, FPG scientist and co-author.

"No statistically significant differences were found among models, which challenged our initial expectations—and likely the field's."

"This study may shift the field's thinking about comprehensive treatment models designed for young children with ASD," said co-author Samuel L. Odom, FPG's director and the study's principal investigator.

"Perhaps it's not the unique features of the models that most contribute to child gains but the common features of the models that most influence child growth."

More information: "Comparative Efficacy of LEAP, TEACCH and Non-Model-Specific Special Education Programs for Preschoolers with Autism Spectrum Disorders," Journal of Autism and Developmental Disorders, published online June 2013. link.springer.com/article/10.1007/s10803-013-1877-9

Homeless and abused children benefit from animal-assisted therapy

Researchers at MIRI have completed a pilot study that used guinea pigs and rabbits as therapists to teach children who have experienced domestic violence situations empathy and coping skills. 

Credit: Erna Vader 

There were almost 32,000 substantiated cases of severe abuse, neglect and violence in Australia last year with some children dying as a result.

According to the Australian Institute of Criminology, the age group most likely to be murdered is 0-12 months.

One particular group amongst the homeless cohort is women with children fleeing violent domestic relationships and living in transitional housing.

Essentially these mothers and children are in hiding. It is known that children who experience traumatic events early in life, particularly abuse and violence, often develop social, emotional, health and behavioural problems as adolescents and adults.

Researchers at the Monash Injury Research Institute (MIRI) have recently completed a pilot study that used animals, such as guinea pigs and rabbits, as therapists to teach children who have experienced domestic violence situations empathy and coping skills.

WAYSS, a registered not-for-profit community based agency in Southern Metropolitan Melbourne region provides family violence and homelessness support services and transitional housing for women and children.

While anecdotal evidence indicated the children who attended the groups showed dramatic improvements in their lives, WAYSS approached the Child Abuse Prevention Research Centre (CAPRA), a specialist unit in MIRI to conduct a two year pilot program to determine whether the program was in fact of benefit.

Neerosh Mudaly

The study was run by Dr Neerosh Mudaly, a Senior Research Fellow. Children are assessed and prepared for entry into the program by a WAYSS Children's Case Worker and they are transported to the program by WAYSS.

The group program is managed by EE&T. The guinea pigs and rabbits, used in the program are carefully chosen and their temperament and health are managed by EE&T.

The group caters for up to 10 children, who attend weekly sessions of 1-1.5 hours.

The children engage in a series of activities which include animal handling (grooming, comforting), animal care (feeding and observing) and art and photography that complement the activities.

According to Dr Mudaly, children who come to the program often do not trust adults. They do not respond to traditional counselling as they are often filled with persistent fear. They may be sad, withdrawn or acting out in aggressive ways.

"These behaviours can make it difficult for the children to settle at school – often resulting in the child either being bullied or becoming a bully," Dr Mudaly said.

"In the group, the children recognise that they are in charge of a vulnerable being such as a guinea pig. They learn empathy and control – and often take these lessons back into their own families where perhaps they bullied their more vulnerable younger siblings."

Dr Mudaly said repeated experiences of gentle, calming contact with small animals in a safe environment appears – from the pilot study – to have had a dramatic effect in helping children heal from abuse and violence.

"It may also help break the cycle of violence and abuse that these children may carry into adolescence and adulthood," Dr Mudaly said.

Eleven children participated in the pilot evaluation, and the results validated a more rigorous evaluation.

According to Dr Mudaly – if funding is found – the next phase of the study would involve in-depth interviews with children, their supportive parent, caseworkers and teachers.

Psychometric measures of trauma and empathy will be administered at entry and again at completion to provide concrete evidence of changes in the children.

"This research has the potential to contribute to international knowledge on effective therapy for traumatised children and the prevention of violence," Dr Mudaly said.

Case study: 
Dr Mudaly talks of one five-year-old girl who witnessed terrible violence towards her mother when the child was injured during one of these episodes.

"When she came into the program she was mute, did not speak for months and would not leave her mother's side," Dr Mudaly said.

The first words she spoke were to a guinea pig in the animal therapy program: "what's your name?" A year later Dr Mudaly saw the child again.

"She was flicking her long hair, talking about how she might work with animals when she grew up. She had so much to say and would not stop talking," Dr Mudaly said.

Reading Skills Benefit from One Modest Change by Teachers

A small change in how teachers and parents read aloud to preschoolers may provide a big boost to their reading skills later on, a new study found. 

That small change involves making specific references to print in books while reading to children -- such as pointing out letters and words on the pages, showing capital letters, and showing how you read from left to right and top to bottom on the page. 

Credit: © Glenda Powers / Fotolia

Preschool children whose teachers used print references during storybook reading showed more advanced reading skills one and even two years later when compared to children whose teachers did not use such references.

Shayne Piasta

This is the first study to show causal links between referencing print and later literacy achievement.

"Using print references during reading was just a slight tweak to what teachers were already doing in the classroom, but it led to a sizeable improvement in reading for kids," said Shayne Piasta, co-author of the study and assistant professor of teaching and learning at Ohio State University.

"This would be a very manageable change for most preschool teachers, who already are doing storybook reading in class."

Joan Kaderavek
University of Toledo

Piasta conducted the study with lead investigator Laura Justice, professor of teaching and learning at Ohio State, as well as co-investigators Anita McGinty of the University of Virginia and Joan Kaderavek of the University of Toledo. Their results appear in the April 2012 issue of the journal Child Development.

The study is part of Project STAR (Sit Together And Read), a randomized clinical trial based at Ohio State to test the short- and long-term impacts associated with reading regularly to preschool children in the classroom.

The study involved more than 300 children in 85 classrooms who participated in a 30-week shared reading program. As a group, the children came from low-income homes, started with below-average language skills and were at substantial risk for later reading difficulties.

The children were separated into three groups: high-dose STAR (four reading sessions per week), low-dose STAR (two reading sessions per week) and a third comparison group who also had four reading sessions per week.

All teachers in the three groups read the same 30 books to their students.

Teachers in the two STAR groups were trained to make specific print references while reading the books.

Teachers in the comparison group were told to read as they normally would, and were not prompted to make print references.

Results showed that both one and even two years later, preschoolers in the high-dose STAR classrooms had higher word reading, spelling and comprehension skills than did children in the comparison group.

The benefits were not as clear for those in the low-dose STAR classrooms, although they did seem to have slightly better skills than those children in the comparison classrooms.

Piasta said it was particularly notable that students in the high-dose STAR classrooms scored higher on tests of reading comprehension.

"If you're getting kids to pay attention to letters and words, it makes sense that they will do better at word recognition and spelling," she said.

"But the fact that they also did better at understanding the passages they read is really exciting. That suggests this intervention may help them become better readers."

How do print references help preschoolers become better readers? Piasta said research suggests it helps children learn the code of letters and how they relate to words and to meaning.

"By showing them what a letter is and what a letter means, and what a word is and what a word means, we're helping them to crack the code of language and understand how to read," she said.

While this study shows the value of using print references with preschoolers, research suggests very few teachers and parents do this systematically, according to Piasta.

NB: STAR-1 has now been superseded by STAR-2