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Institute of Education Sciences


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IES Grant

Title: Comparison of Two Comprehensive Treatment Models for Preschool-Aged Children With Autism Spectrum Disorders and Their Families
Center: NCSER Year: 2007
Principal Investigator: Odom, Samuel Grantee: University of North Carolina, Chapel Hill
Program: Autism Spectrum Disorders      [Program Details]
Award Period: 7/1/2007 to 6/30/2011 Award Amount: $3,019,247
Goal: Efficacy and Replication Award Number: R324B070219
Description:

Purpose: Prevalence rates for Autism Spectrum Disorders (ASD) have risen in the last decade. According to the Centers for Disease Control and Prevention, one in 150 children has an ASD. This increase has created pressure on local school systems to provide effective treatment and services for children with such disorders. To date, few studies have been conducted to evaluate the effects of school-based interventions that address the multiple needs of children with ASD.

To address this need, researchers at the University of North Carolina at Chapel Hill are evaluating two established comprehensive treatment models. Treatment and Education of Autistic and Communication-Handicapped Children and Learning Experiences: Alternative Program for Preschoolers and Parents are widely used and have been in use for over 25 years. Rigorous evidence of the efficacy of these comprehensive treatment models, however, is limited. The purpose of this study is to compare the immediate and long-term effects of the two comprehensive treatment models to each other and to a typical classroom service model. The researchers are including key outcomes related to the learning and development of young children with autism and to family functioning. Furthermore, the project will address the maintenance and differential treatment effects of each model and the relative cost.

Project Activities: This research team is conducting a quasi-experimental evaluation of the treatment models. Children ages 3-5 diagnosed with ASD in 75 classrooms (five students per classroom) will participate in the study. In Phase 1, the reliability, validity, and generalizability of the treatment fidelity measures will be established. In Phase 2, the interventions will be evaluated. Outcomes of interest include children's language, communicative, cognitive, behavioral and social skills. Descriptive information on program costs will also be collected. Data will be analyzed to examine both the short- and long-term treatment effects, as well as the effects of processes and factors that mediate or moderate the effects of the programs.

Products: The expected outcomes from this study include reports on the effects of the two comprehensive interventions and a typical service classroom model on a wide range of developmental skills for children ages 3-5 diagnosed with ASD.

Structured Abstract

Purpose: Prevalence rates for Autism Spectrum Disorders (ASD) have risen in the last decade. According to the Centers for Disease Control and Prevention, one in 150 children has an ASD. This increase has created pressure on local school systems to provide effective treatment and services for children with such disorders. To date, few studies have been conducted to evaluate the effects of school-based interventions that address the multiple needs of children with ASD.

To address this need, researchers at the University of North Carolina at Chapel Hill are evaluating two established comprehensive treatment models. Treatment and Education of Autistic and Communication-Handicapped Children and Learning Experiences: Alternative Program for Preschoolers and Parents are widely used and have been in use for over 25 years. Rigorous evidence of the efficacy of these comprehensive treatment models, however, is limited. The purpose of this study is to compare the immediate and long-term effects of the two comprehensive treatment models to each other and to a typical classroom service model. The researchers are including key outcomes related to the learning and development of young children with autism and to family functioning. Furthermore, the project will address the maintenance and differential treatment effects of each model and the relative cost.

Setting: Participating students will be from Colorado, Florida, North Carolina, and Minnesota.

Population: Approximately 75 classrooms (five students per classroom) that include children age 3-5 identified with ASD will participate. Instruction will be provided by a trained classroom teacher at the individual, small group, and classroom levels.

Intervention: Two interventions will be evaluated: Treatment and Education of Autistic and Communication-Handicapped Children and Learning Experiences: Alternative Program for Preschoolers and Parents. These interventions will be compared with each other and a typical classroom service model on the learning and development as well as family functioning of young children with autism.

Treatment and Education of Autistic and Communication-Handicapped Children is primarily based on cognitive-social learning theory that emphasizes maximizing the learning environment (i.e., structured teaching setting). There are six key features: physical organization of the environment, predictable sequence of activities, visual schedules, routines with flexibility, work/task activity systems, and visually structured activities. Prior research suggests that the intervention may improve learning of adaptive (e.g., self-help) skills, nonverbal concepts, executive function abilities, and/or be associated with changes in the core features of autism, in particular, receptive language abilities.

