|Title:||Efficacy and Sustainability of the STAR Program|
|Principal Investigator:||Mandell, David||Awardee:||University of Pennsylvania|
|Program:||Autism Spectrum Disorders [Program Details]|
|Award Period:||07/01/2008 – 6/30/2012||Award Amount:||$2,719,835|
|Goal:||Efficacy and Replication||Award Number:||R324A080195|
Purpose: The number of children with autism spectrum disorder served in the US public education system has risen an average of 16% each year over the last decade. The education system has struggled to serve students with autism effectively because of the limited number of interventions that have demonstrated efficacy in classroom settings with a diversity of children and teachers. Furthermore, very little research has examined whether and how efficacious interventions can be successfully implemented and sustained in community settings.
To address this need, researchers are evaluating the Strategies for Teaching Based on Autism Research Program. The individual components of the intervention are evidence based but rigorous evidence of the efficacy of the entire program is limited. The purpose of this study is to evaluate the Strategies for Teaching Based on Autism Research Program compared to a typical classroom service model serving children with autism spectrum disorders. Whether the program can be maintained once training support is removed will also be explored. The researchers are including key outcomes related to the learning and development of young children with autism and exploring factors that may moderate outcomes. The project will also address whether length of teacher training affects child outcomes and program sustainability.
Project Activities: Approximately 180 children ages 5-8 diagnosed by the school district with autism spectrum disorder will participate in the study. Recruitment will take place in 36 kindergarten through 2nd grade autism support classrooms (5 students per classroom). In Phase 1, classrooms will be randomly assigned to either the Strategies for Teaching Based on Autism Research Program or typical classroom service model. In Phase 2, the teachers in the typical classroom service model will be trained on the intervention program and local specialists will receive training on providing coaching to classroom staff. In Phase 3, external support from the researchers will be removed to evaluate program sustainability. Outcomes of interest include children's academic, communicative, behavioral and social skills. A clustered randomized design with repeated measures will be used to evaluate the treatment models and whether length of teacher training affects child outcomes and program sustainability. The effects of processes and factors that moderate the effects of the programs will also be explored.
Products: The expected outcomes from this study include evidence on the effects of the Strategies for Teaching Based on Autism Research Program and a typical service classroom model on a wide range of developmental skills for children ages 5-8 diagnosed with autism spectrum disorder, published reports, and presentations.
Setting: Participating students will be from Pennsylvania.
Population: Approximately 36 classrooms (5 students per classroom) that include children ages 5-8 identified with autism spectrum disorder will participate. Instruction will be provided by a trained classroom teacher at the individual and classroom level.
Intervention: The Strategies for Teaching Based on Autism Research Program will be compared to the typical classroom service model, structured teaching and life skills curriculum, on the learning and development of young children with autism.
Strategies for Teaching Based on Autism Research Program is a fully developed, manualized program for children with autism spectrum disorder between the ages of 3 and 7 years. Program materials include detailed lesson plans, teaching materials, and forms and instructions for choosing curriculum content and measuring progress. The program uses discrete trial training as a teaching strategy for curriculum content related to receptive language and academic skills, pivotal response training to teach expressive language and play and social skills and functional routines to teach independence in daily routines. There are three levels of instruction to meet the needs of children at different developmental stages and combines one-to-one interactions between staff and students with group activities to enhance communication and socialization.
Structured teaching and life skills curriculum is a combined approach of maximizing the learning environment as well as teaching critical life skills. In structured teaching, tasks and materials are systematically presented. Tasks are composed of making students aware of work to be conducted, the amount of work needed to complete the work, and the goals. Prompts and reinforcements are used during instruction. Visual instruction and organization are integrated into teaching methods to highlight specific tasks, information and concepts. The environment is organized to help students learn to organize their work and make clear progress with the tasks. The life skills curriculum teaches students to apply academic skills at home and in the community as well as teaches personal, domestic, and leisure skills.
Research Design and Methods: The proposed study will utilize a clustered randomized design with repeated measures to evaluate the developmental outcomes of children being served in classrooms that utilize one of the two types of treatment models. Classrooms will be randomly assigned to either the Strategies for Teaching Based on Autism Research Program or typical classroom service model.
Control Condition: The control condition will be the typical classroom service model. Teachers in the control condition will receive similar training (e.g., length, format) on structured teaching as teachers in the treatment condition.
Key Measures: The curriculum will be evaluated using commercial and non-commercial measures. Outcome measures include the Bracken School Readiness Composite, Receptive and Expressive Language One-Word Picture Vocabulary Tests, Vineland Socialization Subscale, Vineland Adaptive Behavior Composite, and the Aberrant Behavior Checklist. Other measures include Autism Diagnostic Observation Schedule, Child Symptom Inventory, and Wechsler Preschool and Primary Scale of Intelligence – 3rd Edition. Teacher measures, 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 and moderator effects will be explored. For all analyses, including those comparing outcomes and examining effect moderation, separate multivariate nested random effects models will be used for each outcome in each year of the study. Potential moderators will be included in the model as a main effect and in an interaction term with treatment group. The interaction between treatment group and the moderator will be used to assess the presence and magnitude of the moderating effect.
Publications from this project:
Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory. Journal of Autism and Developmental Disorders: 41 (5), 597–609.
Nahmias, A.S., Kase, C., & Mandell, D.S. (2012). Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements. Autism. Advanced online publication.
Mandell D.S., Stahmer, A.C., Shin, S., Xie, M., Reisinger, E.M., Marcus, S.C. (2013). The role of treatment fidelity on outcomes during a randomized trial of an autism intervention. Autism, 17(3), 281-95.
Suhrheinrich, J., Stahmer, A.C., Reed, S., Schreibman, L., Reisinger, E., & Mandell, D. (2013). Implementation challenges in translating pivotal response training into community settings. Journal of Autism and Developmental Disorders. Advanced online publication.
Locke, J., Rotherham-Fuller, E., Xie, M., Harker, C., & Mandell D.S. (in press). Correlation of cognitive and social outcomes among children with autism spectrum disorder in a randomized trial of behavioral intervention. Autism.