Learning Experiences: Alternative Program for Preschoolers and Parents is primarily based on a blend of applied behavior analysis and developmental theory that embeds individualized learning opportunities in the early childhood classroom. There are six key features: individualized learning programs designed from comprehensive assessments with ongoing monitoring, classrooms that include typically developing children, individual instruction, parent participation, transition planning, and extensive staff training. Prior research suggests that the intervention may improve joint attention and social referencing, communication (pragmatic forms), general expressive language, and positive social engagement with peers and adults.

Research Design and Methods: The proposed study will utilize a cluster design to evaluate the developmental outcomes of children being served in classrooms that utilize one of three types of treatment models. Classrooms will be matched on key variables using propensity scores to approximate equivalence across the conditions. Hierarchical linear models will serve as the primary data analytic strategy. Additional statistical model modifications will be introduced (e.g., specification of covariance matrices that vary across geographic site) to accommodate these sampling units and other potential sources of influence. Both short- and long-term treatment and mediator and moderator effects will be explored.

Control Condition: Each comprehensive treatment model classroom will be matched with a typical classroom model in the same community. The matching variables will be: general developmental and diagnostic characteristics of the children in the class, gender ratio of children in the class, ethnic and linguistic characteristics of children and families in the class, general socioeconomic status of the community, and urban/suburban/rural characteristics of the school/class neighborhood.

Key Measures: The curriculum will be evaluated using commercial and non-commercial measures. Diagnostic assessments include Autism Diagnostic Interview, Autism Diagnostic Observation Schedule, and Childhood Autism Rating Scale. Measures of cognitive and developmental skills include the Leiter International Performance Scale-Revised and Mullen Scales of Early Learning. Other measures include the Preschool Language Scale, 4rd Edition, Vineland Adaptive Behavior Scale—Survey Edition, Behavior Rating Inventory of Executive Function-Preschool, Repetitive Behavior Scales-Revised, Social Responsiveness Scale, Child Behavior Checklist, and Sensory Experiences Questionnaire. Family measures, observational assessments, and treatment and fidelity measures will also be administered.

Data Analytic Strategy: Hierarchical linear models will serve as the primary data analytic strategy. Additional statistical model modifications will be introduced (e.g., specification of covariance matrices that vary across geographic site) to accommodate these sampling units and other potential sources of influence. Both short- and long-term treatment and mediator and moderator effects will be explored.

Publications from this project:

Hume, K., Boyd, B., McBee, M., Coman, D., Gutierrez, A., et al. (2011). Assessing implementation of comprehensive treatment models for young children with ASD: Reliability and validity of two measures. Research in Autism Spectrum Disorders, 5 (4), 1430–1440.

Irvin, D., Boyd, B., McBee, M., Hume, K., & Odom, S. (2012). Child and family factors associated with the use of services for preschoolers with autism spectrum disorder. Research in Autism Spectrum Disorders, 6 (1) 565–572.

Coman, D., Alessandri, M., Gutierrez, A., Novotny, S., Boyd, B., Hume, K., et al. (in press). Commitment to classroom model philosophy and burnout symptoms among high fidelity teachers implementing preschool programs for children with autism spectrum disorders. Journal of Autism and Developmental Disorders.

Dykstra, J., Irvin, D., Sabatos-DeVito, M., Boyd, B., Hume, K., & Odom, S. (in press). Using the Language Environment Analysis (LENA) system in preschool classrooms with children with autism spectrum disorders. Autism: The International Journal of Research and Practice.

Reszka, S., Odom, S., & Hume, K. (in press). Ecological features of preschool environments and the peer social engagement of children with autism spectrum disorder. Journal of Early Intervention.

Boyd, B. A., Hume, K., McBee, M. T., Alessandri, M., Gutierrez, A., Johnson, L., Sperry, L., Odom, S. L. (in press). Comparative efficacy of LEAP, TEACCH, and non-model-specific special education programs for preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43.


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